Turner Richard D, Chiu Christopher, Churchyard Gavin J, Esmail Hanif, Lewinsohn David M, Gandhi Neel R, Fennelly Kevin P
Department of Respiratory Medicine, King's College Hospital.
Section of Infectious Diseases & Immunity, Imperial College London, United Kingdom.
J Infect Dis. 2017 Nov 3;216(suppl_6):S636-S643. doi: 10.1093/infdis/jix361.
The transmission of tuberculosis is complex. Necessary factors include a source case with respiratory disease that has developed sufficiently for Mycobacterium tuberculosis to be present in the airways. Viable bacilli must then be released as an aerosol via the respiratory tract of the source case. This is presumed to occur predominantly by coughing but may also happen by other means. Airborne bacilli must be capable of surviving in the external environment before inhalation into a new potential host-steps influenced by ambient conditions and crowding and by M. tuberculosis itself. Innate and adaptive host defenses will then influence whether new infection results; a process that is difficult to study owing to a paucity of animal models and an inability to measure infection directly. This review offers an overview of these steps and highlights the many gaps in knowledge that remain.
结核病的传播很复杂。必要因素包括一个患有呼吸道疾病的传染源，该疾病已发展到足以使结核分枝杆菌存在于气道中。然后，有活力的杆菌必须通过传染源的呼吸道以气溶胶形式释放出来。据推测，这主要通过咳嗽发生，但也可能通过其他方式发生。空气传播的杆菌在被吸入新的潜在宿主之前，必须能够在外部环境中存活——这一过程受环境条件、拥挤程度以及结核分枝杆菌自身的影响。先天性和适应性宿主防御随后将影响是否会发生新的感染；由于缺乏动物模型且无法直接测量感染情况，这一过程很难研究。本综述概述了这些步骤，并突出了仍然存在的许多知识空白。
