Laboratory Confirmation of Buruli Ulcer Disease in Togo, 2007-2010

Background: Since the early 1990s more than 1,800 patients with
lesions suspicious for Buruli ulcer disease (BUD) have been
reported from Togo. However, less than five percent of these were
laboratory confirmed. Since 2007, the Togolese National Buruli
Ulcer Control Program has been supported by the German Leprosy and
Tuberculosis Relief Association (DAHW). Collaboration with the
Department for Infectious Diseases and Tropical Medicine (DITM),
University Hospital, Munich, Germany, allowed IS2404 PCR analysis
of diagnostic samples from patients with suspected BUD during a
study period of three years. Methodology/Principal Findings: The
DAHW integrated active BUD case finding in the existing network of
TB/Leprosy Controllers and organized regular training and outreach
activities to identify BUD cases at community level. Clinically
suspected cases were referred to health facilities for diagnosis
and treatment. Microscopy was carried out locally, external quality
assurance (EQA) at DITM. Diagnostic samples from 202 patients with
suspected BUD were shipped to DITM, 109 BUD patients (54%) were
confirmed by PCR, 43 (29.9%) by microscopy. All patients originated
from Maritime Region. EQA for microscopy resulted in 62% concordant
results. Conclusions/Significance: This study presents a
retrospective analysis of the first cohort of clinically suspected
BUD cases from Togo subjected to systematic laboratory analysis
over a period of three years and confirms the prevalence of BUD in
Maritime Region. Intensified training in the field of case finding
and sample collection increased the PCR case confirmation rate from
initially less than 50% to 70%. With a PCR case confirmation rate
of 54% for the entire study period the WHO standards (case
confirmation rate >= 50%) have been met. EQA for microscopy
suggests the need for intensified supervision and training. In
January 2011 the National Hygiene Institute, Lome, has assumed the
role of a National Reference Laboratory for PCR confirmation and
microscopy.