Improving clinical and epidemiological predictors of Buruli ulcer.
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...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-08-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | http://europepmc.org/articles/PMC6095624?pdf=render |
| _version_ | 1818406747200552960 |
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| author | Gilbert Adjimon Ayelo Ghislain Emmanuel Sopoh Jean-Gabin Houezo René Fiodessihoue Dissou Affolabi Ange Dodji Dossou Yves Thierry Barogui Akpeedje Anita Carolle Wadagni Didier Codjo Agossadou Epco Hasker Françoise Portaels Bouke C de Jong Miriam Eddyani |
| author_facet | Gilbert Adjimon Ayelo Ghislain Emmanuel Sopoh Jean-Gabin Houezo René Fiodessihoue Dissou Affolabi Ange Dodji Dossou Yves Thierry Barogui Akpeedje Anita Carolle Wadagni Didier Codjo Agossadou Epco Hasker Françoise Portaels Bouke C de Jong Miriam Eddyani |
| author_sort | Gilbert Adjimon Ayelo |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T09:16:51Z |
| format | Article |
| id | doaj.art-44f5d6d8d0cd475298edcde3acfd0c04 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-12-14T09:16:51Z |
| publishDate | 2018-08-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-44f5d6d8d0cd475298edcde3acfd0c042022-12-21T23:08:26ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352018-08-01128e000671310.1371/journal.pntd.0006713Improving clinical and epidemiological predictors of Buruli ulcer.Gilbert Adjimon AyeloGhislain Emmanuel SopohJean-Gabin HouezoRené FiodessihoueDissou AffolabiAnge Dodji DossouYves Thierry BaroguiAkpeedje Anita Carolle WadagniDidier Codjo AgossadouEpco HaskerFrançoise PortaelsBouke C de JongMiriam EddyaniBACKGROUND: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.http://europepmc.org/articles/PMC6095624?pdf=render |
| spellingShingle | Gilbert Adjimon Ayelo Ghislain Emmanuel Sopoh Jean-Gabin Houezo René Fiodessihoue Dissou Affolabi Ange Dodji Dossou Yves Thierry Barogui Akpeedje Anita Carolle Wadagni Didier Codjo Agossadou Epco Hasker Françoise Portaels Bouke C de Jong Miriam Eddyani Improving clinical and epidemiological predictors of Buruli ulcer. PLoS Neglected Tropical Diseases |
| title | Improving clinical and epidemiological predictors of Buruli ulcer. |
| title_full | Improving clinical and epidemiological predictors of Buruli ulcer. |
| title_fullStr | Improving clinical and epidemiological predictors of Buruli ulcer. |
| title_full_unstemmed | Improving clinical and epidemiological predictors of Buruli ulcer. |
| title_short | Improving clinical and epidemiological predictors of Buruli ulcer. |
| title_sort | improving clinical and epidemiological predictors of buruli ulcer |
| url | http://europepmc.org/articles/PMC6095624?pdf=render |
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