What the study found
The study found that trace-positive sputum results on Xpert MTB/RIF Ultra were not always linked to tuberculosis (TB) disease. In two high-burden clinical settings, about half of the participants with these trace results were recommended TB treatment, while a smaller group had microbiologically confirmed TB.
Why the authors say this matters
The authors conclude that this prevalence supports treating most people with trace sputum results when multimodal testing and repeated clinical evaluations are not feasible. They also suggest that people with low-risk characteristics and negative results on other widely available tests may be able to defer treatment with clinical follow-up.
What the researchers tested
The researchers enrolled adults and adolescents with trace-positive sputum results during initial TB evaluation in Uganda and South Africa. Participants were evaluated at enrollment, and those with uncertain TB status were followed off treatment for up to 3 months with repeat assessments by TB clinicians.
What worked and what didn't
TB was identified by sputum culture at enrollment in 20% of the 311 participants. Within 3 months, 48% were judged to warrant TB treatment, and among those followed to microbiologic outcomes, 30% had positive culture and 41% had positive culture or Ultra; two participants died. Having TB symptoms, advanced HIV, and no recent TB history were associated with microbiologically confirmed TB disease, and an abnormal chest X-ray or elevated C-reactive protein was also associated in some groups.
What to keep in mind
The study was done in two high-burden clinical settings, so the findings may not apply everywhere. The abstract also notes that some outcomes were based on clinical judgment and follow-up, and it does not describe detailed limitations beyond the available follow-up and testing approach.
Key points
- Trace-positive Ultra results did not always mean TB disease.
- TB culture at enrollment was positive in 20% of participants.
- Nearly half of participants were recommended TB treatment within 3 months.
- TB symptoms, advanced HIV, and no recent TB history were linked to confirmed TB.
- Some participants with low-risk features and negative other tests may defer treatment with follow-up.
Disclosure
- Research title:
- Most patients with trace Ultra results were advised to receive TB treatment
- Authors:
- Caitlin Visek, Ronit R. Dalmat, Annet Nalutaaya, Kamoga Caleb Erisa, Patrick Biché, Gordon Stein, Amanda Ganguloo, R. P. Draper, Mariam Nantale, Adrienne E. Shapiro, D. Wilson, Achilles Katamba, Paul K Drain, Emily A. Kendall
- Institutions:
- Edendale Hospital, Edendale Hospital, Edendale Hospital, Grey's Hospital, Grey's Hospital, Grey's Hospital, Johns Hopkins Medicine, Johns Hopkins Medicine, Johns Hopkins University, Johns Hopkins University, Johns Hopkins University, Makerere University, Novosibirsk Tuberculosis Research Institute, Novosibirsk Tuberculosis Research Institute, Novosibirsk Tuberculosis Research Institute, Novosibirsk Tuberculosis Research Institute, Umkhuseli Innovation and Research Management, Umkhuseli Innovation and Research Management, Umkhuseli Innovation and Research Management, University of Washington, University of Washington, University of Washington, University of Washington
- Publication date:
- 2026-03-20
- DOI:
- 10.1093/cid/ciag019
- OpenAlex record:
- View
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