%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Mueller, Y. K.
%A Bastard, M.
%A Nkemenang, P.
%A Comte, E.
%A Ehounou, G.
%A Eyangoh, S.
%A Rusch, B.
%A Tabah, E. N.
%A Trellu, L. T.
%A Etard, Jean-François
%T The "Buruli Score": development of a multivariable prediction model for diagnosis of Mycobacterium ulcerans infection in individuals with ulcerative skin lesions, Akonolinga, Cameroon
%D 2016
%L fdi:010066860
%G ENG
%J Plos Neglected Tropical Diseases
%@ 1935-2735
%K CAMEROUN
%M ISI:000375376700033
%N 4
%P e0004593 [12 ]
%R 10.1371/journal.pntd.0004593
%U https://www.documentation.ird.fr/hor/fdi:010066860
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers16-05/010066860.pdf
%V 10
%W Horizon (IRD)
%X 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. 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.
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