TABLE 1.

Diagnostic methods for Buruli ulcer

Method	Advantages	Disadvantages
Acid-fast stain microscopy	1. Performed in many countries in the world for diagnosis of tuberculosis	1. Least sensitive and specific of the methods (around 30–40%); however, in patients with classic presentation in an area with high prevalence, a positive result is strongly suggestive of Buruli ulcer
	2. Can be performed in swabs and fine needle aspirates
	3. Requires minimal equipment and reagents
	4. Requires the least amt of technical expertise compared to the other methods
Culture	1. Reference standard with highest specificity	1. Takes 9 to 12 wk to grow even under optimal conditions (temp, 29–33°C; oxygen concn, 2.5–5%)
	2. Can be performed with swabs, fine-needle aspirates, and tissue
	3. Used in cases that do not respond to treatment or when there is a relapse	2. Once growth is present, there is need for use of PCR or MALDI-TOF MS for identification
PCR	1. Most sensitive method for Buruli ulcer cases (detects 54–84% of cases depending on the series)	1. No standardized protocols (mostly laboratory-developed assays)
	2. Can be performed with swabs, fine-needle aspirates, and tissue	2. Requires specialized equipment and, for the most part, a cold chain for reagents
	3. Very specific when targeting the IS2404 gene	3. Requires trained personnel performing the assays
		4. May detect nonviable organisms
Histopathology	1. Best at finding other potential causes of nodules and ulcers (differential diagnosis)	1. Requires obtaining tissue (biopsy or resection)
		2. Requires a pathology laboratory (ability to paraffin embed, cut, and stain the tissue)
		3. Needs highly trained personnel (physician trained in pathology) to read the biopsy result