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Laboratory confirmation of Buruli ulcer disease in Togo, 2007-2010.

Bretzel G, Huber KL, Kobara B, Beissner M, Piten E, Herbinger KH, Wiedemann FX, Amekuse K, Banla Kere A, Helfrich K, Fleischmann E, Löscher T, Diefenhardt A, Nitschke J - PLoS Negl Trop Dis (2011)

Bottom Line: EQA for microscopy resulted in 62% concordant results.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians University, Munich, Germany. bretzel@lrz.uni-muenchen.de

ABSTRACT

Background: Since 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 findings: The 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/significance: This 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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Case confirmation rate per observation period.The PCR case confirmation rate was 36/84 (42.86%) in the first observation period (September 2007–August 2008), 37/66 (56.06%) in the second observation period (September 2008–August 2009) and 36/52 (69.23%) in the third observation period (September 2009–August 2010). The case confirmation rate increased during the three observation periods with a definite trend (coefficient of determination, R2 = 1).
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pntd-0001228-g002: Case confirmation rate per observation period.The PCR case confirmation rate was 36/84 (42.86%) in the first observation period (September 2007–August 2008), 37/66 (56.06%) in the second observation period (September 2008–August 2009) and 36/52 (69.23%) in the third observation period (September 2009–August 2010). The case confirmation rate increased during the three observation periods with a definite trend (coefficient of determination, R2 = 1).

Mentions: The PCR case confirmation rate increased with a definite trend from 42.9% (36/84) to 69.2% (36/52) (coefficient of determination, R2 = 1) from the first through the third observation period (figure 2). Calculated per calendar year, the PCR case confirmation rate was 41.7% (10/24) in 2007, 45.8% (38/83) in 2008, 58.9% (33/56) in 2009, and 71.8% (28/39) in 2010 (data not shown).


Laboratory confirmation of Buruli ulcer disease in Togo, 2007-2010.

Bretzel G, Huber KL, Kobara B, Beissner M, Piten E, Herbinger KH, Wiedemann FX, Amekuse K, Banla Kere A, Helfrich K, Fleischmann E, Löscher T, Diefenhardt A, Nitschke J - PLoS Negl Trop Dis (2011)

Case confirmation rate per observation period.The PCR case confirmation rate was 36/84 (42.86%) in the first observation period (September 2007–August 2008), 37/66 (56.06%) in the second observation period (September 2008–August 2009) and 36/52 (69.23%) in the third observation period (September 2009–August 2010). The case confirmation rate increased during the three observation periods with a definite trend (coefficient of determination, R2 = 1).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139659&req=5

pntd-0001228-g002: Case confirmation rate per observation period.The PCR case confirmation rate was 36/84 (42.86%) in the first observation period (September 2007–August 2008), 37/66 (56.06%) in the second observation period (September 2008–August 2009) and 36/52 (69.23%) in the third observation period (September 2009–August 2010). The case confirmation rate increased during the three observation periods with a definite trend (coefficient of determination, R2 = 1).
Mentions: The PCR case confirmation rate increased with a definite trend from 42.9% (36/84) to 69.2% (36/52) (coefficient of determination, R2 = 1) from the first through the third observation period (figure 2). Calculated per calendar year, the PCR case confirmation rate was 41.7% (10/24) in 2007, 45.8% (38/83) in 2008, 58.9% (33/56) in 2009, and 71.8% (28/39) in 2010 (data not shown).

Bottom Line: EQA for microscopy resulted in 62% concordant results.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians University, Munich, Germany. bretzel@lrz.uni-muenchen.de

ABSTRACT

Background: Since 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 findings: The 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/significance: This 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.

Show MeSH
Related in: MedlinePlus