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Journal of Clinical Microbiology, June 2009, p. 1700-1704, Vol. 47, No. 6
0095-1137/09/$08.00+0 doi:10.1128/JCM.00197-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Fine-Needle Aspiration, an Efficient Sampling Technique for Bacteriological Diagnosis of Nonulcerative Buruli Ulcer 
Miriam Eddyani,1*
Alexandra G. Fraga,2
Fernando Schmitt,3
Cécile Uwizeye,1
Krista Fissette,1
Christian Johnson,4
Julia Aguiar,5
Ghislain Sopoh,6
Yves Barogui,7
Wayne M. Meyers,8
Jorge Pedrosa,2 and
Françoise Portaels1
Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium,1 Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal,2 Institute of Molecular Pathology and Immunology and Medical Faculty, Porto University, Porto, Portugal,3 Programme National de Lutte contre l'Ulcère de Buruli, Cotonou, Benin,4 Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin,5 Centre de Dépistage et de Traitement de l'Ulcère de Buruli, Allada, Benin,6 Centre de Dépistage et de Traitement de l'Ulcère de Buruli, Lalo, Benin,7 Armed Forces Institute of Pathology, Washington, DC 203068
Received 30 January 2009/ Returned for modification 20 March 2009/ Accepted 9 April 2009
Invasive punch or incisional skin biopsy specimens are currently employed for the bacteriological confirmation of the clinical diagnosis of Buruli ulcer (BU), a cutaneous infectious disease caused by Mycobacterium ulcerans. The efficacy of fine-needle aspirates (FNA) using fine-gauge needles (23G by 25 mm) for the laboratory confirmation of BU was compared with that of skin tissue fragments obtained in parallel by excision or punch biopsy. In three BU treatment centers in Benin, both types of diagnostic material were obtained from 33 clinically suspected cases of BU and subjected to the same laboratory analyses: i.e., direct smear examination, IS2404 PCR, and in vitro culture. Twenty-three patients, demonstrating 17 ulcerative and 6 nonulcerative lesions, were positive by at least two tests and were therefore confirmed to have active BU. A total of 68 aspirates and 68 parallel tissue specimens were available from these confirmed patients. When comparing the sensitivities of the three confirmation tests between FNA and tissue specimens, the latter yielded more positive results, but only for PCR was this significant. When only nonulcerative BU lesions were considered, however, the sensitivities of the confirmation tests using FNA and tissue specimens were not significantly different. Our results show that the minimally invasive FNA technique offers enough sensitivity to be used for the diagnosis of BU in nonulcerative lesions.
* Corresponding author. Mailing address: Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. Phone: 32(0)32476336. Fax: 32(0)32476333. E-mail: meddyani{at}itg.be
Published ahead of print on 22 April 2009.
Journal of Clinical Microbiology, June 2009, p. 1700-1704, Vol. 47, No. 6
0095-1137/09/$08.00+0 doi:10.1128/JCM.00197-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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