{"doi":"10.1093/infdis/jiaf110","title":"Improved Detection of Extrapulmonary and Paucibacillary Pulmonary Tuberculosis by Xpert MTB Host Response in a Tuberculosis Low-Endemic, High-Resource Setting","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>The Xpert MTB Host Response (MTB-HR) assay has reached World Health Organization (WHO) test targets for pulmonary tuberculosis (PTB) with high bacillary loads. We investigated the contribution of MTB-HR as a nonsputum, near point-of-care diagnostic method in other prioritized groups, such as extrapulmonary tuberculosis (EPTB) and paucibacillary PTB.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>Individuals with presumed tuberculosis disease were prospectively included in Stockholm, Sweden (n = 307), and underwent MTB-HR venous and capillary testing in parallel. Clinical characterization was based on symptoms, microbiological results (microscopy, polymerase chain reaction [PCR], and culture), radiological assessment, and a panel of biochemical tests. Receiver operating characteristic analysis was performed to calculate cut-offs for maximized sensitivity and specificity, including WHO targets for screening and diagnostic tests.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>MTB-HR performed equally well in microbiologically confirmed PTB (area under the curve [AUC], 0.84 [95% confidence interval {CI}, .78–.90]; n = 69) and EPTB (AUC, 0.82 [95% CI, .75–.90]; n = 34). Based on Youden index cut-offs, the negative predictive value (NPV) was high both in PCR-negative PTB (−1.27, NPV 94%) and in EPTB (−1.58, NPV 95%) and fulfilled the minimum target product profile sensitivity requirement for confirmed EPTB. In individuals without tuberculosis (n = 204), the majority had pulmonary infections. There was a close to perfect correlation between venous and capillary samples (r = 0.97, P &amp;lt; .001).</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>Capillary Xpert MTB-HR improves detection of sputum PCR-negative, culture-verified PTB and is promising as a rule-out test in EPTB. MTB-HR score and bacterial burden were highly correlated. We suggest a graded MTB-HR score as more clinically relevant than a binary result.</jats:p>\n               </jats:sec>","journal":"The Journal of Infectious Diseases","year":2025,"id":613504,"datarank":0.32958368660043297,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.0,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1580590,"name":"Gabrielle Fröberg","orcid":null,"position":1,"is_corresponding":false},{"id":718078,"name":"Christopher Sundling","orcid":"0000-0002-6138-690X","position":2,"is_corresponding":false},{"id":1144394,"name":"Thomas Schön","orcid":"0000-0003-4849-1286","position":3,"is_corresponding":false},{"id":353492,"name":"Erik Södersten","orcid":"0000-0002-2998-4889","position":4,"is_corresponding":false},{"id":1564634,"name":"Judith Bruchfeld","orcid":null,"position":5,"is_corresponding":false},{"id":104838,"name":"Elin Folkesson","orcid":"0000-0002-6585-6235","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Improved Detection of Extrapulmonary and Paucibacillary Pulmonary Tuberculosis by Xpert MTB Host Response in a Tuberculosis Low-Endemic, High-Resource Setting","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>The Xpert MTB Host Response (MTB-HR) assay has reached World Health Organization (WHO) test targets for pulmonary tuberculosis (PTB) with high bacillary loads. We investigated the contribution of MTB-HR as a nonsputum, near point-of-care diagnostic method in other prioritized groups, such as extrapulmonary tuberculosis (EPTB) and paucibacillary PTB.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>Individuals with presumed tuberculosis disease were prospectively included in Stockholm, Sweden (n = 307), and underwent MTB-HR venous and capillary testing in parallel. Clinical characterization was based on symptoms, microbiological results (microscopy, polymerase chain reaction [PCR], and culture), radiological assessment, and a panel of biochemical tests. Receiver operating characteristic analysis was performed to calculate cut-offs for maximized sensitivity and specificity, including WHO targets for screening and diagnostic tests.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>MTB-HR performed equally well in microbiologically confirmed PTB (area under the curve [AUC], 0.84 [95% confidence interval {CI}, .78–.90]; n = 69) and EPTB (AUC, 0.82 [95% CI, .75–.90]; n = 34). Based on Youden index cut-offs, the negative predictive value (NPV) was high both in PCR-negative PTB (−1.27, NPV 94%) and in EPTB (−1.58, NPV 95%) and fulfilled the minimum target product profile sensitivity requirement for confirmed EPTB. In individuals without tuberculosis (n = 204), the majority had pulmonary infections. There was a close to perfect correlation between venous and capillary samples (r = 0.97, P &amp;lt; .001).</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>Capillary Xpert MTB-HR improves detection of sputum PCR-negative, culture-verified PTB and is promising as a rule-out test in EPTB. MTB-HR score and bacterial burden were highly correlated. We suggest a graded MTB-HR score as more clinically relevant than a binary result.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40044585","pmcid":"PMC12308647","openalex_id":null,"authors":[],"funders":[{"funder_name":"Swedish Heart and Lung Foundation","grant_id":"20230511","title":null},{"funder_name":"Swedish Heart-Lung Foundation","grant_id":"unidentified","title":"unidentified"}],"total_grants":2,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"hybrid","license":"CC BY","oa_locations":[{"url":"https://academic.oup.com/jid/advance-article-pdf/doi/10.1093/infdis/jiaf110/62280141/jiaf110.pdf","host_type":"publisher"},{"url":"https://academic.oup.com/jid/article-pdf/232/1/e78/62280141/jiaf110.pdf","host_type":"publisher"},{"url":"https://europepmc.org/articles/PMC12308647","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12308647?pdf=render","host_type":"Europe_PMC"},{"url":"https://doi.org/10.1093/infdis/jiaf110","host_type":""},{"url":"https://pubmed.ncbi.nlm.nih.gov/40044585","host_type":""},{"url":"http://dx.doi.org/10.1093/infdis/jiaf110","host_type":""},{"url":"http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-213284","host_type":""}],"fields_of_study":["0303 health sciences","03 medical and health sciences"],"mesh_terms":["Humans","Mycobacterium tuberculosis","Tuberculosis, Pulmonary","Molecular Diagnostic Techniques","Sensitivity and Specificity","Prospective Studies","ROC Curve","Adolescent","Adult","Aged","Middle Aged","Sweden","Female","Male","Young Adult"],"keywords":["Tuberculosis","Diagnostic methods","Extrapulmonary Tuberculosis","Blood Based","Host-related Marker","Male","Adult","Sweden","Adolescent","tuberculosis; extrapulmonary tuberculosis; blood based; diagnostic methods; host-related marker","Mycobacterium tuberculosis","Middle Aged","Sensitivity and Specificity","Dermatology and Venereal Diseases","Young Adult","ROC Curve","Molecular Diagnostic Techniques","Major Article","Humans","Dermatologi och venereologi","Female","Prospective Studies","Tuberculosis, Pulmonary","Aged"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-02T08:19:54.796323Z","pmid":null,"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":[]}