{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:02:37Z","timestamp":1791576157043,"version":"4.3.4"},"reference-count":28,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"HHS | National Institutes of Health","award":["U01AI152084"],"award-info":[{"award-number":["U01AI152084"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Tongue swabs represent a potential alternative to sputum as a sample type for detecting pulmonary tuberculosis (TB) with molecular diagnostic tests. The methods used to process tongue swabs for testing in the World Health Organization-recommended Xpert MTB\/RIF Ultra (Xpert Ultra) assay vary greatly. Here, we aimed to identify the optimal tongue swab processing for Xpert Ultra testing. We compared four methods for treating dry tongue swabs with the Xpert Sample Reagent (SR) mixed with various concentrations of Tris\u2013EDTA\u2013Tween to treatment with SR alone or to a commonly used heat inactivation protocol. In each condition, swabs obtained from volunteers without TB were placed into test buffer spiked with known amounts of\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      (\n                      <jats:italic>Mtb<\/jats:italic>\n                      ) H37Rv-mc\n                      <jats:sup>2<\/jats:sup>\n                      6230. Swabs processed with 1:1 diluted SR buffer had the lowest\n                      <jats:italic>Mtb<\/jats:italic>\n                      limit of detection (LOD) at 22.7 CFU\/700 \u00b5L (95% confidence interval (CI) 14.2\u201331.2), followed by 2:1 diluted SR buffer at 30.3 CFU\/700 \u00b5L (95% CI 19.9\u201340.7), neat SR at 30.9 CFU\/700 \u00b5L (95% CI 21.5\u201340.3), and SR prefilled in the Xpert Ultra at 57.1 CFU\/700 \u00b5L (95% CI 42.4\u201371.7). Swabs processed using the heat-based protocol had the highest LOD (77.6 CFU\/700 \u00b5L; 95% CI 51.2\u2013104.0). Similar findings were observed for the LOD of RIF susceptibility. The 2:1 diluted SR buffer condition produced similar LODs when swabs were tested in the presence of sputum matrix or phosphate buffer saline. Further studies are needed to assess the performance of this processing protocol in a clinical setting.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Xpert MTB\/RIF Ultra (Xpert Ultra) is approved by the World Health Organization for the diagnosis of tuberculosis (TB). This test is typically performed using sputum specimens obtained from people with presumptive TB. In order to inactivate\n                        <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                        (\n                        <jats:italic>Mtb<\/jats:italic>\n                        ) and aid liquefaction, sputum must be mixed with Xpert SR prior to transfer into the Xpert Ultra. However, some people under evaluation for TB are unable to produce sputum. Alternative sample types for TB diagnosis would, therefore, be of value. Oral swabs, including tongue swabs, have shown promise, but there are technical challenges associated with sample processing. In this study, several new tongue swab processing conditions were evaluated by utilizing SR, either neat or diluted in buffer. The ability of Xpert Ultra to detect TB was improved under these conditions compared with the previously published heat-processing method; processing steps were simplified; and technical challenges were overcome.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02403-24","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T09:04:11Z","timestamp":1738055051000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":12,"title":["Optimal processing of tongue swab samples for\n                    <i>Mycobacterium tuberculosis<\/i>\n                    detection by the Xpert MTB\/RIF Ultra assay"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2387-6198","authenticated-orcid":false,"given":"Gayatri Shankar","family":"Chilambi","sequence":"first","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School","place":["Newark, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Reiss","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School","place":["Newark, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naranjargal","family":"Daivaa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School","place":["Newark, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5217-6142","authenticated-orcid":true,"given":"Padmapriya","family":"Banada","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School","place":["Newark, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3059-2986","authenticated-orcid":true,"given":"Margaretha","family":"De Vos","sequence":"additional","affiliation":[{"name":"FIND","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1883-0059","authenticated-orcid":true,"given":"Adam","family":"Penn-Nicholson","sequence":"additional","affiliation":[{"name":"FIND","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5196-1571","authenticated-orcid":true,"given":"David","family":"Alland","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers New Jersey Medical School","place":["Newark, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","unstructured":"World Health Organization. 2023. Global tuberculosis report 2023. Available from: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2023"},{"key":"e_1_3_3_3_2","unstructured":"World Health Organization. 2024. WHO consolidated guidelines on tuberculosis. module 3: diagnosis \u2013 rapid diagnostics for tuberculosis detection. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240089488"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02360-20"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1086\/651490"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldm009"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-0764-8"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-14-S1-S5"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00421-22"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00469-2"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00019-24"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac332"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2020.100148"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-019-4385-y"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae041"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30474-7"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02345-21"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.00812-17"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-70613-x"},{"key":"e_1_3_3_20_2","volume-title":"Tongue dorsum swab processing for the detection of tuberculosis with Cepheid Xpert MTB\/RIF Ultra","author":"Whitman GR","year":"2021","unstructured":"Whitman GR. 2021. Tongue dorsum swab processing for the detection of tuberculosis with Cepheid Xpert MTB\/RIF Ultra. University of Washington."},{"key":"e_1_3_3_21_2","unstructured":"Charlotte Ahls AD Chilambi GS Cattamanchi A Heard K Heichman K Penn-Nicholson A Scott L Steadman AE Turnbull L David A. 2024. Xpert MTB\/RIF ultra testing from tongue swabs \u2013 diluted SR method."},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01463-09"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00431-22"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S284157"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0251422"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep08668"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.696379"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02314-20"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01053-10"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.02403-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.02403-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T09:10:37Z","timestamp":1741079437000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.02403-24"}},"subtitle":[],"editor":[{"given":"Karen C.","family":"Carroll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,4]]}},"alternative-id":["10.1128\/spectrum.02403-24"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.02403-24","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.06.20.24309244","asserted-by":"object"}]},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"assertion":[{"value":"2024-10-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e02403-24"}}