{ "abstract": "Microbiological diagnosis of childhood pulmonary tuberculosis can be challenging. We investigated the accuracy of Xpert MTB/RIF Ultra on the induced sputum, focused on high-risk groups (infants, malnourished children, and those living with HIV), where data is limited. Children (under 15 years) investigated for pulmonary tuberculosis at Dora Nginza Hospital, South Africa, were prospectively enrolled between January 2018 and January 2024, and followed up for 12 months. Induced sputa were tested with liquid culture and Xpert MTB/RIF Ultra (Ultra). Children were categorized with confirmed, unconfirmed, or unlikely tuberculosis, according to NIH consensus definitions. Ultra diagnostic accuracy was calculated against culture, with analysis by high-risk subgroups. Of 636 children (median age, 27.4 (IQR 11.8–61.6) months), 173 (27.2%) were classified with confirmed TB, 384 (60.4%) with unconfirmed TB, and 79 (12.4%) with unlikely TB. There were 223 (37.8%) children underweight-for-age, 168 (26.5%) living with HIV, and 163 (25.6%) infants. Of 557 children with TB, 145 (26.0%) were confirmed on induced sputa; with 137/557 (24.6%) confirmed on Ultra (46.0%; 63/137, of which were “trace positive”), and 88/557 (15.8%), on culture. Of those confirmed, 57/145 (39.3%) were Ultra positive, culture negative – contributing 10.2% to the overall yield. Ultra performed better in children over 5 years and with weight-for-height Z-scores < -3. Overall, Ultra sensitivity was 90.9% (95%CI 82.9-96.0) and specificity, 89.6% (95%CI 86.7-92.0), with high accuracy across high-risk groups. Mortality amongst children treated for PTB was 4.9% (27/557) with aRR highest for stunted children (7.3; 95% CI, 2.2-24.2), followed by children with HIV (3.5; 95% CI, 1.6-7.5), and infants (3.3; 95% CI, 1.6-6.7). Ultra on induced sputum was feasible, with high yield and diagnostic accuracy for high-risk children.", "abstract_shown": true, "affiliations": [ "Department of Paediatrics and Child Health, University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa", "Department of Paediatrics, Dora Nginza Hospital, Gqeberha, South Africa", "Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, United States of America", "Center for Tuberculosis, Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States of America", "Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, United States of America", "Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town and National Health Laboratory Services, Cape Town, South Africa", "Marshall Centre, School of Biomedical Sciences, University of Western Australia, Perth, Australia" ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Juaneta Luiz" }, { "affs": [ 1 ], "name": "Lesley J. Workman" }, { "affs": [ 2 ], "name": "Cynthia B. Baard" }, { "affs": [ 3 ], "name": "Yekiwe Hlombe" }, { "affs": [ 4 ], "name": "Margaretha Prins" }, { "affs": [ 5 ], "name": "Nomlindo Makubalo" }, { "affs": [ 6 ], "name": "Devan Jaganath" }, { "name": "Adithya Cattamanchi" }, { "name": "Mark P. Nicol" }, { "name": "Heather J. Zar" } ], "bibtex": "https://research.draconitic.com/paper/dvv6v7nygfr6f.bib", "cited_by": 0, "doi": "10.1371/journal.pgph.0007271", "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007271", "id": "dvv6v7nygfr6f", "issns": [ "2767-3375" ], "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007271", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|Tuberculosis Research and Epidemiology" ], [ "plos", "/Biology and life sciences/Anatomy/Body fluids/Mucus/Sputum" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Nutrition/Malnutrition" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Physiology/Body fluids/Mucus/Sputum" ], [ "plos", "/Medicine and health sciences/Anatomy/Body fluids/Mucus/Sputum" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/HIV diagnosis and management" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Tuberculosis diagnosis and management" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Tuberculosis" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Tuberculosis" ], [ "plos", "/Medicine and health sciences/Nutrition/Malnutrition" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/People and places/Population groupings/Age groups/Children/Infants" ], [ "plos", "/People and places/Population groupings/Families/Children/Infants" ] ], "openalex": "W7215114154", "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007271&type=printable", "pmcid": null, "pmid": null, "published": "2026-10-01", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/dvv6v7nygfr6f.ris", "sources": [ { "first_seen": "2026-10-30T12:17:37Z", "native_id": "10.1371/journal.pgph.0007271", "source": "plos", "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007271" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:nutrition", "subfield": "nutrition" }, { "field": "medicine", "origin": "plos:anatomy", "subfield": "physiology" } ], "title": "Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition", "title_text": "Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:37Z", "url": "https://research.draconitic.com/paper/dvv6v7nygfr6f", "venue": "PLOS Global Public Health", "versions": [] }