Working Diagnosis:
Hand Foot and Mouth Disease likely due to poor sanitary practices in high school football locker rooms and inadequate equipment cleaning

Treatment:
Symptomatic care with increased dose non-steroidal anti-inflammatory drugs and over-the-counter sore throat remedies

Outcome:
All athletes recovered completely without complication within 3 weeks.
There is now a plan being implemented in the high school for hand sanitizers to be installed in the locker room along with signs providing education advising soap and water hand washing foremost(some viruses/bacteria not eliminated with sanitizer) but hand sanitizer utlization at minimum. There is discussion occurring to clean equipment more regularly and implementing a policy holding athletes with rashes out for a preset period of time, or mandating adequate coverage similar to wrestling.

Author's Comments:
Much of the focus on locker room infections revolves around Methicillin-resistant staphylococcus aureus, however there are other easily transmitted infectious diseases that cause school/sport absence. Many of these are easily prevented with adherence to adequate hygiene guidelines. This school has sanitary guidelines in place for wrestling, but not football. There is no routine cleaning of helmets, pads, bags or footballs. Locker room surfaces are cleaned daily however there are no hand sanitizer stations in the locker room. The athletes don't shower in the locker room regularly after practice or games so towels are not shared. However showering soon after practice has been shown to reduce transmission. Football athletes with rashes aren't held from sport although they are in other sports raising the question of whether these restrictions should be extended to football.

Editor's Comments:
There is no way to be sure that poor hygiene led to the outbreak of coxsackie virus infection. However, this case illustrates the infection risk posed by having a large team of adolescent athletes sharing close quarters and equipment. Infection outbreaks are common in athletics and team physicians should be aware of strategies to mitigate their spread.

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