Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis

Kevin P. Fennelly, Edward C. Jones-López, Irene Ayakaka, Soyeon Kim, Harriet Menyha, Bruce Kirenga, Christopher Muchwa, Moses Joloba, Scott Dryden-Peterson, Nancy Reilly, Alphonse Okwera, Alison M. Elliott, Peter G. Smith, Roy D. Mugerwa, Kathleen D. Eisenach, Jerrold J. Ellner

Research output: Contribution to journalArticlepeer-review

Abstract

Rationale: Mycobacterium tuberculosis is transmitted by infectious aerosols, but assessing infectiousness currently relies on sputum microscopy that does not accurately predict the variability in transmission. Objectives: To evaluate the feasibility of collecting cough aerosols and the risk factors for infectious aerosol production from patients with pulmonary tuberculosis (TB) in a resource-limited setting. Methods: We enrolled subjects with suspected TB in Kampala, Uganda and collected clinical, radiographic, and microbiological data in addition to cough aerosol cultures. A subset of 38 subjects was studied on 2 or 3 consecutive days to assess reproducibility. Measurements and Main Results: M. tuberculosis was cultured from cough aerosols of 28 of 101 (27.7%; 95% confidence interval [CI], 19.9-37.1%) subjects with culture-confirmed TB, with a median 16 aerosol cfu (range, 1-701) in 10 minutes of coughing. Nearly all (96.4%) cultivable particles were 0.65 to 4.7 μm in size. Positive aerosol cultures were associated with higher Karnofsky performance scores (P = 0.016), higher sputum acid-fast bacilli smear microscopy grades (P = 0.007), lower days to positive in liquid culture (P = 0.004), stronger cough (P = 0.016), and fewer days on TB treatment (P = 0.047). In multivariable analyses, cough aerosol cultures were associated with a salivary/mucosalivary (compared with purulent/ mucopurulent) appearance of sputum (odds ratio, 4.42; 95% CI, 1.23-21.43) and low days to positive (per 1-d decrease; odds ratio, 1.17;95%CI, 1.07-1.33). The within-test (kappa, 0.81; 95%CI, 0.68- 0.94) and interday test (kappa, 0.62; 95% CI, 0.43-0.82) reproducibility were high. Conclusions: A minority of patients with TB (28%) produced culturable cough aerosols. Collection of cough aerosol cultures is feasible and reproducible in a resource-limited setting.

Original languageEnglish (US)
Pages (from-to)450-457
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume186
Issue number5
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Keywords

  • Air microbiology
  • Cough
  • Infection control
  • Infectious disease transmission
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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