Developing and validating a clinical algorithm for the diagnosis of podoconiosis

Abstract

Background Difficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization–recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis. Methods We identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti–specific immunoglobulin G4 in the field using Wb123. Results Based on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100). Conclusions We developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.

Prevalence of podoconiosis and its associated factors in Gamo zone, Southern Ethiopia, 2021

“…Practical training was provided on clinical diagnosis of podoconiosis based on clinical algorithm for the diagnosis of podoconiosis for endemic areas [20], disease staging using a recently developed five level podoconiosis staging system [7] and the procedure for measuring of leg circumference [21].…”

“…The researchers trained the nurses and the health officer on: the nature, etiology, treatment and prevention of podoconiosis, clinical features that differentiate podoconiosis from other diseases such as leprosy and filarial elephantiasis, assessment of ALA, assessment of presence of open wounds and mossy lesions. [20], disease staging using a recently developed five level podoconiosis staging system [7] and the procedure for measuring of leg circumference [21].…”

Infrared Thermal Imaging as a Novel Non-Invasive Point-of-Care Tool to Assess Filarial Lymphoedema

“…This offers the potential to establish baseline measures for individuals, which can be used to monitor lymphoedema progression or the effects of interventions [32,33]. Such a portable and non-invasive tool is needed by health workers in LF-endemic regions [16,17], and may have use for filarial hydrocoele [46] or for other skin NTDs such as onchocerciasis, podoconiosis and leprosy, which could also help in differential diagnosis in co-endemic areas [8,32,[47][48][49]. The use of thermal imaging requires minimal training, and the results can be easily and immediately visualised and interpreted to guide ongoing lymphoedema detection and management at the point of care.…”

Evidence for immune activation in pathogenesis of the HLA class II associated disease, podoconiosis

“…Podoconiosis cases were selected from two health centers in the Bahir Dar district. The cases were already diagnosed and staged by trained nurses and health officers using a validated clinical algorithm 64 and the Tekola staging system 17 and were registered in the health center log books. We deliberately selected podoconiosis cases which were stage two and three.…”