{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:19:21Z","timestamp":1792441161795,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart and Lung Foundation","doi-asserted-by":"publisher","award":["20230511"],"award-info":[{"award-number":["20230511"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Xpert MTB Host Response (MTB-HR) assay has reached World Health Organization (WHO) test targets for pulmonary tuberculosis (PTB) with high bacillary loads. We investigated the contribution of MTB-HR as a nonsputum, near point-of-care diagnostic method in other prioritized groups, such as extrapulmonary tuberculosis (EPTB) and paucibacillary PTB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Individuals with presumed tuberculosis disease were prospectively included in Stockholm, Sweden (n = 307), and underwent MTB-HR venous and capillary testing in parallel. Clinical characterization was based on symptoms, microbiological results (microscopy, polymerase chain reaction [PCR], and culture), radiological assessment, and a panel of biochemical tests. Receiver operating characteristic analysis was performed to calculate cut-offs for maximized sensitivity and specificity, including WHO targets for screening and diagnostic tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>MTB-HR performed equally well in microbiologically confirmed PTB (area under the curve [AUC], 0.84 [95% confidence interval {CI}, .78\u2013.90]; n = 69) and EPTB (AUC, 0.82 [95% CI, .75\u2013.90]; n = 34). Based on Youden index cut-offs, the negative predictive value (NPV) was high both in PCR-negative PTB (\u22121.27, NPV 94%) and in EPTB (\u22121.58, NPV 95%) and fulfilled the minimum target product profile sensitivity requirement for confirmed EPTB. In individuals without tuberculosis (n = 204), the majority had pulmonary infections. There was a close to perfect correlation between venous and capillary samples (r = 0.97, P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Capillary Xpert MTB-HR improves detection of sputum PCR-negative, culture-verified PTB and is promising as a rule-out test in EPTB. MTB-HR score and bacterial burden were highly correlated. We suggest a graded MTB-HR score as more clinically relevant than a binary result.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf110","type":"journal-article","created":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T23:16:16Z","timestamp":1740870976000},"page":"e78-e88","source":"Crossref","is-referenced-by-count":9,"title":["Improved Detection of Extrapulmonary and Paucibacillary Pulmonary Tuberculosis by Xpert MTB Host Response in a Tuberculosis Low-Endemic, High-Resource Setting"],"prefix":"10.1093","volume":"232","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6585-6235","authenticated-orcid":false,"given":"Elin","family":"Folkesson","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Fr\u00f6berg","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Clinical Microbiology, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-690X","authenticated-orcid":false,"given":"Christopher","family":"Sundling","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]},{"name":"Center for Molecular Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Sch\u00f6n","sequence":"additional","affiliation":[{"name":"Division of Infection and Inflammation, Department of Biomedical and Clinical Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Kalmar County Hospital, Link\u00f6ping University , Kalmar ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"S\u00f6dersten","sequence":"additional","affiliation":[{"name":"Research and Development, Cepheid AB , Solna ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Bruchfeld","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"2025073007411889400_jiaf110-B1","volume-title":"End TB strategy","author":"World Health Organization (WHO)","year":"2015"},{"key":"2025073007411889400_jiaf110-B2","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1038\/s41564-023-01365-3","article-title":"Transforming tuberculosis diagnosis","volume":"8","author":"Pai","year":"2023","journal-title":"Nat Microbiol"},{"key":"2025073007411889400_jiaf110-B3","doi-asserted-by":"crossref","first-page":"e1002754","DOI":"10.1371\/journal.pmed.1002754","article-title":"Constructing care cascades for active tuberculosis: a strategy for program monitoring and identifying gaps in quality of care","volume":"16","author":"Subbaraman","year":"2019","journal-title":"PLoS Med"},{"key":"2025073007411889400_jiaf110-B4","volume-title":"Global tuberculosis report 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