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Herpes Gladiatorum With Ocular Involvement in a Mixed Martial Arts Fighter
Abstract
We report a case of herpes gladiatorum (HG) in a professional mixed martial arts (MMA) fighter. The eruption appeared following a sparring session with a new partner and progressed to involve the left eye. Fever and facial rash prompted the patient to go to the hospital where he was treated with antiviral therapy. The considerable increase in popularity of MMA may lead to a greater prevalence of HG as well as other cutaneous infections contracted through skin-to-skin contact. Cutis. 2011;87:146-147.
... 35 MMA fighters are frequently in close skin-to-skin contact and often develop skin lacerations and dermatologic infections. 2,19,28 These infections may be bacterial, viral, or fungal. 2,19,28 MMA athletes are often under extreme competitive pressure to both gain muscle mass and lose significant amounts of weight in short periods of time at various points during their training. ...
... 2,19,28 These infections may be bacterial, viral, or fungal. 2,19,28 MMA athletes are often under extreme competitive pressure to both gain muscle mass and lose significant amounts of weight in short periods of time at various points during their training. 10 Because of weight class restrictions, fighters often engage in potentially dangerous weight loss behaviors immediately before fights to "weigh in." 10 Athletes may employ dehydration to lose water weight, and this can lead to biochemical and hormonal alterations. ...
... 11,20,24 A Submission-predominant martial arts disciplines have high rates of joint injuries. 16,28,33 A Nonorthopaedic injuries, such as skin infections, are also common in MMA athletes. 2 ...
Context:
Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise.
Evidence acquisition:
A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar.
Study design:
Clinical review.
Level of evidence:
Level 5.
Results:
The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries.
Conclusion:
Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.
... Herpes gladiatorum is a recurrent cutaneous infection caused by HSV-1 that is frequently observed in athletes engaged in close skin-to-skin contact such as wrestling and rugby. [1][2][3][4][5] The primary infection characteristically presents with a prodrome of pain, itching, or burning, followed by systemic symptoms including headaches, pharyngitis, fever, lymphadenopathy, and grouped vesicles formed on a red base. [6][7][8][9] The typical length of time from exposure to outbreak ranges from 4 to 11 days and is most likely to occur on the head, face, and neck. 1 Complications of herpes gladiatorum can be serious and some patients have been hospitalized from primary infections. ...
... 3 Cases of ocular involvement including keratitis, conjunctivitis, and acute retinal necrosis leading to blindness have also been reported. 4,10,11 A clinical diagnosis can be difficult to make due to variations in presentation and many providers are unfamiliar with the condition. 8,12 Bacterial conditions are more commonly recognized, and patients are often prescribed antibiotics for suspected bullous impetigo. ...
A 19-year-old active duty Marine presented to clinic with a history of a reoccurring vesicular rash on left side of his forehead. The lesion was cultured and identified as herpes simplex virus 1 (HSV-1). Herpes gladiatorum is a recurrent cutaneous infection caused by HSV-1 and spread by skin-to-skin contact. Serious complications have been reported, including blindness from acute retinal necrosis. Outbreaks of herpes gladiatorum have been observed in the high school and collegiate wrestling community for years and to prevent the spread, screening, and treatment guidelines have been implemented by governing bodies of these organizations. Active duty members who participate in the Marine Corps Martial Arts Program and the Army and US Air Force Combatives programs are exposed to similar conditions; however, no uniform screening or treatment protocol exists. To minimize the spread of skin infections, we propose adopting a uniform screening procedure and implementing a standardized form to assist primary care providers in the evaluation and treatment of herpes gladiatorum and other communicable skin diseases commonly seen in close combat training.
