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
Affiliations
Ryan Dinkele
UCT Molecular Mycobacteriology Research Unit, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
Sophia Gessner
UCT Molecular Mycobacteriology Research Unit, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
Benjamin Patterson
Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam 1105, the Netherlands
Andrea McKerry
Aerobiology and TB Research Unit, Desmond Tutu Health Foundation, Cape Town 7925, South Africa
Zeenat Hoosen
Aerobiology and TB Research Unit, Desmond Tutu Health Foundation, Cape Town 7925, South Africa
Andiswa Vazi
Aerobiology and TB Research Unit, Desmond Tutu Health Foundation, Cape Town 7925, South Africa
Ronnett Seldon
Aerobiology and TB Research Unit, Desmond Tutu Health Foundation, Cape Town 7925, South Africa
Anastasia Koch
UCT Molecular Mycobacteriology Research Unit, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
Digby F. Warner
UCT Molecular Mycobacteriology Research Unit, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Corresponding author
Robin Wood
Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; Aerobiology and TB Research Unit, Desmond Tutu Health Foundation, Cape Town 7925, South Africa; Corresponding author
Summary: 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.
