title: Combining PCR with microscopy to reduce costs of laboratory diagnosis of Buruli ulcer.
abstract: 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.
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana. dyeboah-manu@noguchi.mimcom.org
authors: Dorothy
authors: D
authors: Yeboah-Manu
authors: Adwoa
authors: A
authors: Asante-Poku
authors: Kobina
authors: K
authors: Asan-Ampah
authors: Emelia Danso Edwin
authors: ED
authors: Ampadu
authors: Gerd
authors: G
authors: Pluschke
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D054312:Buruli Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D005869:Ghana / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008853:Microscopy / Q000191:economics* / Q000592:standards; D019911:Mycobacterium ulcerans / Q000302:isolation & purification; D016133:Polymerase Chain Reaction / Q000191:economics* / Q000592:standards; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013307:Streptomycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin