Persistent Bioaerosol Release in a Tuberculosis-endemic Setting

Pioneering studies linking symptomatic disease and cough-mediated () release established the infectious origin of tuberculosis (TB), simultaneously informing the notion that pathology is a prerequisite for transmission. Our recent work has challenged this assumption: by sampling TB clinic attendees, we detected equivalent release of -containing bioaerosols by confirmed TB patients and individuals not receiving a TB diagnosis and observed time-dependent reduction in bioaerosol positivity during 6-month follow-up of both cohorts, irrespective of anti-TB chemotherapy. Now, we report widespread release in our TB-endemic setting: of 89 randomly recruited community members, 79.8% (71/89) produced containing bioaerosols independently of QuantiFERON status, a standard test for exposure. Moreover, during 2-month longitudinal sampling, only 2% (1/50) were serially bioaerosol negative. These results necessitate a reframing of the prevailing paradigm of transmission and TB etiology, perhaps explaining the historical inability to elucidate transmission networks in TB-endemic regions.