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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Variability of Infectious Aerosols Produced during Coughing by Patients with Pulmonary Tuberculosis
American Journal of Respiratory and Critical Care Medicine, Volume 186, No. 5, Year 2012
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Description
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. Copyright © 2012 by the American Thoracic Society.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3443801/bin/supp_186_5_450__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC3443801/bin/supp_186.5.450_201203-0444OC.pdf
Authors & Co-Authors
Fennelly, Kevin P.
Unknown Affiliation
Jones-López, Edward C.
Unknown Affiliation
Ayakaka, Irene
Unknown Affiliation
Kim, Soyeon
Unknown Affiliation
Menyha, Harriet
Unknown Affiliation
Kirenga, Bruce James
Unknown Affiliation
Muchwa, Christopher
Unknown Affiliation
Joloba, Moses Lutaakome
Unknown Affiliation
Dryden-Peterson, Scott L.
Unknown Affiliation
Reilly, Nancy
Unknown Affiliation
Okwera, Alphonse
Unknown Affiliation
Elliott, Alison M.
Unknown Affiliation
Smith, Peter George
Unknown Affiliation
Mugerwa, Roy D.
Unknown Affiliation
Eisenach, Kathleen D.
Unknown Affiliation
Ellner, Jerrold J.
Unknown Affiliation
Statistics
Citations: 134
Authors: 16
Affiliations: 10
Identifiers
Doi:
10.1164/rccm.201203-0444OC
ISSN:
1073449X
Research Areas
Infectious Diseases
Study Design
Case-Control Study
Study Locations
Uganda