Document Detail


Cough aerosols of Mycobacterium tuberculosis predict new infection: a household contact study.
MedLine Citation:
PMID:  23306539     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: Airborne transmission of Mycobacterium tuberculosis results from incompletely characterized host, bacterial, and environmental factors. Sputum smear microscopy is associated with considerable variability in transmission.
OBJECTIVES: To evaluate the use of cough-generated aerosols of M. tuberculosis to predict recent transmission.
METHODS: Patients with pulmonary tuberculosis (TB) underwent a standard evaluation and collection of cough aerosol cultures of M. tuberculosis. We assessed household contacts for new M. tuberculosis infection. We used multivariable logistic regression analysis with cluster adjustment to analyze predictors of new infection.
MEASUREMENTS AND MAIN RESULTS: From May 2009 to January 2011, we enrolled 96 sputum culture-positive index TB cases and their 442 contacts. Only 43 (45%) patients with TB yielded M. tuberculosis in aerosols. Contacts of patients with TB who produced high aerosols (≥10 CFU) were more likely to have a new infection compared with contacts from low-aerosol (1-9 CFU) and aerosol-negative cases (69%, 25%, and 30%, respectively; P = 0.009). A high-aerosol patient with TB was the only predictor of new M. tuberculosis infection in unadjusted (odds ratio, 5.18; 95% confidence interval, 1.52-17.61) and adjusted analyses (odds ratio, 4.81; 95% confidence interval, 1.20-19.23). Contacts of patients with TB with no aerosols versus low and high aerosols had differential tuberculin skin test and interferon-γ release assay responses.
CONCLUSIONS: Cough aerosols of M. tuberculosis are produced by a minority of patients with TB but predict transmission better than sputum smear microscopy or culture. Cough aerosols may help identify the most infectious patients with TB and thus improve the cost-effectiveness of TB control programs.
Authors:
Edward C Jones-López; Olive Namugga; Francis Mumbowa; Martin Ssebidandi; Olive Mbabazi; Stephanie Moine; Gerald Mboowa; Matthew P Fox; Nancy Reilly; Irene Ayakaka; Soyeon Kim; Alphonse Okwera; Moses Joloba; Kevin P Fennelly
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  187     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-02     Completed Date:  2013-06-27     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1007-15     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aerosols / diagnostic use*
Contact Tracing
Cough / microbiology*
Family Characteristics
Female
Humans
Interferon-gamma Release Tests / methods
Logistic Models
Male
Mycobacterium tuberculosis / pathogenicity*
Predictive Value of Tests
Sputum / microbiology*
Tuberculin Test
Tuberculosis, Pulmonary / complications,  diagnosis,  transmission*
Grant Support
ID/Acronym/Agency:
K01 AI083097/AI/NIAID NIH HHS; K01AI083097/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Aerosols
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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