Performance of Tongue Swabs for Tuberculosis Diagnosis in Hospitalized Children Under 5 Years of Age.

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases Pub Date : 2025-08-20 eCollection Date: 2025-09-01 DOI:10.1093/ofid/ofaf474

Sanjay G Lala, Christopher Ealand, Ziyaad Dangor, Khuthadzo Hlongwane, Minja Milovanovic, Kathleen Car, Alison van der Nest, Tannah Cleak, Olivia Jacobs, Astika Sewcharran, Serene Keenan, Gary Reubenson, Pattamukkil Abraham, Mulisa Mudau, Jonathan E Golub, Neil Martinson, Bavesh Kana

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引用次数: 0

Abstract

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.

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舌拭子在5岁以下住院儿童肺结核诊断中的应用

背景：5岁以下儿童（5岁以下）的结核病诊断仍然很困难，他们的结核病发病率和死亡率很高。在结核病高负担环境中，我们调查了从5岁以下儿童收集的舌拭子（TS-XU）的Xpert MTB/RIF Ultra检测的诊断特征。方法：在一项隐蔽的、前瞻性的观察性研究中，从被认为是结核病高风险的入院的5岁以下儿童中收集舌拭子，这些儿童被分为以下1类：确诊、未确诊或不太可能患有结核病。结果：在201名入组的5岁以下儿童中，确诊结核病11人（5.5%），未确诊结核病53人（26.4%），疑似结核病137人（68.2%）。TS-XU检测报告201例5岁以下儿童中116例（57.7%）检测出结核分枝杆菌，阳性结果为“微量”（90/116,77.6%）、“极低”（21/116,18.1%）、“低”或“中”（4/116[3.4%]和1/116[0.8%]）。没有“高”的TS-XU结果。当微量结果被推定为阴性时，TS-XU敏感性为17.2% (95% CI, 7.9%-26.4%)，特异性为89.1% (95% CI, 83.8%-94.3%)，在137名不太可能患有结核病的儿童中，TS-XU检测出15名（10.9%）Mtb。我们的数据显示，TS-XU除了常规结核病检测外，还使结核病检出率提高了19.2%。结论：尽管难以解释微量阳性结果，TS-XU检测提高了住院的5岁以下推定结核病患者的结核病检出率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Forum Infectious Diseases Medicine-Neurology (clinical)

CiteScore

6.70

自引率

4.80%

发文量

630

审稿时长

9 weeks

期刊介绍： Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.