Implementation of a national reference laboratory for Buruli ulcer disease in Togo.

• Published in: PLoS Neglected Tropical Diseases
• Main Authors: Marcus Beissner, Kristina Lydia Huber, Kossi Badziklou, Wemboo Afiwa Halatoko, Issaka Maman, Felix Vogel, Bawimodom Bidjada, Koffi Somenou Awoussi, Ebekalisai Piten, Kerstin Helfrich, Carolin Mengele, Jörg Nitschke, Komi Amekuse, Franz Xaver Wiedemann, Adolf Diefenhardt, Basile Kobara, Karl-Heinz Herbinger, Abiba Banla Kere, Mireille Prince-David, Thomas Löscher, Gisela Bretzel
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2013
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doi.org/10.1371/journal.pntd.0002011; https://doaj.org/article/96bf937e4cd84fbbb9ef99a43afc07ef

BACKGROUND: In a previous study PCR analysis of clinical samples from suspected cases of Buruli ulcer disease (BUD) from Togo and external quality assurance (EQA) for local microscopy were conducted at an external reference laboratory in Germany. The relatively poor performance of local microscopy as well as effort and time associated with shipment of PCR samples necessitated the implementation of stringent EQA measures and availability of local laboratory capacity. This study describes the approach to implementation of a national BUD reference laboratory in Togo. METHODOLOGY: Large scale outreach activities accompanied by regular training programs for health care professionals were conducted in the regions "Maritime" and "Central," standard operating procedures defined all processes in participating laboratories (regional, national and external reference laboratories) as well as the interaction between laboratories and partners in the field. Microscopy was conducted at regional level and slides were subjected to EQA at national and external reference laboratories. For PCR analysis, sample pairs were collected and subjected to a dry-reagent-based IS2404-PCR (DRB-PCR) at national level and standard IS2404 PCR followed by IS2404 qPCR analysis of negative samples at the external reference laboratory. PRINCIPAL FINDINGS: The inter-laboratory concordance rates for microscopy ranged from 89% to 94%; overall, microscopy confirmed 50% of all suspected BUD cases. The inter-laboratory concordance rate for PCR was 96% with an overall PCR case confirmation rate of 78%. Compared to a previous study, the rate of BUD patients with non-ulcerative lesions increased from 37% to 50%, the mean duration of disease before clinical diagnosis decreased significantly from 182.6 to 82.1 days among patients with ulcerative lesions, and the percentage of category III lesions decreased from 30.3% to 19.2%. CONCLUSIONS: High inter-laboratory concordance rates as well as case confirmation rates of 50% (microscopy), 71% (PCR at national ...