Commentary on the new WHO recommendations for tuberculosis diagnosis
The World Health Organization (WHO) has published a preliminary summary of new recommendations for the diagnosis of tuberculosis. The goal is to make diagnosis simpler, more cost-effective, and more accessible at the local level. The recommendations are aimed in particular at tuberculosis programs in high-prevalence regions with limited resources.
The new recommendations include, for example:
• Sputum pooling, in which samples from multiple individuals with tuberculosis symptoms are tested together in a single batch to reduce screening and diagnostic costs.
• Tongue swabs for adults with suspected tuberculosis when a respiratory specimen cannot be obtained.
These recommendations are not currently relevant for Germany, as diagnostic options with higher sensitivity are generally available. In particular, there is currently no need for pooling sputum samples in the German healthcare system.
In the future, a tongue swab could be a diagnostic option for patients who are unable to produce sputum. However, there are currently no validated laboratory tests for this in Germany, so this method is not yet available.
The WHO’s detailed new recommendations on tuberculosis diagnosis will be published in the coming weeks.
The full text of the WHO’s recommendations can be found here >>
Background information on diagnosis using tongue swabs:
One study reported a sensitivity of 78–86%, which was comparable to that of sputum-based diagnostics (XpertMTB/RIF Ultra) (1). Diagnostic performance varies depending on the test platform and processing method. Advantages are also seen in the feasibility of testing individuals who do not produce sufficient sputum and in the acceptance of the testing method among those being tested (2).
Reference List
1. Steadman A, Kumar KM, Asege L, Kato-Maeda M, Mukwatamundu J, Shah K, et al. Diagnostic accuracy of swab-based molecular tests for tuberculosis using near-point-of-care platforms: a multi-country evaluation. EBioMedicine. 2025;121:105991.
2. Moe CA, Luswata RK, Barrameda AJ, Le H, Muzazu S, Crowder R, et al. Diagnostic Yield of Tongue Swab-Based Molecular Testing Compared to Sputum-Based Molecular Testing for Tuberculosis in Four High-Burden Countries. Clin Infect Dis. 2026.
