Published ahead of print on December 4, 2003, doi:10.1164/rccm.200308-1101OC Am. J. Respir. Crit. Care Med., Volume 169, Number 5, March 2004, 604-609 A more recent version of this article appeared on March 1, 2004
Submitted on August 7, 2003 Cough-Generated Aerosols of Mycobacterium tuberculosis: A New Method to Study InfectiousnessKevin P Fennelly1*,1 Medicine, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, The Center for the Study of Emerging and Re-Emerging Pathogens, Newark, NJ, USA, 2 Medicine, National Jewish Medical and Research Center, Denver, CO, USA, 3 Microbiology, Colorado State University, Fort Collins, CO, USA, 4 Microbiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA * To whom correspondence should be addressed. 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 four of 16 (25%) subjects with smear-positive pulmonary tuberculosis. There was a rapid decrease in the cough-generated aerosol cultures within the first three 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 Mycobacterium tuberculosis and other airborne pathogens. Key words: Disease transmission, communicable disease control, air microbiology, infectivity, contact tracing
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