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Enfoque escalonado del diagnóstico en laboratorio de la úlcera de Buruli
Author(s) -
Bretzel G.,
Siegmund V.,
Nitschke J.,
Herbinger K. H.,
Thompson W.,
Klutse E.,
Crofts K.,
Massavon W.,
Etuaful S.,
Thompson R.,
AsamoahOpare K.,
Racz P.,
Vloten F.,
Van Berberich C.,
Kruppa T.,
Ampadu E.,
Fleischer B.,
Adjei O.
Publication year - 2007
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2006.01761.x
Subject(s) - buruli ulcer , medicine , mycobacterium ulcerans , diagnostic test , diagnostic accuracy , gold standard (test) , pathology , surgery , disease , veterinary medicine
Summary 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.