What is GIDEON? +
GIDEON is the world’s premier global infectious disease knowledge management tool. It is an easy to use online application that helps you diagnose infectious diseases and stay up to date on the latest trends in epidemiology and treatment.
What does GIDEON stand for? +
Global Infectious Disease and Epidemiology
How do I sign up for a free trial of GIDEON? +
How do I order GIDEON? +
See ordering GIDEON.
How do I cancel my account? +
If you signed up for a free trial, your account will expire automatically at completion. If you wish to cancel your subscription, click on the link in your email receipt or contact us.
How are signs, symptoms and laboratory tests selected for inclusion in GIDEON? +
Signs and symptoms incorporated in GIDEON are those generally used by specialists in the field. Most are easy to assess, and discriminative in the consideration or elimination of large groups of individual diseases. Similarly, the phenotypic tests listed in the Microbiology module are useful in the identification of large subgroups of bacteria, or the identification of individual major taxa. For example, one of our users asked, ‘Why is yellow pigment included, but not red pigment?’ The presence or absence of yellow pigment is extremely important in the identification of major human pathogens; while red color is limited to only a few minor taxa. In addition to these considerations, one must realize that each symptom or phenotypic test occupies an extremely long column in one of the GIDEON spread sheets – with additional concerns of computer space, speed, etc.
Is GIDEON an Evidence based medicine (EBM) database? +
Yes, since all sources are peer-reviewed and backed by scientific evidence – most are considered the premier scientific sources. Uncontrolled, or poorly-analyzed studies will not appear in these publications. This also holds for websites used in maintaining GIDEON. Virtually all are governmental sites. Reputable computer lists in the field are used, in a manner which fits the standards of evidenced-based medicine. For example, although ProMED is considered THE site for new and ongoing outbreaks, many of its own sources consist of newspapers and news agencies. Therefore we cite ProMED in circumstances where they this is the only information source for a given outbreak (often in underdeveloped and remote; new information sources which become available will also be included.
The reference feature in GIDEON further supports GIDEON as an Evidence Based Medicine database by allowing the user to view all source information, and to reach their own conclusions regarding the credibility of those sources if needed.
How are the data in GIDEON collected? +
The data in GIDEON are accessed and collated through a system of computer macros and dedicated source lists developed over the past 25 years. A monthly search of PubMed is conducted against a listing of all GIDEON key words, and titles / abstracts of interest are reviewed. All available national Health Ministry publications [print and electronic] are scanned, as are standard publications of WHO and CDC. Relevant peer-reviewed publications (Infectious Diseases, Microbiology, Antimicrobial Agents, Tropical Medicine, etc) are continually examined for relevant articles. A partial listing of resources appears here.
Which scientific journals are resources for GIDEON? +
Please refer to Resources.
What time span does GIDEON cover? +
Most diseases are covered from the 1920’s. There are smallpox graphs that start in the 1880’s to 1890’s (Egypt and Japan), and outbreaks covered from from as early as 1770 (anthrax), 1793 (botulism), 1832 (cholera), 1850 (dengue).
How does GIDEON provide disease statistics from some small countries, such as countries in Africa? +
The sources for data included in GIDEON currently include all relevant health ministry publications (electronic and print), peer review journal publications and standard texts. A partial listing is available. The quality and frequency of data input vary widely from source to source. GIDEON is updated every few days and daily when major events occur (ie, new case of avian influenza or an Ebola outbreak). A summary of newly added data is available at Updates link. When possible, data are assigned an electronically-linked reference number; and when any user requires further details regarding sources, they are encouraged to contact us through the feedback link.
The literature suggests that GIDEON is updated in "real-time"; however, my understanding is that GIDEON updates content in the form of a weekly batch process. Could you clarify the true meaning of real time? +
GIDEON is updated every few days, see updates. “Real-time” may be used as a descriptive term relative to the typical publishing cycle of months and years.
What aspects of GIDEON can be modified by the end-user? +
In addition to published materials, GIDEON relies on user input to provide corrections and new information – which after verification appear in the next update. Provide feedback.
The Personal Notes box allows users or admins to add additional information relevant to their practice or insitution.
How can I use GIDEON when I am visiting patients away from the computer? +
GIDEON access is available on most mobile devices.
