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Ahortor EK, Gwira TM, Mahazu S, Erber AC, Ablordey A. Evaluation of an electricity-independent method for IS2404 Loop-mediated isothermal amplification (LAMP) diagnosis of Buruli ulcer in resource-limited settings. PLoS Negl Trop Dis 2024; 18:e0012338. [PMID: 39141676 DOI: 10.1371/journal.pntd.0012338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/04/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Buruli ulcer (BU) caused by Mycobacterium ulcerans (MU) is a devastating necrotic skin disease. PCR, recommended for confirmation of BU by WHO, requires an adequately equipped laboratory, therefore often delaying timely diagnosis and treatment of BU patients in remote settings. Loop-mediated isothermal amplification (LAMP) is a PCR-based protocol for isothermal amplification of DNA that has been suggested for diagnosis of BU in low-resource settings. STUDY AIMS AND METHODS This is an exploratory diagnostic test evaluation study, with an embedded qualitative sub-study. Its aims are two-fold: First, to evaluate a simple rapid syringe-based DNA extraction method (SM) in comparison with a more elaborate conventional DNA extraction method (CM), followed by a LAMP assay targeting IS2404 for the detection of MU, either using a commercially available pocket warmer (pw) or a heat block (hb) for incubation. Second, to complement this by exploring the diagnostic workflow for BU at a community-based health centre in an endemic area in rural Ghana as an example of a potential target setting, using interviews with researchers and health care workers (HCWs). Diagnostic test evaluation results are discussed in relation to the requirements of a target product profile (TPP) for BU diagnosis and the target setting. RESULTS A protocol using SM for DNA extraction followed by IS2404 PCR (IS2404 PCRSM) was able to identify MU DNA in 73 out of 83 BU clinical specimens submitted for diagnosis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IS2404 PCRSM were 90.12%, 100%, 100% and 65.21% respectively, as compared to the reference standard IS2404 PCR in combination with a standard extraction protocol for mycobacterial DNA. Evaluation of the LAMP assay on 64 SM DNA extracts showed a sensitivity, specificity, PPV and NPV of 83.6%, 100%, 100% and 50%, respectively, using either pocket warmer (pwLAMPSM) or heat block (hbLAMPSM) for incubation of the reaction, as compared to the same reference standard. The limit of detection of pwLAMPSM was found to be 30 copies of the IS2404 target. Interview findings explored barriers to BU diagnosis and treatment, including perceptions of the disease, costs, and availability of transport. Participants confirmed that a diagnosis at the PoC, in addition to screening based on clinical criteria, would be advantageous in order to prevent delays and loss to follow-up. DISCUSSION AND CONCLUSIONS The high diagnostic and analytic accuracy of the pwLAMP, evaluated by us in combination with a syringe-based DNA extraction method, supports its potential use for the rapid detection of MU in suspected BU samples at the community or primary health care level without reliable electricity supply. Further optimization needs include a lysis buffer, evaluation directly at the PoC and/or other sites, assessing staff training requirements and quality control.
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Affiliation(s)
- Evans K Ahortor
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, Wales, United Kingdom
| | - Theresa Manful Gwira
- Department of Biochemistry, Cell and Molecular Biology & West African Centre for Cell Biology of Infectious Pathogens, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | - Samiratu Mahazu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Department of Molecular Microbiology and Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Astrid C Erber
- Department of Epidemiology, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Infectious Diseases Data Observatory, Oxford, United Kingdom
| | - Anthony Ablordey
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Butler J, Ogden J, Phillips R, Hay R, Simmonds RE, Erolin C. Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment. J Vis Commun Med 2024:1-13. [PMID: 38771591 DOI: 10.1080/17453054.2024.2348170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropical disease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in the absence of surgery, BU must be detected at its earliest stages (an innocuous-looking lump under the skin) and adherence to prescribed drugs must be high. This study aimed to develop multisensory medical illustrations of BU to support communication with at-risk communities. We used a Think Aloud method to explore community health workers' (n = 6) experiences of BU with a focus on the role of their five senses, since these non-medical disease experts are familiar with the day-to-day challenges presented by BU. Thematic analysis of the transcripts identified three key themes relating to 'Detection,' 'Help Seeking,' and 'Adherence' with a transcending theme 'Senses as key facilitators of health care'. New medical illustrations, for which we coin the phrase "5D illustrations" (signifying the contribution of the five senses) were then developed to reflect these themes. The senses therefore facilitated an enriched narrative enabling the production of relevant and useful visuals for health communication. The medical artist community could utilise sensory experiences to create dynamic medical illustrations for use in practice.
