Efficacy of the Combination Rifampin-Streptomycin in Preventing Growth of
            <i>Mycobacterium ulcerans</i>
            in Early Lesions of Buruli Ulcer in Humans

Etuaful, Samuel; Carbonnelle, B; Grosset, J; Lucas, Sebastian; Horsfield, Catherine; Phillips, Richard Odame; Evans, M.R.W.; Ofori‐Adjei, David; Klustse, E.; Owusu-Boateng, J.; Amedofu, Geoffrey K.; Awuah, P.; Ampadu, Edwin; Amofah, George; Asiedu, Kingsley; Wansbrough‐Jones, Mark

doi:10.1128/aac.49.8.3182-3186.2005

Cited by 220 publications

(222 citation statements)

References 21 publications

(18 reference statements)

Supporting

Mentioning

212

Contrasting

Unclassified

Order By: Relevance

“…The epidemiological, scientific, and management aspects of this disease have been well described (12). Over recent years, the management of Buruli ulcer patients has considerably changed with advances in antibiotherapy (3,5).Laboratory diagnosis of this mycobacterial infection is based on detection of acid-fast bacilli (AFB) through the direct examination of samples, isolation of mycobacteria by culture, histological analysis, and detection of M. ulcerans DNA by PCR (12). Ulcerative lesion specimens are collected using swabs (12).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Use of Fine-Needle Aspiration for Diagnosis of Mycobacterium ulcerans Infection

Cassisa

Chauty²,

Marion

et al. 2010

J Clin Microbiol

View full text Add to dashboard Cite

Noninvasive methods for the bacteriological diagnosis of early-stage Mycobacterium ulcerans infection are not available. It was recently shown that fine-needle aspiration (FNA) could be used for diagnosing M. ulcerans infection in ulcerative lesions. We report that FNA is an appropriate sampling method for diagnosing M. ulcerans infection in nonulcerative lesions.Mycobacterium ulcerans infection (Buruli ulcer) is one of the 13 most neglected tropical diseases (9) and the third most common mycobacterial infection after tuberculosis and leprosy in immunocompetent humans (2,6,(13)(14). In general, this skin disease initially manifests as a painless nodule or papule, plaque, or edema (2). Without early intervention, these symptoms evolve into painless ulcers with undermined edges. The epidemiological, scientific, and management aspects of this disease have been well described (12). Over recent years, the management of Buruli ulcer patients has considerably changed with advances in antibiotherapy (3,5).Laboratory diagnosis of this mycobacterial infection is based on detection of acid-fast bacilli (AFB) through the direct examination of samples, isolation of mycobacteria by culture, histological analysis, and detection of M. ulcerans DNA by PCR (12). Ulcerative lesion specimens are collected using swabs (12). Swabbing from the undermined edges of ulcers may sometimes be difficult and painful. Collecting specimens from patients with nonulcerative lesions necessitates invasive procedures, such as incisional, excisional, or punch biopsies, which require hospital infrastructure not available in remote rural areas in Africa where M. ulcerans infection is endemic. Two studies recently reported that fine-needle aspirates could be used to diagnose M. ulcerans infection in ulcerative lesions. In both studies, the number of patients enrolled was not large enough to draw conclusions on the effectiveness of this technique in diagnosing nonulcerative forms.First, we compared the diagnostic sensitivities of fine-needle aspiration (FNA) and swabbing in 64 patients with ulcerative lesions. These patients had skin lesions consistent with active M. ulcerans infection, based on the clinical definition of the World Health Organization (12). For each patient with ulcerative lesions, two swab samples were taken from beneath the undermined edges of the ulcers and one FNA sample was taken from the edge of the lesion. The FNA procedure was similar to that described previously (4, 11); however, we used 20-gauge, 25-mm needles (attached to 5-ml syringes) instead of the 21-gauge and 23-gauge needles used in other studies. All samples were placed in sterile Venosafe tubes (Terumo) and sent, at room temperature, to the bacteriology unit of Angers University Hospital, France, within 7 days of collection for processing.Significant differences were observed in the efficacies of the two sampling methods. PCR using FNA samples detected M. ulcerans DNA in 56 of the 71 patients (diagnostic sensitivity of 79%), and PCR using swab samples detected M. ulcer...

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Use of Fine-Needle Aspiration for Diagnosis of Mycobacterium ulcerans Infection

Cassisa

Chauty²,

Marion

et al. 2010

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…Although there was little error by experienced clinicians in endemic areas of ulcers, there were a number of reports of misdiagnosis, which could be as high as 30%. [10][11][12][13][14] The WHO now puts a lot of emphasis on laboratory confirmation, because the introduction of antibiotic therapy results in the formation of a network of laboratories that confirms BU cases. Nevertheless, more emphasis on laboratory support for case management is focusing on IS2404 PCR [15][16][17][18] and sidelining smear microscopy, which is the cornerstone of TB control.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] In the past, surgery was used as the only means of BU case management; however, the World Health Organization (WHO) currently recommends an 8-week combination therapy with rifampicin and streptomycin as first-line treatment. 14 With the introduction of this antimycobacterial treatment, laboratory confirmation of clinically suspected cases became even more crucial for the clinical management of BU. We, therefore, evaluated the usefulness of microscopy for analyzing swab and fine-needle aspiration (FNA) samples to reduce cost of laboratory confirmation of clinical diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Combining PCR with Microscopy to Reduce Costs of Laboratory Diagnosis of Buruli Ulcer

Yeboah-Manu

Asante-Poku²,

Asan-Ampah³

et al. 2011

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

The introduction of antibiotic therapy as first-line treatment of Buruli ulcer underlines the importance of laboratory confirmation of clinical diagnosis. Because smear microscopy has very limited sensitivity, the technically demanding and more expensive IS2404 diagnostic polymerase chain reaction (PCR) has become the main method for confirmation. By optimization of the release of mycobacteria from swab specimen and concentration of bacterial suspensions before smearing, we were able to improve the detection rate of acid-fast bacilli by microscopy after Ziehl–Neelsen staining. Compared with IS2404 PCR, which is the gold standard diagnostic method, the sensitivity and specificity of microscopy with 100 concentrated specimens were 58.4% and 95.7%, respectively. We subsequently evaluated a stepwise laboratory confirmation algorithm with detection of AFB as first-line method and IS2404 PCR performed only with those samples that were negative in microscopic analysis. This stepwise approach reduced unit cost by more than 50% to $5.41, and the total costs were reduced from $917 to $433.

show abstract

“…The use of rifampicin and streptomycin is noted to have a positive impact on treatment outcomes (Amofah, Asamoah & Afram-Gyening, 1998;WHO, 2004;Etuaful, Carbonnelle, Grosset, Lucas, Horsfield, Phillips, Evans, Ofori-Adjei, Klutse, Owusu-Boateng, Amedofu, Awuah, Ampadu, Amofah, Asiedu & Wansbrough-Jones, 2005;). It has the potential of curing small lesions and limiting surgical acts for large lesions.…”

Section: Introductionmentioning

confidence: 99%