{"doi":"10.1093/cid/ciaf397","title":"Oral Washes and Tongue Swabs for Xpert MTB/RIF Ultra–Based Tuberculosis Diagnosis in People With and Without the Ability to Make Sputum","abstract":"BACKGROUND: Oral samples show promise for tuberculosis (TB) diagnosis, but data from different sample types and sputum-scarce individuals remain limited. METHODS: We 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. RESULTS: In 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. CONCLUSIONS: Ultra on OWs or foam swabs offers higher sensitivity than other oral methods and effectively detects TB in sputum-scarce individuals.","journal":"Clinical Infectious Diseases","year":2025,"id":519895,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8893,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1352747,"name":"Shima M. Abdulgader","orcid":"0000-0003-1911-3729","position":1,"is_corresponding":false},{"id":523476,"name":"Stephanie Minnies","orcid":"0000-0003-2877-2419","position":2,"is_corresponding":false},{"id":661148,"name":"Zaida Palmer","orcid":null,"position":3,"is_corresponding":false},{"id":660386,"name":"C Naidoo","orcid":"0000-0003-0822-3180","position":4,"is_corresponding":false},{"id":523475,"name":"Rouxjeane Venter","orcid":"0000-0002-8710-8166","position":5,"is_corresponding":false},{"id":1388870,"name":"D P Naidoo","orcid":"0000-0001-7711-9526","position":6,"is_corresponding":false},{"id":876501,"name":"Gcobisa Ndlangalavu","orcid":"0000-0001-8450-6460","position":7,"is_corresponding":false},{"id":660389,"name":"Byron W P Reeve","orcid":"0000-0002-3332-3477","position":8,"is_corresponding":false},{"id":326537,"name":"Andrew Medina‐Marino","orcid":"0000-0002-0095-4141","position":9,"is_corresponding":false},{"id":1388871,"name":"Tim J. Bull","orcid":"0000-0001-8082-6811","position":10,"is_corresponding":false},{"id":787868,"name":"Alaina M. Olson","orcid":"0000-0003-2384-5025","position":11,"is_corresponding":false},{"id":404662,"name":"Rachel C. Wood","orcid":"0009-0006-3931-8595","position":12,"is_corresponding":false},{"id":404665,"name":"Gerard A. Cangelosi","orcid":"0000-0003-0006-6520","position":13,"is_corresponding":false},{"id":89652,"name":"Robin M. Warren","orcid":"0000-0001-5741-7358","position":14,"is_corresponding":false},{"id":244855,"name":"Grant Theron","orcid":"0000-0002-9216-2415","position":15,"is_corresponding":false},{"id":821657,"name":"Loren Rockman","orcid":"0000-0002-7882-2157","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:49:23.618703Z","pmid":"40686067","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}