... Pain, discomfort and other infection symptoms caused by infections adversely affect performances of athletes (Brukner and Khan., 2007). In many studies conducted in the field of wrestling, training loss and losing competition due to skin infections, ( Meulener and Smith, 2011;adam, 2002) cause anxiety among athletes which is consequently assumed to adversely affect the performance. On the contrary to this assumption, the results of the present study report no statistically significant the effects of skin infections on anxiety in wrestling. ...
z: Bu çalışmanın amacı Türk güreşçilerinde deri enfeksiyonlarının sıklığını incelemek ve güreşçilerde deri enfeksiyonlarının anksiyeteye neden olup olmadığını araştırmak. Araştırmaya Türkiye'de farklı illerdeki spor kulüplerinde güreş yapan 190 gönüllü erkek sporcu dâhil edilmiştir. Çalışmaya katılan sporculara, araştırma öncesi hazırlanan Dermatolojik Muayene Bulguları (DMB) anketindeki sorular bir dermatoloji uzmanı tarafından muayene edildikleri esnada sorulmuştur. Ayrıca her bir güreşçinin muayene bulguları da bu anket formuna kaydedilmiştir. Anksiyete düzeyi Beck Anksiyete Envanteri (BAE) ile değerlendirilmiştir. İstatistiksel analiz SPSS 22.0 bilgi-sayar programı kullanılarak değerlendirilmiştir. Çalışmamızda yer alan 190 gönüllü erkek güreşçinin 92 (%57.86)'sinde deri enfeksi-yonlarının görüldüğü tespit edilirken, 67 (% 42.14) sinde deri enfeksiyonu tespit edilmemiştir. Güreşçilerde en sık görülen deri enfek-siyonları sırayla tinea pedis 24 (15.09), tinea korporis 16 (10.16), eritrazma 13 (8.17), folikülit 11 (6.91), verrü (siğil) 11 (6.94), oni-komikoz 6 (3.57), paronişi 5 (3.14), herpes 3 (1.88), impetigo 1 (0.64 %), ve tinea versikolor 2 (1.36) olarak tespit edilmiştir. Deri enfeksiyonu görülen güreşçiler ile deri enfeksiyonu görülmeyen güreşçilerin anksiyete düzeyleri karşılaştırıldığında her iki grupta da anlamlı bir farkın olmadığı tespit edilmiştir (p>0.05). Spor literatüründe ilk defa yapılan bu çalışmada, deri enfeksiyonlarının güreşçi-lerde anksiyeteye neden olmadığı sonucuna varılmıştır. Abstract: This study aims to examine the prevalence of skin infections in Turkish wrestlers and to investigate whether skin infections cause anxiety in the wrestlers with infections. 159 volunteer male athletes engaged in freestyle wrestling from sports clubs of Turkey participated in the research. Before the research, questions in "Dermatological Examination Findings (DEF)" questionnaire were asked to participants by a dermatologist during the examination. In addition, examination findings of each wrestler were recorded in this questionnaire form and the detected anxiety levels were evaluated via Beck Anxiety Inventory (BAI). Statistical analysis program; SPSS 22.0 was used for the evaluation. Of 159 voluntary free style male wrestlers in our research, 92 (57.86 %) were detected to have skin infections while 67 (42.14 %) did not have any skin infection. The most common skin infections found in wrestlers are tinea pedis 24 (15.09), tinea corporis 16 (10.16), erythrasma 13 (8.17), folliculitis 11 (6.91), verrucous 11 (6.94), onychomycosis 6 (3.57), paronychia 5 (3.14), herpes 3 (1.88), tinea versicolor 2 (1.36) and impetigo 1 (0.64 %), respectively. Comparing anxiety levels of wrestlers who have skin infections and those who do not have, no significant difference was found between two groups (p>0.05). In this study which is the first study conducted on this issue in sports literature, it was concluded that skin infections do not lead to anxiety in wrestlers.
... Pain, discomfort and other infection symptoms caused by infections adversely affect performances of athletes (Brukner and Khan., 2007). In many studies conducted in the field of wrestling, training loss and losing competition due to skin infections, ( Meulener and Smith, 2011;adam, 2002) cause anxiety among athletes which is consequently assumed to adversely affect the performance. On the contrary to this assumption, the results of the present study report no statistically significant the effects of skin infections on anxiety in wrestling. ...
