Rapid molecular diagnosis of chronic skin ulcers
Authors: Sapna Pahil, Kapil Goyal
Journal: The Lancet Global Health (2014)

Oriol Mitjà and colleagues1Mitjà O Lukehart SA Pokowas G et al.Haemophilus ducreyi as a cause of skin ulcers in children from a yaws-endemic area of Papua New Guinea: a prospective cohort study.Lancet Glob Health. 2014; 2: e235-e241Summary Full Text Full Text PDF Scopus (84) Google Scholar provide insight into the cause of chronic skin ulcers in a yaws-endemic area of Papua New Guinea. PCR was used to detect Haemophilus ducreyi in swabs collected from chronic skin ulcers. Conventional microbiological techniques, such as isolation of fastidious microorganisms by culture, are time-consuming and difficult. The investigators show the usefulness of the PCR technique to diagnose H ducreyi infection. Clinicians should consider this previously unrecognised causative agent of skin ulcer in children living in a yaws-endemic area. Sally Roberts and Susan Taylor2Roberts SA Taylor SL Haemophilus ducreyi: a newly recognised cause of chronic skin ulceration.Lancet Glob Health. 2014; 2: e187-e188Summary Full Text Full Text PDF Scopus (6) Google Scholar summarise some facts on the diagnosis and treatment of skin ulcers. Accurate diagnosis and laboratory confirmation are important for clinicians to provide timely therapy. Without a point-of-care test, empirical use of antimicrobials can lead to drug resistance.2Roberts SA Taylor SL Haemophilus ducreyi: a newly recognised cause of chronic skin ulceration.Lancet Glob Health. 2014; 2: e187-e188Summary Full Text Full Text PDF Scopus (6) Google Scholar Therefore, there is a need for a diagnostic technique that does not involve costly equipment and that can be used even in remote areas. The development of a multiplex3Orle KA Gates CA Martin DH Body BA Weiss JB Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers.J Clin Microbiol. 1996; 34: 49-54PubMed Google Scholar loop-mediated isothermal amplification4Tomita N Mori Y Kanda H Notomi T Loop-mediated isothermal amplification (LAMP) of gene sequences and simple visual detection of products.Nat Protoc. 2008; 3: 877-882Crossref PubMed Scopus (1224) Google Scholar (LAMP) assay can identify many causative agents in a single reaction and within a short time, without a thermocycler and gel documentation system. Thus, LAMP could have future application as a point-of-care test for the diagnosis of chronic skin ulcers. We declare no competing interests. Haemophilus ducreyi as a cause of skin ulcers in children from a yaws-endemic area of Papua New Guinea: a prospective cohort studyIn this yaws-endemic community, H ducreyi is an important and previously unrecognised cause of chronic skin ulceration. Reactive syphilis serology caused by latent yaws can occur in ulcers with the presence of H ducreyi alone. The introduction of PCR for ulcer surveillance could improve the accuracy of diagnosis in countries with yaws eradication campaigns. Full-Text PDF Open AccessRapid molecular diagnosis of chronic skin ulcers – Authors' replyWe thank Sapna Pahil and Kapil Goyal for their interest in our work. Our research has identified a previously unrecognised cause of skin ulcers in the tropics, namely Haemophilus ducreyi.1 Although there had been several case reports implicating this organism as a causative agent of chronic skin ulceration, we show that this is indeed a very common pathogen in the tropics and that it can be a confusing factor in the diagnosis of yaws. Full-Text PDF Open Access