Related Experiment Video

Updated: Jan 7, 2026

Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test

Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test

Published on: April 9, 2012

Improving Tuberculosis Diagnosis Through Artificial Intelligence (CAD4TB) and Stool Xpert MTB/RIF Testing: A

Giacomo Guido¹, Berhanu Gulo², Sergio Cotugno¹

¹Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro," Bari, Italy.

Open Forum Infectious Diseases

|December 29, 2025

Abstract

Background:

Tuberculosis remains the leading cause of death by a single infectious agent globally, with Ethiopia among the highest tuberculosis- and human immunodeficiency virus/tuberculosis-burden countries. Diagnostic gaps-particularly among household contacts (HHCs) unable to expectorate-hinder early case detection. Computer-aided detection software for chest radiography and nonrespiratory molecular assays, such as stool-based Xpert MTB/RIF testing, represent promising strategies for scalable screening.

Methods:

We conducted a prospective diagnostic accuracy study at St Luke Catholic Hospital, Oromia, Ethiopia, enrolling 478 participants (152 tuberculosis index patients and 326 HHCs). All HHCs ≥4 years underwent digital chest radiographic screening, with or without CAD4TB (Delft Imaging) software assistance, and provided stool and sputum samples for Xpert MTB/RIF testing. The accuracy of CAD4TB and stool Xpert testing was evaluated against sputum Xpert testing as the reference.

Results:

CAD4TB showed strong diagnostic performance, with a sensitivity of 0.77 (95% confidence interval, .70-.83) and specificity of 0.93 (.90-.96). Performance was higher among adults (sensitivity and specificity, 0.79 and 0.94) than in children (0.64 and 0.92). Stool and sputum Xpert testing demonstrated high concordance (Cohen's κ = 0.76), with a sensitivity of 0.77 (95% confidence interval, .70-.84) and specificity of 0.97 (.93-.99). During the study, 10.6% of HHCs (34 of 321) were newly diagnosed microbiologically with tuberculosis.

Conclusions:

The combined use of CAD4TB and stool Xpert testing significantly improves tuberculosis detection, particularly among HHCs in high-burden, low-resource settings. This strategy is especially valuable in children and adults unable to produce sputum and where radiological expertise is limited.

Keywords:

CAD4TB Xpert MTB/RIF artificial intelligence household contacts tuberculosis

More Related Videos

Synthesis, Characterization, and Application of Superparamagnetic Iron Oxide Nanoprobes for Extrapulmonary Tuberculosis Detection

Synthesis, Characterization, and Application of Superparamagnetic Iron Oxide Nanoprobes for Extrapulmonary Tuberculosis Detection

Published on: February 16, 2020

Amplicon Sequencing using the Long-Read Sequencing Technologies

Amplicon Sequencing using the Long-Read Sequencing Technologies

Published on: August 29, 2025

Related Concept Videos

Pulmonary Tuberculosis IV

Pulmonary Tuberculosis IV

Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...

Pulmonary Tuberculosis V

Pulmonary Tuberculosis V

Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...

Pulmonary Tuberculosis I

Pulmonary Tuberculosis I

Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...

Serum Laboratory Studies, Stool Test, Breath Test

Serum Laboratory Studies, Stool Test, Breath Test

Gastrointestinal (GI) diagnostic studies are pivotal in confirming, ruling out, diagnosing, or staging various diseases, including cancers. Following diagnosis, allocating time for discussions with the patient and providing informational resources is crucial. Diagnostic assessments of the GI tract often occur in outpatient settings like endoscopy suites or GI labs. Preparation for these tests may include dietary restrictions, fasting, liquid bowel preparations, laxatives, enemas, and the...

Pulmonary Tuberculosis II

Pulmonary Tuberculosis II

Tuberculosis, or TB, is a bacterial infectious disease caused by Mycobacterium tuberculosis. While its primary impact is on the lungs, leading to pulmonary tuberculosis, it can also affect various other organs, a condition referred to as extrapulmonary tuberculosis.
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...

Pulmonary Tuberculosis III

Pulmonary Tuberculosis III

Tuberculosis (TB) is a contagious infection primarily affecting the lung parenchyma but which can also affect other body parts. TB can be classified based on disease development, presentation, and the affected anatomical site.
The first classification is based on the development of the disease, and it includes the following categories:

Articles linked to this work by shared authors, journal, and citation graph.

Real-World Data on the Effectiveness and Use of Intravenous Fosfomycin for the Treatment of Difficult-to-Treat Infections Caused by Carbapenem-Resistant Gram-Negative Bacteria-A Subgroup Analysis from the FORTRESS Study.

Infectious diseases and therapy·2026

Effect of sulfadoxine-pyrimethamine resistance on birthweight and parasite persistence among women receiving intermittent preventive treatment for malaria in pregnancy in Northern Uganda: a directed acyclic graph-guided analysis.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases·2026

Is early combination therapy associated with lower risk of respiratory failure in severely immunocompromised hosts with COVID-19? a target trial emulation study from the omicron-dominant era.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology·2026

Real-world outcomes of cefepime/enmetazobactam for Enterobacterales infections: a retrospective descriptive study.

Microbiology spectrum·2026

Knowledge, attitudes, and perceived barriers to tuberculosis care among patients and household contacts in Wolisso District, Oromia Region, Ethiopia.

Journal of clinical tuberculosis and other mycobacterial diseases·2026

UltRaSoUnd-guided evaLuAtion of metabolic health in a cohort of midlife women with HIV: The URSULA study.

HIV medicine·2026

See all related articles