What are the limitations of GIDEON's Diagnosis module? +
GIDEON assumes that:
1. a single, Infectious Disease is responsible for the signs and symptoms entered. Non-infectious diseases may also produce fever, leukocytosis, etc.
2. all clinical findings are causally related to the Infectious Disease in question. Clinical findings which predate the infection or are related to an underlying disease should not be entered in the Signs / symptoms list.
Seemingly long and irrelevant Differential Diagnosis lists result from failure to enter all positive AND NEGATIVE clinical findings.
The GIDEON disease base does not include:
1. Self defined and obvious infectious diseases which should not require computer diagnosis: paronychia, otitis externa, phlebitis, suppurating wounds, olecranon bursitis, etc.
2. Conditions which are not diagnosed and treated by specialists in Infectious Diseases: human papillomavirus infections, Creutzfelt-Jakob disease, Helicobacter gastritis, etc.
What is the "GIDEON First case scenario - differential diagnosis"? +
The diseases listed are compatible with the signs and symptoms selected, but are not endemic to the chosen country. This tool was developed in consultation with the World Health Organization, and is designed to identify the initial cases of known diseases in new settings; ie, SARS in Canada (2003), Monkeypox in the United States (2003) West Nile fever in the United States (1999), Japanese spotted fever in Korea (2004), etc. For an example of use, see First Case Scenario.
How does GIDEON circumvent the ambiguity of less accurate information, i.e. "suspected" vs "reported" vs "confirmed" cases...? +
The reliability of information in GIDEON is only as reliable as the primary source. As such, “suspect cases” , “reported outbreaks” etc are quoted as given with a reference link.
GIDEON is only limited to infectious diseases. Won't this mislead the clinician? +
This problem has existed long before the creation of GIDEON. Several disclaimers in the program warn the user that non-infectious diseases may mimic infection, and that the program is not intended as a replacement for sound clinical judgment.
Is Avian flu listed as a diagnosis in your database? +
GIDEON covers ‘Avian flu’ under the heading “Influenza.”
Often, users search for Disease names, Country names, etc using alternative terminology – notably because this program is used by English and non-English speakers, worldwide. In the Diseases module, click on the ‘Synonyms’ button [upper left] and scroll to ‘Avian influenza’ or ‘Bird flu’ – GIDEON will automatically access ‘Influenza.’ Note that this Synonyms list also contains the Spanish, French, Norwegian, etc term for all diseases in the program.
I couldn't locate Avian Flu and thought it should come up as a potential for the set of symptoms I put in: fever, adult patient, meat and poultry ingestion, diarrhea, vomiting, pneumonia or lung infiltrate? +
When a given disease does not appear in the Diagnosis list, you can ‘ask’ for an explanation from GIDEON. If you run the symptoms, “fever, adult patient, meat and poultry ingestion, diarrhea, vomiting, pneumonia or lung infiltrate” … Influenza does not appear. Click on the ‘Why not’ button for an explanation, and scroll to ‘Influenza.’
In this case, Influenza was not considered because you indicated ‘Meat and poultry’ ingestion. Although WHO has warned travelers against eating undercooked poultry in Asia, no cases of Influenza (including Avian influenza) have been acquired through ingestion.
Perhaps you are referring to bird Contact. In the list of symptoms, scroll to Exposure – Animal injury, contact… Open this list and click on ‘Bird contact’ .. and re-run the case.
For a comprehensive and up-to-date summary of Avian flu, go to the Diseases module, click on Disease = Influenza [lower left], and Country = ‘Worldwide’ [upper right]. See resulting note. Similar focused notes are available for individual countries: Thailand, Indonesia, etc.
During a recent outbreak, why did newspapers report Avian Influenza in more countries than are listed by GIDEON? +
GIDEON only reports cases after they are confirmed by WHO / Authorized reference lab. Individual countries and the media often report new cases of “bird flu”, only to retract these reports after a day or two. In some cases they report H5N1, and it later turns into H5 – not N1. Many reports are simply rumors.