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Affiliation(s)
- Joanna Butler
- Department of Microbial Sciences, School of Biosciences and Medicine, University of Surrey, Haslemere, Surrey, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
| | - Richard Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Rachel E Simmonds
- Department of Microbial Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Caroline Erolin
- Center for Anatomy and Human Identification, University of Dundee, Medical Sciences Institute, Dundee, UK
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Pluschke G, Warryn L. How our molecular understanding of the pathogenesis of Mycobacterium ulcerans infection can improve diagnosis of Buruli ulcer. Expert Rev Mol Diagn 2024; 24:1-4. [PMID: 38073533 DOI: 10.1080/14737159.2023.2294333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/09/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Gerd Pluschke
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Louisa Warryn
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Dofitas BL, Kalim SP, Toledo CB, Richardus JH. Stigma, psychosocial and economic effects of yaws in the Philippines: an exploratory, qualitative study. Trop Med Health 2022; 50:43. [PMID: 35794656 PMCID: PMC9258159 DOI: 10.1186/s41182-022-00433-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Yaws is a chronic, non-venereal, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecie pertenue. Social stigma and economic losses due to yaws have been reported anecdotally in the Southern Philippines but have not been well-documented. Objective To describe and compare the psychological, social, and economic effects of yaws from the perspective of patients, contacts, and key informants in two areas of the Philippines. Materials and methods Yaws and contacts were identified through clinicoseroprevalence surveys conducted in the Liguasan Marsh area, Mindanao, Southern Philippines in 2017 and among the Aetas, an indigenous people community in Quezon province, Luzon region in 2020. Skin examinations and serologic tests confirmed the diagnosis of active, latent, or past yaws among the children and adults. Trained health personnel conducted in-depth interviews of those affected by yaws and their guardians, household contacts, and key informants, such as health workers regarding their perceptions, feelings, health-seeking behaviors, and effects of yaws on their lives. Results A total of 26 participants were interviewed: 17 from Mindanao and 9 from Luzon. Aside from the physical discomforts and embarrassment, yaws was considered stigmatizing in Mindanao, because positive non-treponemal tests or treponemal antibody tests were associated with syphilis and promiscuity. These have led to loss of employment and income opportunities for adults with latent or past yaws. In contrast, the Aetas of Luzon did not perceive yaws as stigmatizing, because it was a common skin problem. Plantar yaws interfered with the Aeta’s gold panning livelihood due to the pain of wounds. Conclusions Yaws is not merely a chronic skin and bone disease. It can lead to significant psychosocial and economic problems as well. Yaws is a generally forgotten disease in the Philippines. There is no yaws surveillance and control program. Treatments are not readily available for the populations affected, thus perpetuating the infection and negative effects. Significance of study This is the first study to document the psychosocial and economic effects of yaws among Filipinos. Information campaigns about yaws and a yaws control program are needed to reduce stigma and discrimination.
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Affiliation(s)
- Belen Lardizabal Dofitas
- Department of Dermatology, College of Medicine, University of the Philippines Manila, Metro Manila, Philippines. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Sherjan P Kalim
- Department of Pathology, Cotabato Regional and Medical Center, Sinsuat Ave., Cotabato City, Philippines
| | - Camille B Toledo
- Institute of Psychiatry and Behavioral Medicine, Southern Philippines Medical Center, Davao City, Philippines
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abdul-Karim A, Schroeder LF. Inadequate Capacity to Diagnose Cutaneous Infections in Ghana: Extensive Skin Ulceration in a 28-Year-Old Man in the Northern Region. J Appl Lab Med 2020; 6:298-303. [PMID: 33347587 DOI: 10.1093/jalm/jfaa216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Abass Abdul-Karim
- Ghana Health Services, Zonal Public Health Laboratory, Tamale, Ghana
| | - Lee F Schroeder
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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Yotsu RR, Comoé CC, Ainyakou GT, Konan N, Akpa A, Yao A, Aké J, Vagamon B, Abbet Abbet R, Bedimo R, Hay R. Impact of common skin diseases on children in rural Côte d'Ivoire with leprosy and Buruli ulcer co-endemicity: A mixed methods study. PLoS Negl Trop Dis 2020; 14:e0008291. [PMID: 32421709 PMCID: PMC7274456 DOI: 10.1371/journal.pntd.0008291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/05/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Skin-related neglected tropical diseases (skin NTDs) occur against a background of a very high prevalence of common skin diseases in sub-Saharan Africa. In this study, we examined the knowledge, attitude and practices (KAP) and the impact of common skin diseases in children living in a leprosy and Buruli ulcer (BU) co-endemic district in a west African country of Côte d'Ivoire, in order to help inform disease control efforts for skin NTDs. METHODS AND PRINCIPLE FINDINGS Fourteen