The current understanding of airborne tuberculosis (TB) transmission is based on classic 1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we recreated this model in Lima, Peru, and in this paper we report the use of molecular fingerprinting to investigate patient infectiousness in the current era of HIV infection and multidrug-resistant (MDR) TB

A. Roderick Escombe

Alland

Armando Gonzalez

Balasubramanian

Beggs

Behr

Bock

Bonnet

Borgdorff

Burgos

Calder

Capewell

Carlos Martínez

Carlton A Evans

Catanzaro

Catherine J Noakes

Caviedes

Cruciani

David A. J Moore

Desjardin

Eduardo Ticona

Escombe

Espinal

Fennelly

Gandhi

Garc&iacute

Jindani

Jon S Friedland

Kamerbeek

Loudon

Luz Caviedes

Malasky

Marcos Navincopa

Nardell

Palmero

Patricia Sheen

Peter Wilson

Riley

Robert H Gilman

Rose

Rouillon

Shamputa

Snider

Sultan

Teixeira

van Soolingen

William Pan

PLoS Medicine

English

PubMed

The current understanding of airborne tuberculosis (TB) transmission is based on classic 1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we recreated this model in Lima, Perú, and in this paper we report the use of molecular fingerprinting to investigate patient infectiousness in the current era of HIV infection and multidrug-resistant (MDR) TB.. Temporal exposure patterns, drug susceptibility testing, and DNA fingerprinting of patient and animal TB strains defined infectious TB patients. Relative patient infectiousness was calculated using the Wells-Riley model of airborne infection. Over 505 study days there were 118 ward admissions of 97 HIV-positive pulmonary TB patients. Of 292 exposed guinea pigs, 144 had evidence of TB disease; a further 30 were tuberculin skin test positive only. There was marked variability in patient infectiousness; only 8.5% of 118 ward admissions by TB patients were shown by DNA fingerprinting to have caused 98% of the 125 characterised cases of secondary animal TB. 90% of TB transmission occurred from inadequately treated MDR TB patients. Three highly infectious MDR TB patients produced 226, 52, and 40 airborne infectious units (quanta) per hour.A small number of inadequately treated MDR TB patients coinfected with HIV were responsible for almost all TB transmission, and some patients were highly infectious. This result highlights the importance of rapid TB drug-susceptibility testing to allow prompt initiation of effective treatment, and environmental control measures to reduce ongoing TB transmission in crowded health care settings. TB infection control must be prioritized in order to prevent health care facilities from disseminating the drug-resistant TB that they are attempting to treat

Escombe A. Roderick

Moore David A. J

Gilman Robert H

Pan William

Navincopa Marcos

Ticona Eduardo

Martínez Carlos

Caviedes Luz

Sheen Patricia

Gonzalez Armando

Noakes Catherine J

Friedland Jon S

Evans Carlton A

Public Library of Science (PLOS)

The Infectiousness of Tuberculosis Patients Coinfected with HIV

Background
The current understanding of airborne tuberculosis (TB) transmission is based on classic
1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we
recreated this model in Lima, Peru´, and in this paper we report the use of molecular
fingerprinting to investigate patient infectiousness in the current era of HIV infection and
multidrug-resistant (MDR) TB.
Methods and Findings
All air from a mechanically ventilated negative-pressure HIV-TB ward was exhausted over
guinea pigs housed in an airborne transmission study facility on the roof. Animals had monthly
tuberculin skin tests, and positive reactors were removed for autopsy and organ culture for M.
tuberculosis. Temporal exposure patterns, drug susceptibility testing, and DNA fingerprinting of
patient and animal TB strains defined infectious TB patients. Relative patient infectiousness was
calculated using the Wells-Riley model of airborne infection. Over 505 study days there were
118 ward admissions of 97 HIV-positive pulmonary TB patients. Of 292 exposed guinea pigs,
144 had evidence of TB disease; a further 30 were tuberculin skin test positive only. There was
marked variability in patient infectiousness; only 8.5% of 118 ward admissions by TB patients
were shown by DNA fingerprinting to have caused 98% of the 125 characterised cases of
secondary animal TB. 90% of TB transmission occurred from inadequately treated MDR TB
patients. Three highly infectious MDR TB patients produced 226, 52, and 40 airborne infectious
units (quanta) per hour.
Conclusions
A small number of inadequately treated MDR TB patients coinfected with HIV were
responsible for almost all TB transmission, and some patients were highly infectious. This result
highlights the importance of rapid TB drug-susceptibility testing to allow prompt initiation of
effective treatment, and environmental control measures to reduce ongoing TB transmission in
crowded health care settings. TB infection control must be prioritized in order to prevent health
care facilities from disseminating the drug-resistant TB that they are attempting to treat