The Canary Islands and Aruba are listed among the countries in GIDEON. Why not Curacao, Saint Martin and Corsica? +
In addition to established and independent entities such as France and Tonga, GIDEON has assigned “country” status to Puerto Rico, French Polynesia, Martinique and several other island states which are ruled / politically linked to other nations. The existence of published data and a useful reporting system allow us to integrate these entities into the Diagnosis and Diseases modules. A Zika virus outbreak has increased awareness the medical situation in Curacao, Saint Martin, St. Maarten. Currently, these islands will remain within the “Netherlands Antilles” grouping in GIDEON.
Why are some vital signs missing from GIDEON's list of signs and symptoms? +
Vital signs consist of temperature, pulse, blood pressure and respiratory rate. The pulse rate can increase in any systemic infection; and fails to increase in over 20 infectious diseases [click + next to Fever = Relative bradycardia]. Any severe systemic infection may be associated with an increase in pulse or decrease in blood pressure. Although tachypnea and hypotension are useful prognostic indicators, neither is specific or helpful in differentiating among most of the diseases in GIDEON.
How do I enter a cluster of patients having the same signs and symptoms? +
Open the last symptom group in the GIDEON diagnosis module – “Exposure” – choose the first option that appears: “Case Cluster.”
Mousing over this heading produces the following text box: “Assumes that this infection was acquired from another patient; or related to an ongoing outbreak. Enter only “typical” clinical features shared by several patients”.
Are there any plans to further expand the Symptoms and Signs section of the Diagnosis module? One of the considerations is a more elaborate Fever option e.g. intermittent versus remittent and less than or greater than 100 F (38 C) temperature trending. +
The symptoms and signs list has been expanding all along – largely based on user request. Four criteria are used in assignment of clinical signs used in the Diagnosis module of GIDEON:
1) accessibility of the sign to clinicians;
2) relevance of the sign to a substantial number of diseases in GIDEON;
3) availability of published data regarding percent presence / absence of the sign in each disease;
4) ability of the sign to significantly alter disease ranking;
Some of the issues involved:
1. A new symptom requires entry of statistical fit (chance of occurrence) for ALL diseases in the database. In the examples provided, useful published data regarding fever pattern may exist for only 50% of the diseases – the spread sheets employed do not allow for a null or ‘We don’t know’ option. You will note that such an option (‘Missed test’) exists in the Microbiology modules.
2. Most new symptoms added at this point will be useful only in affecting the relative ranking of diseases in the Diagnosis list – and would not serve to rule out specific diseases. Thus the actual extent of fever (38 vs. 39 vs. 40) is not that useful in discounting any given disease [for example: people with septic shock may be afebrile, while we’ve all seen 40+ in influenza] – and would require a number of disclaimers (oral vs. rectal; antipyretics given?; time of day). Indeed, a comprehensive differential diagnosis list is often more useful to the clinician than the actual ranking of that list.
3. If possible, new symptoms/signs are restricted to those which carry discriminative value for the more common or ‘important’ diseases. Thus, ‘Long subcutaneous legworm’ , albeit a very useful diagnostic finding for dracontiasis – is helpful in diagnosing only a single disappearing disease. Similarly, in the Microbiology module ‘Red pigment’ is a finding which might be relevant to only one group of nonfermenters + one facultative rod; while ‘Yellow pigment’ is of obvious importance for several key taxa.
Why are HPV and Kuru not included in GIDEON? +
GIDEON has been designed to follow the practical aspects of Clinical Infectious Diseases. As such, it does not contain a number of diseases which are clearly ‘infectious’ … but rarely treated by the ID clinician. Thus, you will not find the following in GIDEON:
– CJD, Kuru, Multifocal leukoencephalopathy [Neurology]
– Viral leukemias, lymphomas, Kaposi’s sarcoma [Hematology, Oncology]
– Nasopharyngeal carcinoma, Leukoplakia [ENT]
– HPV infection, Uterine cervical dysplasia [Gynecology, Oncology]
– Helicobacter infection, gastritis / peptic ulcer [Gastroenterology]
Why is Monkey Pox not listed as endemic to the U.S? +
GIDEON did in fact include the United States as an ‘endemic’ country for monkeypox during the 2003 outbreak; however, the disease is no longer reported from this country. There is an option in the Diagnosis module which lists when a “first case” = heretofore non-endemic disease is suspected.
