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Aeonose breath analysis on TB screening South Africa

This year, the Union World Conference on Lung Health was held in Hyderabad, India. At the TBScience pre-conference, an official event entirely devoted to basic and translational tuberculosis (TB) research, study results were presented on the Aeonose exhaled-breath tests in Cape Town.


It shows the Aeonose may be useful as a triage test for tuberculosis in HIV-infected and uninfected persons as it meets the FIND/WHO minimum Target Product Profile (TPP) for a rule-out TB test.



An exhaled-breath screening test for the detection of active pulmonary tuberculosis in patients presenting to primary health care clinics in Cape Town, South Africa.

Aliasgar Esmail, Keertan Dheda, Muhammed Dhansay


Introduction: GeneXpert Ultra is unsuitable for community-based mass screening and in up to one-third of patients an adequate sputum sample is unavailable. By contrast, the analysis of exhaled breath obtained by the Aeonose-TB device has the potential to provide an easy, onsite, rapid, and non-invasive diagnosis of tuberculosis. Thus, it may serve as a useful community-based triage tool (a major unmet need in the TB field).


Methods: We enrolled 1,143 participants (31% HIV- infected) with suspected TB (243 microbiologically-con- firmed TB, 130 probable TB, and 770 non-TB) from primary care clinics in Cape Town, South Africa. Sputum GeneXpert MTB/RIF and/ or culture served as the reference standard. Volatile organic compounds in exhaled-breath were detected using an electronic nose containing 3 metal-oxide sensors (AeonoseTM, Zutphen, The Netherlands). Data were analysed by machine learning using artificial neural networks (ANN) in a ‘leave-10%-out’ cross-validation training set (n=756; 189 TB and 567 non-TB) and the findings ratified in a test set (n=257).


Results: In the training set the sensitivity, specificity, PPV, NPV of Aeonose-TB (95% CI) was 81% (74-86) and 60% (55-64), 40% (35-45), and 90% (87-93), respectively. However, in HIV uninfected patients, using a ANN- derived rule-in threshold, performance characteristics were 59% (50-69), 91% (87-93), 68% (58-77), and 87% (83-90), respectively. In the same group, using an ANN- derived rule-out threshold, the performance characteristics were 90% (83-95), 59% (54-65), 43% (36-49) and 95% (91-97), respectively. Results in the validation set, and in HIV-infected persons, showed comparable performance characteristics.


Conclusion: Aeonose-TB may be useful as a triage test for tuberculosis in HIV-infected and uninfected persons as it meets the FIND/WHO minimum Target Product Profile (TPP) for a rule-out TB test. However, it may also have utility to rule in TB in sputum scarce or smear-negative persons. Further studies are now required to clarify these findings.

Aeonose breath analysis on TB screening Peru

The Union World Conference on Lung Health 2019 was held in Hyderabad (India) from October 30 – November 2. Dr. Ruvandhi Nathavitharana (Harvard University) presented results on the Aeonose exhaled-breath TB-study in Lima, suggesting Aeonose may meet WHO triage test criteria to rule out TB (90% sensitivity, 70% specificity) in lower-risk patients admitted with cough or TB risk factors.

Presentations on European Respiratory Society (ERS)


At the International Congress of the European Respiratory Society (ERS), held in Paris from 15-19 September 2018, the following results on clinical Aeonose studies were presented:

  • Sharina Kort (Enschede, Netherlands), Mayke Tiggeloven, Marjolein Brusse-Keizer, Hugo Schouwink, Frans De Jongh, Emanuel Citgez, Jan Willem Gerritsen, Job Van Der Palen, Detecting subtypes of non-small cell lung cancer by electronic nose. (PA1761)
  • Sharina Kort (Enschede, Netherlands), Marjolein Brusse-Keizer, Hugo Schouwink, Frans De Jongh, Emanuel Citgez, Jan Willem Gerritsen, Job Van Der Palen, Detection of small cell lung cancer by electronic nose. (PA1762)
  • Ekaterina Krauss (Giessen, Germany), Jana Zoelitz, Jasmin Wagner, Guillermo Barretto, Maria Degen, Werner Seeger, Andreas Guenther, The use of electronic nose technology for the detection of Lung Cancer (LC): analysis of exhaled volatile compounds by Aeonose® (PA1758)
  • Michiel Bannier (Maastricht, Netherlands), Kim Van De Kant, Quirijn Jobsis, Edward Dompeling, Feasibility and diagnostic accuracy of an electronic nose in children with asthma and cystic fibrosis (OA338)
  • Luisa Quesada (Brookline, United States of America), Sergio Poli De Frías, Gessica Di Toro, Emines Salas, Ana Gutierrez, Jessica Bello, Isabel Tovar, Maria España, Heriberto Perez, Julian Villalba, Marlene Villalon, Jacobus De Waard, Late Breaking Abstract – An Electronic Nose as a screening tool for childhood Tuberculosis (PA4757)

We’re Losing the Fight’: Tuberculosis Batters a Venezuela in Crisis

Article Aeonose project Venezuela

Tuberculosis (TB) is the world’s deadliest infectious disease, and a top ten cause of death worldwide. Each year, almost 2 million people die from TB. Venezuela is one of the high burden countries with devastating consequences. In Caracas, a medical team (PI: Dr. Jacobus de Waard, mentioned in the NYT-article) is conducting a study for fast TB-screening using an electronic nose (‘Aeonose’) for exhaled-breath analysis. Improved treatment regimes and diagnostics are urgently needed!

Paper on ParaNose study published


Coronel R, Rodríguez M, Jiménez N, Bruins M, Gómez R, Yntema JB, Chaparro G, Gerritsen JW, Wiegerink W, Pérez D, Magis-Escurra C.  The potential of a portable, point-of-care electronic nose to diagnose tuberculosis. Journal of Infection, August 2017.

TB presentation at ALAT Conference, Santiago

Coronel R, IJdema D, Fretes J, Gómez C, Arce D, Gerritsen JW, Aguirre S, Gonzalez F, Chaparro G, Jiménez N, Pérez D, Magis-Escurra C.  prevalencia de la tuberculosis en una población indígena del paraguay con la nariz electrónica (indipanose), ALAT Conference, Santiago (Chili), July 2016.

Certificate for highly cited research


The editors of Tuberculosis are delighted to inform you that your paper, Diagnosis of active tuberculosis by e-nose analysis of exhaled air, published in 2013, is one of the most highly cited papers during 2014 and 2015.  We would like to take this opportunity to thank you for publishing with us, and congratulate you.

46th World Conference on Lung Health

At the 46th World Conference on Lung Health, Cape Town, South Africa (December 2-6, 2015), results from two Aeonose studies on TB were presented:


EP-138-04: Diagnosis of pulmonary and extra-pulmonary tuberculosis in Paraguay using the electronic nose (Paranose study) by R. Coronel et al,

86 participants were evaluated in 2015, 41 patients suffered from pulmonary TB and 45 were healthy controls. Preliminary analyses show sensitivity of 93% and specificity of 89 %.
A paper is in preparation.


EP-212-0: A new tuberculosis-screening tool: a hand-held electronic nose. A cross-sectional field study in Indonesia by A.M. Saktiawati et al.

87 participants from 5 groups (20 TB patients, 20 TB suspects who were later diagnosed as non TB, 20 non-TB patients, 20 healthy matched controls, and 7 MDR-TB patients) have been investigated showing a sensitivity of 92% and a specificity of 88%. More participants are being included.




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