Persistent Mycobacterium tuberculosis bioaerosol release in a tuberculosis-endemic setting
Ryan Dinkele, Sophia Gessner, Benjamin Patterson, Andrea McKerry, Zeenat Hoosen, Andiswa Vazi, Ronnett Seldon, Anastasia Koch, Digby F. Warner, Robin Wood
Abstract
Pioneering studies linking symptomatic disease and cough-mediated Mycobacterium tuberculosis ( Mtb ) release established the infectious origin of tuberculosis (TB), simultaneously informing the notion that pathology is a prerequisite for Mtb transmission. Our recent work has challenged this assumption: by sampling TB clinic attendees, we detected equivalent release of Mtb -containing bioaerosols by confirmed TB patients and individuals not receiving a TB diagnosis and observed time-dependent reduction in Mtb bioaerosol positivity during 6-month follow-up of both cohorts, irrespective of anti-TB chemotherapy. Now, we report widespread Mtb release in our TB-endemic setting: of 89 randomly recruited community members, 79.8% (71/89) produced Mtb- containing bioaerosols independently of QuantiFERON status, a standard test for Mtb exposure. Moreover, during 2-month longitudinal sampling, only 2% (1/50) were serially Mtb bioaerosol negative. These results necessitate a reframing of the prevailing paradigm of Mtb transmission and TB etiology, perhaps explaining the historical inability to elucidate Mtb transmission networks in TB-endemic regions.