External quality assurance for the laboratory diagnosis of Buruli ulcer disease in Ghana

Bretzel, Gisela; Siegmund, Vera; Nitschke, Jörg; Herbinger, Karl‐Heinz; Thompson, Ruth; Fleischmann, Erna; Fleischer, Bernhard; Adjei, Ohene

doi:10.1111/j.1365-3156.2006.01722.x

Cited by 9 publications

(15 citation statements)

References 3 publications

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“…Diagnostic samples were collected according to standardized procedures which have been developed in the context of previous studies on laboratory diagnosis of BUD in Ghana [13], [19]–[22]. Briefly, swabs were taken by circling the entire undermined edges of ulcerative lesions.…”

Section: Methodsmentioning

confidence: 99%

Laboratory Confirmation of Buruli Ulcer Disease in Togo, 2007–2010

et al. 2011

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BackgroundSince 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. Since 2007, the Togolese National Buruli Ulcer Control Program has been supported by the German Leprosy and Tuberculosis Relief Association (DAHW). Collaboration with the Department for Infectious Diseases and Tropical Medicine (DITM), University Hospital, Munich, Germany, allowed IS2404 PCR analysis of diagnostic samples from patients with suspected BUD during a study period of three years.Methodology/Principal FindingsThe DAHW integrated active BUD case finding in the existing network of TB/Leprosy Controllers and organized regular training and outreach activities to identify BUD cases at community level. Clinically suspected cases were referred to health facilities for diagnosis and treatment. Microscopy was carried out locally, external quality assurance (EQA) at DITM. Diagnostic samples from 202 patients with suspected BUD were shipped to DITM, 109 BUD patients (54%) were confirmed by PCR, 43 (29.9%) by microscopy. All patients originated from Maritime Region. EQA for microscopy resulted in 62% concordant results.Conclusions/SignificanceThis study presents a retrospective analysis of the first cohort of clinically suspected BUD cases from Togo subjected to systematic laboratory analysis over a period of three years and confirms the prevalence of BUD in Maritime Region. Intensified training in the field of case finding and sample collection increased the PCR case confirmation rate from initially less than 50% to 70%. With a PCR case confirmation rate of 54% for the entire study period the WHO standards (case confirmation rate ≥50%) have been met. EQA for microscopy suggests the need for intensified supervision and training. In January 2011 the National Hygiene Institute, Lomé, has assumed the role of a National Reference Laboratory for PCR confirmation and microscopy.

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Section: Methodsmentioning

confidence: 99%

Laboratory Confirmation of Buruli Ulcer Disease in Togo, 2007–2010

et al. 2011

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“…In addition, it is well known that, even if identical source material is used, repeated testing of material containing few bacilli may render variable results. In view of the agreement rates, DRB-PCR is a reliable method for the laboratory diagnosis of BUD [7,13].…”

Section: Discussionmentioning

confidence: 99%

“…Tissue specimens for different laboratory tests were located adjacent to each other to guarantee maximum comparability of results of all diagnostic tests. Tissue specimens had to contain subcutaneous adipose tissue to be included in the analysis [13,14]. To provide optimal conditions for storage and transportation of specimens, standardized specimen collection bags containing all required items and containers, as well as standardized, laboratory data entry forms, were distributed to the hospitals.…”

Section: Methodsmentioning

confidence: 99%

Dry Reagent-Based Polymerase Chain Reaction Compared with Other Laboratory Methods Available for the Diagnosis of Buruli Ulcer Disease

Siegmund

Adjei

Nitschke

et al. 2007

Clinical Infectious Diseases

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“…These strategies currently include the direct examination of Ziehl-Neelsen stained smears, culture of M. ulcerans and PCR from swabs or tissue samples. Microscopy based on the Ziehl-Neelsen stain from BU swabs or biopsies is quick, however, several studies have shown that the sensitivity of this method is highly variable (40 – 80%, depending on the laboratory) [18], [19]. Culture of M. ulcerans from a suspect lesion remains the gold standard for diagnosis, however, due to the long incubation times required (up to 12 weeks) and low sensitivity it is not appropriate for pre-treatment diagnosis [20].…”

Section: Introductionmentioning

confidence: 99%

Serological Evaluation of Mycobacterium ulcerans Antigens Identified by Comparative Genomics

et al. 2010

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A specific and sensitive serodiagnostic test for Mycobacterium ulcerans infection would greatly assist the diagnosis of Buruli ulcer and would also facilitate seroepidemiological surveys. By comparative genomics, we identified 45 potential M. ulcerans specific proteins, of which we were able to express and purify 33 in E. coli. Sera from 30 confirmed Buruli ulcer patients, 24 healthy controls from the same endemic region and 30 healthy controls from a non-endemic region in Benin were screened for antibody responses to these specific proteins by ELISA. Serum IgG responses of Buruli ulcer patients were highly variable, however, seven proteins (MUP045, MUP057, MUL_0513, Hsp65, and the polyketide synthase domains ER, AT propionate, and KR A) showed a significant difference between patient and non-endemic control antibody responses. However, when sera from the healthy control subjects living in the same Buruli ulcer endemic area as the patients were examined, none of the proteins were able to discriminate between these two groups. Nevertheless, six of the seven proteins showed an ability to distinguish people living in an endemic area from those in a non-endemic area with an average sensitivity of 69% and specificity of 88%, suggesting exposure to M. ulcerans. Further validation of these six proteins is now underway to assess their suitability for use in Buruli ulcer seroepidemiological studies. Such studies are urgently needed to assist efforts to uncover environmental reservoirs and understand transmission pathways of the M. ulcerans.

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External quality assurance for the laboratory diagnosis of Buruli ulcer disease in Ghana

Cited by 9 publications

References 3 publications

Laboratory Confirmation of Buruli Ulcer Disease in Togo, 2007–2010

Laboratory Confirmation of Buruli Ulcer Disease in Togo, 2007–2010

Dry Reagent-Based Polymerase Chain Reaction Compared with Other Laboratory Methods Available for the Diagnosis of Buruli Ulcer Disease

Serological Evaluation of Mycobacterium ulcerans Antigens Identified by Comparative Genomics

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