Open forum infectious diseases · 2025
Performance of Tongue Swabs for Tuberculosis Diagnosis in Hospitalized Children Under 5 Years of Age.
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Lala Sanjay G, Ealand Christopher, Dangor Ziyaad, Hlongwane Khuthadzo, Milovanovic Minja, Car Kathleen, van der Nest Alison, Cleak Tannah, Jacobs Olivia, Sewcharran Astika, Keenan Serene, Reubenson Gary, Abraham Pattamukkil, Mudau Mulisa, Golub Jonathan E, Martinson Neil, Kana Bavesh
Аннотация
BACKGROUND: Tuberculosis (TB) diagnosis remains difficult in children under 5 years of age (under-5s), who have high TB morbidity and mortality rates. In a high-burden TB setting, we investigated the diagnostic characteristics of Xpert MTB/RIF Ultra testing of tongue swabs (TS-XU) collected from under-5s.
METHODS: In a masked, prospective, observational study, tongue swabs were collected from enrolled hospitalized under-5s deemed high risk for TB disease who were categorized into 1 of the following: confirmed, unconfirmed, or unlikely TB.
RESULTS: Of 201 enrolled under-5s, 11 (5.5%) had confirmed TB, 53 (26.4%) unconfirmed TB, and 137 (68.2%) unlikely TB. TS-XU testing reported "Mtb detected" in 116 (57.7%) of 201 under-5s: positive results were "trace" (90/116, 77.6%), "very low" (21/116, 18.1%), and "low" or "medium" (4/116 [3.4%] and 1/116 [0.8%], respectively). There were no "high" TS-XU results. When trace results were presumed negative, TS-XU sensitivity was 17.2% (95% CI, 7.9%-26.4%) and specificity 89.1% (95% CI, 83.8%-94.3%), and TS-XU detected Mtb in 15 (10.9%) of 137 children with unlikely TB. Our data showed that TS-XU, in addition to routine TB testing, increased TB detection rates by 19.2%.
CONCLUSIONS: Despite the difficulty of interpreting trace-positive results, TS-XU testing increased TB detection rates in hospitalized under-5s with presumptive TB.
METHODS: In a masked, prospective, observational study, tongue swabs were collected from enrolled hospitalized under-5s deemed high risk for TB disease who were categorized into 1 of the following: confirmed, unconfirmed, or unlikely TB.
RESULTS: Of 201 enrolled under-5s, 11 (5.5%) had confirmed TB, 53 (26.4%) unconfirmed TB, and 137 (68.2%) unlikely TB. TS-XU testing reported "Mtb detected" in 116 (57.7%) of 201 under-5s: positive results were "trace" (90/116, 77.6%), "very low" (21/116, 18.1%), and "low" or "medium" (4/116 [3.4%] and 1/116 [0.8%], respectively). There were no "high" TS-XU results. When trace results were presumed negative, TS-XU sensitivity was 17.2% (95% CI, 7.9%-26.4%) and specificity 89.1% (95% CI, 83.8%-94.3%), and TS-XU detected Mtb in 15 (10.9%) of 137 children with unlikely TB. Our data showed that TS-XU, in addition to routine TB testing, increased TB detection rates by 19.2%.
CONCLUSIONS: Despite the difficulty of interpreting trace-positive results, TS-XU testing increased TB detection rates in hospitalized under-5s with presumptive TB.