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The 'buruli score': development of a multivariable prediction model for diagnosis of mycobacterium ulcerans infection in individuals with ulcerative skin lesions, Akonolinga, Cameroon | Journal Article / Research | MSF Science Portal
Journal Article
|Research

The 'buruli score': development of a multivariable prediction model for diagnosis of mycobacterium ulcerans infection in individuals with ulcerative skin lesions, Akonolinga, Cameroon

Mueller YK, Bastard M, Nkemenang P, Comte E, Ehounou G, Eyangoh S, Rusch B, Tabah EN, Trellu LT, Etard JF
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Abstract
BACKGROUND
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.

METHODOLOGY/PRINCIPLA FINDINGS
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 >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 <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.

CONCLUSIONS/SIGNIFICANCE
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.

Countries

Cameroon

Subject Area

Buruli ulcer

Languages

English
DOI
10.1371/journal.pntd.0004593
Published Date
05 Apr 2016
PubMed ID
27045293
Journal
PLOS Neglected Tropical Diseases
Volume | Issue | Pages
Volume 10, Issue 4, Pages e0004593
Issue Date
2016-04-05
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