focus group discussions (FGDs) with schoolchildren, 5 FGDs with parents of a child affected with skin disease(s), and 27 in-depth semi-structured interviews with key personnel were conducted. The Children's Dermatology Quality of Life Index (CDLQI) questionnaire was applied to 184 schoolchildren with skin diseases. We found that there was ignorance or neglect towards skin diseases in general, due to their high prevalence and also the perceived minimal impact on children's daily lives. While the median score for the CDLQI questionnaire was 5 (IQR 2-9) out of 30, a range of scores was observed. Symptoms such as pruritus and experiencing bullying by classmates contributed to reduction in their quality of life. Poor hygiene was considered as a major cause of skin diseases. CONCLUSIONS/SIGNIFICANCE Despite their high impact on affected populations, we observed a high level of ignorance and neglect toward common skin diseases. There is a critical need to increase awareness of skin diseases, or skin health promotion, which supports changing of the health-seeking behaviour for skin conditions. This will aid in early detection and treatment of the skin NTDs, in addition to providing benefits for those affected by other skin diseases. Educational opportunities should be utilized to their utmost. One would be associated with water, sanitation, and hygiene (WASH) strategies, but careful messages need to be developed and delivered.
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Affiliation(s)
- Rie Roselyne Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
| | - Colombe Coffie Comoé
- Department of Social Sciences, University of Felix Houphouët Boigny (UFHB), Abidjan, Côte d’Ivoire
- Laboratoire d’Étude et de Recherches Interdisciplinaire en Sciences Sociales (LERISS), Abidjan, Côte d’Ivoire
| | - Germaine Taïba Ainyakou
- Laboratoire d’Étude et de Recherches Interdisciplinaire en Sciences Sociales (LERISS), Abidjan, Côte d’Ivoire
- Department of Social Sciences, University of Peleforo Gon Coulibaly, Korhogo, Côte d’Ivoire
| | | | - Amari Akpa
- MAP International Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Aubin Yao
- MAP International Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Julien Aké
- MAP International Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Bamba Vagamon
- Raoul Follereau Institute Côte d’Ivoire, Adzopé, Côte d’Ivoire
- Department of Dermatology, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | | | - Roger Bedimo
- Division of Infectious Diseases, University of Texas Southwestern, Dallas, United States of America
| | - Roderick Hay
- International Foundation for Dermatology, London, United Kingdom
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Eddyani M, Sopoh GE, Ayelo G, Brun LVC, Roux JJ, Barogui Y, Affolabi D, Faber WR, Boelaert M, Van Rie A, Portaels F, de Jong BC. Diagnostic Accuracy of Clinical and Microbiological Signs in Patients With Skin Lesions Resembling Buruli Ulcer in an Endemic Region. Clin Infect Dis 2019. [PMID: 29538642 PMCID: PMC6117443 DOI: 10.1093/cid/ciy197] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Miriam Eddyani
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ghislain E Sopoh
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli, Allada
| | - Gilbert Ayelo
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli, Allada
| | - Luc V C Brun
- Département d'Anatomie Pathologique, Faculté de Medécine, Université de Parakou, Benin
| | | | - Yves Barogui
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli, Lalo
| | | | - William R Faber
- Academic Medical Centre, Department of Dermatology, University of Amsterdam, The Netherlands
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Annelies Van Rie
- Global Health Institute, Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Françoise Portaels
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bouke C de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Ibrahim YL, Masouyé I, Tschanz E, Atangana P, Etard JF, Serafini M, Mueller YK, Toutous Trellu L. Diagnostic Value of Histological Analysis of Punch Biopsies in Suspected Cutaneous Buruli Ulcer: A Study on 32 Cases of Confirmed Buruli Ulcer in Cameroon. Dermatopathology (Basel) 2019; 6:28-36. [PMID: 31192197 PMCID: PMC6547264 DOI: 10.1159/000498969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background Buruli ulcer (BU) is a cutaneous infectious disease caused by Mycobacterium ulcerans. In this prospective study, we aim to clarify the main histopathological features of cutaneous BU based on 4-mm skin punch biopsies and to evaluate the diagnostic value of this method. Methods Between 2011 and 2013, a prospective study was conducted in Cameroon. Dry swabs from ulcerative lesions and fine-needle aspirates of nonulcerative lesions were examined for Ziehl-Neelsen (ZN) staining, followed by PCR targeting IS2404 and culture. Two 4-mm punch biopsies were performed in the center and in the periphery of each lesion. Results The 364 patients included in the study had 422 lesions (381 were ulcerative and 357 lesions were biopsied). Among the 99 ulcerated lesions with a final diagnosis of BU, histological features for BU were fulfilled in 32 lesions. 32/32 showed subcutaneous necrosis with a neutrophilic inflammatory infiltrate. 26/32 presented alcohol-resistant bacilli confirmed by ZN stain on histology. Conclusion Punch biopsies help in establishing the correct diagnosis of BU and also in the differential diagnosis of chronic ulcers. The main histological feature for BU is diffuse coagulative necrosis of subcutaneous tissue, with acid-fast bacilli detected by ZN stain.
