{"doi":"10.1093/cid/ciaa1824","title":"The Spectrum of Tuberculosis Disease in an Urban Ugandan Community and Its Health Facilities","abstract":"BACKGROUND: New, sensitive diagnostic tests facilitate identification and investigation of milder forms of tuberculosis (TB) disease. We used community-based TB testing with the Xpert MTB/RIF Ultra assay (\"Ultra\") to characterize individuals with previously undiagnosed TB and compare them to those from the same community who were diagnosed with TB through routine care. METHODS: We offered community-based sputum Ultra testing to adult residents of a well-defined area (population 34 000 adults) in Kampala, Uganda, via door-to-door screening and venue-based testing, then used detailed interview and laboratory testing to characterize TB-positive individuals. We compared these individuals to residents diagnosed with pulmonary TB at local health facilities and a representative sample of residents without TB (controls). RESULTS: Of 12 032 residents with interpretable Ultra results, 113 (940 [95% confidence interval {CI}, 780-1130] per 100 000) tested positive, including 71 (63%) positive at the lowest (trace) level. A spectrum of TB disease was observed in terms of chronic cough (93% among health facility-diagnosed cases, 77% among residents with positive community-based Ultra results at levels above trace, 33% among trace-positive community participants, and 18% among TB-negative controls), TB symptom prevalence (99%, 87%, 60%, and 38%, respectively), and C-reactive protein (75th percentile: 101 mg/L, 28 mg/L, 6 mg/L, and 4 mg/L, respectively). Community-diagnosed cases were less likely than health facility-diagnosed cases to have human immunodeficiency virus coinfection or previous TB. The specificity of Ultra was 99.4% (95% CI, 99.2%-99.5%) relative to a single spot sputum culture. CONCLUSIONS: People with undiagnosed prevalent TB in the community have different characteristics than those diagnosed with pulmonary TB in health facilities. Newer diagnostic tests may identify a group of people with early or very mild disease.","journal":"Clinical Infectious Diseases","year":2020,"id":59920,"datarank":0.6307038929086449,"base_score":4.204692619390966,"endowment":4.204692619390966,"self_citation_contribution":0.6307038929086449,"citation_network_contribution":0.0,"self_endowment_contribution":0.6307038929086449,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":66,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9301,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":315462,"name":"Peter James Kitonsa","orcid":"0000-0003-2971-216X","position":1,"is_corresponding":false},{"id":315463,"name":"Annet Nalutaaya","orcid":"0000-0003-3903-303X","position":2,"is_corresponding":false},{"id":316275,"name":"Kamoga Caleb Erisa","orcid":null,"position":3,"is_corresponding":false},{"id":316276,"name":"James Mukiibi","orcid":null,"position":4,"is_corresponding":false},{"id":316277,"name":"Olga Nakasolya","orcid":null,"position":5,"is_corresponding":false},{"id":316278,"name":"David Isooba","orcid":null,"position":6,"is_corresponding":false},{"id":315464,"name":"Yeonsoo Baik","orcid":"0000-0001-7016-0438","position":7,"is_corresponding":false},{"id":315465,"name":"Katherine Robsky","orcid":"0000-0001-7789-5779","position":8,"is_corresponding":false},{"id":231919,"name":"Midori Kato‐Maeda","orcid":"0000-0003-0539-2472","position":9,"is_corresponding":false},{"id":315466,"name":"Adithya Cattamanchi","orcid":"0000-0002-6553-2601","position":10,"is_corresponding":false},{"id":315467,"name":"Achilles Katamba","orcid":"0000-0002-2347-4183","position":11,"is_corresponding":false},{"id":315468,"name":"David W. Dowdy","orcid":"0000-0003-0481-7475","position":12,"is_corresponding":false},{"id":315461,"name":"Emily A. Kendall","orcid":"0000-0002-0083-422X","position":0,"is_corresponding":true}],"reference_count":14,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T21:08:26.834549Z","pmid":"33283227","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}