Journal
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
Volume 22, Issue 9, Pages 972-+Publisher
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
DOI: 10.5588/ijtld.18.0173
Keywords
droplets; dust and guinea pigs
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Funding
- National Research Foundation, Pretoria, South Africa
- US National Institutes of Health (Bethesda, MD, USA)
- German Centre for Infection Research (DZIF), Borstel, Germany
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
- Bill and Melinda Gates Foundation, Seattle, WA, USA
- South African Medical Research Council, Pretoria, South Africa
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The transmission of tuberculosis (TB) occurs mainly via inhalation of airborne droplet nuclei; however, the precise details of this process remain uncertain. We reviewed the literature from 1870 to 1940, when Mycobacterium tuberculosis was discovered and the concept of transmission emerged as a hallmark of the infectious disease. By 1940, laboratory experiments, animal studies and clinical observation had demonstrated that cough was central to TB transmission, and that guinea pigs close to patients with cough could be infected, mainly by patients coughing small droplets likely containing only 1-2 bacilli. A minority of pulmonary TB patients, usually during the early stages of the disease, with thin watery sputum, more successfully coughed small infectious droplets than patients with heavily smear-positive tenacious sputum who were often too ill and too weak to cough vigorously. There was ongoing debate regarding the possible importance of desiccated sputum particles found in surface dust. Investigation of TB transmission has a history of more than 130 years.
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