{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:56:59Z","timestamp":1784627819942,"version":"3.55.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Science Center, general foundation, Sagamihara, Kanagawa, Japan","award":["Reiwa 06"],"award-info":[{"award-number":["Reiwa 06"]}]},{"name":"Sasebo city medical association, Sasebo, Nagasaki, Japan","award":["Reiwa 06"],"award-info":[{"award-number":["Reiwa 06"]}]},{"name":"Nagasaki prefecture medical association, Nagasaki, Japan","award":["Reiwa 06"],"award-info":[{"award-number":["Reiwa 06"]}]}],"content-domain":{"domain":["www.plosdigitalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Digit Health"],"abstract":"<jats:p>This study aimed to identify differences in patient background and symptoms between individuals who tested positive using conventional rapid antigen (Ag) tests and those who tested positive using a novel artificial intelligence (AI)\u2013powered pharyngeal endoscopy system. A total of 813 patients underwent both influenza\/COVID-19 Ag testing and AI-powered endoscopic testing. We analyzed differences in patient characteristics and symptoms between the two test-positive groups. AI testing showed an overall percent agreement of 62% (95% confidence interval [CI] 58\u201366%) (442\/713), a positive percent agreement of 47% (95% CI 40\u201353%) (125\/269), and a negative percent agreement of 71% (95% CI 67\u201376%) (317\/444) compared with Ag testing. Compared with Ag-positive cases, AI-positive cases exhibited a shorter interval from symptom onset to testing; median 18 hours (Interquartile range [IQR] 10\u201327) for AI+ and Ag-, 24 hours (IQR 18\u201341) for AI+ and Ag\u2009+\u2009, and 27 hours (IQR 17\u201347) for AI- and Ag+ (p\u2009&lt;\u20090.001). In analyses comparing the AI+ and Ag- vs. AI- and Ag\u2009+\u2009, AI+ and Ag- were more frequently paediatric (&lt;15 years old) (odds ratio [OR] 3.4 (95% CI 1.6-7.2), p\u2009=\u20090.001), tested earlier after symptom onset (&lt;24 hours) (OR 2.6 (95% CI 1.3-4.9), p\u2009=\u20090.005), had contact with infected individuals (OR 4.6 (95% CI 2.2-9.3), p\u2009&lt;\u20090.001), cough (OR 11 (95% CI 4.7-27), p\u2009&lt;\u20090.001), and fever (\u226538.0\u00b0C) (OR 5.6 (95% CI 2.8-11), p\u2009&lt;\u20090.001), but showed lower frequencies of gastrointestinal symptoms (OR 0.2 (95% CI 0.05-0.9), p\u2009=\u20090.04). Notably, the AI system misdiagnosed 23% (23\/99) of COVID-19-positive patients as influenza-positive, likely due to follicular lesions on the pharyngeal wall\u2014a key feature used by the AI system for diagnosing influenza. These findings demonstrate the impact of differences in diagnostic methodologies between conventional Ag testing (which detects pathogen viral load) and novel AI testing (which assesses host immune response to viral infection) on the clinical characteristics of test-positive patients.<\/jats:p>","DOI":"10.1371\/journal.pdig.0001233","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:28:45Z","timestamp":1770834525000},"page":"e0001233","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Infectious disease diagnosis by artificial intelligence (AI): Differences in patient backgrounds and symptoms between antigen test positives and novel AI-powered pharyngeal endoscopy test positives"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9314-3291","authenticated-orcid":true,"given":"Masahiko","family":"Mori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Yoshinaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadayoshi","family":"Moriyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Maekawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"issue":"1","key":"pdig.0001233.ref001","doi-asserted-by":"crossref","DOI":"10.1111\/irv.13248","article-title":"Surveillance of seasonal influenza viruses during the COVID-19 pandemic in Tokyo, Japan, 2018-2023, a single-center study","volume":"18","author":"H Takahashi","year":"2024","journal-title":"Influenza Other Respir Viruses"},{"issue":"3","key":"pdig.0001233.ref002","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1001\/jamainternmed.2024.7452","article-title":"Severity and long-term mortality of COVID-19, influenza, and respiratory syncytial virus","volume":"185","author":"KL Bajema","year":"2025","journal-title":"JAMA Intern Med"},{"key":"pdig.0001233.ref003","doi-asserted-by":"crossref","first-page":"105492","DOI":"10.1016\/j.jcv.2023.105492","article-title":"Current regulatory landscape for viral point-of-care testing in the United