Fennelly, Kevin P.Jones-Lopez, Edward C.Ayakaka, IreneKim, SoyeonMenyha, HarrietKirenga, BruceMuchwa, ChristopherJoloba, MosesDryden-Peterson, ScottReilly, NancyOkwera, AlphonseElliott, Alison M.Smith, Peter G.Mugerwa, Roy D.Eisenach, Kathleen D.Ellne, Jerrold J.2022-05-182022-05-182012Fennelly, K. P., Jones-López, E. C., Ayakaka, I., Kim, S., Menyha, H., Kirenga, B., ... & Ellner, J. J. (2012). Variability of infectious aerosols produced during coughing by patients with pulmonary tuberculosis. American journal of respiratory and critical care medicine, 186(5), 450-457. DOI: 10.1164/rccm.201203-0444OC10.1164/rccm.201203-0444OChttps://nru.uncst.go.ug/handle/123456789/3256Mycobacterium tuberculosis is transmitted by infectious aerosols, but assessing infectiousness currently relies on sputum microscopy that does not accurately predict the variability in transmission. Objectives: To evaluate the feasibility of collecting cough aerosols and the risk factors for infectious aerosol production from patients with pulmonary tuberculosis (TB) in a resource-limited setting. Methods: We enrolled subjects with suspected TB in Kampala, Uganda and collected clinical, radiographic, and microbiological data in addition to cough aerosol cultures. A subset of 38 subjects was studied on 2 or 3 consecutive days to assess reproducibility. Measurements and Main Results: M. tuberculosis was cultured from cough aerosols of 28 of 101 (27.7%; 95% confidence interval [CI], 19.9–37.1%) subjects with culture-confirmed TB, with a median 16 aerosol cfu (range, 1–701) in 10 minutes of coughing. Nearly all (96.4%) cultivable particles were 0.65 to 4.7 mm in size. Positive aerosol cultures were associated with higher Karnofsky performance scores (P ¼ 0.016), higher sputum acid-fast bacilli smear microscopy grades (P ¼ 0.007), lower days to positive in liquid culture (P ¼ 0.004), stronger cough (P ¼ 0.016), and fewer days on TB treatment (P ¼ 0.047). In multivariable analyses, cough aerosol cultures were associated with a salivary/mucosalivary (compared with purulent/ mucopurulent) appearance of sputum (odds ratio, 4.42; 95% CI, 1.23–21.43) and low days to positive (per 1-d decrease; odds ratio, 1.17;95%CI, 1.07–1.33). The within-test (kappa, 0.81; 95%CI, 0.68– 0.94) and interday test (kappa, 0.62; 95% CI, 0.43–0.82) reproducibility were high. Conclusions: A minority of patients with TB (28%) produced culturable cough aerosols. Collection of cough aerosol cultures is feasible and reproducible in a resource-limited setting.enTuberculosisCoughAir microbiologyInfectious disease transmissionInfection controlArticle