ArticlePLoS medicine2008
The infectiousness of tuberculosis patients coinfected with HIV.
Article in PLoS medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 98 papers, 2 of them syntheses that pooled it.
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Who cites it
98 citing papers in PubMed, 2 syntheses or guidelines pooled it, 182 citations in OpenAlex.
- A Systematic Literature Review of Indoor Air Disinfection Techniques for Airborne Bacterial Respiratory Pathogens.International journal of environmental research and public health · 2022Pooled it
- Dynamics of sputum conversion during effective tuberculosis treatment: A systematic review and meta-analysis.PLoS medicine · 2021Pooled it
- Trial
- Importance of cough and M. tuberculosis strain type as risks for increased transmission within households.PloS one · 2014Trial
- Article
- An Interactive Pharmacokinetic-Pharmacodynamic Framework to Evaluate Bedaquiline Dose Modifications in Adults With Tuberculosis.CPT: pharmacometrics & systems pharmacology · 2026Article
- Predictors of culture status in patients with persistent smear-positive pulmonary tuberculosis at two months of treatment.BMC infectious diseases · 2026Article
- Reducing spatial clustering to prevent tuberculosis transmission in a busy Zambian hospital: a modelling study based on person movements, environmental and clinical data.medRxiv : the preprint server for health sciences · 2025Article
- Impact of indoor ventilation on TB transmission risk: implications of climate change.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2025Article
- Assessing Infectiousness and the Impact of Effective Treatment to Guide Isolation Recommendations for People With Pulmonary Tuberculosis.The Journal of infectious diseases · 2025Review
- Estimating Mycobacterium tuberculosis transmission in a South African clinic: Spatiotemporal model based on person movements.PLoS computational biology · 2025Article
- Bioaerosols and Airborne Transmission in the Dental Clinic.International dental journal · 2024Review
- Mycobacterium tuberculosis cough aerosol culture status associates with host characteristics and inflammatory profiles.Nature communications · 2024Article
- Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise.The Lancet. Respiratory medicine · 2024Review
- NTCA Guidelines for Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Tuberculosis Infectiousness is Associated with Distinct Clinical and Inflammatory Profiles.Research square · 2024Article
- Airborne transmission risks of tuberculosis and COVID-19 in schools in South Africa, Switzerland, and Tanzania: Modeling of environmental data.PLOS global public health · 2024Article
- Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context.BMJ open · 2023Article
- Exhaled Mycobacterium tuberculosis Predicts Incident Infection in Household Contacts.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Clinic presentation delay and tuberculosis treatment outcomes in the Lake Victoria region of East Africa: A multi-site prospective cohort study.PLOS global public health · 2023Article
38 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 7 institutions in 3 countries.
Funding
Abstract
backgroundThe 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
findingsAll 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.
conclusionsA 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.