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Updated: Sep 9, 2025

Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
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Performance of Tongue Swabs for Tuberculosis Diagnosis in Hospitalized Children Under 5 Years of Age

Sanjay G Lala1, Christopher Ealand2, Ziyaad Dangor1,3

  • 1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Open Forum Infectious Diseases
|September 2, 2025
PubMed

Insights

Xpert MTB/RIF Ultra testing of tongue swabs (TS-XU) improved tuberculosis detection in young children. This method increased detection rates by 19.2% in hospitalized children under 5 years old.

Area of Science:

  • Pediatric infectious diseases
  • Diagnostic microbiology
  • Global health

Background:

  • Tuberculosis (TB) diagnosis is challenging in children under 5 years old, a group with high morbidity and mortality.
  • Investigated diagnostic performance of Xpert MTB/RIF Ultra testing on tongue swabs (TS-XU) in this population within a high-burden setting.

Purpose of the Study:

  • To evaluate the diagnostic characteristics of TS-XU for TB detection in hospitalized children under 5 years old.
  • To assess the impact of TS-XU on overall TB detection rates when used alongside routine testing.

Main Methods:

  • A masked, prospective, observational study enrolled hospitalized children under 5 years old at high risk for TB.
  • Tongue swabs were collected for Xpert MTB/RIF Ultra testing (TS-XU) and children were categorized into confirmed, unconfirmed, or unlikely TB groups.

Main Results:

  • Of 201 children, 11% had confirmed TB. TS-XU detected "Mtb" in 57.7%, with most results being "trace" (77.6%).
  • When trace results were considered negative, TS-XU sensitivity was 17.2% and specificity was 89.1%.
  • TS-XU testing, combined with routine methods, increased TB detection by 19.2%.

Conclusions:

  • TS-XU testing shows potential to enhance TB detection rates in hospitalized young children with presumptive TB.
  • Interpreting "trace" positive results requires careful consideration, but the method contributes to improved diagnosis.
Abstract

Keywords:
Xpert MTB/RIF Ultrachildren less than 5 years of agetongue swabstuberculosis

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