ArticlePloS one2017
Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 4 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Studying intrapulmonary pharmacokinetics for tuberculosis treatment: a systematic review of methodology.The Journal of antimicrobial chemotherapy · 2025Pooled it
- Efficacy of Xpert in tuberculosis diagnosis based on various specimens: a systematic review and meta-analysis.Frontiers in cellular and infection microbiology · 2023Pooled it
- Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults.The Cochrane database of systematic reviews · 2019Pooled it
- Treatment outcomes, diagnostic and therapeutic impact: Xpert vs. smear. A systematic review and meta-analysis.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019Pooled it
- Comparison of two diagnostic intervention packages for community-based active case finding for tuberculosis: an open-label randomized controlled trial.Nature medicine · 2023Trial
- Impact of sputum quality on Xpert MTB/RIF Ultra test results for tuberculosis: A multi-country study.medRxiv : the preprint server for health sciences · 2026Article
- Diagnostic accuracy of sputum smear microscopy compared with culture in patients with tuberculosis confirmed by XpertThe Journal of international medical research · 2025Article
- The Role of Salivary Diagnostic Techniques in Screening for Active Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis.Microorganisms · 2025Review
- Barriers to GeneXpert utilization for tuberculosis detection at a regional referral hospital in Malawi: a qualitative study.The Pan African medical journal · 2025Article
- Enhanced diagnosis of pulmonary tuberculosis through nucleotide MALDI-TOF MS analysis of BALF: a retrospective clinical study.Scientific reports · 2024Article
- Multi-centric evaluation of Truenat MTB and MTB-RIF Dx assays for diagnosis of extrapulmonary tuberculosis.Scientific reports · 2024Article
- The impact of sputum quality on Xpert positivity in active case-finding for TB.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2024Article
- Nutritional status in patients with active pulmonary tuberculosis and new nutritional risk screening model for active tuberculosis: a national, multicenter, cross-sectional study in China.Journal of thoracic disease · 2023Article
- A spatial analysis of TB cases and abnormal X-rays detected through active case-finding in Karachi, Pakistan.Scientific reports · 2023Article
- Diagnosis of Chest Wall Tuberculosis Using Fine Needle Aspiration: A Single-Center Experience.Infection and drug resistance · 2023Article
- Feasibility and Sensitivity of Saliva GeneXpert MTB/RIF Ultra for Tuberculosis Diagnosis in Adults in Uganda.Microbiology spectrum · 2022Observational
- Diagnostic Yield of Xpert MTB/RIF Assay Using Bronchoalveolar Lavage Fluid in DetectingDiagnostics (Basel, Switzerland) · 2022Article
- Effect of sputum quality and role of XpertAfrican journal of laboratory medicine · 2022Article
- Assessing the utility of the Xpert Mycobacterium tuberculosis/rifampin assay for analysis of bronchoalveolar lavage fluid in patients with suspected pulmonary tuberculosis.Journal of clinical laboratory analysis · 2022Article
- The Value of GeneXpert MTB/RIF for Detection in Tuberculosis: A Bibliometrics-Based Analysis and Review.Journal of analytical methods in chemistry · 2022Review
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundIntroduction of GeneXpert MTB/RIF (Xpert) assay has constituted a major breakthrough for tuberculosis (TB) diagnostics. Several patient factors may influence diagnostic performance of Xpert including sputum quality.
objectiveWe carried out a prospective, observational, cross-sectional study to determine the effect of sputum quality on diagnostic performance of Xpert among presumed TB patients in Uganda.
methodsWe collected clinical and demographic information and two sputum samples from participants. Staff recorded sputum quality and performed LED fluorescence microscopy and mycobacterial culture on each sample. If both smear examinations were negative, Xpert testing was performed. We calculated diagnostic yield, sensitivity, specificity, and other indicators for Xpert for each stratum of sputum quality in reference to a standard of mycobacterial culture.
resultsPatients with salivary sputum showed a trend towards a substantially higher proportion of samples that were Xpert-positive (54/286, 19%, 95% CI 15-24) compared with those with all other sputum sample types (221/1496, 15%, 95% CI 13-17). Blood-stained sputum produced the lowest sensitivity (28%; 95% CI 12-49) and salivary sputum the highest (66%; 95% CI 53-77). Specificity didn't vary meaningfully by sample types. Salivary sputum was significantly more sensitive than mucoid sputum (+13%, 95% CI +1 to +26), while blood-stained sputum was significantly less sensitive (-24%, 95% CI -42 to -5).
conclusionsOur findings demonstrate the need to exercise caution in collecting sputum for Xpert and in interpreting results because sputum quality may impact test yield and sensitivity. In particular, it may be wise to pursue additional testing should blood-stained sputum test negative while salivary sputum should be readily accepted for Xpert testing given its higher sensitivity and potentially higher yield than other sample types. These findings challenge conventional recommendations against collecting salivary sputum for TB diagnosis and could inform new standards for sputum quality.
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