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Peer-reviewedCC BY 4.0PLOS Global Public Health

Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition

  • Juaneta Luiz1
  • Lesley J. Workman2
  • Cynthia B. Baard3
  • Yekiwe Hlombe4
  • Margaretha Prins5
  • Nomlindo Makubalo6
  • Devan Jaganath7
  • Adithya Cattamanchi
  • Mark P. Nicol
  • Heather J. Zar
7 affiliations
  1. 1Department 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
  2. 2Department of Paediatrics, Dora Nginza Hospital, Gqeberha, South Africa
  3. 3Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, United States of America
  4. 4Center for Tuberculosis, Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States of America
  5. 5Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, United States of America
  6. 6Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town and National Health Laboratory Services, Cape Town, South Africa
  7. 7Marshall Centre, School of Biomedical Sciences, University of Western Australia, Perth, Australia
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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.

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Cite

BibTeXRIS
BibTeX
@article{luiz2026rapid,
  title = {{Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition}},
  author = {Juaneta Luiz and Lesley J. Workman and Cynthia B. Baard and Yekiwe Hlombe and Margaretha Prins and Nomlindo Makubalo and Devan Jaganath and Adithya Cattamanchi and Mark P. Nicol and Heather J. Zar},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pgph.0007271},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007271},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition
AU  - Juaneta Luiz
AU  - Lesley J. Workman
AU  - Cynthia B. Baard
AU  - Yekiwe Hlombe
AU  - Margaretha Prins
AU  - Nomlindo Makubalo
AU  - Devan Jaganath
AU  - Adithya Cattamanchi
AU  - Mark P. Nicol
AU  - Heather J. Zar
PY  - 2026
DA  - 2026/10/01
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0007271
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007271
AB  - 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.
SN  - 2767-3375
ER  -