Turner CT, Gupta RK, Tsaliki E, et al. - Given the value of blood transcriptional signatures for non-sputum triage or confirmatory tests of tuberculosis, researchers compared the diagnostic accuracy of candidate transcriptional signatures recognized by systematic review, in a setting with a high burden of tuberculosis and HIV. Within a diagnostic accuracy study of sputum Xpert MTB/RIF (Xpert) and Xpert MTB/RIF Ultra (Ultra) tests for pulmonary tuberculosis, this prospective observational study was nested. At a tuberculosis clinic in Cape Town, South Africa, self-presenting symptomatic adults (aged 18 years or older) provided blood for RNA sequencing, and sputum samples for liquid culture and molecular testing using Xpert and Ultra.  From Feb 12, 2016, to July 18, 2017, paired sputum and RNA sequencing data were gathered from 181 participants; of these, 54 (30%) had confirmed pulmonary tuberculosis. Systematic review yielded 27 eligible signatures; of these, four attained the highest diagnostic accuracy with similar area under the receiver operating characteristic curves (Sweeney3; Kaforou25; Roe3; and BATF2), independent of age, gender, HIV status, previous tuberculosis, or sputum smear result. The minimum WHO benchmarks for a tuberculosis triage test but not for a confirmatory test were met by these four blood transcriptional signatures.