States","volume":"164","author":"JD Shirley","year":"2023","journal-title":"J Clin Virol"},{"issue":"4","key":"pdig.0001233.ref004","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.anorl.2020.06.001","article-title":"How to perform a nasopharyngeal swab in adults and children in the COVID-19 era","volume":"137","author":"S Pondaven-Letourmy","year":"2020","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"issue":"12","key":"pdig.0001233.ref005","doi-asserted-by":"crossref","DOI":"10.2196\/38751","article-title":"Examining the use of an artificial intelligence model to diagnose influenza: development and validation study","volume":"24","author":"S Okiyama","year":"2022","journal-title":"J Med Internet Res"},{"issue":"1091","key":"pdig.0001233.ref006","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1136\/postgradmedj-2016-134271","article-title":"Influenza follicles and their buds as early diagnostic markers of influenza: typical images","volume":"92","author":"A Miyamoto","year":"2016","journal-title":"Postgrad Med J"},{"issue":"5","key":"pdig.0001233.ref007","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1007\/s10620-021-07086-z","article-title":"Artificial intelligence in endoscopy","volume":"67","author":"Y Okagawa","year":"2022","journal-title":"Dig Dis Sci"},{"issue":"7","key":"pdig.0001233.ref008","doi-asserted-by":"crossref","first-page":"500","DOI":"10.7326\/0003-4819-156-7-201204030-00403","article-title":"Accuracy of rapid influenza diagnostic tests: a meta-analysis","volume":"156","author":"C Chartrand","year":"2012","journal-title":"Ann Intern Med"},{"issue":"2","key":"pdig.0001233.ref009","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1442-200X.2008.02696.x","article-title":"Sensitivity of rapid immunoassay for influenza A and B in the early phase of the disease","volume":"51","author":"M Watanabe","year":"2009","journal-title":"Pediatr Int"},{"issue":"2","key":"pdig.0001233.ref010","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/path.2104","article-title":"Immunosenescence of ageing","volume":"211","author":"AL Gruver","year":"2007","journal-title":"J Pathol"},{"issue":"5","key":"pdig.0001233.ref011","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.coi.2005.07.020","article-title":"T cell development and receptor diversity during aging","volume":"17","author":"JJ Goronzy","year":"2005","journal-title":"Curr Opin Immunol"},{"issue":"1","key":"pdig.0001233.ref012","doi-asserted-by":"crossref","first-page":"19328","DOI":"10.1038\/s41598-023-46823-4","article-title":"Impact of sex and age on vaccine-related side effects and their progression after booster mRNA COVID-19 vaccine","volume":"13","author":"M Mori","year":"2023","journal-title":"Sci Rep"},{"key":"pdig.0001233.ref013","article-title":"Impact of sex and age on mRNA COVID-19 vaccine-related side effects in Japan","author":"M Mori","year":"2022","journal-title":"Microbiol Spectr"},{"issue":"4","key":"pdig.0001233.ref014","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1093\/infdis\/jiad495","article-title":"Impact of nutritional status on antibody titer after booster mRNA COVID-19 vaccine among elderly adults in Japan","volume":"229","author":"M Mori","year":"2024","journal-title":"J Infect Dis"},{"issue":"5","key":"pdig.0001233.ref015","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1038\/ni.2588","article-title":"Understanding immunosenescence to improve responses to vaccines","volume":"14","author":"JJ Goronzy","year":"2013","journal-title":"Nat Immunol"},{"issue":"21","key":"pdig.0001233.ref016","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1001\/archinte.160.21.3243","article-title":"Clinical signs and symptoms predicting influenza infection","volume":"160","author":"AS Monto","year":"2000","journal-title":"Arch Intern Med"},{"issue":"5","key":"pdig.0001233.ref017","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1086\/506352","article-title":"Symptomatic predictors of influenza virus positivity in children during the influenza season","volume":"43","author":"SE Ohmit","year":"2006","journal-title":"Clin Infect Dis"},{"issue":"23","key":"pdig.0001233.ref018","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1056\/NEJMoa2509834","article-title":"High-dose influenza vaccine to reduce hospitalizations","volume":"393","author":"J Pardo-Seco","year":"2025","journal-title":"N Engl J Med"},{"issue":"1","key":"pdig.0001233.ref019","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s12985-024-02388-w","article-title":"Analyzing