Differential Diagnosis of Skin Ulcers in a Mycobacterium ulcerans Endemic Area: Data from a Prospective Study in Cameroon

Abstract

BackgroundClinical diagnosis of Buruli ulcer (BU) due to Mycobacterium ulcerans can be challenging. We aimed to specify the differential diagnosis of skin lesions in a BU endemic area.MethodWe conducted a prospective diagnostic study in Akonolinga, Cameroon. Patients presenting with a skin ulcer suspect of BU were included. M. ulcerans was detected using swabs for Ziehl-Neelsen staining, PCR and culture. Skin punch biopsies were taken and reviewed by two histopathologists. Photographs of the lesions were taken and independently reviewed by two dermatologists. Final diagnosis was based on consensus, combining the results of laboratory tests and expert opinion.Results/ DiscussionBetween October 2011 and December 2013, 327 patients with ulcerative lesions were included. Median age was 37 years (0 to 87), 65% were males, and 19% HIV-positive. BU was considered the final diagnosis for 27% of the lesions, 85% of which had at least one positive laboratory test. Differential diagnoses were vascular lesions (22%), bacterial infections (21%), post-traumatic (8%), fistulated osteomyelitis (6%), neoplasia (5%), inflammatory lesions (3%), hemopathies and other systemic diseases (2%) and others (2%). The proportion of BU was similar between HIV-positive and HIV-negative patients (27.0% vs. 26.5%; p = 0.940). Half of children below 15 years of age were diagnosed with BU, compared to 26.8% and 13.9% among individuals 15 to 44 years of age and above, respectively (chi2 p<0.001). Children had more superficial bacterial infections (24.3%) and osteomyelitis (11.4%).ConclusionWe described differential diagnosis of skin lesions in a BU endemic area, stratifying results by age and HIV-status.

The “Buruli Score”: Development of a Multivariable Prediction Model for Diagnosis of Mycobacterium ulcerans Infection in Individuals with Ulcerative Skin Lesions, Akonolinga, Cameroon

“…Between October 2011 and December 2013, 367 patients were included in the study, out of 447 screened, and 364 were finally analyzed (3 secondary exclusions due to missing clinical data), corresponding to 422 lesions, of which 381 were ulcerative (90.3%). Detailed patient flow is presented elsewhere [ 11 ]. There were more inclusions during the first half of the study period compared to the second half (215 vs. 110).…”

Improving clinical and epidemiological predictors of Buruli ulcer

“…It is thus likely that these PCR negative patients did not have BU. Lesions on the lower limbs have a broader range of etiologies with proportionally less BU [ 4 , 24 ]. The clinical suspicion for BU can moreover be broadened since 10.0% of patients clinically diagnosed as non-BU in our study turned out to have BU by PCR, as we reported before [ 17 ].…”

A Deep Insight on the Causative Agents Symptoms and Cure for Skin Cancer: A Review

“…There are several diseases caused by skin some of that are as follows Scabies is a skin condition caused by tiny mites called Sarcoptes scabiei 4 , Pyoderma is a skin infection caused by bacteria 5 , Fungal infection includes infections such as ringworm or dermatophytosis caused by lipophilic yeasts & Malassezia Species, Tropical ulcer is a chronic ulcerative skin lesion thought to be caused by polymicrobial infection 6 and Hyperpigmentation associated with inflammatory skin lesions such as acne 7 .…”