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Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness

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dc.contributor.author Datta, Sumona
dc.contributor.author Sherman, Jonathan M.
dc.contributor.author Tovar, Marco A.
dc.contributor.author Bravard, Marjory A.
dc.contributor.author Valencia, Teresa
dc.contributor.author Montoya, Rosario
dc.contributor.author Quino, Willi
dc.contributor.author D'Arcy, Nikki
dc.contributor.author Ramos, Eric S.
dc.contributor.author Gilman, Robert H.
dc.contributor.author Evans, Carlton A.
dc.date.accessioned 2019-01-25T16:03:21Z
dc.date.available 2019-01-25T16:03:21Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4765
dc.description.abstract Background: Sputum from patients with tuberculosis contains subpopulations of metabolically active and inactive Mycobacterium tuberculosis with unknown implications for infectiousness. Methods: We assessed sputum microscopy with fluorescein diacetate (FDA, evaluating M. tuberculosis metabolic activity) for predicting infectiousness. Mycobacterium tuberculosis was quantified in pretreatment sputum of patients with pulmonary tuberculosis using FDA microscopy, culture, and acid-fast microscopy. These 35 patients’ 209 household contacts were followed with prevalence surveys for tuberculosis disease for 6 years. Results: FDA microscopy was positive for a median of 119 (interquartile range [IQR], 47–386) bacteria/µL sputum, which was 5.1% (IQR, 2.4%–11%) the concentration of acid-fast microscopy–positive bacteria (2069 [IQR, 1358–3734] bacteria/μL). Tuberculosis was diagnosed during follow-up in 6.4% (13/209) of contacts. For patients with lower than median concentration of FDA microscopy–positive M. tuberculosis, 10% of their contacts developed tuberculosis. This was significantly more than 2.7% of the contacts of patients with higher than median FDA microscopy results (crude hazard ratio [HR], 3.8; P = .03). This association maintained statistical significance after adjusting for disease severity, chemoprophylaxis, drug resistance, and social determinants (adjusted HR, 3.9; P = .02). Conclusions: Mycobacterium tuberculosis that was FDA microscopy negative was paradoxically associated with greater infectiousness. FDA microscopy–negative bacteria in these pretreatment samples may be a nonstaining, slowly metabolizing phenotype better adapted to airborne transmission. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartof urn:issn:1537-6613
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Microscopy en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject fluorescein diacetate en_US
dc.subject Fluoresceins/chemistry en_US
dc.subject Humans en_US
dc.subject infectiousness en_US
dc.subject Linear Models en_US
dc.subject Male en_US
dc.subject microscopy en_US
dc.subject Multivariate Analysis en_US
dc.subject Mycobacterium tuberculosis/isolation & purification en_US
dc.subject Prevalence en_US
dc.subject Sputum/microbiology en_US
dc.subject Surveys and Questionnaires en_US
dc.subject TB en_US
dc.subject Tuberculin Test en_US
dc.subject tuberculosis en_US
dc.subject Tuberculosis, Pulmonary/diagnosis en_US
dc.subject Young Adult en_US
dc.title Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/infdis/jix229
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08


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