... Pain, discomfort and other infection symptoms caused by infections adversely affect performances of athletes (Brukner and Khan., 2007). In many studies conducted in the field of wrestling, training loss and losing competition due to skin infections, ( Meulener and Smith, 2011;adam, 2002) cause anxiety among athletes which is consequently assumed to adversely affect the performance. On the contrary to this assumption, the results of the present study report no statistically significant the effects of skin infections on anxiety in wrestling. ...
z: Bu çalışmanın amacı Türk güreşçilerinde deri enfeksiyonlarının sıklığını incelemek ve güreşçilerde deri enfeksiyonlarının anksiye-teye neden olup olmadığını araştırmak. Araştırmaya Türkiye'de farklı illerdeki spor kulüplerinde güreş yapan 190 gönüllü erkek sporcu dâhil edilmiştir. Çalışmaya katılan sporculara, araştırma öncesi hazırlanan Dermatolojik Muayene Bulguları (DMB) anketindeki sorular bir dermatoloji uzmanı tarafından muayene edildikleri esnada sorulmuştur. Ayrıca her bir güreşçinin muayene bulguları da bu anket formuna kaydedilmiştir. Anksiyete düzeyi Beck Anksiyete Envanteri (BAE) ile değerlendirilmiştir. İstatistiksel analiz SPSS 22.0 bilgi-sayar programı kullanılarak değerlendirilmiştir. Çalışmamızda yer alan 190 gönüllü erkek güreşçinin 92 (%57.86)'sinde deri enfeksi-yonlarının görüldüğü tespit edilirken, 67 (% 42.14) sinde deri enfeksiyonu tespit edilmemiştir. Güreşçilerde en sık görülen deri enfek-siyonları sırayla tinea pedis 24 (15.09), tinea korporis 16 (10.16), eritrazma 13 (8.17), folikülit 11 (6.91), verrü (siğil) 11 (6.94), oni-komikoz 6 (3.57), paronişi 5 (3.14), herpes 3 (1.88), impetigo 1 (0.64 %), ve tinea versikolor 2 (1.36) olarak tespit edilmiştir. Deri enfeksiyonu görülen güreşçiler ile deri enfeksiyonu görülmeyen güreşçilerin anksiyete düzeyleri karşılaştırıldığında her iki grupta da anlamlı bir farkın olmadığı tespit edilmiştir (p>0.05). Spor literatüründe ilk defa yapılan bu çalışmada, deri enfeksiyonlarının güreşçi-lerde anksiyeteye neden olmadığı sonucuna varılmıştır. Abstract: This study aims to examine the prevalence of skin infections in Turkish wrestlers and to investigate whether skin infections cause anxiety in the wrestlers with infections. 159 volunteer male athletes engaged in freestyle wrestling from sports clubs of Turkey participated in the research. Before the research, questions in "Dermatological Examination Findings (DEF)" questionnaire were asked to participants by a dermatologist during the examination. In addition, examination findings of each wrestler were recorded in this questionnaire form and the detected anxiety levels were evaluated via Beck Anxiety Inventory (BAI). Statistical analysis program; SPSS 22.0 was used for the evaluation. Of 159 voluntary free style male wrestlers in our research, 92 (57.86 %) were detected to have skin infections while 67 (42.14 %) did not have any skin infection. The most common skin infections found in wrestlers are tinea pedis 24 (15.09), tinea corporis 16 (10.16), erythrasma 13 (8.17), folliculitis 11 (6.91), verrucous 11 (6.94), onychomycosis 6 (3.57), paronychia 5 (3.14), herpes 3 (1.88), tinea versicolor 2 (1.36) and impetigo 1 (0.64 %), respectively. Comparing anxiety levels of wrestlers who have skin infections and those who do not have, no significant difference was found between two groups (p>0.05). In this study which is the first study conducted on this issue in sports literature, it was concluded that skin infections do not lead to anxiety in wrestlers.
Within the sporting landscape much has changed from the proliferation and integration of new technologies, for example, the practice of mixed martial arts (MMA) has developed on the fringes of modern sport. It combines several martial arts, is practised in a cage, and allows ground strikes. MMA is presented here within a framework inspired by Norbert Elias’s theory of civilizing of aggressive impulses through sport. We reviewed more than 20 years of literature, with 785 international references and a triple analysis of the discipline, those being physical violence, symbolism, the play impulse.