Escombe, AR

Moore, DAJ

Gilman, RH

Pan, W

Navincopa, M

Ticona, E

Martinez, C

Caviedes, L

Sheen, P

Gonzalez, A

Noakes, CJ

Friedland, JS

Evans, CA

Spiral - Imperial College Digital Repository

Background: The current understanding of airborne tuberculosis (TB) transmission is based on classic 1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we recreated this model in Lima, Perú, and in this paper we report the use of molecular fingerprinting to investigate patient infectiousness in the current era of HIV infection and multidrug-resistant (MDR) TB. Methods and Findings: All air from a mechanically ventilated negative-pressure HIV-TB ward was exhausted over guinea pigs housed in an airborne transmission study facility on the roof. Animals had monthly tuberculin skin tests, and positive reactors were removed for autopsy and organ culture for M. tuberculosis. Temporal exposure patterns, drug susceptibility testing, and DNA fingerprinting of patient and animal TB strains defined infectious TB patients. Relative patient infectiousness was calculated using the Wells-Riley model of airborne infection. Over 505 study days there were 118 ward admissions of 97 HIV-positive pulmonary TB patients. Of 292 exposed guinea pigs, 144 had evidence of TB disease; a further 30 were tuberculin skin test positive only. There was marked variability in patient infectiousness; only 8.5% of 118 ward admissions by TB patients were shown by DNA fingerprinting to have caused 98% of the 125 characterised cases of secondary animal TB. 90% of TB transmission occurred from inadequately treated MDR TB patients. Three highly infectious MDR TB patients produced 226, 52, and 40 airborne infectious units (quanta) per hour. Conclusions: A small number of inadequately treated MDR TB patients coinfected with HIV were responsible for almost all TB transmission, and some patients were highly infectious. This result highlights the importance of rapid TB drug-susceptibility testing to allow prompt initiation of effective treatment, and environmental control measures to reduce ongoing TB transmission in crowded health care settings. TB infection control must be prioritized in order to prevent health care facilities from disseminating the drug-resistant TB that they are attempting to treat

White Rose Research Online

Crossref

The current understanding of airborne tuberculosis (TB) transmission is based on classic 1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we recreated this model in Lima, Perú, and in this paper we report the use of molecular fingerprinting to investigate patient infectiousness in the current era of HIV infection and multidrug-resistant (MDR) TB.All air from a mechanically ventilated negative-pressure HIV-TB ward was exhausted over guinea pigs housed in an airborne transmission study facility on the roof. Animals had monthly tuberculin skin tests, and positive reactors were removed for autopsy and organ culture for M. tuberculosis. Temporal exposure patterns, drug susceptibility testing, and DNA fingerprinting of patient and animal TB strains defined infectious TB patients. Relative patient infectiousness was calculated using the Wells-Riley model of airborne infection. Over 505 study days there were 118 ward admissions of 97 HIV-positive pulmonary TB patients. Of 292 exposed guinea pigs, 144 had evidence of TB disease; a further 30 were tuberculin skin test positive only. There was marked variability in patient infectiousness; only 8.5% of 118 ward admissions by TB patients were shown by DNA fingerprinting to have caused 98% of the 125 characterised cases of secondary animal TB. 90% of TB transmission occurred from inadequately treated MDR TB patients. Three highly infectious MDR TB patients produced 226, 52, and 40 airborne infectious units (quanta) per hour.A small number of inadequately treated MDR TB patients coinfected with HIV were responsible for almost all TB transmission, and some patients were highly infectious. This result highlights the importance of rapid TB drug-susceptibility testing to allow prompt initiation of effective treatment, and environmental control measures to reduce ongoing TB transmission in crowded health care settings. TB infection control must be prioritized in order to prevent health care facilities from disseminating the drug-resistant TB that they are attempting to treat

A Roderick Escombe

David A J Moore

Directory of Open Access Journals

The infectiousness of tuberculosis patients coinfected with HIV.

Escombe, A.R.

Moore, D.A.J.

Gilman, R.H.

Pan, W.

Navincopa, M.

Ticona, E.

Martinez, C.

Caviedes, L.

Sheen, P.

Gonzalez, A.

Noakes, C.J.

Friedland, J.S.

Evans, C.A.

