ArticleMicrobiology spectrum2026
Tongue swab Xpert MTB/RIF Ultra for tuberculosis diagnosis in Ethiopian prisons.
Article in Microbiology spectrum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Tuberculosis (TB) diagnosis remains a major challenge in Ethiopian prisons, where access to diagnostics is limited. Current TB diagnostic strategies in Ethiopian prisons rely primarily on sputum-based testing. However, sputum collection is often challenging due to logistical barriers and infection-control concerns. Tongue swabs offer a promising non-sputum alternative. We assessed the diagnostic accuracy and feasibility of tongue swab testing using Xpert MTB/RIF Ultra (Ultra) for diagnosing pulmonary TB in Ethiopian prisons. Incarcerated men (≥18 years) presenting with a cough of any duration were enrolled. Two tongue swabs were collected from each participant: an early-morning swab and a second swab collected 30 min later. Tongue swabs were processed using a 2:1 sample reagent (SR) to sample ratio and tested with Ultra. Diagnostic accuracy was assessed against a composite microbiological reference standard (MRS) comprising sputum Ultra and liquid culture. Of 221 participants included in the final analysis, 34 (15.4%) had TB. Compared with the MRS, tongue swab Ultra detected 21 cases, yielding a sensitivity of 61.8% (95% CI: 44.7%-76.6%) and a specificity of 100.0%. Sensitivity compared with sputum Ultra was 63.6% (95% CI: 45.1%-79.6%), with 100.0% specificity. Sensitivity varied according to sputum Ultra bacillary load: 100.0% (9/9) for medium or high loads, 70.6% (12/17) for low or very low loads, and 0.0% (0/7) for "trace" loads. Tongue swab testing with Ultra was feasible and showed modest sensitivity but excellent specificity for TB diagnosis in Ethiopian prisons, supporting its use as a complementary diagnostic approach to improve case detection. IMPORTANCE: This study is among the few to evaluate tongue swab testing using Ultra for TB diagnosis in a sub-Saharan African prison setting. It demonstrates the diagnostic performance and operational feasibility of this approach in a high-burden prison context. It supports the potential integration of non-sputum-based diagnostic approaches into prison TB diagnostic systems. Tongue swab testing using Ultra could improve access to TB diagnostics within existing case-finding algorithms, particularly by identifying individuals who are unable or unwilling to produce sputum.
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