The development of sports activities promoted as a health factor should not hide the increased risk for diseases, more particularly infections. A review of articles made over the last 20 years was made with a descriptive epidemiological purpose. The most marked risk is skin infection with methicillin-resistant community acquired Staphylococcus aureus (27.4% of the articles), followed by Tinea corporis and capitis (13.7%), and leptospirosis (11.7%). The risk of blood-borne infection seems low, and articles are rare (3.9%). The risk of disease with respiratory transmission (measles, meningococcal meningitis) must be taken into account. The effect of physical activity on the immune system depends on the type and duration of the work out: it seems to be beneficial for a workout of a moderate intensity, and deleterious for a sustained acute work out, or a period of intensive training. These periods of protection or susceptibility to infections are described as "open window" and "J curve". The only recommendations for prevention of sport-related infections arise from the frequency of skin infections and the severity of blood-borne infections. These recommendations are published by American and international sports authorities. The specificity of athletes' management is due to imperatives of competitiveness (maintaining physical performance) and the necessity of temporary eviction from sports, in case of contagiousness. The athletes must make sure their recommended vaccinations are up-to-date.
Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high.
To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries.
Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed.
Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine.
This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns.
To the Editor.—
It is patently difficult to dislodge a bit of inappropriate terminology from the medical literature. We are, however, bemused and bedeviled when from time to time the name "herpes gladiatorum" surfaces in dermatological articles. As far as we can determine, this terminology was first coined in a report by Selling and Kibrick1 in 1964 entitled "Outbreak of Herpes Simplex Among Wrestlers (Herpes Gladiatorum)" and in the following year perpetuated by Wheeler and Cabaniss.2 Since that time the name has received the imprimatur of such standard sources as Fitzpatrick's Dermatology in General Practice and others.We submit that this nomenclature is etymologically inaccurate from the standpoint of the basic activities of both gladiators and wrestlers. Since the term "herpes simplex" is a bastardized Greco-Roman name, long ago firmly established, it seems appropriate to continue these linguistic anomalies. But we would suggest that the correct Latin term
An epidemic of herpes simplex virus type 1 occurred in 60 of 175 wrestlers (34%) attending a four-week intensive training camp. Five of these 60 patients (8%) developed ocular involvement that included follicular conjunctivitis, blepharitis, and phlyctenular disease. Cultures of the conjunctiva and eyelid vesicles were positive for herpes simplex virus type 1 in four of the five patients with ocular disease. The viral isolates were compared by restriction-endonuclease analysis, which disclosed that three of the four isolates were the same strain. None of the patients had corneal involvement and there has been no evidence of viral recurrence to date. Herpes simplex virus type 1 is a health risk for wrestlers, and ocular infections are part of the clinical spectrum. Prompt diagnosis and appropriate management of the outbreak may reduce the severity of the outbreak transmission.
Herpes skin infections among wrestlers--called herpes gladiatorum--occur frequently among high school and college wrestlers nationwide. Contact with opponents with active herpes infections appears to be the strongest risk factor associated with acquisition of infection. Previously acquired antibody to herpes simplex virus 1 infection may offer some protection from acquiring this disease. Morbidity associated with this disease can be significant, and widespread efforts to educate participants in close contact sports, such as wrestling, are advocated as control measures.
Herpes simplex virus type 1 (HSV-1) has been identified as a cause of cutaneous or ocular infection among athletes involved in contact sports; in this context it is known as herpes gladiatorum. In July 1989, we investigated an outbreak among 175 high-school wrestlers attending a four-week intensive-training camp. Cases of infection were identified by review of medical records, interview and examination of the wrestlers, and culture of skin lesions. Oropharyngeal swabs were obtained for HSV-1 culture, and serum samples for HSV-1 serologic studies. HSV-1 isolates were compared by restriction-endonuclease analysis.