The infectiousness of tuberculosis patients coinfected with HIV

BACKGROUND: The current understanding of airborne tuberculosis (TB) transmission is based on classic 1950s studies in which guinea pigs were exposed to air from a tuberculosis ward. Recently we recreated this model in Lima, Perú, and in this paper we report the use of molecular fingerprinting to investigate patient infectiousness in the current era of HIV infection and multidrug-resistant (MDR) TB. METHODS AND FINDINGS: All air from a mechanically ventilated negative-pressure HIV-TB ward was exhausted over guinea pigs housed in an airborne transmission study facility on the roof. Animals had monthly tuberculin skin tests, and positive reactors were removed for autopsy and organ culture for M. tuberculosis. Temporal exposure patterns, drug susceptibility testing, and DNA fingerprinting of patient and animal TB strains defined infectious TB patients. Relative patient infectiousness was calculated using the Wells-Riley model of airborne infection. Over 505 study days there were 118 ward admissions of 97 HIV-positive pulmonary TB patients. Of 292 exposed guinea pigs, 144 had evidence of TB disease; a further 30 were tuberculin skin test positive only. There was marked variability in patient infectiousness; only 8.5% of 118 ward admissions by TB patients were shown by DNA fingerprinting to have caused 98% of the 125 characterised cases of secondary animal TB. 90% of TB transmission occurred from inadequately treated MDR TB patients. Three highly infectious MDR TB patients produced 226, 52, and 40 airborne infectious units (quanta) per hour. CONCLUSIONS: A small number of inadequately treated MDR TB patients coinfected with HIV were responsible for almost all TB transmission, and some patients were highly infectious. This result highlights the importance of rapid TB drug-susceptibility testing to allow prompt initiation of effective treatment, and environmental control measures to reduce ongoing TB transmission in crowded health care settings. TB infection control must be prioritized in order to prevent health care facilities from disseminating the drug-resistant TB that they are attempting to treat

Martínez, C

St George's Online Research Archive

Actualizacion de la doctrina, normas y procediminetos para el control de la tuberculosis en el Peru ´.L i m a( P e r u ´): Ministerio de Salud.

Aerial Dissemination of pulmonary TB—A two year study of contagion on a tuberculosis ward.

Airborne infection. Theoretical limits of protection achievable by building ventilation.

Bactericidal and sterilizing activities of antituberculosis drugs during the ﬁrst 14 days.

Clearing the air. The theory and application of ultraviolet air disinfection.

Cough frequency and infectivity in patients with pulmonary tuberculosis.

Cough-generated aerosols of Mycobacterium tuberculosis: a new method to study infectiousness.

Does one size ﬁt all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries.

Effect of drug resistance on the generation of secondary cases of tuberculosis.

Establishing priority during investigation of tuberculosis contacts.

Extensively drug-resistant tuberculosis as a cause of death in patients coinfected with tuberculosis and HIV in a rural area of South Africa.

Garcı ´a-Garcı ´a ML, Ponce de Leo ´n A, Jime ´nez-Corona ME,

Growth characteristics of recent sputum isolates of Mycobacterium tuberculosis in guinea pigs infected by the respiratory route.

Infection and disease among contacts of tuberculosis cases with drugresistant and drug-susceptible bacilli.

Infection and disease among household contacts of patients with multidrug resistant tuberculosis.

Infectiousness and virulence of multi-drug resistant and drug susceptible tuberculosis in adult contacts.

Infectiousness of air from a tuberculosis ward. Ultraviolet irradiation of infected air: comparative infectiousness of different patients.

Measurement of sputum Mycobacterium tuberculosis messenger RNA as a surrogate for response to chemotherapy.

Mixed infection and clonal representativeness of a single sputum sample in tuberculosis patients from a penitentiary hospital in Georgia. Respir Res 7:

Molecular epidemiology of tuberculosis in the Netherlands: a nationwide study from

Mycobacterium tuberculosis transmission in a health clinic.

Natural ventilation for the prevention of airborne contagion.

Nosocomial tuberculosis.

Occupational tuberculous infections among pulmonary physicians in training.

Rapid, efﬁcient detection and drug susceptibility testing of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures.

Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology.

SPSS User Manual Version 10.0.

Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries.

Tetrazolium microplate assay as a rapid and inexpensive colorimetric method for determination of antibiotic susceptibility of Mycobacterium tuberculosis.

The detection and prevention of airborne TB transmission [PhD dissertation]. London (UK):

The detection of airborne transmission of tuberculosis from HIV-infected patients, using an in vivo air sampling model.

The impact of human immunodeﬁciency virus type 1 on infectiousness of tuberculosis: a meta-analysis.

The transmission of tuberculosis in conﬁned spaces: an analytical review of alternative epidemiological models.

The value of contact procedures for tuberculosis in Edinburgh.

Transmission of Mycobacterium tuberculosis depending on the age and sex of source cases.

Transmission of Mycobacterium tuberculosis from patients smearnegative for acid-fast bacilli.

Transmission of tubercle bacilli: The effects of chemotherapy.

Transmission of tuberculosis in New York City. An analysis by DNA ﬁngerprinting and conventional epidemiologic methods.

Tuberculosis disseminators. A study of the variability of aerial infectivity of tuberculous patients.

Tuberculosis infection control in resource limitied settings in the era of expanding HIV care and treatment.

Tuberculosis recurrence and mortality after successful treatment: impact of drug resistance.

Variability of airborne transmission of Mycobacterium tuberculosis: implications for control of tuberculosis in the HIV era.

World Health Organisation

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The infectiousness of tuberculosis patients coinfected with HIV

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Directory of Open Access Journals

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