A stepwise approach to the laboratory diagnosis of Buruli ulcer disease (original) (raw)
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Presumptive Diagnosis of Buruli Ulcer based on Clinical Presentations
Journal of Microbiology and Infectious Diseases, 2017
Objectives: Buruli ulcer disease (BUD) is a neglected tropical disease of the skin, subcutaneous tissue and occasionally bone. Except in endemic areas, the diagnosis of BUD can be a challenge. This study was an attempt to presumptively identify cases of Buruli ulcer in the absence of a laboratory confirmation. Methods: A presumptive diagnosis of Buruli ulcer by directly comparing clinical presentations with WHO-confirmed pictorial images of the disease was carried out on patients with suspected Buruli ulcers presenting to two government-owned hospitals in Ogun State, SouthWest , Nigeria. Results: Eighteen suspected cases of BUD from as many outpatients were identified within a three-month period, comprising 13 (72.2%) females and five (27.8%) males. 10 (55.6%) and eight (44.4%) of them were from the tertiary and secondary health facilities, respectively. Eleven (61%) of the ulcers were located on the leg, four (22%) on the breast and four (22%) on the hand. 14 (77.8%) of the patients were above 40 years of age, two (11.1%) were between 18 and 30 years while only two (11.1%) were below 15 years. 16 (89%) of the patients could not remember how the ulcer started while two (11%) of them said their lesions started with a scratch. 7(39%) of the ulcers were painless; 11 (61%) were minimally painful while 15 (83%) had undermined edges which are presentations consistent with Buruli ulcer disease. Conclusions: The detection of these ulcers in just two hospitals and within a period of three months is significant and suggestive of Buruli ulcer being probably more prevalent in Southwest Nigeria than aforethought.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2007
Because of the multifaceted clinical presentation of Buruli ulcer disease, misclassification of clinically diagnosed cases may occur frequently. Laboratory tests for the confirmation of suspected cases include microscopic examination, culture, polymerase chain reaction (PCR), and histopathologic examination. However, microscopic examination, the only test usually available in areas of endemicity, has a low sensitivity. To make a highly sensitive diagnostic method locally available, dry reagent-based PCR (DRB-PCR), which is well adapted to tropical conditions, was pilot-tested in Ghana. Subsequently, the assay was used for the routine diagnosis of Buruli ulcer disease over a period of 2 years. The method was compared with other diagnostic tests to evaluate its performance under field conditions. The interassay agreement rate between DRB-PCR and standard PCR was 91.7% for swab specimens and 95% for tissue specimens. Among all of the locally available tests, DRB-PCR revealed the highes...
Laboratory Confirmation of Buruli Ulcer Disease in Togo, 2007–2010
PLoS Neglected Tropical Diseases, 2011
Background: Since the early 1990s more than 1,800 patients with lesions suspicious for Buruli ulcer disease (BUD) have been reported from Togo. However, less than five percent of these were laboratory confirmed. allowed IS2404 PCR analysis of diagnostic samples from patients with suspected BUD during a study period of three years.
Implementation of a National Reference Laboratory for Buruli Ulcer Disease in Togo
PLoS Neglected Tropical Diseases, 2013
Background: In a previous study PCR analysis of clinical samples from suspected cases of Buruli ulcer disease (BUD) from Togo and external quality assurance (EQA) for local microscopy were conducted at an external reference laboratory in Germany. The relatively poor performance of local microscopy as well as effort and time associated with shipment of PCR samples necessitated the implementation of stringent EQA measures and availability of local laboratory capacity. This study describes the approach to implementation of a national BUD reference laboratory in Togo.
Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016
PLOS Neglected Tropical Diseases
Background Buruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana. Method/Principal findings Pathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS2404 PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions
Journal of Cosmetics, Dermatological Sciences and Applications, 2019
Introduction: The objective of our work was to describe the epidemiological, clinical and biological profile of Buruli ulcer in "Centre de Dépistage et de traitement de l'ulcère de Buruli" (CDTUB) in Allada. Methods: A descriptive and retrospective study focused on new cases of Buruli ulcer received in the CDTUB of Allada from 2010 to 2014. The diagnosis of Buruli ulcer was based on epidemiological, clinical and biological arguments. Results: Over 5 years, 274 new cases of Buruli ulcer have been diagnosed. The average age of the patients was 12 years and the sex ratio was 0.8. The average time to first consultation was 45 days. Clinically, 61% had a joint functional limitation. Lesions were ulcerated in 69% of cases, category I (26%), category II (53%), category III (21%) and were present on the lower limbs in 57% of cases. Microscopy was positive in 65.7% of cases and PCR in 78.1% of cases. Microscopy supplemented by PCR confirmed the diagnosis in 81% of cases. Conclusion: The epidemiological, clinical and biological profile of Buruli ulcer in Allada was characterized by a predominant disease in children, a predominance of ulce
Histopathologic features of Buruli ulcer patients in a referral hospital in South Eastern Nigeria
Zenodo (CERN European Organization for Nuclear Research), 2023
Background: Buruli ulcers are characterized by massive subcutaneous tissue destruction which can be treated effectively and completely when detected early. Characteristic histopathologic changes are considered one of the confirmatory laboratory methods for the diagnosis of Buruli ulcers. Objective: To assess the histopathologic features of Buruli ulcer cases presenting in a referral hospital in South Eastern Nigeria. Methods: A cross-sectional prospective study was carried out among a cohort of 39 Buruli ulcer disease patients referred to a referral hospital in South Eastern Nigeria between July and December 2021. A semi-structured, interviewer-administered questionnaire was used to collect data on the socio-demographic characteristics of the respondents while the incisional skin biopsy specimens obtained from the patients in the course of their treatments were sent for histopathologic evaluation. Data were analyzed using SPSS version 22; with alpha set at p-value ≤ 0.05. Results: Twenty one (53.8%) of the study participants were males while 18 (46.2%) were females. Their mean age was 28.41±18.668. Epidermal hyperplasia and elastolysis of the dermis were present in 35 (89.7%) of the patients. There was inflammation of the dermis and subcutis in 34 (87.2%) of the patients while necrosis of the subcutis was present in 38 (97.4%) of the patients. AFB was not visualized in any of the lesions of the patients. Overall, the characteristic histopathologic features of Buruli ulcer were demonstrated in 33 (84.6%) of the patients and four (10.3%) of the patients had features of squamous cell carcinoma while 2 (5.1%) had features of varicose veins.
Buruli Ulcer in Ghana: Results of a National Case Search
Emerging Infectious Diseases, 2002
A national search for cases of Buruli ulcer in Ghana identified 5,619 patients, with 6,332 clinical lesions at various stages. The overall crude national prevalence rate of active lesions was 20.7 per 100,000, but the rate was 150.8 per 100,000 in the most disease-endemic district. The case search demonstrated wide- spread disease and gross underreporting compared with the routine reporting
Clinical Infectious Diseases, 2018
See the Editorial Commentary by van der Werf on pages 835-6.) Background. The diagnosis of the neglected tropical skin and soft tissue disease Buruli ulcer (BU) is made on clinical and epidemiological grounds, after which treatment with BU-specific antibiotics is initiated empirically. Given the current decline in BU incidence, clinical expertise in the recognition of BU is likely to wane and laboratory confirmation of BU becomes increasingly important. We therefore aimed to determine the diagnostic accuracy of clinical signs and microbiological tests in patients presenting with lesions clinically compatible with BU. Methods. A total of 227 consecutive patients were recruited in southern Benin and evaluated by clinical diagnosis, direct smear examination (DSE), polymerase chain reaction (PCR), culture, and histopathology. In the absence of a gold standard, the final diagnosis in each patient was made using an expert panel approach. We estimated the accuracy of each test in comparison to the final diagnosis and evaluated the performance of 3 diagnostic algorithms. Results. Among the 205 patients with complete data, the attending clinicians recognized BU with a sensitivity of 92% (95% confidence interval [CI], 85%-96%), which was higher than the sensitivity of any of the laboratory tests. However, 14% (95% CI, 7%-24%) of patients not suspected to have BU at diagnosis were classified as BU by the expert panel. The specificities of all diagnostics were high (≥91%). All diagnostic algorithms had similar performances. Conclusions. A broader clinical suspicion should be recommended to reduce missed BU diagnoses. Taking into consideration diagnostic accuracy, time to results, cost-effectiveness, and clinical generalizability, a stepwise diagnostic approach reserving PCR to DSE-negative patients performed best.