Peer-reviewed article
Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition
Juaneta Luiz, Lesley Jean Workman, Cynthia B. Whitman, Yekiwe Hlombe, Margaretha L.M. Prins et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study looked at how well a rapid test (Xpert MTB/RIF Ultra) finds pulmonary tuberculosis in induced sputum from children. It enrolled 636 children under 15 at Dora Nginza Hospital in South Africa between 2018 and 2024. Many of the children were infants, underweight, or living with HIV. Compared with culture, the test was accurate overall and in these high-risk groups. It also found more confirmed cases than culture alone. About 5% of children treated for TB died, and the risk was highest in stunted children, children with HIV and infants.
Key points
- Of 636 children, 173 (27.2%) had confirmed TB, 384 (60.4%) unconfirmed TB and 79 (12.4%) unlikely TB.
- 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.
- Of 145 children confirmed on induced sputum, 57 (39.3%) were Ultra positive but culture negative, adding 10.2% to the overall yield.
- Ultra performed better in children over 5 years and in those with weight-for-height Z-scores below -3.
- Mortality among children treated for TB was 4.9% (27/557), with the highest adjusted risk ratio in stunted children (7.3), then children with HIV (3.5) and infants (3.3).
Limitations
The document is an abstract from a single hospital, so the results may not apply to other settings. Culture is an imperfect reference standard, and most children had unconfirmed rather than confirmed TB.
Abstract
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 11.8-61.6) 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 "trace positive"), and 88/557 (15.8%), on culture. Of those confirmed, 57/145 (39.3%) were Ultra positive, culture negative - contributing 10.2% to the overall yield. Ultra performed better in children over 5 years and with weight-for-height Z-scores < -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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Testing induced sputum with Xpert MTB/RIF Ultra, alongside liquid culture.
- Population
- 636 children under 15 years investigated for pulmonary TB at Dora Nginza Hospital, South Africa, including infants, underweight children and children living with HIV.
Key finding
Ultra sensitivity was 90.9% (95%CI 82.9-96.0) and specificity 89.6% (95%CI 86.7-92.0).
Luiz et al. · OpenAlex · 1 Oct 2026