@article {Martinez1802302, author = {Leonardo Martinez and Renu Verma and Julio Croda and C. Robert Horsburgh, Jr and Katharine S. Walter and Nicholas Degner and Keren Middelkoop and Anastasia Koch and Sabine Hermans and Digby F. Warner and Robin Wood and Frank Cobelens and Jason R. Andrews}, title = {Detection, survival and infectious potential of Mycobacterium tuberculosis in~the environment: a review of the evidence and epidemiological implications}, volume = {53}, number = {6}, elocation-id = {1802302}, year = {2019}, doi = {10.1183/13993003.02302-2018}, publisher = {European Respiratory Society}, abstract = {Much remains unknown about Mycobacterium tuberculosis transmission. Seminal experimental studies from the 1950s demonstrated that airborne expulsion of droplet nuclei from an infectious tuberculosis (TB) 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/early 20th century and contemporary studies investigating the presence, persistence and infectiousness of environmental M. tuberculosis. We found both experimental and epidemiological~evidence 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. Furthermore, 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 M. tuberculosis in environments represents an infectious threat to humans~requires further investigation; this 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 TB transmission in congregate settings.Although airborne transmission is accepted as the primary mechanistic route of Mycobacterium tuberculosis, there is a high-quality scientific evidence base supporting the presence, persistence and infectiousness of M. tuberculosis in the environment http://bit.ly/2VwoSnK}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/53/6/1802302}, eprint = {https://erj.ersjournals.com/content/53/6/1802302.full.pdf}, journal = {European Respiratory Journal} }