title: Laboratory confirmation of Buruli ulcer disease in Togo, 2007-2010.
abstract: BACKGROUND
  Since the early 1990s more than 1,800 patients with lesions suspicious for Buruli ulcer disease (BUD) have been reported from Togo. However, less than five percent of these were laboratory confirmed. Since 2007, the Togolese National Buruli Ulcer Control Program has been supported by the German Leprosy and Tuberculosis Relief Association (DAHW). Collaboration with the Department for Infectious Diseases and Tropical Medicine (DITM), University Hospital, Munich, Germany, allowed IS2404 PCR analysis of diagnostic samples from patients with suspected BUD during a study period of three years.
  
  
  RESULTS
  The DAHW integrated active BUD case finding in the existing network of TB/Leprosy Controllers and organized regular training and outreach activities to identify BUD cases at community level. Clinically suspected cases were referred to health facilities for diagnosis and treatment. Microscopy was carried out locally, external quality assurance (EQA) at DITM. Diagnostic samples from 202 patients with suspected BUD were shipped to DITM, 109 BUD patients (54%) were confirmed by PCR, 43 (29.9%) by microscopy. All patients originated from Maritime Region. EQA for microscopy resulted in 62% concordant results.
  
  
  CONCLUSIONS
  This study presents a retrospective analysis of the first cohort of clinically suspected BUD cases from Togo subjected to systematic laboratory analysis over a period of three years and confirms the prevalence of BUD in Maritime Region. Intensified training in the field of case finding and sample collection increased the PCR case confirmation rate from initially less than 50% to 70%. With a PCR case confirmation rate of 54% for the entire study period the WHO standards (case confirmation rate ≥50%) have been met. EQA for microscopy suggests the need for intensified supervision and training. In January 2011 the National Hygiene Institute, Lomé, has assumed the role of a National Reference Laboratory for PCR confirmation and microscopy.
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians University, Munich, Germany. bretzel@lrz.uni-muenchen.de
authors.forename: Gisela
authors.initials: G
authors.lastname: Bretzel
authors.forename: Kristina Lydia
authors.initials: KL
authors.lastname: Huber
authors.forename: Basil
authors.initials: B
authors.lastname: Kobara
authors.forename: Marcus
authors.initials: M
authors.lastname: Beissner
authors.forename: Ebekalisai
authors.initials: E
authors.lastname: Piten
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herbinger
authors.forename: Franz Xaver
authors.initials: FX
authors.lastname: Wiedemann
authors.forename: Komi
authors.initials: K
authors.lastname: Amekuse
authors.forename: Abiba
authors.initials: A
authors.lastname: Banla Kere
authors.forename: Kerstin
authors.initials: K
authors.lastname: Helfrich
authors.forename: Erna
authors.initials: E
authors.lastname: Fleischmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Löscher
authors.forename: Adolf
authors.initials: A
authors.lastname: Diefenhardt
authors.forename: Jörg
authors.initials: J
authors.lastname: Nitschke
mesh_terms: D000293:Adolescent; D000368:Aged; D054312:Buruli Ulcer / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012189:Retrospective Studies; D014037:Togo / Q000453:epidemiology; D014330:Tropical Medicine