Wishing you all a happy 2010!

• Suggestions
• Dynamic diagnosis
• Usability improvements

Suggestions
Until now, GIDEON’s Diagnosis Compare function has ranked signs and symptoms which are most likely to impact the Differential Diagnosis list. Now, the top four clinical findings which are most likely to focus and shorten the list of possible diseases are displayed and dynamically updated as each new sign or symptom is entered. Clickable boxes which allow the user to enter a “yes”, “no” or “unknown”, appear and enlarge each time the mouse passes near a perspective finding.

Dynamic diagnosis

The Diagnose button has been eliminated! Now, the differential diagnosis list updates automatically as you enter signs and symptoms. This feature demonstrates the effects of each new sign or symptom as it is entered.
The First case scenario list still appears below the diagnosis list.
The familiar buttons: Compare, Why Not, Open case, Save case, Remove All, Print, Email are all in the Diagnosis Results area.

Usability improvements

Country and incubation period in symptom list
Country name and Incubation period have been appended to the Clinical Presentation list.  Now, whenever you indicate a country name, or dates of exposure, the Differential diagnosis list instantly re-adjusts accordingly.

Collapsible windows
Windows, such as Suggestions and Clinical Summary can be minimized and hidden. For example to not see suggestions, click on the minimize button to the left title.

Mouse overs
More mouse-overs have been added: Clickable boxes expand as you mouse over them, and display clear symbols to select “yes” or “no.”

Clinical Summary
You can now click on the signs and symptoms in the Clinical Summary. Clicking on Country will display “Worldwide”. Clicking again displays the country.

Quick sorting
Diagnosis results can be sorted alphabetically or by probability easily by clicking the column title.

Resize window
Changing vertical window size expands size of Clinical presentation and Diagnosis results sub-windows. This is a great feature for larger monitors.

Previous version
Click “Original diagnosis” to use the older interface.

Using the database of the Global Infectious Disease and Epidemiology Network (GIDEON ) to see possible etiologies for a hemorrhagic fever syndrome in China, the most likely diagnosis would be Old World hantavirus infection (57 percent probability), followed by _Streptococcus suis_ infection (40 percent), leptospirosis (1.8 percent) and Crimean-Congo hemorrhagic fever (CCHF — less than one percent probability).

According to the GIDEON database, hantaviruses are endemic in 28 of the 32 provinces, with most cases occurring in the eastern and northeastern provinces (where Shandong is located). Hantaan virus is endemic to Hubei, Heilongjiang, Jiangxi, Jilin and Shanxi. (Fang LQ, Li CY, Yang H, Wu XM, Yang H, Chen HX, Li XW, Cao WC [Using geographic information system to study the association between epidemic areas and main animal hosts of hemorrhagic fever with renal syndrome in China.] Zhonghua Liu Xing Bing Xue Za Zhi 2004 Nov ;25(11):929-33.

- 52.2 percent of infections in Hubei are caused by Hantaan virus, and 31.5 percent by Seoul virus.
- Most infections in Shandong province are caused by Seoul virus. (Wang ZQ, Wang YL, Fu JH, Zhao L, Sun CY, Zhang XQ, Zhang YX, Fan SZ, Wang ND [Molecular analysis of hantavirus isolated from Shandong province]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2003 Jun ;17(2):121-3.)
- Seoul virus was identified in humans and rodents (_Rattus norvegicus_ and _Mus musculus_) in Beijing during 2003 to 2005. (Zuo SQ, Zhang PH, Jiang JF, Zhan L, Wu XM, Zhao WJ, Wang RM, Tang F, Dun Z, Cao WC. Seoul virus in patients and rodents from Beijing, China. Am J Trop Med Hyg 2008 May ;78(5):833-7.

A new Puumala virus subtype, most closely related to strains from Japan and South Korea, has been isolated from bank voles in Northeast China. (2007 publication) (Tang LH, Zhang QF, Xiu MH, Gu GW, Bo S, Yang XD, Liang MF, Li DX [Identification of a new Puumala hantavirus subtype in rodents from China] Bing Du Xue Bao 2007 Jul ;23(4):320-5. The abstract does not give any information about human infection by it.

ProMED-mail has reported on hantavirus outbreaks in China earlier this year in Inner Mongolia (see Hantavirus infection – Taiwan ex China (Inner Mongolia) 20080119.0249), and in prior years (see references below)

According to the GIDEON database, CCHF has been reported from the southwestern desert region in Xinjiang province and is referred to as Xinjiang fever. Hence it would be a significant geographic change were this outbreak to be due to CCHF. There is also mention that 10 to 20 percent of sheep, goats and cattle in Sichuan are seropositive — so movement of livestock from the southwest to other provinces may very well move the disease geographically.

One should not forget the earlier major outbreaks of _Streptococcus suis_ in China in 2005. A recurrence of the problem is possible.

It is noteworthy that according to the question and answer part of the referred media report, there is mention that the cases to date have been in predominantly in men, suggesting that exposure may well be occupational, which places both hantavirus infection and _Streptococcus suis_ as leading possibilities for the etiologic agent for this outbreak. The outbreak is occurring in a rural zone where there is a high likelihood of exposure of males to rodents and to the porcine population during usual occupational activities in an agricultural zone.

In the Diagnosis module, the mouse-over description for symptoms will display the code, if available. For example, to the left is the description for “Jaundice”.

The General tab of diseases in Epidemiology will display the ICD9 and ICD10 codes below the list of disease synonyms. Synonyms and codes for Babesiosis:

The codes have been integrated both into diagnosis and text search. So if you want to diagnose an infectious disease based on the ICD9 and/or ICD10 codes for symptoms, just enter them in diagnosis search and click the button.

Likewise if you’re searching for a disease based on the ICD9 or ICD10 code, enter the code in text search and click.

When one checks GIDEON (Global Infectious Disease and Epidemiology Network) for the clinical picture associated with contact with animals, one gets 3 main possibilities — Q fever, ornithosis, and bunyaviridae. Of the bunyaviridae family, one does think of Rift Valley fever (RVF) as consistent with this clinical picture, but the involvement of poultry rules this out, as the RVF virus does not affect avians. Gideon also gives a “1st case scenario”, where it “ignores” the geographic location of the outbreak in the event that this is a new geographic extension of an otherwise known pathogen. In this case, the GIDEON program suggested Congo-Crimean hemorrhagic fever (CCHF).