Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study

Helen Cox; Lesley Workman; Lindy Bateman; Zoe Franckling-Smith; Margaretha Prins; Juaneta Luiz; Judi Van Heerden; Lemese Ah Tow Edries; Samantha Africa; Veronica Allen; Cynthia Baard; Widaad Zemanay; Mark P Nicol; Heather J Zar

doi:10.1093/cid/ciac332

Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study

Helen Cox, Lesley Workman, Lindy Bateman, Zoe Franckling-Smith, Margaretha Prins, Juaneta Luiz, Judi Van Heerden, Lemese Ah Tow Edries, Samantha Africa, Veronica Allen, Cynthia Baard, Widaad Zemanay, Mark P Nicol, Heather J Zar

Marshall Centre

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31 Citations (Scopus)

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Abstract

BACKGROUND: Microbiological diagnosis of childhood tuberculosis may be difficult. Oral swabs are a potential non-invasive alternative to sputum for diagnosis.

METHODS: A prospective diagnostic accuracy study of oral swabs (buccal and tongue) for pulmonary tuberculosis (PTB) diagnosis in children (aged ≤15 years) in two South African hospital sites. Children with cough of any duration and either: a positive tuberculin skin test, TB contact, loss of weight or chest X-ray suggestive of PTB were enrolled. Two induced sputum specimens were tested with Xpert MTB/RIF (or Ultra) and liquid culture. Oral swabs were taken preceding sputum, frozen and later tested with Xpert MTB/RIF Ultra. Children were classified as microbiologically confirmed TB, Unconfirmed TB (received TB treatment) or unlikely TB according to NIH consensus definitions based on sputum microbiological results.

RESULTS: Among 291 participants (median age 32 [IQR 14-73] months), 57 (20%) were living with HIV and 87 (30%) were malnourished. 90 (31%) had confirmed PTB (six (7%) with rifampicin-resistant TB), 157 (54%) unconfirmed PTB and 44 (15%) unlikely TB. One oral swab was obtained from 126 (43%) participants (96 tongue, 30 buccal) and two swabs from 165 (57%) (110 tongue, 55 buccal). Sensitivity was low; 22% (95% CI 15-32) for all swabs combined (confirmed PTB as reference), but specificity was high (100%, 95% CI 91-100). The highest sensitivity was 33% (15-58) among participants living with HIV. Overall yield was 6.9% with one oral swab, and 7.2% with two.

CONCLUSIONS: Ultra on oral swabs provides poor yield for microbiologic PTB confirmation in children.

Original language	English
Pages (from-to)	2145-2152
Number of pages	8
Journal	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume	75
Issue number	12
DOIs	https://doi.org/10.1093/cid/ciac332
Publication status	Published - 15 Dec 2022

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Cox, et al., 2022 Oral swabs tested with XpertAccepted author manuscript, 3.79 MB

Cite this

Cox, H., Workman, L., Bateman, L., Franckling-Smith, Z., Prins, M., Luiz, J., Van Heerden, J., Edries, L. A. T., Africa, S., Allen, V., Baard, C., Zemanay, W., Nicol, M. P., & Zar, H. J. (2022). Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 75(12), 2145-2152. https://doi.org/10.1093/cid/ciac332

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title = "Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study",

abstract = "BACKGROUND: Microbiological diagnosis of childhood tuberculosis may be difficult. Oral swabs are a potential non-invasive alternative to sputum for diagnosis.METHODS: A prospective diagnostic accuracy study of oral swabs (buccal and tongue) for pulmonary tuberculosis (PTB) diagnosis in children (aged ≤15 years) in two South African hospital sites. Children with cough of any duration and either: a positive tuberculin skin test, TB contact, loss of weight or chest X-ray suggestive of PTB were enrolled. Two induced sputum specimens were tested with Xpert MTB/RIF (or Ultra) and liquid culture. Oral swabs were taken preceding sputum, frozen and later tested with Xpert MTB/RIF Ultra. Children were classified as microbiologically confirmed TB, Unconfirmed TB (received TB treatment) or unlikely TB according to NIH consensus definitions based on sputum microbiological results.RESULTS: Among 291 participants (median age 32 [IQR 14-73] months), 57 (20%) were living with HIV and 87 (30%) were malnourished. 90 (31%) had confirmed PTB (six (7%) with rifampicin-resistant TB), 157 (54%) unconfirmed PTB and 44 (15%) unlikely TB. One oral swab was obtained from 126 (43%) participants (96 tongue, 30 buccal) and two swabs from 165 (57%) (110 tongue, 55 buccal). Sensitivity was low; 22% (95% CI 15-32) for all swabs combined (confirmed PTB as reference), but specificity was high (100%, 95% CI 91-100). The highest sensitivity was 33% (15-58) among participants living with HIV. Overall yield was 6.9% with one oral swab, and 7.2% with two.CONCLUSIONS: Ultra on oral swabs provides poor yield for microbiologic PTB confirmation in children.",

author = "Helen Cox and Lesley Workman and Lindy Bateman and Zoe Franckling-Smith and Margaretha Prins and Juaneta Luiz and {Van Heerden}, Judi and Edries, {Lemese Ah Tow} and Samantha Africa and Veronica Allen and Cynthia Baard and Widaad Zemanay and Nicol, {Mark P} and Zar, {Heather J}",

year = "2022",

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day = "15",

doi = "10.1093/cid/ciac332",

language = "English",

volume = "75",

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Cox, H, Workman, L, Bateman, L, Franckling-Smith, Z, Prins, M, Luiz, J, Van Heerden, J, Edries, LAT, Africa, S, Allen, V, Baard, C, Zemanay, W, Nicol, MP & Zar, HJ 2022, 'Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 75, no. 12, pp. 2145-2152. https://doi.org/10.1093/cid/ciac332

Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study. / Cox, Helen; Workman, Lesley; Bateman, Lindy et al.
In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 75, No. 12, 15.12.2022, p. 2145-2152.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children

T2 - a diagnostic accuracy study

AU - Cox, Helen

AU - Workman, Lesley

AU - Bateman, Lindy

AU - Franckling-Smith, Zoe

AU - Prins, Margaretha

AU - Luiz, Juaneta

AU - Van Heerden, Judi

AU - Edries, Lemese Ah Tow

AU - Africa, Samantha

AU - Allen, Veronica

AU - Baard, Cynthia

AU - Zemanay, Widaad

AU - Nicol, Mark P

AU - Zar, Heather J

PY - 2022/12/15

Y1 - 2022/12/15

N2 - BACKGROUND: Microbiological diagnosis of childhood tuberculosis may be difficult. Oral swabs are a potential non-invasive alternative to sputum for diagnosis.METHODS: A prospective diagnostic accuracy study of oral swabs (buccal and tongue) for pulmonary tuberculosis (PTB) diagnosis in children (aged ≤15 years) in two South African hospital sites. Children with cough of any duration and either: a positive tuberculin skin test, TB contact, loss of weight or chest X-ray suggestive of PTB were enrolled. Two induced sputum specimens were tested with Xpert MTB/RIF (or Ultra) and liquid culture. Oral swabs were taken preceding sputum, frozen and later tested with Xpert MTB/RIF Ultra. Children were classified as microbiologically confirmed TB, Unconfirmed TB (received TB treatment) or unlikely TB according to NIH consensus definitions based on sputum microbiological results.RESULTS: Among 291 participants (median age 32 [IQR 14-73] months), 57 (20%) were living with HIV and 87 (30%) were malnourished. 90 (31%) had confirmed PTB (six (7%) with rifampicin-resistant TB), 157 (54%) unconfirmed PTB and 44 (15%) unlikely TB. One oral swab was obtained from 126 (43%) participants (96 tongue, 30 buccal) and two swabs from 165 (57%) (110 tongue, 55 buccal). Sensitivity was low; 22% (95% CI 15-32) for all swabs combined (confirmed PTB as reference), but specificity was high (100%, 95% CI 91-100). The highest sensitivity was 33% (15-58) among participants living with HIV. Overall yield was 6.9% with one oral swab, and 7.2% with two.CONCLUSIONS: Ultra on oral swabs provides poor yield for microbiologic PTB confirmation in children.

AB - BACKGROUND: Microbiological diagnosis of childhood tuberculosis may be difficult. Oral swabs are a potential non-invasive alternative to sputum for diagnosis.METHODS: A prospective diagnostic accuracy study of oral swabs (buccal and tongue) for pulmonary tuberculosis (PTB) diagnosis in children (aged ≤15 years) in two South African hospital sites. Children with cough of any duration and either: a positive tuberculin skin test, TB contact, loss of weight or chest X-ray suggestive of PTB were enrolled. Two induced sputum specimens were tested with Xpert MTB/RIF (or Ultra) and liquid culture. Oral swabs were taken preceding sputum, frozen and later tested with Xpert MTB/RIF Ultra. Children were classified as microbiologically confirmed TB, Unconfirmed TB (received TB treatment) or unlikely TB according to NIH consensus definitions based on sputum microbiological results.RESULTS: Among 291 participants (median age 32 [IQR 14-73] months), 57 (20%) were living with HIV and 87 (30%) were malnourished. 90 (31%) had confirmed PTB (six (7%) with rifampicin-resistant TB), 157 (54%) unconfirmed PTB and 44 (15%) unlikely TB. One oral swab was obtained from 126 (43%) participants (96 tongue, 30 buccal) and two swabs from 165 (57%) (110 tongue, 55 buccal). Sensitivity was low; 22% (95% CI 15-32) for all swabs combined (confirmed PTB as reference), but specificity was high (100%, 95% CI 91-100). The highest sensitivity was 33% (15-58) among participants living with HIV. Overall yield was 6.9% with one oral swab, and 7.2% with two.CONCLUSIONS: Ultra on oral swabs provides poor yield for microbiologic PTB confirmation in children.

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U2 - 10.1093/cid/ciac332

DO - 10.1093/cid/ciac332

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SN - 1058-4838

VL - 75

SP - 2145

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JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study

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The microbial ecology of the upper airways in children

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Oral swabs tested with Xpert MTB/RIF Ultra for diagnosis of pulmonary tuberculosis in children: a diagnostic accuracy study

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UN SDGs

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The microbial ecology of the upper airways in children

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