How is susceptibility defined in the Drugs module? Is it based on FDA approval? +
‘Susceptible [sensitive]’ in GIDEON is defined as >=50% of strains susceptible to therapeutic drug levels. In many cases, this material comes from journal publications. FDA approval might take years after publication. Susceptible is not defined as ‘FDA-approved’ since the process is very slow, and does not necessarily represent standards outside of the US.
Why does the Microbiology module lack information about Parasites? +
The Microbiology module is designed to identify bacteria [yeasts, mycobacteria] based on phenotypic tests. In theory, this could extend to parasites, based on a long list of relatively obscure morphological criteria [aphasmid, nematode, vaginal pore, position of gonads, etc]. This could also be used to identify viruses [ether solubility, isocahedron, etc]. In either instance – much work for a limited user list. Much of the practical ID is in the current Diseases module. For example, click on agent = Apicomplexa and then search to access a list of Apicomplexa. Then Apicomplexa, vector = tick, country = United States to focus the list. For example, you can access a list of Trematodes acquired from Fish in the Republic of Korea.
There is no listing of viruses in the Microbiology module. Does GIDEON have information on viruses? +
GIDEON Infectious Diseases module includes all viruses associated with human disease, including a few which have been reported only once or twice. If the user does not find a specific virus in the list of diseases (Diseases module) they can click on the Synonym button (upper left); or they can write the name of the virus in the Search box (upper right). Viruses and Parasites are not presented in the Microbiology module because, unlike bacteria-mycobacteria-yeasts, they are not identified using simple laboratory tests (sugar fermentation, appearance on stained smears, motility).
Does GIDEON include information on "mold" or "aspergillus"? +
Aspergillus is extensively covered in the Diseases module (as “Aspergillosis”) and Drugs module. Type “Aspergillus” into the search box at upper right of screen – you will find several other notes. Other molds are covered in the Diseases module as specific diseases (Zygomycosis, Coccidioidomycosis, Sporotrichosis…etc) or grouped under “Fungal infection – invasive – systemic.”
The Microbiology module covers bacteria and yeasts. Molds are identified on the basis of a long list of sophisticated morphological parameters – size and position of spores / septae / buds, color of hyphae, changes in growth according to temperature, etc, etc. An identification key for this mass of information would not be useful for most Infectious Diseases specialists.
Why are there discrepancies regarding time line information for boosters of Typhim Vi and Oral Typhoid? +
Recommendations regarding Typhoid vaccines are inconsistent. For example, the Berna and CDC websites suggest that a booster following a 4-dose schedule of Vivotif be administered after four years. Others suggest a booster at seven years following a 3-dose schedule (RXMed.com). The CDC website recommends a booster at 2 years following Typhim Vi (CDC ). A position paper by OMS recommends a booster at 3 years for both vaccines ( referring to 3-dose initial schedule for oral typhoid).
How can I check to see which vaccines are required for different Countries? +
Extensive vaccine information is displayed in three modules, as follows:
1. Drugs – Vaccines. A complete and up-to-date discussion of all vaccine and globulin preparations, worldwide: Vaccine content, dosing and boosters, side effects, contraindications and trade names. Information can be accessed by specific generic name, trade name, side effect or contraindication.
2. Diseases. Extensive text outlines the status of all diseases requiring vaccination, both on a global scale (Worldwide notes, Clinical tab) or country-by-country (ie, scroll to a specific disease, and then the country in question). Each relevant disease note follows the status of each of these diseases – including areas of risk within every country (ie, Yellow Fever, Tick-borne encephalitis, Meningitis-bacterial) and official vaccine recommendations (ie, Yellow fever – country and CDC recommendations). The national routine immunization schedule for every vaccine is also outlined, where relevant (measles, BCG, poliomyelitis, etc).
3. Travel. Clicking on each of the countries listed in the “Region” box will display a comprehensive summary of vaccine requirements for that country, as well as recommendations regarding malaria prophylaxis and the routine vaccination schedule suggested by the country itself to its own population.
How do I access information regarding malaria prophylaxis in a specific country? +
Malaria prophylaxis advice is based on the presence or absence of chloroquine-resistant Plasmodium falciparum. Travelers to countries having resistance are advised to take either Malarone [Atovoquone-Proguanil] or Mefloquine. When the user clicks on Distribution, countries with / without chloroquine-resistance are so designated in the Country list, with further details in the individual country notes. Details for drug dosing and use are given in the Therapy module.
How is GIDEON able to provide a percent probability for diagnosis? +
The Disease diagnosis and Microbiology identification modules in GIDEON are powered by a Bayesian matrix which calculates probability based on the formula:
P [S/D1] X PD1
P-D1 [given S] = —————————————————–
P [S/D1] X PD1 + P [S/D2] X PD2 … + P [S/Dn] X PDn
– where P=Probability S=Symptom complex D1=Disease 1 D2=Disease 2 [etc]
In the microbiology module, PD=Organism probability and S=Phenotype complex
Two basic spread sheets feed data into this formula:
1) incidence of diseases vs country name
2) likelihood of symptom vs. disease name
In other words, when the user enters a list of symptoms and country of acquisition for a patient, GIDEON does the following:
1- access a list of diseases for the country in question
2- rank the diseases by relative incidence
3- delete diseases which are not compatible with the indicated symptoms
4- multiply each disease probability by symptom probability
5- re-rank the diseases by the relative product size in ‘4’
What is the definition for "disease is endemic to" a given country? +
“Endemic” is defined by the reported occurrence of autochthonous or locally-acquired cases. In some instances, a given disease has been reported in recent years, as opposed to continued ongoing occurrence.
What is the definition for "reservoir"? +
Infectious Diseases practitioners are primarily concerned with the site of each disease in nature (“reservoir”) and their route into the body (vehicle / vector). GIDEON is primarily designed as a practical tool for clinicians in the field of Infectious Diseases. As such, designations of “reservoir” were largely derived from those listed for each individual disease in standard textbooks. The staff of GIDEON was never concerned in verifying or “determining” the veracity of these terms, but rather in relaying published information on the natural site for each pathogen / disease. Finer points regarding pathogen biology within specific animals are extremely interesting, but beyond the scope of our project.
How are Outbreaks defined in GIDEON? +
In GIDEON, the designation “outbreak” may appear for one of four reasons.
1. An event is specifially reported as “an outbreak” in source literature.
2. In general, any grouping of cases – including family clusters and epidemics – will be listed as an “outbreak” for purpose of consistency. The term “outbreak” is generic here, and much will depend on the nature of the disease itself as there is no numerical cutoff.
3. Citations of animal disease are denoted as “outbreaks” – even when only one animal is involved – in keeping with OIE definitions. Thus, a report of anthrax in a single goat is considered an outbreak in their reporting system.
Does the GIDEON Diagnosis module work for animal diseases? Is GIDEON adaptable to the use of veterinarians? +
GIDEON is designed specifically for human disease, and we are unaware of a parallel program for animals. The existing program could not be used for diagnosis of veterinary disease for several reasons:
1. the data base does not include most of the necessary diseases
2. the Bayesian statistical matrix is based on human incidence and prevalence data;
3. the diagnostic data base is limited to signs/symptoms relevant to human disease.
In theory, a similar program could be designed for veterinary use, but would require a complete set of data bases and spread sheets for each individual species, each set tied to relevant signs and symptoms for that particular species, in turn tied to additional data sets for each of over 200 countries (It’s taken us over 20 years to design, test and bring-to-market a system useful for only one species – Homo sapiens).
The Bioterrorism simulator appears to be giving information on past potential terrorism events; but, what does the tool simulate? Are there additional characteristics that are missing? +
The Bioterrorism module generates a ranked differential diagnosis list of Infectious Diseases having potential use as Bioterror agents – based on signs, symptoms, incubation period [ie, time from exposure], laboratory tests, etc. (The concept of ‘Country of acquisition’ is not relevant). Also see Why is the differential diagnosis list for a Bioterrorism scenario not Bayesian?