HSV-1 infection was diagnosed in 60 wrestlers (34 percent). The lesions were on the head in 73 percent of the wrestlers, the extremities in 42 percent, and the trunk in 28 percent. HSV-1 was isolated from 21 wrestlers (35 percent), and in 39 (65 percent) infection was identified by clinical criteria. Five had conjunctivitis or blepharitis; none had keratitis. Constitutional symptoms were common, including fever (25 percent), chills (27 percent), sore throat (40 percent), and headache (22 percent). The attack rate varied significantly among the three practice groups, ranging from 25 percent for practice group 1 (lightweights) to 67 percent for group 3 (heavyweights). Restriction-endonuclease analysis identified four strains of HSV-1 among the 21 isolates. All 10 isolates from practice group 3 were identical (strain A), and 5 of 7 isolates from practice group 2 (middleweights) were identical (strain B), which suggested concurrent transmission of different strains within different groups. HSV-1 was not isolated from any oropharyngeal swabs.
Herpes gladiatorum may cause substantial morbidity among wrestlers, and it is primarily transmitted by direct skin-to-skin contact. Prompt identification and exclusion of wrestlers with skin lesions may reduce transmission.
Skin infections, both bacterial and viral, are endemic in contact sports such as wrestling and rugby football. In this report, we describe four cases of extensive cutaneous herpes simplex virus in players on a rugby team. All players had a prodrome of fever, malaise, and anorexia with a weight loss of 3.6 to 9.0 kg. Two players experienced ocular lesions associated with cutaneous vesicular lesions of the face. A third player, who had herpetic lesions on his lower extremity, experienced paresthesias, weakness, and intermittent urinary retention and constipation. All infected players on the team were forwards or members of the "scrum," which suggests a field-acquired infection analogous to the herpetic infections seen in wrestlers (herpes gladiatorum). Considering the serious sequelae of recurrent herpes simplex keratitis, the traumatic skin lesions in rugby football players should be cultured for herpes virus, and infected individuals should be restricted from playing until crusted lesions have disappeared.
An outbreak of herpes rugbiorum involved nine players including the scrum half and the full back. The infection was characterized by significant constitutional upset with decreased levels of general fitness and match performance for 1-4 months following the outbreak; one player had herpetic lesions on his right eyelid and corneum. Every infected player, 15 non-infected players and five sociosexual contacts received two vaccinations with intracellular subunit vaccine NFU. Ac. HSV-1 (S-MRC5). None of the players or contacts developed cutaneous herpetic recurrence during a follow-up period of 3 years; the player with ocular disease had one recurrence at 30 months following the original episode. These findings encourage consideration of prophylactic or post-exposure vaccination of participants in rugby or other contact sports with this or other appropriate herpes simplex vaccine.
Myriad dermatoses can affect athletes. One of the most common cutaneous manifestations of athletic activity are skin infections. Bacteria,1–4 viruses,1,2,4–8 and fungi1,2,4,9–11 cause these infections. Many are contagious and may have serious ramifications for team practices and competitions. Knowledge of these infections facilitates implementation of rapid treatment and preventive measures to ensure the least disruption in daily team activities.
Several specific sports related dermatological conditions are caused by bacterial infection. Staphylococcal infection is the most common but streptococcal infection also commonly occurs.1–4 Both organisms may present as varying clinical entities including impetigo, erysipelas, folliculitis,1,2,4 and furunculosis.3 In general, they are probably contagious to some degree. Impetigo, characterised by well defined, erythematous, yellow crusted, scaling plaques, and erysipelas, characterised by well defined, advancing, erythematous plaques, can be treated with topical warm soaks and oral antibiotics.1,4 Folliculitis presents as small follicular pustules that can be treated with topical or oral antibiotics.1 These bacterial infections occur in sports in which close personal contact occurs, including rugby, judo, and wrestling.2,4 Furunculosis outbreaks, however, have been noted also in football and basketball athletes. One study showed that 25% of high school athletes in these sports developed furunculosis.3 …
Sports-related dermatoses are among the most common ailments affecting athletes, from the neophyte to the professional. The general types of skin conditions related to athletic activity include infections, aberrant growths, inflammatory reactions, traumatic conditions, and environment-related conditions. Knowledge of the skin disorders common to athletes and familiarity with the specific activities of each sport which place these athletes at greater risk are critical to making accurate clinical diagnoses, and educating athletes regarding treatment interventions and prevention.
The most common injuries afflicting the athlete affect the skin. The list of sports-related dermatoses is vast and includes infections, inflammatory conditions, traumatic entities, environmental encounters, and neoplasms. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.
