Diagnostic Accuracy of Clinical and Microbiological Signs in Patients With Skin Lesions Resembling Buruli Ulcer in an Endemic Region

Abstract

BackgroundThe 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.MethodsA 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.ResultsAmong 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.ConclusionsA 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.

Individual and clinical variables associated with the risk of Buruli ulcer acquisition: A systematic review and meta-analysis

“…This timeframe was also considered in the evaluation of exposure periods, which was here established as minimum for the correct sorting of controls. Furthermore, literature supports that BU clinical diagnosis can be correctly achieved in over 90% of cases, although this value is dependent on the experience of the physician documenting the event [49]. This reinforces the assertions made by WHO and other authors to confirm BU cases by any of the PLOS NEGLECTED TROPICAL DISEASES specified laboratorial methods [2,49].…”

“…Furthermore, literature supports that BU clinical diagnosis can be correctly achieved in over 90% of cases, although this value is dependent on the experience of the physician documenting the event [49]. This reinforces the assertions made by WHO and other authors to confirm BU cases by any of the PLOS NEGLECTED TROPICAL DISEASES specified laboratorial methods [2,49]. Finally, there appeared to be a reporting bias in the BCG analysis, as observed by the asymmetric funnel plot of the studies (S7 Fig).…”

Global Epidemiology of Buruli Ulcer, 2010–2017, and Analysis of 2014 WHO Programmatic Targets

“…The infection manifests as a nonulcerative nodule, plaque, or edema, which ulcerates within 4-6 weeks and develops the characteristic undermined edges and yellowish-white necrotic slough ( Figure 1) (2). The disease is diagnosed by its characteristic clinical features and confirmed in the laboratory using histopathology, microbiological culture, and PCR for the IS2404 mycobacterial insertion sequence element (3). There is no efficient vaccine for Buruli ulcer (4), and disease control strategy focuses on early case detection and comprehensive treatment of individual patients.…”

Genome-wide association study of Buruli ulcer in rural Benin highlights role of two LncRNAs and the autophagy pathway

“…Known genes in the chromosomal region are plotted, with arrows indicating their orientation. criteria had a sensitivity of 92% [95%CI: 85-96%] and a specificity of 91% [95%CI: 81-96%] 57 . These estimates are particularly relevant in the context of our study as the CDTLUB was the main center of the abovementioned study providing approximately half of the total number of patients 57 .…”