{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:47:49Z","timestamp":1791910069747,"version":"4.3.4"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T00:00:00Z","timestamp":1651708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jimma University-Mycobacteriology Research Center"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Diagnosis of tuberculosis (TB) in children is challenging mainly due to the difficulty of obtaining respiratory specimen and lack of sensitive diagnostic tests. The objective of this study was to evaluate the diagnostic performance of Xpert MTB\/RIF (Xpert here after) for the diagnosis of pulmonary TB (PTB) from stool specimen in children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional study was conducted among consecutively recruited children (less than 15 years old) with presumptive PTB at Jimma Medical Center, Ethiopia. One pulmonary specimen (expectorated sputum or gastric aspirate) was collected from each participant and tested for TB by Xpert and Lowenstein-Jensen (LJ) culture. In addition, one stool specimen per child was collected and tested by Xpert after a single step, centrifuge-free stool processing method adapted from KNCV TB Foundation. Diagnostic performance of Xpert was calculated with reference to LJ culture and to a composite reference standards (CRS) comprising of confirmed TB (positive by Xpert and\/or culture) and unconfirmed TB (clinical diagnosis with improvement after anti-TB treatment).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 178 children were enrolled; 152 of whom had complete microbiological results. Overall, TB was diagnosed in 13.2% (20\/152) of the children with presumptive TB. Of these, only ten had microbiologically confirmed TB (positive Xpert and\/or culture) and the remaining ten were clinically diagnosed with positive response to anti-TB treatment and were classified as unconfirmed TB. Stool Xpert had sensitivity of 100% (95%CI: 66.4\u2013100) and specificity of 99.3% (95%CI: 96.2\u2013100) compared to culture; however, the sensitivity was decreased to 50% (95%CI: 27.2\u201372.8) when compared to CRS. The Xpert on gastric aspirate had sensitivity of 77.8% (95%CI: 40\u201397.2) compared to culture and 40% (95%CI: 19.1\u201364) compared to CRS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The sensitivity of Xpert for stool sample is comparable to that for gastric aspirate. Stool sample is a potential alternative to pulmonary specimen in the diagnosis of pulmonary TB in children using Xpert.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0267661","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T17:39:16Z","timestamp":1651772356000},"page":"e0267661","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Stool-based Xpert MTB\/RIF assay for the diagnosis of pulmonary tuberculosis in children at a teaching and referral hospital in Southwest Ethiopia"],"prefix":"10.1371","volume":"17","author":[{"given":"Mitiku","family":"Dubale","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4751-2225","authenticated-orcid":true,"given":"Mulualem","family":"Tadesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melkamu","family":"Berhane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mekidim","family":"Mekonnen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemeda","family":"Abebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,5]]},"reference":[{"key":"pone.0267661.ref001","volume-title":"Global tuberculosis report","author":"World Health Organization","year":"2019"},{"issue":"6","key":"pone.0267661.ref002","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1128\/JCM.03043-15","article-title":"Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children","volume":"54","author":"JJ Dunn","year":"2016","journal-title":"J Clin Microbiol"},{"issue":"S2","key":"pone.0267661.ref003","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1093\/infdis\/jiu803","article-title":"Tuberculosis Diagnostics in 2015: Landscape, Priorities, Needs, and Prospects","volume":"211","author":"M Pai","year":"2015","journal-title":"J Infect Dis"},{"key":"pone.0267661.ref004","first-page":"222:1","article-title":"Induced sputum versus gastric lavage for the diagnosis of pulmonary tuberculosis in children","volume":"13","author":"MR Jim\u00e9nez","year":"2013","journal-title":"BMC Infect Dis"},{"issue":"6","key":"pone.0267661.ref005","doi-asserted-by":"crossref","first-page":"893","DOI":"10.4269\/ajtmh.2008.79.893","article-title":"Europe PMC Funders Group Diagnosis of Pediatric Pulmonary Tuberculosis by Stool PCR","volume":"79","author":"H Wolf","year":"2010","journal-title":"Am J Trop Med Hyg"},{"issue":"9","key":"pone.0267661.ref006","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1097\/INF.0000000000001563","article-title":"Xpert MTB\/RIF on Stool is Useful for the Rapid Diagnosis of Tuberculosis in Young Children with Severe Pulmonary Disease","volume":"36","author":"E Walters","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0267661.ref007","unstructured":"World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB\/RIF assay for the diagnosis of pulmonary and extra- pulmonary TB in adults and children. Policy update. WHO. 2013. https:\/\/apps.who.int\/iris\/handle\/10665\/112472."},{"issue":"2","key":"pone.0267661.ref008","first-page":"198","article-title":"Gene Xpert for Direct Detection of Mycobacterium Tuberculosis in Stool Specimens from Children with Presumptive Pulmonary Tuberculosis","volume":"46","author":"HS Moussa","year":"2016","journal-title":"Ann Clin Lab Sci"},{"key":"pone.0267661.ref009","unstructured":"Jimma Medical Center. https:\/\/www.ju.edu.et\/?q=article\/specialized-hosptial&page=5%0AAddis."},{"key":"pone.0267661.ref010","unstructured":"KNCV Tuberculosis Foundation. Simple KNCV stool test breakthrough for Childhood TB. https:\/\/www.kncvtbc.org\/en\/2018\/10\/25\/simple-kncv-stool-test-break-through-for-childhood- tb\/."},{"key":"pone.0267661.ref011","unstructured":"Federal Democratic Republic of Ethiopia-Ministry of Health. Guidlines for clinical and programmatic management of TB, Leprosy and TB\/HIV in Ethiopia, 2012. 5th ed."},{"key":"pone.0267661.ref012","unstructured":"Teklu S, Mohammed HA. Evaluation of Gene Xpert in Detecting Suspected Pulmonary Tuberculosis, From Stool Sample, For Children <15years, Adama, Ethiopia. 2019; http:\/\/www.etpha.org\/conference\/index.php\/30thConference\/ 30thConference\/paper\/view\/2307"},{"key":"pone.0267661.ref013","first-page":"83","article-title":"Stool as Appropriate Sample for the Diagnosis of Mycobacterium tuberculosis by Gene Xpert Test","volume":"4","author":"SH Welday","year":"2014","journal-title":"Open J Respir Dis"},{"issue":"473","key":"pone.0267661.ref014","first-page":"1","article-title":"Evaluation of Xpert MTB \/ RIF testing for rapid diagnosis of childhood pulmonary tuberculosis in children by Xpert MTB \/ RIF testing of stool samples in a low resource setting","volume":"10","author":"Z Hasan","year":"2017","journal-title":"BMC Res Notes"},{"issue":"6","key":"pone.0267661.ref015","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S2213-2600(15)00095-8","article-title":"Xpert MTB\/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis","volume":"3","author":"I Schiller","year":"2015","journal-title":"Lancet Respir Med"},{"issue":"2","key":"pone.0267661.ref016","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5588\/ijtld.16.0357","article-title":"Stool Xpert MTB \/ RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe","volume":"21","author":"M Chipinduro","year":"2017","journal-title":"Int J Tuberc Lung Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267661","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T17:39:35Z","timestamp":1651772375000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267661"}},"subtitle":[],"editor":[{"given":"Silvia S.","family":"Chiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,5]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0267661","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,5]]}}}