factors affecting positivity in drive-through COVID-19 testing: a cross-sectional study","volume":"21","author":"M Mori","year":"2024","journal-title":"Virol J"},{"issue":"10353","key":"pdig.0001233.ref020","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/S0140-6736(22)00982-5","article-title":"Influenza","volume":"400","author":"TM Uyeki","year":"2022","journal-title":"Lancet"},{"key":"pdig.0001233.ref021","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/978-3-319-91080-2_5","article-title":"Pharyngitis and pharyngeal space infections.","volume-title":"Introduction to clinical infectious diseases: A problem-based approach","author":"S Orzell","year":"2019"},{"issue":"2","key":"pdig.0001233.ref022","doi-asserted-by":"crossref","first-page":"221","DOI":"10.4269\/ajtmh.22-0747","article-title":"Cobblestone throat in a younger patient infected with the omicron variant of the SARS-CoV-2 virus","volume":"109","author":"G Inui","year":"2023","journal-title":"Am J Trop Med Hyg"},{"key":"pdig.0001233.ref023","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ijid.2022.03.056","article-title":"Variations in the appearance of posterior pharyngeal wall follicles in individuals with viral upper respiratory infections according to the virus and the stage of infection: A case series","volume":"119","author":"H Takahashi","year":"2022","journal-title":"Int J Infect Dis"},{"issue":"1111","key":"pdig.0001233.ref024","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1136\/postgradmedj-2017-135540","article-title":"Reply to \u201cInfluenza follicles and their buds as early diagnostic markers of influenza: typical images\u201d and demonstration of lymphoid follicles in the posterior pharyngeal walls of patients with mycoplasmal pneumonia","volume":"94","author":"T Kenzaka","year":"2018","journal-title":"Postgrad Med J"},{"issue":"2","key":"pdig.0001233.ref025","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/jgf2.589","article-title":"Appearance of a sore throat caused by the SARS-CoV-2 Omicron variant","volume":"24","author":"T Yamashita","year":"2022","journal-title":"J Gen Fam Med"},{"issue":"7902","key":"pdig.0001233.ref026","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1038\/s41586-022-04462-1","article-title":"Attenuated fusogenicity and pathogenicity of SARS-CoV-2 Omicron variant","volume":"603","author":"R Suzuki","year":"2022","journal-title":"Nature"},{"issue":"10335","key":"pdig.0001233.ref027","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/S0140-6736(22)00327-0","article-title":"Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID Study","volume":"399","author":"C Menni","year":"2022","journal-title":"Lancet"},{"issue":"6654","key":"pdig.0001233.ref028","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1126\/science.adh1114","article-title":"Leveraging artificial intelligence in the fight against infectious diseases","volume":"381","author":"F Wong","year":"2023","journal-title":"Science"},{"key":"pdig.0001233.ref029","article-title":"Artificial intelligence and infectious disease diagnostics: state of the art and future perspectives","author":"L Miglietta","year":"2025","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"pdig.0001233.ref030","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.amjmed.2020.05.004","article-title":"How to perform a nasopharyngeal swab - an otolaryngology perspective","volume":"133","author":"AC Kaufman","year":"2020","journal-title":"Am J Med"},{"issue":"7","key":"pdig.0001233.ref031","doi-asserted-by":"crossref","DOI":"10.1128\/jcm.03189-20","article-title":"Pandemic demand for SARS-CoV-2 testing led to critical supply and workforce shortages in U.S. clinical and public health laboratories","volume":"61","author":"NE Cornish","year":"2023","journal-title":"J Clin Microbiol"},{"issue":"3","key":"pdig.0001233.ref032","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u201cEZR\u201d for medical statistics","volume":"48","author":"Y Kanda","year":"2013","journal-title":"Bone Marrow Transplant"}],"container-title":["PLOS Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001233","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:28:50Z","timestamp":1770834530000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001233"}},"subtitle":[],"editor":[{"given":"Tyler","family":"Wray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pdig.0001233","relation":{},"ISSN":["2767-3170"],"issn-type":[{"value":"2767-3170","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]}}}