Runners competing in mountain ultra-marathons (MUMs) are known to display features of marked inflammation due to muscle micro-trauma, oxidative stress, gastrointestinal dysfunction, or endotoxin translocation. Furthermore, most immune functions exhibit adverse changes following prolonged, heavy exertion like competitive MUMs. This period of immune alteration may last for a few days and be responsible for increased occurrence of upper respiratory tract infection (URTI) or even more severe bacterial complications.

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