Novel Diagnostics for Kaposi Sarcoma and Other Skin Diseases in Resource-Limited Settings.

In resource-limited settings, point-of-care diagnostic devices have the potential to reduce diagnostic delays and improve epidemiologic surveillance of dermatologic conditions. We outline novel-point-of care diagnostics that have recently been developed for dermatologic conditions that primarily affect patients living in resource-limited settings, namely, Kaposi sarcoma, cutaneous leishmaniasis, leprosy, Buruli ulcer, yaws, onchocerciasis, and lymphatic filariasis. All of the technologies described in this article are prototypes, and some have undergone field testing. These devices still require validation in real-world settings and effective pricing to have a major impact on dermatologic care in resource-limited settings.

Integrated approach in the control and management of skin neglected tropical diseases in three health districts of Côte d'Ivoire.

BACKGROUND: Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw. METHOD: This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting. RESULTS: We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions. CONCLUSIONS: The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.

The significance of the V.D.R.L., R.P.C.F., and F.T.A.-ABS tests in the diagnosis of syphilis in Jamaica

A study was conducted in Jamaica on 401 patients consisting of 228 clinically diagnosed cases of syphilis, 20 cases of yaws, 50 cases of leprosy, and 102 "problem cases", from among patients interviewed who were attending the Government clinics at May Pen and Kingston. In addition there were patients from the Hospital of the University of the West Indies, and the Hansen Home, a leper hospital in Spanish Town. The purpose of the investigation of the V.D.R.L., R.P.C.F. and F.T.A.-Abs. tests in the serology of syphilis in the island, where yaws was once very prevalent, and to determine the incidence of biological false positives in some cases of leprosy. The V.D.R.L. test was reactive in 67.3 percent; the R.P.C.F. test was reactive in 77.5 percent; and the F.T.A.-Abs. test was reactive in 86.0 percent of all cases. Cases of yaws still appear, but the characteristics of lesions may be changed due to environmental and other factors. An incidence of 6.7 percent and 5.8 percent biological false positives were obtained with the V.D.R.L. test in lepromatous and tuberculoid leprosy respectively. The incidence of congenital syphilis appears to be high. Syphilis as a whole appears to be more concentrated in the poorer areas as well as in a relatively young age group in Kingston. The necessity for increased health education in those areas is suggested and an epidemiological survey on an island wide basis is indicated. Since none of the tests used adequate differentiates between yaws and syphilis, a detailed clinical history and examination of "problem cases" appears necessary before a final diagnosis is made and treatment given (AU)