02632nas a2200289   4500000000100000008004100001653001400042653001900056653001300075653001700088100001400105700001400119700001600133700001200149700001400161700001400175700001200189700001200201700002100213700001200234245018900246856007800435300001300513490000700526520179500533022001402328       2016                            d10adiagnosis10aClinical score10aCameroon10aBuruli ulcer1 aMueller Y1 aBastard M1 aNkemenang P1 aComte E1 aEhounou G1 aEyangoh S1 aRusch B1 aTabah E1 aToutous Trellu L1 aEtard J00aThe "Buruli score": development of a multivariable prediction model for diagnosis of Mycobacterium ulcerans infection in individuals with ulcerative skin lesions, Akonolinga, Cameroon.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004593  ae00045930 v103 a<p><strong>BACKGROUND: </strong>Access to laboratory diagnosis can be a challenge for individuals suspected of Buruli Ulcer (BU). Our objective was to develop a clinical score to assist clinicians working in resource-limited settings for BU diagnosis.</p>

<p><strong>METHODODOLOGY/PRINCIPAL FINDINGS: </strong>Between 2011 and 2013, individuals presenting at Akonolinga District Hospital, Cameroon, were enrolled consecutively. Clinical data were collected prospectively. Based on a latent class model using laboratory test results (ZN, PCR, culture), patients were categorized into high, or low BU likelihood. Variables associated with a high BU likelihood in a multivariate logistic model were included in the Buruli score. Score cut-offs were chosen based on calculated predictive values. Of 325 patients with an ulcerative lesion, 51 (15.7%) had a high BU likelihood. The variables identified for the Buruli score were: characteristic smell (+3 points), yellow color (+2), female gender (+2), undermining (+1), green color (+1), lesion hyposensitivity (+1), pain at rest (-1), size &gt;5cm (-1), locoregional adenopathy (-2), age above 20 up to 40 years (-3), or above 40 (-5). This score had AUC of 0.86 (95%CI 0.82-0.89), indicating good discrimination between infected and non-infected individuals. The cut-off to reasonably exclude BU was set at scores &lt;0 (NPV 96.5%; 95%CI 93.0-98.6). The treatment threshold was set at a cut-off ≥4 (PPV 69.0%; 95%CI 49.2-84.7). Patients with intermediate BU probability needed to be tested by PCR.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>We developed a decisional algorithm based on a clinical score assessing BU probability. The Buruli score still requires further validation before it can be recommended for wide use.</p>
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