Why is the differential diagnosis list for a Bioterrorism scenario not Bayesian? +
The standard GIDEON diagnosis matrix is Bayesian; ie, based on the product of disease incidence X symptom/sign probability. In contrast, the Bioterror module is non-Bayesian – ie, relative disease incidence (prior probability) is not factored into generation of the differential diagnosis list. Although we may intuitively assume that Anthrax and Smallpox carry higher ‘probability’ for use in Bioterror, vs. Marburg disease or Argentine hemorrhagic fever, precise numbers are lacking. Associated Epidemiology notes stress the history and relevance of individual diseases to Bioterrorism. The number of people who develop smallpox from a “smallpox-bomb” may be the same as the number who develop Ebola from an “Ebola-bomb.” For this reason, if there is a possibility of bioterror, GIDEON ranks the diseases only on the basis of the chance for symptoms in each disease.
Does GIDEON follow trends in MRSA and other resistant bacteria ? +
The only drug resistance trends that GIDEON follows are for Tuberculosis, Malaria and Gonorrhea. Data for these are reported on a national level. Bacterial resistance (MRSA, VRE, ESBL) data are very extensive, and vary from hospital to hospital, state to state, and week to week.
Why can't I find details on the management of endocarditis in GIDEON ? +
Entire books are written on the treatment of endocarditis, meningitis, urinary tract infection, bacterial pneumonia and other generic infections. This is well beyond the scope of GIDEON. The best source for this type of material has always been standard texts and review articles. The Clinical Notes in GIDEON do provide links to major journal reviews, including diagnosis and treatment of endocarditis, etc.
How does GIDEON identify organisms in the Microbiology module? +
GIDEON generates a ranked ID list for bacteria based on the occurrence of phenotypic tests times the likelihood for each relative taxon in clinical material [“prior prevalence”]. Phenotypic data used for ID are taken from Bergey’s Manual and other standard tests, J Clin Microbiol. Int J Syst Evolut Microbiol, and other relevant journals.
To generate a listing of phenotypic tests used by GIDEON for any taxa, click Bacteria, Mycobacteria or Yeasts tab, scroll to the taxon of interest, click on it’s name, and click on phenotype. In the comparison module, blank spaces for any given reaction indicate lack of data.
Why would I use GIDEON if I already use Maldi-Tof? +
1. contains hundreds of organisms that are not identified by Maldi-Tof
2. is updated almost daily – thus organisms which were published a week ago will be in Gideon, but will not be identifiable in Maldi-Tof for many months
3. follows parasites, viruses etc – of interest to the laboratory, but not identifiable in Maldi-Tof
4. follows descriptive info on every organism (ecology, disease association, drug susceptibility), and a compare function which is invaluable for teaching.
Why is the Bacillus Simplex not included in GIDEON? +
GIDEON includes only taxa found in humans / clinical material.
How do I cite GIDEON in a paper that I'm writing? +
“[cited material] In GIDEON online. Retrieved from www.gideononline.com on [access date]”. If required: ISSN 1938-6508.
Is GIDEON available in languages other than English? +
GIDEON is available only in English. Some of the synonyms for diseases, countries and drugs are in other languages. The personal notes accept any language that works with a browser.
Technical: GIDEON Web Version
What do I need to access GIDEON? +
You need an internet connection and any web browser on your computer or device.
What should I know as a librarian administrating an institutional version of GIDEON? +
I accessed GIDEON using my unique URL, and bookmarked the Diagnosis page in my browser. Now this bookmark won't open to the correct page...why? +
When using a unique URL to access GIDEON you have to bookmark the unique URL, or add it into the existing bookmark.
I click Diagnosis on the web version and nothing happens. What's wrong? +
If Symantec’s Norton Internet Security Suite or a similar pop up blocker, such as AOL’s toolbar, is installed on your system, the pop-up blocker may be stopping the Diagnosis results window from appearing. The solution is to enable pop ups for the gideononline.com domain.
Does GIDEON work on a Mac or on Linux? +
Yes. GIDEON web version works with any browser on any platform: Windows, Mac, Linux, iOS and Android (see “What do I need to access GIDEON?” above).
Does GIDEON work on a mobile device? +
Yes. GIDEON web works with any compatible browser. You can access GIDEON from anywhere you have reception using your phone or mobile device.
How can I configure GIDEON to work with EZproxy? +
Please use the following configuration with EZproxy for GIDEON (config.txt/ezproxy.cfg):
Title GIDEON Online