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Cough-generated Aerosols of Mycobacterium tuberculosis

A New Method to Study Infectiousness

Department of Medicine, Center for the Study of Emerging and Re-Emerging Pathogens, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey; Department of Medicine, National Jewish Medical and Research Center, Denver; Department of Microbiology, Colorado State University, Fort Collins, Colorado; and Department of Microbiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Correspondence and requests for reprints should be addressed to Kevin P. Fennelly, M.D., M.P.H., Center for the Study of Emerging and Re-Emerging Pathogens, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 185 South Orange Avenue, MSB A-901, Newark, NJ 07103. E-mail: fennelkp{at}umdnj.edu

The concentration and size distribution of infectious aerosols produced by patients with pulmonary tuberculosis (TB) has never been directly measured. We aimed to assess the feasibility of a method that we developed to collect and quantify culturable cough-generated aerosols of Mycobacterium tuberculosis. Subjects were recruited from a referral hospital and most had multidrug-resistant TB. They coughed into a chamber containing microbial air samplers while cough frequency was measured during two 5-minute sessions. Cough-generated aerosol cultures were positive in 4 of 16 subjects (25%) with smear-positive pulmonary TB. There was a rapid decrease in the cough-generated aerosol cultures within the first 3 weeks of effective treatment. Culture-positive cough aerosols were associated with lack of treatment during the previous week (p = 0.007), and there was a trend in the association with cough frequency (p = 0.08). The size distributions of these aerosols were variable, but most particle sizes were in the respirable range. Quantification of viable cough-generated aerosols is feasible and offers a new approach to study infectiousness and transmission of M. tuberculosis and other airborne pathogens.

Key Words: disease transmission • communicable disease control • air microbiology • infectivity • contact tracing

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