Aerosolization of viable Mycobacterium tuberculosis bacilli by tuberculosis clinic attendees independent of sputum-Xpert Ultra status

Potential ( ) transmission during different pulmonary tuberculosis (TB) disease states is poorly understood. We quantified viable aerosolized from TB clinic attendees following diagnosis and through six months' follow-up thereafter. Presumptive TB patients (n=102) were classified by laboratory,...

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Published in:Proceedings of the National Academy of Sciences - PNAS Vol. 121; no. 12; p. e2314813121
Main Authors: Patterson, Benjamin, Dinkele, Ryan, Gessner, Sophia, Koch, Anastasia, Hoosen, Zeenat, January, Vanessa, Leonard, Bryan, McKerry, Andrea, Seldon, Ronnett, Vazi, Andiswa, Hermans, Sabine, Cobelens, Frank, Warner, Digby F, Wood, Robin
Format: Journal Article
Language:English
Published: United States 19.03.2024
Subjects:
Bacillus
Firmicutes
Humans
Mycobacterium tuberculosis
Sensitivity and Specificity
Sputum - microbiology
Tuberculosis - microbiology
Tuberculosis, Pulmonary - diagnosis
aerosol sampling
subclinical
tuberculosis
ISSN:1091-6490, 1091-6490
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Summary:Potential ( ) transmission during different pulmonary tuberculosis (TB) disease states is poorly understood. We quantified viable aerosolized from TB clinic attendees following diagnosis and through six months' follow-up thereafter. Presumptive TB patients (n=102) were classified by laboratory, radiological, and clinical features into Group A: Sputum-Xpert Ultra-positive TB (n=52), Group B: Sputum-Xpert Ultra-negative TB (n=20), or Group C: TB undiagnosed (n=30). All groups were assessed for bioaerosol release at baseline, and subsequently at 2 wk, 2 mo, and 6 mo. Groups A and B were notified to the national TB program and received standard anti-TB chemotherapy; was isolated from 92% and 90% at presentation, 87% and 74% at 2 wk, 54% and 44% at 2 mo and 32% and 20% at 6 mo, respectively. Surprisingly, similar numbers were detected in Group C not initiating TB treatment: 93%, 70%, 48% and 22% at the same timepoints. A temporal association was observed between bioaerosol release and TB symptoms in all three groups. Persistence of bioaerosol positivity was observed in ~30% of participants irrespective of TB chemotherapy. Captured bacilli were predominantly acid-fast stain-negative and poorly culturable; however, three bioaerosol samples yielded sufficient biomass following culture for whole-genome sequencing, revealing two different lineages. Detection of viable aerosolized in clinic attendees, independent of TB diagnosis, suggests that unidentified transmitters might contribute a significant attributable proportion of community exposure. Additional longitudinal studies with sputum culture-positive and -negative control participants are required to investigate this possibility.
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ISSN:1091-6490
1091-6490
DOI:10.1073/pnas.2314813121