Buruli Ulcer, Central African Republic

Minime-Lingoupou, Fanny; Beyam, Narcisse; Zandanga, Germain; Manirakiza, Alexandre; N'Domackrah, Alain; Njuimo, Siméon P; Eyangoh, Sara; Cottin, Jane; Marsollier, Laurent; Marion, Estelle; Portaels, Françoise; Faou, Alain Le; Bercion, Raymond

doi:10.3201/eid1604.090195

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…Whereas until the early 2000s laboratory diagnostic services for endemic countries were mainly provided by external reference laboratories, until 2011 six African countries (Ivory Coast, Ghana, Benin, Cameroon, Central African Republic, Democratic Republic of Congo) installed their own reference laboratories upon increasing demand for local diagnostic capacity [6], [10], [11], [18], [20]–[26], [29], [30], [32], [37], [44]–[46]. Due to the absence of laboratory facilities a number of countries still require support from external reference laboratories; in general however, the role of external reference laboratories has shifted to development of improved laboratory techniques for application in endemic countries, technical support and training of local laboratory staff, as well as external quality assurance for newly established reference laboratories [6], [11], [21], [23]–[32], [37]–[40], [43].…”

Section: Discussionmentioning

confidence: 99%

Implementation of a National Reference Laboratory for Buruli Ulcer Disease in Togo

et al. 2013

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BackgroundIn a previous study PCR analysis of clinical samples from suspected cases of Buruli ulcer disease (BUD) from Togo and external quality assurance (EQA) for local microscopy were conducted at an external reference laboratory in Germany. The relatively poor performance of local microscopy as well as effort and time associated with shipment of PCR samples necessitated the implementation of stringent EQA measures and availability of local laboratory capacity. This study describes the approach to implementation of a national BUD reference laboratory in Togo.MethodologyLarge scale outreach activities accompanied by regular training programs for health care professionals were conducted in the regions “Maritime” and “Central,” standard operating procedures defined all processes in participating laboratories (regional, national and external reference laboratories) as well as the interaction between laboratories and partners in the field. Microscopy was conducted at regional level and slides were subjected to EQA at national and external reference laboratories. For PCR analysis, sample pairs were collected and subjected to a dry-reagent-based IS2404-PCR (DRB-PCR) at national level and standard IS2404 PCR followed by IS2404 qPCR analysis of negative samples at the external reference laboratory.Principal FindingsThe inter-laboratory concordance rates for microscopy ranged from 89% to 94%; overall, microscopy confirmed 50% of all suspected BUD cases. The inter-laboratory concordance rate for PCR was 96% with an overall PCR case confirmation rate of 78%. Compared to a previous study, the rate of BUD patients with non-ulcerative lesions increased from 37% to 50%, the mean duration of disease before clinical diagnosis decreased significantly from 182.6 to 82.1 days among patients with ulcerative lesions, and the percentage of category III lesions decreased from 30.3% to 19.2%.ConclusionsHigh inter-laboratory concordance rates as well as case confirmation rates of 50% (microscopy), 71% (PCR at national level), and 78% (including qPCR confirmation at external reference laboratory) suggest high standards of BUD diagnostics. The increase of non-ulcerative lesions, as well as the decrease in diagnostic delay and category III lesions, prove the effect of comprehensive EQA and training measures involving also procedures outside the laboratory.

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Section: Discussionmentioning

confidence: 99%

Implementation of a National Reference Laboratory for Buruli Ulcer Disease in Togo

et al. 2013

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“…The high proportion (26.5%) of initial lesions in people aged over 17 years is surprising. In this region, a diagnosis of yaws can be differentiated from primary lesions of tropical ulcers [ 22 , 23 ], hence, usefulness of serological tests to overcome this difficulty with diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of skin yaws lesions after treatment with benzathinebenzylpenicillin in a pygmy population in Lobaye, Central African Republic

et al. 2011

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BackgroundYaws is a bacterial skin and bone infectious disease caused by Treponema pallidum pertenue. It is endemic, particularly among pygmies in Central African Republic. To assess the clinical cure rate after treatment with benzathinepenicillin in this population, we conducted a cohort survey of 243 patients in the Lobaye region.Findings and conclusionThe rate of healing of lesions after 5 months was 95.9%. This relatively satisfactory level of therapeutic response implies that yaws could be controlled in the Central African Republic. Thus, reinforcement of the management of new cases and of contacts is suggested.

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“…It has been identified in 30 countries, including 12 African countries ( 1 – 3 ). For Gabon, the first report of a case consistent with Buruli ulcer was published in 1961 ( 4 ).…”

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confidence: 99%

“…To the Editor : Worldwide, Buruli ulcer is the third most common mycobacterial infection, following only tuberculosis and leprosy ( 1 , 2 ). It has been identified in 30 countries, including 12 African countries ( 1 – 3 ). For Gabon, the first report of a case consistent with Buruli ulcer was published in 1961 ( 4 ).…”

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confidence: 99%