Comparative Study of the Sensitivity of Different Diagnostic Methods for the Laboratory Diagnosis of Buruli Ulcer Disease

Autor: Karl-Heinz Herbinger, Simone Reu, Kerstin Helfrich, Gisela Bretzel, Letitia Kunaa, Ohene Adjei, Vera Siegmund, Erasmus Klutse, Jürg Nitschke, Thomas Lüscher, Alexander Schipf, Willemien A. Nienhuis, Marcus Beissner, Paul Racz, Nana-Yaa Awua-Boateng, Erna Fleischmann, Pius Agbenorku, William Thompson, Tjip S. van der Werf, Bernhard Fleischer
Přispěvatelé: Faculteit Medische Wetenschappen/UMCG
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
Buruli ulcer
Pathology
Antimycobacterial
Polymerase Chain Reaction
Gastroenterology
law.invention
law
Medicine
Child
Buruli Ulcer
Polymerase chain reaction
Aged
80 and over
Microscopy
medicine.diagnostic_test
biology
Buruli Ulcer Disease
Middle Aged
GHANA
Infectious Diseases
Streptomycin
Child
Preschool
Data Interpretation
Statistical
Mycobacterium ulcerans
MYCOBACTERIUM-ULCERANS
Female
medicine.symptom
medicine.drug
Adult
Microbiology (medical)
medicine.medical_specialty
Adolescent
POLYMERASE-CHAIN-REACTION
medicine.drug_class
INFECTION BURULI
Sensitivity and Specificity
Lesion
Young Adult
Internal medicine
PCR ASSAY
Biopsy
Humans
COMBINATION
Aged
Bacteriological Techniques
Chi-Square Distribution
STREPTOMYCIN
IDENTIFICATION
business.industry
Infant
medicine.disease
biology.organism_classification
GENE
SPECIMENS
business
Zdroj: Clinical Infectious Diseases, 48(8), 1055-1064. Oxford University Press
ISSN: 1058-4838
Popis: Background. Several diagnostic laboratory methods are available for case confirmation of Buruli ulcer disease. This study assessed the sensitivity of various diagnostic tests in relation to clinical presentation of the disease, type of diagnostic specimen, and treatment history.Methods. Swab samples, 3-mm punch biopsy tissue specimens, and surgically excised tissue specimens from 384 individuals with suspected Buruli ulcer disease were obtained at 9 different study sites in Ghana and were evaluated with dry reagent-based polymerase chain reaction (PCR), microscopic examination, culture, and histopathological analysis. The study subjects presented with nonulcerative and ulcerative lesions and were divided into 3 treatment groups: (1) previously untreated patients scheduled for antimycobacterial treatment, (2) patients treated with surgery alone, and (3) patients treated with surgery in combination with previous antimycobacterial treatment.Results. Of 384 suspected cases of Buruli ulcer disease, 268 were confirmed by at least 1 positive test result. The overall sensitivity of PCR (85%) was significantly higher than that of microscopic examination (57%) and culture (51%). After data were stratified by treatment group, type of lesion, and diagnostic specimen type, analysis revealed that PCR of 3-mm punch biopsy tissue specimens (obtained from previously untreated nonulcerative lesions) and of swab samples (obtained from previously untreated ulcers) had the highest diagnostic sensitivity (94% and 90%, respectively). Although duration of the disease did not significantly influence the sensitivity of any test, previous antimycobacterial treatment was significantly associated with decreased sensitivity of PCR and culture.Conclusions. Across all subgroups, PCR had the highest sensitivity. PCR assessment of 3-mm punch biopsy tissue specimens proved to be the best diagnostic tool for nonulcerative lesions, and PCR assessment of swab samples was the best diagnostic tool for ulcerative lesions. For monitoring of antimycobacterial treatment success within controlled trials, however, only culture is appropriate.
Databáze: OpenAIRE
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