@article{fdi:010066860,
  title = {{T}he "{B}uruli {S}core": development of a multivariable prediction model for diagnosis of {M}ycobacterium ulcerans infection in individuals with ulcerative skin lesions, {A}konolinga, {C}ameroon},
  author = {{M}ueller, {Y}. {K}. and {B}astard, {M}. and {N}kemenang, {P}. and {C}omte, {E}. and {E}hounou, {G}. and {E}yangoh, {S}. and {R}usch, {B}. and {T}abah, {E}. {N}. and {T}rellu, {L}. {T}. and {E}tard, {J}ean-{F}ran{\c{c}}ois},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {A}ccess to laboratory diagnosis can be a challenge for individuals suspected of {B}uruli {U}lcer ({BU}). {O}ur objective was to develop a clinical score to assist clinicians working in resource- limited settings for {BU} diagnosis. {M}ethododology/{P}rincipal {F}indings {B}etween 2011 and 2013, individuals presenting at {A}konolinga {D}istrict {H}ospital, {C}ameroon, were enrolled consecutively. {C}linical data were collected prospectively. {B}ased on a latent class model using laboratory test results ({ZN}, {PCR}, culture), patients were categorized into high, or low {BU} likelihood. {V}ariables associated with a high {BU} likelihood in a multivariate logistic model were included in the {B}uruli score. {S}core cut-offs were chosen based on calculated predictive values. {O}f 325 patients with an ulcerative lesion, 51 (15.7%) had a high {BU} likelihood. {T}he variables identified for the {B}uruli 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). {T}his score had {AUC} of 0.86 (95% {CI} 0.82-0.89), indicating good discrimination between infected and non-infected individuals. {T}he cut-off to reasonably exclude {BU} was set at scores <0 ({NPV} 96.5%; 95% {CI} 93.0-98.6). {T}he treatment threshold was set at a cut-off >= 4 ({PPV} 69.0%; 95% {CI} 49.2-84.7). {P}atients with intermediate {BU} probability needed to be tested by {PCR}. {C}onclusions/{S}ignificance {W}e developed a decisional algorithm based on a clinical score assessing {BU} probability. {T}he {B}uruli score still requires further validation before it can be recommended for wide use.},
  keywords = {{CAMEROUN}},
  booktitle = {},
  journal = {{P}los {N}eglected {T}ropical {D}iseases},
  volume = {10},
  numero = {4},
  pages = {e0004593 [12 p.]},
  ISSN = {1935-2735},
  year = {2016},
  DOI = {10.1371/journal.pntd.0004593},
  URL = {https://www.documentation.ird.fr/hor/fdi:010066860},
}