ArticleOpen forum infectious diseases2025
Evaluation of the Performance of Stool Samples to Diagnose Pediatric Pulmonary Tuberculosis in Routine Care: A Cohort Study From Pakistan.
Article in Open forum infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Centrifugation Versus Centrifugation-Free Stool Processing: Can the Simple One-Step Method Reliably Diagnose Pediatric Pulmonary Tuberculosis Using Xpert MTB/RIF Ultra?Diagnostics (Basel, Switzerland) · 2026Article
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Authors and funding
10 authors.
Funding
Abstract
Background: The World Health Organization (WHO) recommends stool as an alternative respiratory sample (RS) for diagnosing pulmonary tuberculosis (PTB) in children <10 years. This study assessed stool-Xpert-Ultra diagnostic performance against microbiologically confirmed (MC-PTB) cases identified based on the composite reference standard (CRS) in children <15 years, stratified by age and nutritional status. Methods: Children <15 years with presumptive PTB were assessed at 2 tertiary-care hospitals in Pakistan. Stools and RS were tested using Xpert MTB/RIF-Ultra (Xpert-Ultra) and culture. Using the CRS, PTB cases were MC-PTB or clinically confirmed. Nutritional status was classified using WHO criteria. Stool-Xpert-Ultra diagnostic performance was assessed against MC-PTB or positive RS-Xpert-Ultra. Logistic regression identified predictors of microbiological yields. Results: Among 650 children, we obtained 587 RS, 258 stool and 195 both stool and RS. Of 650, 264 (41%) had MC and 136 (21%) had clinically confirmed PTB. Stool-Xpert-Ultra had sensitivity, specificity, and accuracy of 47%, 88%, 77%, and 72%, 73%, 72% against MC-PTB in children <10 and ≥10, respectively. Stool-Xpert-Ultra performed similarly against RS-Xpert-Ultra in each age group. Stool-Xpert-Ultra detected 11% additional MC-PTB cases when RS was negative or unavailable. Stool-Xpert-Ultra had high sensitivity (64%) in severely acute malnourished (SAM) children. Age ≥10, female, SAM and TB-consistent chest X-rays were strongly associated with stool and RS microbiological positivity. Conclusions: Stool-Xpert-Ultra demonstrated moderate sensitivity against MC-PTB in <10. It identified additional MC-PTB cases when RS was unavailable or/negative, making it a valuable noninvasive alternative, especially in children ≥10 and with SAM, where it missed fewer cases.
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