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Developing and validating a clinical algorithm for the diagnosis of podoconiosis

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Version 2 2023-06-07, 08:55
Version 1 2023-06-07, 07:41
journal contribution
posted on 2023-06-07, 08:55 authored by Kebede Kassaye, Lyndsey Florence, Abebe Kelemework, Tigist Getaneh, Girmay Tsegay, Jorge Cano, Emanuele Giorgi, Melanie NewportMelanie Newport, Gail DaveyGail Davey
Background Difficulties 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. Methods We 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. Results Based 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). Conclusions We 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.

Funding

The Global Atlas of Podoconiosis; G1974; WELLCOME TRUST; 201900/Z/16/Z

History

Publication status

  • Published

File Version

  • Published version

Journal

Transactions of the Royal Society of Tropical Medicine and Hygiene

ISSN

0035-9203

Publisher

Oxford University Press

Issue

12

Volume

114

Page range

916-925

Department affiliated with

  • Global Health and Infection Publications

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2020-08-04

First Open Access (FOA) Date

2020-11-16

First Compliant Deposit (FCD) Date

2020-08-03

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