Abstract

Tuberculosis (TB) diagnosis is increasingly based on the detection of Mycobacterium tuberculosis complex (MTBC) DNA in sputum using molecular diagnostic tests as the first test for diagnosis. However, sputum can be difficult to obtain in children, patients without productive cough, and the elderly and approaches testing non-sputum samples are needed. We evaluated whether TB can be detected from the oral mucosa of patients with TB. Adults with presumptive TB were examined using culture, Xpert MTB/RIF, smear microscopy and X-Rays. Oral mucosa swabs collected on PrimeStore-MTM, stored at room temperature if tested within 30 days or at −20 °C if examined at a later time. RT-PCR was performed to detect M. tuberculosis DNA. Eighty patients had bacteriologically-confirmed TB, 34 had bacteriologically-negative TB (negative tests but abnormal X-rays) and 152 were considered not to have TB (not TB). Oral swabs RT-PCR were positive in 29/80 (36.3%) bacteriologically-confirmed, 9/34 (26.5%) bacteriologically-negative and 29/152 (19.1%) not TB. The yield varied among samples stored for less and more than 30 days (p = 0.013) from 61% (11/18) and 29% (18/62) among bacteriologically confirmed, and 30.8% (4/13) and 23.8% (5/21) among bacteriologically-negative participants. Among not TB patients, the specificity was 80.9% (123/152), being 78.3% (18/23) among samples stored less than 30 days and 81.4% (105/129) among samples stored for more than 30 days (p = 0.46). The detection of M. tuberculosis in oral mucosa samples is feasible, but storage conditions may affect the yield.

Highlights

  • Tuberculosis (TB) causes 10 million annual cases and is the leading cause of adult death from an infectious agent [1]

  • Tuberculosis (TB) diagnosis is increasingly based on the detection of Mycobacterium tuberculosis complex (MTBC) DNA in sputum using molecular diagnostic tests as the first test for diagnosis

  • Its diagnosis is increasingly based on the detection of Mycobacterium tuberculosis complex (MTBC) DNA using molecular diagnostic assays, after the World Health Organization (WHO) recommendation to use these assays as the first test for diagnosis for people with presumptive TB

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Summary

Introduction

Tuberculosis (TB) causes 10 million annual cases and is the leading cause of adult death from an infectious agent [1]. Recent studies have reported it is possible to recover MTBC DNA from the oral cavity of individuals with bacteriologically confirmed TB [3,4,5]. This is an unusual location, MTBC was frequently detected from the tonsils and adenoids of individuals undergoing tonsillectomies in the 19th and 20th centuries, and was proposed as a method to assess the prevalence of TB in the 1930s, and the presence of MTBC in the mouth is biologically plausible [6].

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