Diagnostic Accuracy of Stool Cartridge-based Nucleic Acid Amplification Test in Pediatric Pulmonary Tuberculosis: A Cross-sectional Study

often swallow sputum, leading to the presence of MTB in stool, 4,5 making it a potentially accessible, painless, and noninvasive sample for diagnostic testing.6 Previous studies have explored the utility of stool CBNAAT in children, showing varying sensitivities and specificities when compared to conventional methods.However, comprehensive data on its diagnostic accuracy in the Indian context, particularly IntroductIonPediatric pulmonary tuberculosis (PTB) continues to represent a significant global public health challenge, particularly in high-burden countries like India.According to the most recent World Health Organization (WHO) data for children younger than 15, 1.3 million cases of tuberculosis (TB) were diagnosed, and nearly a quarter million TB-related deaths were reported.1 Diagnosing PTB in children is notoriously difficult due to several factors, including the paucibacillary nature of the disease, nonspecific clinical symptoms, and the inherent challenges in obtaining adequate respiratory samples from young children.Sputum collection, the cornerstone of TB diagnosis in adults, is often unfeasible in children under 10 years of age, necessitating invasive procedures like gastric aspirate (GA).These procedures are uncomfortable, require specialized facilities, and may pose risks, limiting their widespread applicability, especially in resource-constrained settings.The introduction of the cartridge-based nucleic acid amplification test (CBNAAT) has revolutionized TB diagnosis by offering rapid detection of Mycobacterium tuberculosis (MTB) and simultaneous identification of rifampicin resistance. 2 While initially validated for respiratory specimens, its application in nonrespiratory samples, including stool, has emerged as a promising avenue for pediatric TB diagnosis.3 Children with PTB 1-5,