Variability of Airborne Transmission of Mycobacterium tuberculosis: Implications for Control of Tuberculosis in the HIV Era

Fennelly, Kevin P.

doi:10.1086/516617

Cited by 34 publications

(28 citation statements)

References 12 publications

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“…There is experimental (22)(23)(24), classic epidemiologic (25,26), and molecular epidemiologic (27)(28)(29)(30) evidence of considerable variability of infectiousness among sputum smear-positive patients (6). In addition, cough aerosols may provide a better estimate of inhaled dose than the sputum AFB smear and, thus, may help provide insights into TB pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

“…Mycobacterium tuberculosis is transmitted by fine aerosols (i.e., via the airborne route in infectious droplet nuclei , 5 mm in diameter), yet assessment of infectiousness has been based on microscopic examination of sputum for more than a century. Both experimental and epidemiological data suggest that sputum examination for acid-fast bacilli (AFB) is neither a sensitive nor a specific indicator of infectiousness (4)(5)(6)(7). Moreover, although the size of aerosol particles is a critical determinant of aerosol deposition in the lungs and a factor that impacts infection control measures, the magnitude and size distribution of aerosols generated by patients with TB is unknown.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

Fennelly

Jones-López

Ayakaka

et al. 2012

Am J Respir Crit Care Med

142

137

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

Fennelly

Jones-López

Ayakaka

et al. 2012

Am J Respir Crit Care Med

142

137

View full text Add to dashboard Cite

“…In these classical studies, guinea pigs were contained in a penthouse exposed to exhaust air from a TB ward, and their TST conversion was monitored. Only 3 of 77 patients were responsible for over 73% of TB infections in guinea pigs, and half of all TB infections in guinea pigs were caused by one patient with laryngeal TB (91). Similarly, Escombe et al recreated the in vivo sampling model using guinea pigs housed above a mechanically ventilated HIV-TB ward in Lima, Peru (86,87).…”

Section: With or Without Hiv Tb Infectiousness Is Highly Variablementioning

confidence: 99%

HIV and Tuberculosis: a Deadly Human Syndemic

2011

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SUMMARY A syndemic is defined as the convergence of two or more diseases that act synergistically to magnify the burden of disease. The intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have had deadly consequences around the world. Without adequate control of the TB-HIV syndemic, the long-term TB elimination target set for 2050 will not be reached. There is an urgent need for additional resources and novel approaches for the diagnosis, treatment, and prevention of both HIV and TB. Moreover, multidisciplinary approaches that consider HIV and TB together, rather than as separate problems and diseases, will be necessary to prevent further worsening of the HIV-TB syndemic. This review examines current knowledge of the state and impact of the HIV-TB syndemic and reviews the epidemiological, clinical, cellular, and molecular interactions between HIV and TB.

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“…There is little data regarding the aerosolization of bacilli by individual patients and increased knowledge regarding shedding of bacteria through the course of a tuberculosis infection would greatly enhance our understanding of transmission dynamics and spread of the disease. Epidemiological studies suggest there is considerable variation in infectiousness, with some patients infecting a large number of contacts whereas others apparently fail to pass on the disease [8-10]. Previous attempts to assess airborne transmission have relied on exposure of guinea pigs to hospitalized TB patients [11,12].…”

Section: Introductionmentioning

confidence: 99%

Field test of a novel detection device for Mycobacterium tuberculosis antigen in cough

et al. 2010

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BackgroundTuberculosis is a highly infectious disease that is spread from person to person by infected aerosols emitted by patients with respiratory forms of the disease. We describe a novel device that utilizes immunosensor and bio-optical technology to detect M. tuberculosis antigen (Ag85B) in cough and demonstrate its use under field conditions during a pilot study in an area of high TB incidence.MethodsThe TB Breathalyzer device (Rapid Biosensor Systems Ltd) was field tested in the outpatient clinic of Adama Hospital, Ethiopia. Adults seeking diagnosis for respiratory complaints were tested. Following nebulization with 0.9% saline patients were asked to cough into a disposable collection device where cough aerosols were deposited. Devices were then inserted into a portable instrument to assess whether antigen was present in the sample. Demographic and clinical data were recorded and all patients were subjected to chest radiogram and examination of sputum by Ziehl-Nielsen microscopy. In the absence of culture treatment decisions were based on smear microscopy, chest x-ray and clinical assessment. Breathalyzer testing was undertaken by a separate physician to triage and diagnostic assessment.ResultsSixty individuals were each subjected to a breathalyzer test. The procedure was well tolerated and for each patient the testing was completed in less than 10 min. Positive breath test results were recorded for 29 (48%) patients. Of 31 patients with a diagnosis of tuberculosis 23 (74%; 95% CI 55-87) were found positive for antigen in their breath and 20 (64%; 95% CI 45-80) were smear positive for acid fast bacilli in their sputum. Six patients provided apparent false positive breathalyzer results that did not correlate with a diagnosis of tuberculosis.ConclusionsWe propose that the breathalyzer device described warrants further investigation as a tool for studying exhalation of M. tuberculosis. The portability, simplicity of use and speed of the test device suggest it may also find use as a tool to aid early identification of infectious cases. We recommend studies be undertaken to determine the diagnostic sensitivity and specificity of the device when compared to microbiological and clinical indicators of tuberculosis disease.

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Variability of Airborne Transmission of Mycobacterium tuberculosis: Implications for Control of Tuberculosis in the HIV Era

Cited by 34 publications

References 12 publications

Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

HIV and Tuberculosis: a Deadly Human Syndemic

Field test of a novel detection device for Mycobacterium tuberculosis antigen in cough

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