{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:06:58Z","timestamp":1791810418614,"version":"4.3.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Academy for Health Innovation Uganda","award":["RFA 003\/2017"],"award-info":[{"award-number":["RFA 003\/2017"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["2R01HL128156-05A1"],"award-info":[{"award-number":["2R01HL128156-05A1"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"DNAgenotek Inc."},{"name":"SPUTUM"}],"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>Stool is a potential sample for diagnosing <jats:italic>Mycobacterium tuberculosis<\/jats:italic> (<jats:italic>Mtb<\/jats:italic>) in patients with difficulty in expectorating. However, high mycobacterial culture contamination rates and Xpert MTB\/RIF Ultra test error rates on stool samples have limited its use. OMNIgene SPUTUM (OM-S) is a sample transport reagent with characteristics of sputum decontamination while maintaining viable <jats:italic>Mtb<\/jats:italic>. We evaluated the impact of OM-S on <jats:italic>Mtb<\/jats:italic> diagnostic yield from stool using smear microscopy, Xpert MTB\/RIF Ultra, and culture among presumptive TB patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Paired stool and expectorated sputum samples were collected from consecutive Ugandan adults undergoing diagnostic evaluation for pulmonary TB between June 2018 and June 2019. Stool was divided into 2 portions: one was homogenized in OM-S (OM-S stool) and the other in PBS (PBS stool) as control. Both sputum and processed stool were tested for <jats:italic>Mtb<\/jats:italic> using concentrated smear fluorescence microscopy (CFM), Xpert MTB\/RIF Ultra (Xpert) and Mycobacteria Growth Indicator Tube (MGIT) culture. Sensitivity, specificity, and predictive values for each test were calculated against sputum MGIT culture as the reference standard.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 200 participants, 120 (60%) were male, 73 (37%) were HIV positive (median CD4 120 cells\/uL (IQR 43\u2013297)) and 128 (64%) had confirmed pulmonary TB by sputum MGIT culture. Seven (4%) OM-S stool Xpert samples reported errors while 47 (25%) and 103 (61%) were contaminated on OM-S stool MGIT and PBS stool MGIT, respectively. OM-S stool MGIT was able to accurately diagnose 56 of the contaminated PBS stool MGIT samples compared to only 5 of the contaminated OM-S stool MGIT samples diagnosed by PBS stool MGIT.<\/jats:p>\n<jats:p>Sensitivity (95% Confidence Interval, CI) 89% (83\u201394) for OM-S stool Xpert was higher compared to that of OM-S stool MGIT 60% (51\u201369) and PBS stool MGIT 42% (32\u201352). Specificity (95%CI) 91% (82\u201397) was also higher for OM-S stool Xpert compared to OM-S stool MGIT 64% (51\u201375) and PBS stool MGIT 26% (16\u201338).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Stool processed with OM-S showed potential to improve <jats:italic>Mtb<\/jats:italic> diagnostic yield and reduce rates of indeterminate results when tested on Xpert and MGIT culture. The method may thus be of value in <jats:italic>Mtb<\/jats:italic> detection among patients with difficulty to expectorate.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284041","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T17:44:40Z","timestamp":1682099080000},"page":"e0284041","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Diagnostic accuracy of Xpert MTB\/RIF Ultra and culture assays to detect Mycobacterium Tuberculosis using OMNIgene-sputum processed stool among adult TB presumptive patients in Uganda"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1793-5251","authenticated-orcid":true,"given":"Abdulwahab","family":"Sessolo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Musisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Kaswabuli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Zawedde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Byanyima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4742-2791","authenticated-orcid":true,"given":"Wilber","family":"Sabiiti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Walimbwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingvar","family":"Sanyu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-9879","authenticated-orcid":true,"given":"Rejani","family":"Lalitha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8629-9992","authenticated-orcid":true,"given":"Lucian","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Worodria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"pone.0284041.ref001","volume-title":"Global tuberculosis report 2020","author":"World Health Organization","year":"2020"},{"key":"pone.0284041.ref002","volume-title":"Global tuberculosis report 2019","author":"World Health Organization","year":"2019"},{"issue":"6","key":"pone.0284041.ref003","first-page":"455","article-title":"\u2018Suspected pulmonary tuberculosis in rural South Africa-Sputum induction as a simple diagnostic tool?","volume":"92","author":"T Hartung","year":"2002","journal-title":"South African Medical Journal"},{"issue":"1","key":"pone.0284041.ref004","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/S1473-3099(12)70245-1","article-title":"\u2018Assessment of the Xpert MTB\/RIF assay for diagnosis of tuberculosis with gastric lavage aspirates in children in sub-Saharan Africa: a prospective descriptive study","volume":"13","author":"O Bates M","year":"2013","journal-title":"The Lancet infectious diseases"},{"issue":"10","key":"pone.0284041.ref005","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1164\/rccm.200511-1809SO","article-title":"\u2018Childhood pulmonary tuberculosis: old wisdom and new challenges","volume":"173","author":"BJ Marais","year":"2006","journal-title":"American journal of respiratory and critical care medicine"},{"key":"pone.0284041.ref006","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1128\/JCM.02268-10","article-title":"\u2018Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB\/RIF system","volume":"49","author":"D Hillemann","year":"2011","journal-title":"J Clin Microbiol"},{"key":"pone.0284041.ref007","author":"A. 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