Persistent Mycobacterium tuberculosis bioaerosol release in a tuberculosis-endemic setting

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