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MEDICAL NEWS These articles are in PDF format: Heat Illness and the Dangers of Dehydration Soccer Heat Stress Guidelines Soccer Heat Stress Information BLOOD ON THE FIELD AND ON ME . . . WHEN DO I PANIC? By Sark Nazarian, M.D. Bleeding from an injury sustained while playing soccer is not a rare occurrence, and the rules of the game mandate that the player must be substituted and cannot return to the field until the bleeding stops.  This rule was wisely adapted to minimize the risk of blood-borne diseases.  What are the diseases that can be contracted by exposure to blood?  What is the best way to protect oneself and others from these potentially fatal diseases? Diseases spread by direct contact with someone else’s blood are caused by viruses which live inside blood cells.  They include the HIV virus (which causes AIDS) and the Hepatitis B and C viruses.  To infect someone, blood must contact an open wound or a mucous membrane (that is, the eye, nose, mouth, genitals, or rectum).  Intact skin is a good barrier to spread of the virus.  Although HIV is the most feared virus, it is fastidious, and generally a large amount of blood exposure (such as a transfusion) has to take place for successful infection.  Hepatitis B, on the other hand, can be transmitted by exposure to a minute quantity of blood.  It usually leads to hepatic (liver) failure and death.  Hepatitis C is a milder form, and most patients are not very sick, though in some cases, their livers can also rapidly deteriorate and lead to death.  Hepatitis A, contracted by eating shellfish, etc., and is a very mild, self-limited disease. All three of these diseases are usually spread by sexual contact or exposure to an infected person’s blood through sharing of syringes used to inject drugs.   Although none of these diseases are common in young people engaged in sports, people can appear to be healthy in the early stages of these diseases.  If exposed to someone’s blood, it is always a good idea to ask them if they have been diagnosed with any of these diseases.  Panic is counterproductive, but prompt action is required if one is exposed. Injections of serum antibodies, and in the case of AIDS, a brief course of medications, can thwart successful infection.  If exposed, contact your family physician immediately. There are a variety of diseases that are spread by mosquitoes and ticks as a result of a blood meal, such as malaria, Lyme disease, St. Louis encephalitis, West Nile Virus disease, etc., but these need not concern us, as they cannot be spread by direct contact with an infected person’s blood.  The insect intermediary has to be present to spread the disease.   Another rare virus, rabies, is shed in saliva, and infects humans when the saliva from an animal contaminates a bite or aerosolized bat saliva is breathed in.  Even more exotic disease such as Creutzfeld-Jacob (or its bovine equivalent, Mad Cow Disease) can theoretically be spread by blood, though, transfusions or actually eating the animal’s meat are generally required.