Developing and validating a clinical algorithm for the diagnosis of podoconiosis

Kassaye, Kebede, Florence, Lyndsey, Kelemework, Abebe, Getaneh, Tigist, Tsegay, Girmay, Cano, Jorge, Giorgi, Emanuele, Newport, Melanie J and Davey, Gail (2020) Developing and validating a clinical algorithm for the diagnosis of podoconiosis. Transactions of the Royal Society of Tropical Medicine and Hygiene, 114 (12). pp. 916-925. ISSN 0035-9203

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Abstract

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.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 04 Aug 2020 09:05
Last Modified: 23 Feb 2022 12:45
URI: http://sro.sussex.ac.uk/id/eprint/92914

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Project NameSussex Project NumberFunderFunder Ref
The Global Atlas of PodoconiosisG1974WELLCOME TRUST201900/Z/16/Z