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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Developing and validating a clinical algorithm for the diagnosis of podoconiosis
AU - Deribe, Kebede
AU - Florence, Lyndsey
AU - Kelemework, Abebe
AU - Getaneh, Tigist
AU - Tsegay, Girmay
AU - Cano, Jorge
AU - Giorgi, Emanuele
AU - Newport, Melanie J.
AU - Davey, Gail
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BackgroundDifficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization–recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis.MethodsWe identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti–specific immunoglobulin G4 in the field using Wb123.ResultsBased on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100).ConclusionsWe developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.
AB - BackgroundDifficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization–recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis.MethodsWe identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti–specific immunoglobulin G4 in the field using Wb123.ResultsBased on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100).ConclusionsWe developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.
KW - diagnosis
KW - clinical algorithm
KW - clinical decision algorithms
KW - Ethiopia
KW - lymphoedema
KW - podoconiosis
U2 - 10.1093/trstmh/traa074
DO - 10.1093/trstmh/traa074
M3 - Journal article
VL - 114
SP - 916
EP - 925
JO - Transactions of The Royal Society of Tropical Medicine and Hygiene
JF - Transactions of The Royal Society of Tropical Medicine and Hygiene
SN - 0035-9203
IS - 12
ER -