{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:39:47Z","timestamp":1792510787069,"version":"4.5.0"},"reference-count":22,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K24AI190403"],"award-info":[{"award-number":["K24AI190403"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P30AI168386"],"award-info":[{"award-number":["P30AI168386"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["D43TW009127"],"award-info":[{"award-number":["D43TW009127"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>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 (\u226518 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%\u201376.6%) and a specificity of 100.0%. Sensitivity compared with sputum Ultra was 63.6% (95% CI: 45.1%\u201379.6%), 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 \u201ctrace\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00840-26","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:00:53Z","timestamp":1786971653000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Tongue swab Xpert MTB\/RIF Ultra for tuberculosis diagnosis in Ethiopian prisons"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0409-5620","authenticated-orcid":true,"given":"Kelemework","family":"Adane","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/038b8e254","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7188-4996","authenticated-orcid":true,"given":"Russell R.","family":"Kempker","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine","place":["Atlanta, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kidist","family":"Bobosha","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05mfff588","id-type":"ROR","asserted-by":"publisher"}],"name":"Armauer Hansen Research Institute, Mycobacterial Diseases Research Directorate","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abyot","family":"Meaza","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00xytbp33","id-type":"ROR","asserted-by":"publisher"}],"name":"Ethiopian Public Health Institute","place":["Addis Ababa, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry M.","family":"Blumberg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine","place":["Atlanta, USA"]},{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Global Health, Emory University Rollins School of Public Health","place":["Atlanta, USA"]},{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Epidemiology, Emory University Rollins School of Public Health","place":["Atlanta, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","unstructured":"World Health Organization. 2025. Global tuberculosis report. World Health Organization Geneva Switzerland"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07961-8"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000381"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/6226200"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1789"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149453"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijregi.2025.100621"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271666"},{"key":"e_1_3_5_10_2","volume-title":"WHO operational handbook on tuberculosis. Module 2: screening\u2014systematic screening for tuberculosis disease","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. 2021. WHO operational handbook on tuberculosis. Module 2: screening\u2014systematic screening for tuberculosis disease. World Health Organization, Geneva, Switzerland."},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1278716"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00421-22"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2025.01.029"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00019-24"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-019-4385-y"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2020.100148"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf397"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02403-24"},{"key":"e_1_3_5_19_2","unstructured":"Siddiqi SH R\u00fcsch-Gerdes SJ. 2006. Mycobacteria growth indicator tube (MGIT) culture and drug susceptibility demonstration project. Foundation for innovative new diagnostics (FIND) Geneva Switzerland"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02441-13"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciag077"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01847-18"}],"container-title":["Microbiology Spectrum"],"original-title":[],"contributor":[{"given":"Harley T.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]},{"given":"Melissa","family":"Richard-Greenblatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]}],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00840-26","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00840-26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:50:38Z","timestamp":1792507838000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.00840-26"}},"subtitle":[],"editor":[{"given":"Victoria L.","family":"Campod\u00f3nico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":22,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,6]]}},"alternative-id":["10.1128\/spectrum.00840-26"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.00840-26","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2026-03-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00840-26"}}