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Sensitivity optimisation of tuberculosis bioaerosol sampling.

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Improved bioaerosol sampling using the RASC-2 method significantly enhances the detection of Mycobacterium tuberculosis (Mtb) in patients with active TB. This advancement increases Mtb detection yields, offering a more sensitive tool for assessing infectiousness.

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Area of Science:

  • Microbiology
  • Pulmonology
  • Infectious Diseases

Background:

  • Detection of Mycobacterium tuberculosis (Mtb) in bioaerosols can measure infectiousness in TB patients.
  • Current bioaerosol sampling methods show low detection yields in sputum-positive TB cases.

Purpose of the Study:

  • To improve Mtb detection yields by advancing bioaerosol collection and identification techniques.
  • To enhance the utility of bioaerosol sampling for assessing TB infectiousness.

Main Methods:

  • Modified the Respiratory Aerosol Sampling Chamber (RASC) protocol to RASC-2, incorporating liquid bioaerosol collection with a high-flow wet-walled cyclone.
  • Sampled GeneXpert-positive pulmonary TB patients pre-treatment, detecting Mtb using fluorescence microscopy with DMN-Trehalose.
  • Estimated exhaled air and bioaerosol volumes using CO2 monitoring and particle counting.

Main Results:

  • RASC-2 sampled significantly more exhaled air (median 258.4L) and bioaerosol volume (median 2.3nL) compared to RASC-1.
  • Mtb detection yield improved from 43% (RASC-1) to 95% (RASC-2).
  • The limit of detection was lowered to 0.9 Mtb bacilli per 100L of exhaled air with RASC-2.

Conclusions:

  • Technical improvements in particle collection and sensitive detection enable rapid quantification of viable Mtb in TB patient bioaerosols.
  • Increased sensitivity may allow TB transmission studies in sputum-negative and subclinical individuals.
  • Bioaerosol measurement shows potential for rapid intervention in other airborne infectious diseases.