02617nas a2200325   4500000000100000008004100001653003900042653001700081653002300098653003100121100001300152700001300165700001300178700002000191700001500211700001400226700001500240700001400255700001700269700001400286700001500300700001200315700001400327245007100341856009800412300001300510490000700523520174700530022001402277       2018                            d10aNeglected tropical diseases (NTDs)10aBuruli ulcer10aClincal predictors10aEpidemiological predictors1 aAyelo GA1 aSopoh GE1 aHouezo J1 aFiodessihoué R1 aAffolabi D1 aDossou AD1 aBarogui YT1 aWadagni A1 aAgossadou DC1 aHasker EC1 aPortaels F1 aJong BC1 aEddyani M00aImproving clinical and epidemiological predictors of Buruli ulcer.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006713&type=printable  ae00067130 v123 a<p><strong>BACKGROUND: </strong>Buruli ulcer (BU) is a chronic necrotizing infectious skin disease caused by Mycobacterium ulcerans. The treatment with BU-specific antibiotics is initiated after clinical suspicion based on the WHO clinical and epidemiological criteria. This study aimed to estimate the predictive values of these criteria and how they could be improved.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>A total of 224 consecutive patients presenting with skin and soft tissue lesions that could be compatible with BU, including those recognized as unlikely BU by experienced clinicians, were recruited in two BU treatment centers in southern Benin between March 2012 and March 2015. For every participant, the WHO and four additional epidemiological and clinical diagnostic criteria were recorded. For microbiological confirmation, direct smear examination and IS2404 PCR were performed. We fitted a logistic regression model with PCR positivity for BU confirmation as outcome variable. On univariate analysis, most of the clinical and epidemiological WHO criteria were associated with a positive PCR result. However, lesions on the lower limbs and WHO category 3 lesions were rather associated with a negative PCR result (respectively OR: 0.4, 95%CI: 0.3-0.8; OR: 0.5, 95%IC: 0.3-0.9). Among the additional characteristics studied, the characteristic smell of BU was strongest associated with a positive PCR result (OR = 16.4; 95%CI = 7.5-35.6).</p>

<p><strong>CONCLUSION/SIGNIFICANCE: </strong>The WHO diagnostic criteria could be improved upon by differentiating between lesions on the upper and lower limbs and by including lesion size and the characteristic smell recognized by experienced clinicians.</p>
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