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Affiliation(s)
| | - Isabelle Masouyé
- Division of Dermatology, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Jean-François Etard
- Epicentre, Paris, France & Institut de Recherche pour le Développement (IRD) UMI 233-INSERM U 1175, Montpellier University, Montpellier, France
| | | | - Yolanda K Mueller
- Institut Universitaire de Médecine de Famille (IUMF), Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Bretzel G, Beissner M. PCR detection of Mycobacterium ulcerans-significance for clinical practice and epidemiology. Expert Rev Mol Diagn 2018; 18:1063-1074. [PMID: 30381977 DOI: 10.1080/14737159.2018.1543592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Buruli ulcer (BU) is a neglected disease which has been reported from mostly impoverished, remote rural areas from 35 countries worldwide. BU affects skin, subcutaneous tissue, and bones, and may cause massive tissue destruction and life-long disabilities if not diagnosed and treated early. Without laboratory confirmation diagnostic and treatment errors may occur. This review describes the application of IS2404 PCR, the preferred diagnostic test, in the area of individual patient management and clinico-epidemiological studies. Areas covered: A Medline search included publications on clinical sample collection, DNA extraction, and PCR detection formats of the past and present, potential and limitations of clinical application, as well as clinico-epidemiological studies. Expert commentary: A global network of reference laboratories basically provides the possibility for PCR confirmation of 70% of all BU cases worldwide as requested by the WHO. Keeping laboratory confirmation on a constant level requires continuous outreach activities. Among the potential measures to maintain sustainability of laboratory confirmation and outreach activities are decentralized or mobile diagnostics available at point of care, such as IS2404-based LAMP, which complement the standard IS2404-based diagnostic tools available at central level.
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Affiliation(s)
- Gisela Bretzel
- a Division of Infectious Diseases and Tropical Medicine , University Hospital, Ludwigs-Maximilians-University , Munich , Germany
| | - Marcus Beissner
- a Division of Infectious Diseases and Tropical Medicine , University Hospital, Ludwigs-Maximilians-University , Munich , Germany
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Improving clinical and epidemiological predictors of Buruli ulcer. PLoS Negl Trop Dis 2018; 12:e0006713. [PMID: 30080870 PMCID: PMC6095624 DOI: 10.1371/journal.pntd.0006713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/16/2018] [Accepted: 07/21/2018] [Indexed: 11/21/2022] Open
Abstract
Background Buruli ulcer (BU) is a chronic necrotizing infectious skin disease caused by Mycobacterium ulcerans. The treatment with BU-specific antibiotics is initiated after clinical suspicion based on the WHO clinical and epidemiological criteria. This study aimed to estimate the predictive values of these criteria and how they could be improved. Methodology/Principal findings A total of 224 consecutive patients presenting with skin and soft tissue lesions that could be compatible with BU, including those recognized as unlikely BU by experienced clinicians, were recruited in two BU treatment centers in southern Benin between March 2012 and March 2015. For each participant, the WHO and four additional epidemiological and clinical diagnostic criteria were recorded. For microbiological confirmation, direct smear examination and IS2404 PCR were performed. We fitted a logistic regression model with PCR positivity for BU confirmation as outcome variable. On univariate analysis, most of the clinical and epidemiological WHO criteria were associated with a positive PCR result. However, lesions on the lower limbs and WHO category 3 lesions were rather associated with a negative PCR result (respectively OR: 0.4, 95%CI: 0.3–0.8; OR: 0.5, 95%IC: 0.3–0.9). Among the additional characteristics studied, the characteristic smell of BU was strongest associated with a positive PCR result (OR = 16.4; 95%CI = 7.5–35.6). Conclusion/Significance The WHO diagnostic criteria could be improved upon by differentiating between lesions on the upper and lower limbs and by including lesion size and the characteristic smell recognized by experienced clinicians. Buruli ulcer (BU) is a neglected necrotizing skin disease caused by Mycobacterium