In Telek Ayove and colleagues report a

In , Telek Ayove and colleagues report a comparison of the Dual Path Platform (DPP) Syphilis Screen and Confirm test (Chembio Diagnostic Systems, Medford, NY, USA) with non-treponemal (RPR) and treponemal (TPHA) serological tests for diagnosis of yaws in two remote communities in Papua New Guinea with a high prevalence of the infection. The DPP point-of-care test detects treponemal (T1) and non-treponemal (T2) dna staining simultaneously. When compared with TPHA, the DPP T1 test had a sensitivity of 88·4% and specificity of 95·2%. By comparison with the RPR test, the DPP T2 test had a sensitivity of 87·9% and specificity of 92·5%. However, sensitivity of the DPP T2 test rose to 94·1% for specimens with higher quantitative RPR titres—ie, 1:8 or higher. Furthermore, the combined results of the DPP T1 and T2 tests had a sensitivity of 93·9%, compared with the combined results of reactive TPHA and high-titre RPR, which together are judged indicative of true yaws infection. The key value of the DPP test resides in the non-treponemal T2 part, which provides rapid and accurate results for field diagnosis of active untreated yaws infection with only finger-stick blood. Moreover, T2 optical density measurements taken before and after treatment (assessed with an automatic reader) fell progressively after treatment, showing a response comparable with that of quantitative RPR titres and, thus, possibly providing a way to monitor the effectiveness of treatment. Although advances in the treatment and diagnosis of yaws should substantially help eradication efforts, several uncertainties related to the biology and epidemiology of the disease merit consideration, because they could impede eradication. First, the availability of a vaccine and the absence of a non-human reservoir were key factors for smallpox eradication. However, no vaccine is available for yaws and non-human primates might be a reservoir for the disease. Second, because of the scarcity of adequate surveillance data, the true burden and distribution of yaws is currently unknown. Third, although azithromycin is effective for treatment of yaws, resistance could emerge to this macrolide antibiotic, which has been reported for the syphilis agent. Fourth, although the DPP test worked well for diagnosis of yaws in a setting of high prevalence, the positive predictive value of the DPP T2 test will diminish when the prevalence of yaws falls to very low levels, leading to false-positive results and the need for a more specific test to ensure that transmission has been interrupted. Fifth, limited access to mobile populations in remote, sometimes dangerous, areas is a logistical difficulty that must be overcome to prevent reintroduction of yaws to treated communities. Despite the many hurdles, yaws eradication remains a worthwhile goal that, if successful, would prevent the suffering of thousands of people, particularly children, who are most affected by this neglected tropical disease. The recent elimination of yaws in India, which was the result of an intensive government-backed programme, along with these advances in treatment and diagnosis, rekindle the hope that yaws eradication could be possible, as long as sufficient resources and strong political commitment are available for the very long term.
Buruli ulcer is a necrotising skin and soft tissue disease caused by the environmental bacterium . The organism belongs to the same family as those that cause leprosy and tuberculosis, but uniquely, produces the toxin mycolactone, which causes tissue damage. Clinical manifestations include nodules, oedema, and plaques, but the most typical presentation is a large ulcer, usually on the limbs. Buruli ulcer is rarely fatal, but victims are often left deformed and with permanent disability. Under-reporting of the disease is a major problem in several countries. Although advances in treatment have been made with WHO\'s recommendation of the use of combined antibiotic treatment with rifampicin and streptomycin for 8 weeks for all types of lesion, laboratory confirmation of clinical diagnosis is still a limiting factor. The development of a PCR test that targets IS2404 (an insertion sequence found on the genome) allows accurate diagnosis, but is available only in reference laboratories that are far from areas endemic for Buruli ulcer. Microscopy is available in local health facilities, but is less sensitive than PCR testing. To ensure standardised recording and reporting of cases, WHO developed the Buruli ulcer clinical and treatment 01 form to collect clinical and laboratory data for all patients with suspected or confirmed Buruli ulcer.