OBJECTIVE: In view of technical and financial limitations in areas of endemicity, the current practice and recommendations for the laboratory diagnosis of Buruli ulcer disease (BUD) may have to be reconsidered. We reviewed diagnostic results in order to explore options for a modified, more practicable, cost-effective and timely approach to the laboratory diagnosis of BUD. METHODS: Diagnostic specimens from 161 clinically diagnosed BUD patients from four different treatment centres in Ghana were subjected to laboratory analysis. The positivity rates of the laboratory assays were compared. RESULTS: The number of laboratory-confirmed clinically diagnosed BUD cases with one positive confirmative test was 20% higher than that with two positive confirmative tests. The specificity of microscopy (MIC) and PCR was 96.6% and 100%, respectively. Subsequent analysis of specimens from surgically excised pre-ulcerative tissue-by-tissue MIC and tissue PCR rendered 65% laboratory-confirmed BUD cases. Subsequent analysis of diagnostic swabs from ulcerative lesions by swab smear MIC and swab PCR rendered 70% of laboratory-confirmed BUD cases. CONCLUSIONS: The specificity of the diagnostic tests used in this study suggests that one positive diagnostic test may be considered sufficient for the laboratory confirmation of BUD. Subsequent application of different diagnostic tests rendered a laboratory confirmation of 65% pre-ulcerative and of 70% ulcerative lesions. Implementation of a stepwise, subsequent analysis of diagnostic specimens will result in considerable cost saving compared with simultaneous testing of specimens by several diagnostic assays.
OBJECTIVE: In view of technical and financial limitations in areas of endemicity, the current practice and recommendations for the laboratory diagnosis of Buruli ulcer disease (BUD) may have to be reconsidered. We reviewed diagnostic results in order to explore options for a modified, more practicable, cost-effective and timely approach to the laboratory diagnosis of BUD. METHODS: Diagnostic specimens from 161 clinically diagnosed BUD patients from four different treatment centres in Ghana were subjected to laboratory analysis. The positivity rates of the laboratory assays were compared. RESULTS: The number of laboratory-confirmed clinically diagnosed BUD cases with one positive confirmative test was 20% higher than that with two positive confirmative tests. The specificity of microscopy (MIC) and PCR was 96.6% and 100%, respectively. Subsequent analysis of specimens from surgically excised pre-ulcerative tissue-by-tissue MIC and tissue PCR rendered 65% laboratory-confirmed BUD cases. Subsequent analysis of diagnostic swabs from ulcerative lesions by swab smear MIC and swab PCR rendered 70% of laboratory-confirmed BUD cases. CONCLUSIONS: The specificity of the diagnostic tests used in this study suggests that one positive diagnostic test may be considered sufficient for the laboratory confirmation of BUD. Subsequent application of different diagnostic tests rendered a laboratory confirmation of 65% pre-ulcerative and of 70% ulcerative lesions. Implementation of a stepwise, subsequent analysis of diagnostic specimens will result in considerable cost saving compared with simultaneous testing of specimens by several diagnostic assays.
Authors: Marcus Beissner; Nana-Yaa Awua-Boateng; William Thompson; Willemien A Nienhuis; Erasmus Klutse; Pius Agbenorku; Joerg Nitschke; Karl-Heinz Herbinger; Vera Siegmund; Erna Fleischmann; Ohene Adjei; Bernhard Fleischer; Tjip S van der Werf; Thomas Loscher; Gisela Bretzel Journal: Am J Trop Med Hyg Date: 2010-11 Impact factor: 2.345
Authors: Miriam Eddyani; Alexandra G Fraga; Fernando Schmitt; Cécile Uwizeye; Krista Fissette; Christian Johnson; Julia Aguiar; Ghislain Sopoh; Yves Barogui; Wayne M Meyers; Jorge Pedrosa; Françoise Portaels Journal: J Clin Microbiol Date: 2009-04-22 Impact factor: 5.948
Authors: Sacha J Pidot; Jessica L Porter; Laurent Marsollier; Annick Chauty; Florence Migot-Nabias; Cyril Badaut; Angèle Bénard; Marie-Therese Ruf; Torsten Seemann; Paul D R Johnson; John K Davies; Grant A Jenkin; Gerd Pluschke; Timothy P Stinear Journal: PLoS Negl Trop Dis Date: 2010-11-02
Authors: K-H Herbinger; D Brieske; J Nitschke; V Siegmund; W Thompson; E Klutse; N Y Awua-Boateng; E Bruhl; L Kunaa; M Schunk; O Adjei; T Löscher; G Bretzel Journal: Infection Date: 2008-12-03 Impact factor: 3.553