Mueller Yolanda K, Bastard Mathieu, Nkemenang Patrick, Comte Eric, Ehounou Geneviève, Eyangoh Sara, Rusch Barbara, Tabah Earnest Njih, Trellu Laurence Toutous, Etard Jean-Francois
Epicentre, Paris, France.
Médecins Sans Frontières, Geneva, Switzerland.
PLoS Negl Trop Dis. 2016 Apr 5;10(4):e0004593. doi: 10.1371/journal.pntd.0004593. eCollection 2016 Apr.
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.
METHODODOLOGY/PRINCIPAL 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.
对于疑似布氏杆菌溃疡（BU）的个体而言，获得实验室诊断可能是一项挑战。我们的目标是制定一个临床评分系统，以协助在资源有限环境中工作的临床医生进行BU诊断。
方法/主要发现：2011年至2013年期间，连续纳入喀麦隆阿科诺林加区医院就诊的个体。前瞻性收集临床数据。基于使用实验室检测结果（ZN、PCR、培养）的潜在类别模型，将患者分为高或低BU可能性类别。多变量逻辑模型中与高BU可能性相关的变量被纳入布氏杆菌评分。根据计算出的预测值选择评分临界值。在325例有溃疡性病变的患者中，51例（15.7%）有高BU可能性。为布氏杆菌评分确定的变量为：特征性气味（+3分）、黄色（+2分）、女性性别（+2分）、潜行性破坏（+1分）、绿色（+1分）、病变感觉减退（+1分）、静息痛（-1分）、大小>5cm（-1分）、局部淋巴结病（-2分）、年龄20岁至40岁以上（-3分）或40岁以上（-5分）。该评分的AUC为0.86（95%CI 0.82 - 0.89），表明在感染和未感染个体之间具有良好的区分能力。合理排除BU的临界值设定为评分<0（NPV 96.5%；95%CI 93.0 - 98.6）。治疗阈值设定为临界值≥4（PPV 69.0%；95%CI 49.2 - 84.7）。具有中等BU可能性的患者需要通过PCR检测。
结论/意义：我们基于评估BU可能性的临床评分制定了一种决策算法。布氏杆菌评分在被推荐广泛使用之前仍需要进一步验证。
