Persistent bioaerosol release in a tuberculosis-endemic setting.

Pioneering studies linking symptomatic disease and cough-mediated release of () established the infectious origin of tuberculosis (TB), simultaneously informing the pervasive notion that pathology is a prerequisite for transmission. Our prior 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 we demonstrated a time-dependent reduction in bioaerosol positivity during six-months' follow-up, irrespective of anti-TB chemotherapy. Now, by extending bioaerosol sampling to a randomly selected community cohort, we show that release is common in a TB-endemic setting: of 89 participants, 79.8% (71/89) produced bioaerosols independently of QuantiFERON-TB Gold status, a standard test for infection; moreover, during two-months' longitudinal sampling, only 2% (1/50) were serially bioaerosol negative. These results necessitate a reframing of the prevailing paradigm of transmission and infection, and may explain the current inability to elucidate transmission networks in TB-endemic regions.