Letters The cough that packed a punch: is boxing a risk for tuberculosis transmission?MJA 2000; 173: 671
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To the Editor: The medical community is spearheading the movement for
the banning of boxing as a health risk.1-3 Chronic traumatic
encephalopathy, or dementia pugilistica, which is
attributed to boxing is one of the associated hazards. We report a
possible additional and hitherto undescribed health hazard of
boxing.
A 34-year-old male prison inmate identified himself as having been in close contact with someone with sputum-smear-positive, culture-positive, pulmonary tuberculosis. The inmate provided a detailed account of his contact with the index case, stating that they had sparred and boxed almost daily for three months. This involved close contact, to the point where they were cheek-to-cheek. The boxing ring was in a well-ventilated area in the prison-yard. The exposure took place between February and May 2000. The inmate underwent Mantoux testing by the two-step technique4 in May and June 2000. He tested Mantoux negative at the time. However, when Mantoux testing was repeated in August, he responded with a 10 mm lesion. His chest x-ray was normal. As he had a cough, his sputum was examined for acid-fast bacilli, but findings were negative. Preventive therapy with isoniazid was initiated. The inmate had been in the same prison since August 1999. There were no other inmates with infectious tuberculosis, apart from the index case, during the period under review. We believe that the mode of transmission of Mycobacterium tuberculosis was during boxing sessions, and propose hyperventilation and forced expiration as the direct mechanisms. One other Mantoux conversion was identified, but the mode of transmission was presumed to be shared air-space during transportation in a van with recirculated air in a confined cabin for over six hours. It should be noted that the affected inmate did not travel with the index case, at any time. This case only came to light because the exposure was so specific, and because the index case and the Mantoux conversion both occurred during periods of incarceration. Anyone acquiring a similar infection in the community would have had multiple contacts, and therefore several probable transmission modes -- this may be why this mode of transmission has not previously been proposed among community contacts of people known to have tuberculosis. Boxing is unlikely to be a major cause of tuberculosis transmission, but may make a small contribution to tuberculosis notifications among young male adults.5 Michael H Levy
Craig Gater
©MJA 2000
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