PT - JOURNAL ARTICLE AU - Leonardo Martinez AU - Renu Verma AU - Julio Croda AU - C. Robert Horsburgh AU - Katharine S. Walter AU - Nicholas Degner AU - Keren Middelkoop AU - Anastasia Koch AU - Sabine Hermans AU - Digby Warner AU - Robin Wood AU - Frank Cobelens AU - Jason R. Andrews TI - Detection, survival and infectious potential of <em>Mycobacterium tuberculosis</em> in the environment: A review of the evidence and epidemiological implications AID - 10.1183/13993003.02302-2018 DP - 2019 Jan 01 TA - European Respiratory Journal PG - 1802302 4099 - http://erj.ersjournals.com/content/early/2019/04/25/13993003.02302-2018.short 4100 - http://erj.ersjournals.com/content/early/2019/04/25/13993003.02302-2018.full AB - Much remains unknown about Mycobacterium tuberculosis transmission. Seminal experimental studies from the 1950s demonstrated that airborne expulsion of droplet nuclei from an infectious tuberculosis patient is the primary route of transmission. However, these findings did not rule out other routes of M. tuberculosis transmission. We reviewed historical scientific evidence from the late 19th and early 20th century and contemporary studies investigating the presence, persistence, and infectiousness of environmental M. tuberculosis. We found evidence – both experimental and epidemiological – supporting the presence and viability of M. tuberculosis in multiple natural and built environments for months to years, presumably following contamination by a human source. Further, several studies confirm M. tuberculosis viability and virulence in the environment using guinea pig and mouse models. Most of this evidence was historical; however, several recent studies have reported consistent findings of M. tuberculosis detection and viability in the environment using modern methods. Whether or not M. tuberculosis in environments represents an infectious threat to humans, it may represent an untapped source of data with which to further understand M. tuberculosis transmission. We discuss potential opportunities for harnessing these data to generate new insights into tuberculosis transmission in congregate settings.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Martinez has nothing to disclose.Conflict of interest: Dr. Verma has nothing to disclose.Conflict of interest: Dr. Croda has nothing to disclose.Conflict of interest: Dr. Horsburgh has nothing to disclose.Conflict of interest: Dr. Walter has nothing to disclose.Conflict of interest: Dr. Degner has nothing to disclose.Conflict of interest: Dr. Middelkoop has nothing to disclose.Conflict of interest: Dr. Koch has nothing to disclose.Conflict of interest: Dr. Hermans has nothing to disclose.Conflict of interest: Dr. Warner has nothing to disclose.Conflict of interest: Dr. Wood has nothing to disclose.Conflict of interest: Dr. Cobelens has nothing to disclose.Conflict of interest: Dr. Andrews has nothing to disclose.