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. 2022 Oct 10;12:16972. doi: 10.1038/s41598-022-21244-x

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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The performance of the metagenomic assay in discriminating (A) sputum positive versus sputum negative samples, (B) tuberculosis versus endemic cohorts, and (C) tuberculosis versus non-endemic cohorts (AUC = area under the curve). (D) Evaluating the effects of incorporating non-endemic samples (blue) and endemic samples (red) on the diagnostic performance via simulation show that the inclusion of non-endemic samples skews the assay’s sensitivity.