ulcerans. The treatment with BU-specific antibiotics is initiated after clinical suspicion based on WHO diagnostic criteria. In this study we evaluated the WHO diagnostic guidelines for BU and how these criteria could be improved. A total of 224 patients presenting with skin lesions were recruited in two BU treatment centers in southern Benin between March 2012 and March 2015. Most of the clinical and epidemiological WHO criteria were associated with a confirmed BU diagnosis although lesions on the lower limbs were rather associated with a negative PCR result. Among the additional characteristics studied, the characteristic smell of BU was most strongly associated with a positive PCR result. The WHO diagnostic criteria could therefore be improved upon by discriminating between lesions on the upper and lower limbs and by including lesion size and the characteristic smell recognized by experienced clinicians. The volatiles responsible for this smell could serve as a Point-of-Care diagnostic test, useful for non-invasive confirmation during active case-finding activities, and for training of clinicians.
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van der Werf TS. Diagnostic Tests for Buruli Ulcer: Clinical Judgment Revisited. Clin Infect Dis 2018. [DOI: 10.1093/cid/ciy203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tjip S van der Werf
- Infectious Diseases Division, Internal Medicine, and Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, The Netherlands
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12
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Van Leuvenhaege C, Vandelannoote K, Affolabi D, Portaels F, Sopoh G, de Jong BC, Eddyani M, Meehan CJ. Bacterial diversity in Buruli ulcer skin lesions: Challenges in the clinical microbiome analysis of a skin disease. PLoS One 2017; 12:e0181994. [PMID: 28750103 PMCID: PMC5531519 DOI: 10.1371/journal.pone.0181994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Buruli ulcer (BU) is an infectious disease caused by Mycobacterium ulcerans and considered the third most prevalent mycobacterial disease in humans. Secondary bacterial infections in open BU lesions are the main cause of pain, delayed healing and systemic illness, resulting in prolonged hospital stay. Thus, understanding the diversity of bacteria, termed the microbiome, in these open lesions is important for proper treatment. However, adequately studying the human microbiome in a clinical setting can prove difficult when investigating a neglected tropical skin disease due to its rarity and the setting. METHODOLOGY/PRINCIPAL FINDINGS Using 16S rRNA sequencing, we determined the microbial composition of 5 BU lesions, 3 non-BU lesions and 3 healthy skin samples. Although no significant differences in diversity were found between BU and non-BU lesions, the former were characterized by an increase of Bacteroidetes compared to the non-BU wounds and the BU lesions also contained significantly more obligate anaerobes. With this molecular-based study, we were also able to detect bacteria that were missed by culture-based methods in previous BU studies. CONCLUSIONS/SIGNIFICANCE Our study suggests that BU may lead to changes in the skin bacterial community within the lesions. However, in order to determine if such changes hold true across all BU cases and are either a cause or consequence of a specific wound environment, further microbiome studies are necessary. Such skin microbiome analysis requires large sample sizes and lesions from the same body site in many patients, both of which can be difficult for a rare disease. Our study proposes a pipeline for such studies and highlights several drawbacks that must be considered if microbiome analysis is to be utilized for neglected tropical diseases.
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Affiliation(s)
- Chloé Van Leuvenhaege
- Mycobacteriology unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Vandelannoote
- Mycobacteriology unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Françoise Portaels
- Mycobacteriology unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ghislain Sopoh
- Institut Régionale de Santé Publique, CDTUB Allada, Benin
| | - Bouke C. de Jong
- Mycobacteriology unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Miriam Eddyani
- Mycobacteriology unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Conor J. Meehan
- Mycobacteriology unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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