gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Fine needle aspiration compared with other sampling techniques for the diagnosis of buruli ulcer disease

Feinnadelaspiration im Vergleich mit anderen Techniken der Probensammlung für die Diagnose des Buruli Ulcus

Meeting Abstract

  • K.-H. Herbinger - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany
  • K. Huber - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany
  • N.-Y. Awua-Boateng - Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
  • J. Nitschke - Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
  • W. Thompson - Agogo Presbyterian Hospital, Agogo, Germany
  • E. Klutse - Dunkwa Governmental Hospital, Dunkwa-on-Offin, Ghana
  • P. Agbenorku - Reconstructive Plastic Surgery and Burns Unit, Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
  • A. Assiobo - Centre National de Référence et de Traitement d'Ulcµre de Buruli (CNRTUB), Centre Hospitalier Régionale Tsevié (CHR), Tsevié, Togo
  • E. Piten - Centre National de Référence et de Traitement d'Ulcµre de Buruli (CNRTUB), Centre Hospitalier Régionale Tsevié (CHR), Tsevié, Togo
  • F. Wiedemann - German Leprosy and Tuberculosis Relief Association (DAHW), Würzburg, Germany
  • M. Beissner - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany
  • E. Fleischmann - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany
  • K. Helfrich - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany
  • O. Adjei - Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
  • T. Löscher - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany
  • G. Bretzel - Medizinische Polikinik der LMU München, Department of Infectious Diseases and Tropical Medicine, München, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP94

DOI: 10.3205/10kit149, URN: urn:nbn:de:0183-10kit1495

Published: June 2, 2010

© 2010 Herbinger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: A variety of diagnostic specimens (swabs, punch biopsies, surgically excised tissue) is available for the laboratory diagnosis of Buruli Ulcer Disease (BUD). Recently the World Health Organization (WHO) also encouraged assessment of fine needle aspirates (FNA) for non-ulcerative lesions and ulcerative lesions where scarring of edges prevents collection of swab samples. This study compares the sensitivity of PCR and microscopy of FNA with other diagnostic specimens.

Methods: Fine needle aspirates, swab specimens (SW), 3 mm punch biopsies (“tissue-punch”, TP), and surgically excised tissue samples from 173 BUD suspects from 5 different study sites in Ghana (Agogo, Agroyesum, Apromase, Dunkwa) and Togo (Tsévié) were subjected to dry-reagent based PCR, microscopy (MIC), and culture (CUL; swabs and punch biopsies only).

Results: Among the BUD suspects, 110 cases (37 non-ulcerative and 73 ulcerative lesions) were laboratory confirmed by at least one positive test. The median of age of these cases was 12 years, with a range from 2 to 75 years. Seventy (63.6%) cases were male.

For non-ulcerative lesions, the sensitivity of PCR was 88.9% for FNA and 87.5% for punch biopsies. The sensitivity of microscopy was 58.3% for FNA and 55.6% for punch biopsies. The sensitivity of culture was 28.6% for punch biopsies.

For ulcerative lesions, the sensitivity of PCR was 75.0% for swabs, 55.6% for FNA, 66.2% for punch biopsies and 30.0% for surgically excised tissue. The sensitivity of microscopy was 45.7% for swabs, 22.2% for FNA, 37.5% for punch biopsies and 20.0% for surgically excised tissue. The sensitivity of culture was 18.8% for swabs, 8.3% for punch biopsies and 0% for surgically excised tissue. Other study in Ghana with 43 confirmed BUD cases (Phillips, 2009) and in Benin with 23 confirmed BUD cases (Eddyani, 2009) had shown similar results.

Conclusions: The results of this study suggest that laboratory assessment of FNA from non-ulcerative lesions provides an excellent alternative to punch biopsies. The sensitivity of PCR and microscopy of FNA samples from ulcerative lesions however, was lower than that of swab samples and punch biopsies. Therefore, for ulcerative lesions FNA should only be applied if scarring of edges prevents collection of swabs and collection of punch biopsies (which requires local anesthesia) is not feasible.