ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Oral Washes and Tongue Swabs for Xpert MTB/RIF Ultra-Based Tuberculosis Diagnosis in People With and Without the Ability to Make Sputum.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Diagnostic Accuracy of Molecular Testing on Saliva and Oral Swabs for Pulmonary Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- An optimal processing method for recovery of tuberculosis in the tongue swab using theMicrobiology spectrum · 2026Article
- Xpert Ultra on nasopharyngeal swabs detects one-third of pulmonary tuberculosis: a nested case-control study in South African primary care.Research square · 2026Article
- Tongue swab-based Targeted Universal Tuberculosis Testing in people living with HIV in KwaZulu-Natal, South Africa.medRxiv : the preprint server for health sciences · 2026Article
- Diagnostic accuracy of Pluslife MiniDock MTB on tongue swabs in sputum scarce people with presumptive TB: a retrospective analysis.Research square · 2026Article
- Development of a Rapid Automated Point-of-Care Test formedRxiv : the preprint server for health sciences · 2026Article
- Tongue swabmedRxiv : the preprint server for health sciences · 2026Article
- Acceptability of tongue swabs for tuberculosis screening in migrant settings in northern Italy: A qualitative study.PLOS global public health · 2026Article
- Testing tongue swab samples by Cepheid Xpert MTB/RIF Ultra: comparison of two protocols applied to samples from persons with low-bacillary load TB.Microbiology spectrum · 2025Article
- Global status of policies and practices for systematic TB screening in high-burden countries.IJTLD open · 2025Article
- Oral Rinse versus Facemask Capture for Nonsputum Diagnosis of Pulmonary Tuberculosis.American journal of respiratory and critical care medicine · 2025Article
- Do no harm - re-evaluating the risks of overtreatment in community-wide tuberculosis screening.medRxiv : the preprint server for health sciences · 2025Article
- The potential impact, cost and cost-effectiveness of tuberculosis interventions - a modelling exercise.medRxiv : the preprint server for health sciences · 2025Article
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Authors and funding
16 authors.
Funding
Abstract
backgroundOral samples show promise for tuberculosis (TB) diagnosis, but data from different sample types and sputum-scarce individuals remain limited.
methodsWe evaluated Xpert MTB/RIF Ultra (Ultra) in symptomatic clinic attendees (cohort A, n = 891) and people initiating antiretroviral therapy without symptom screening (cohort B, n = 258). In cohort A, we collected oral washes (OWs) and, separately, tongue swabs (flocked or foam with heat). In cohort B, we collected OWs, 3 flocked tongue swabs (1 heated, 2 pooled), and, separately, buccal swabs and periodontal brushes. Sputum induction was offered, and different culture methods were applied to a subset of cohort B tongue swabs.
resultsIn cohort A, Ultra sensitivity was 80% (95% confidence interval [CI], 56%-94%) for OWs, 59% (95% CI, 53%-65%) for flocked swabs, and 65% (95% CI, 58%-72%) for foam swabs, with high specificity. Foam swabs detected more people with Ultra sputum semi-quantitation categories of low or less than flocked swabs (53% [95% CI, 41%-64%] vs 37% [95% CI, 29%-46%]). In cohort B, OWs and single heated swabs had sensitivities of 71% (95% CI, 42%-92%) and 64% (95% CI, 35%-87%), respectively. Pooled tongue swabs, buccal swabs, and brushes had lower sensitivity. MGIT960 showed the highest sensitivity (64% [95% CI, 35%-87%]) among culture methods. Oral sampling identified TB in sputum-scarce people: 25% (7/28) positive by flocked or foam swabs (cohort A); 18% (10/56) were OW and 23% (13/56) single swab positive (cohort B). In cohort B, this could double Ultra positivity if induction were unavailable.
conclusionsUltra on OWs or foam swabs offers higher sensitivity than other oral methods and effectively detects TB in sputum-scarce individuals.
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