Conformity of yaws clinical features to combined rapid diagnostic test in children aged 2-15 years in an endemic area

Abstract

Introduction: The diagnosis of yaws is established by clinical examination and confirmed through a laboratory test. Unrecognized lesions may lead to a missed opportunity for diagnosis and complete eradication of yaws. The use of Dual Path Platform (DPP® RDT) Syphilis Screen and Confirm RDT (Chembio, Medford, New York) has been recommended by the World Health Organization (WHO) for endemic areas with limited laboratory facilities. To date, there have not been any studies assessing the conformity of clinical features based on the WHO guidelines with DPP® RDT. Methodology: A cross-sectional study was conducted to evaluate the conformity of yaws clinical features based on the WHO guidelines to the DPP® RDT. We recruited children aged 2–15 years old in Alor, Indonesia. All subjects underwent clinical examination and were tested with DPP® RDT. Fisher's exact test was used to analyze the overall agreement between the clinical features and the DPP® RDT results. Results: A total of 197 study subjects (mean age 9 years) were enrolled. The most frequent skin lesion was a yaws scar (79.7%). Eight subjects (3%) were diagnosed with yaws based on the DPP® RDT examination. The overall agreement between clinical features and DPP® RDT was 26.9% (p = 0.202). Conclusions: The conformity of clinical features in suspected yaws to DPP® RDT is low; thus, clinical features should not be used as a sole initial reference in establishing yaws diagnosis, even in endemic areas.