Infections probably cause the most disruption to individual and team activities. Herpes gladiatorum, tinea corporis gladiatorum, impetigo, and furunculosis are sometimes found in epidemic proportions in athletes. Vigilant surveillance and early treatment help teams avoid these epidemics. Fortunately, several recent studies suggest that pharmacotherapeutic prevention may be effective for some of these sports-related infections. Inflammatory cutaneous conditions may be banal or potentially life threatening as in the case of exercise-induced anaphylaxis. Athletes who develop exercise-induced anaphylaxis may prevent outbreaks by avoiding food before exercise and extreme temperatures while they exercise. Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger’s nipples and mogul’s palm, occur in specific sports. Several techniques and special clothing exist to help prevent traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer’s itch or sea bather’s eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that results from the deposition of copper within the hair. Finally, athletes are at risk of developing both benign and malignant neoplasms. Hockey players, surfers, boxers and football players can develop athlete’s nodules. Outdoor sports enthusiasts are at greater risk of developing melanoma and non-melanoma skin cancer. Athletes spend a great deal of time outdoors, typically during peak hours of ultraviolet exposure. The frequent use of sunscreens and protective clothing will decrease the athlete’s sun exposure. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.
PRIMARY infection with herpes simplex is not generally manifested by disease. As a result outbreaks of illness due to this agent have not been commonly observed. Small epidemics of eczema herpeticum have been recorded, however, among children hospitalized with eczema1 , 2 and epidemics of herpetic whitlow have occurred at sites of minor nail-bed trauma among hospital personnel who were caring for patients disseminating this virus.3 , 4 This report describes an unusual outbreak of herpetic disease occurring among 5 members of a small amateur wrestling group over a ten-month period. The circumstances under which these infections were acquired indicated that they had resulted . . .
PURPOSE The purpose of this analysis was to determine whether present National Federation of State High School Associations (NFHS) guidelines adequately prevent and control outbreaks of primary herpes gladiatorum (HG) in high-school wrestlers.
Using telephone interviews, direct physical examinations, and review of medical charts, data were collected on HG outbreaks among participating teams in the 1999 Minnesota State High School League (MSHSL) wrestling season and on HG outbreaks for 3 yr at a 28-d summer wrestling camp.
The outbreak during the 1999 MSHSL wrestling season involved 61 wrestlers and three coaches on 19 teams over 42 d, with a 32.7% probability of transmission to sparring partners. Typical length of time from exposure to outbreak varied from 4 to 11 d with an average of 6.80 +/- 1.70 d. Analysis of data from three outbreaks at a 28-d wrestling camp showed that most outbreaks (96%) occurred on the ventral surface of the body, with 71.9% on the head, face, and neck, areas in direct contact when wrestlers are engaged in the lock-up position. Analysis of data from the 2001 camp outbreak showed that the locations of the lesions reflected the handedness of the wrestler.
The NFHS guidelines are inadequate to prevent and control outbreaks of HG. The focus of preventive efforts needs to change from mat cleanliness to more rapid detection of outbreaks by requiring culture results and appropriate therapy for all suspected bacterial and herpes lesions before allowing return to contact. To minimize and control spread of HG, treatment and isolation should be implemented based not only on vesicle formation but also on systemic signs and symptoms.
To identify the most salient medical issues that may be associated with mixed martial arts competition by determining the types and proportions of match stoppages.
Publicly available video footage of 1284 men competing in 642 consecutive televised matches from November 1993 to November 2003 was reviewed to determine the reasons for which matches were stopped. Matches were sanctioned by either a United States or Japan based mixed martial arts organisation.
Of the 642 matches, 182 (28.3+/-3.4%) were stopped because of head impact, 106 (16.5+/-2.9%) because of musculoskeletal stress, 91 (14.1+/-2.7%) because of neck choke, 83 (12.9+/-2.6%) because of miscellaneous trauma, 173 (27.0+/-3.4%) because of expiration of match time, and seven (1.0+/-0.8%) because of disqualification, where the values in parentheses are percentages+/-95% confidence interval.
Blunt force to the head resulted in the highest proportion of match stoppages. Further research is warranted to delineate the morbidity associated with participation in mixed martial arts.