Consumption in the Shadows

Re-thinking Tuberculosis Diagnosis with Copan Swabs

October is the season of spectres, when shadows linger and old names resurface. Once, tuberculosis was known as “consumption,” a wasting disease that haunted Victorian novels and sanatoria alike. Today, the ghost has not gone - Mycobacterium tuberculosis (MTB) still claims millions of lives each year.

For clinical microbiologists, the challenge has shifted. Sputum, the traditional specimen, is often difficult to obtain, especially from children or immunocompromised patients, and its collection carries aerosol risks. Could a simple swab, brushed across the tongue, bring this hidden pathogen into the light?

Recent studies suggest it might. Rigouts et al. (2024) showed that viable MTB can be cultured directly from tongue swabs, proof that living bacilli can be captured, though sensitivity remains lower than sputum. Others have turned their focus to sample processing, showing that careful reagent preparation can strengthen molecular detection on platforms.

Even more striking are results with Copan FLOQSwabs, which have captured more microbial material than traditional swabs due to their flocked tips and achieved sensitivities approaching that of sputum in some trials. Yet success depends on more than performance alone. In South Africa, Codsi et al. (2023) found that healthcare workers valued supervised self-swabbing for its reduced aerosol risk, but cultural stigmas and safety concerns still presented barriers.

As Byrne et al. (2024) remind us, innovation in TB diagnostics is not only about new tests, but about ensuring they work in real-world health systems.

So, as we reflect this October on diseases that consume from within, there is hope that a small, sterile swab could one day help banish TB. For clinical microbiologists, the message is clear: pay attention to these emerging swab studies. They may not yet replace sputum, but they represent an important step toward safer, simpler, and more accessible TB diagnostics.

References:

1. Byrne et al., Finding the missed millions: innovations to bring tuberculosis diagnosis closer to key populations, BMC Global Public Health (2024)
2. Rigouts et al., Successful Mycobacterium tuberculosis culture isolation from tongue swabs, Diagnostic Microbiology and Infectious Disease (2024)
3. Codsi et al., Healthcare worker perceptions of tongue swabs for TB diagnosis during COVID-19, PLOS Global Public Health (2023)