{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:03:13Z","timestamp":1790877793960,"version":"4.1.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["1R01AI152161"],"award-info":[{"award-number":["1R01AI152161"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004419","name":"CRDF Global","doi-asserted-by":"publisher","award":["DAA2-16-62066-1, DAA3-17-63190-1"],"award-info":[{"award-number":["DAA2-16-62066-1, DAA3-17-63190-1"]}],"id":[{"id":"10.13039\/100004419","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>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\u201361.6) 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 \u201ctrace positive\u201d), and 88\/557 (15.8%), on culture. Of those confirmed, 57\/145 (39.3%) were Ultra positive, culture negative \u2013 contributing 10.2% to the overall yield. Ultra performed better in children over 5 years and with weight-for-height Z-scores\u2009&lt;\u2009-3. 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.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007271","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:25:43Z","timestamp":1790875543000},"page":"e0007271","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7921-8129","authenticated-orcid":true,"given":"Juaneta","family":"Luiz","sequence":"first","affiliation":[{"name":"University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children\u2019s Hospital","place":["Cape Town, South Africa"],"department":["Department of Paediatrics and Child Health"]},{"name":"Dora Nginza Hospital","place":["Gqeberha, South Africa"],"department":["Department of Paediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3433-6106","authenticated-orcid":true,"given":"Lesley J.","family":"Workman","sequence":"additional","affiliation":[{"name":"University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children\u2019s Hospital","place":["Cape Town, South Africa"],"department":["Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4747-7610","authenticated-orcid":true,"given":"Cynthia B.","family":"Baard","sequence":"additional","affiliation":[{"name":"University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children\u2019s Hospital","place":["Cape Town, South Africa"],"department":["Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yekiwe","family":"Hlombe","sequence":"additional","affiliation":[{"name":"University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children\u2019s Hospital","place":["Cape Town, South Africa"],"department":["Department of Paediatrics and Child Health"]},{"name":"Dora Nginza Hospital","place":["Gqeberha, South Africa"],"department":["Department of Paediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9755-9614","authenticated-orcid":true,"given":"Margaretha","family":"Prins","sequence":"additional","affiliation":[{"name":"University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children\u2019s Hospital","place":["Cape Town, South Africa"],"department":["Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomlindo","family":"Makubalo","sequence":"additional","affiliation":[{"name":"Dora Nginza Hospital","place":["Gqeberha, South Africa"],"department":["Department of Paediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devan","family":"Jaganath","sequence":"additional","affiliation":[{"name":"University of California San Francisco","place":["San Francisco, United States of America"],"department":["Division of Pediatric Infectious Diseases"]},{"name":"Center for Tuberculosis, Institute for Global Health Sciences, University of California San Francisco","place":["San Francisco, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6553-2601","authenticated-orcid":true,"given":"Adithya","family":"Cattamanchi","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis, Institute for Global Health Sciences, University of California San Francisco","place":["San Francisco, United States of America"]},{"name":"University of California Irvine","place":["Irvine, United States of America"],"department":["Division of Pulmonary Diseases and Critical Care Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P.","family":"Nicol","sequence":"additional","affiliation":[{"name":"University of Cape Town and National Health Laboratory Services","place":["Cape Town, South Africa"],"department":["Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine"]},{"name":"Marshall Centre, School of Biomedical Sciences, University of Western Australia","place":["Perth, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J.","family":"Zar","sequence":"additional","affiliation":[{"name":"University of Cape Town, and South African Medical Research Council Unit on Child & Adolescent Health, Red Cross War Memorial Children\u2019s Hospital","place":["Cape Town, South Africa"],"department":["Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"pgph.0007271.ref001","volume-title":"WHO consolidated guidelines on tuberculosis. 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