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Archive for the ‘Diagnosis’ Category

Neglected Diseases – Neglected Once Again

written by Dr. Stephen A. Berger

For several years, the World Health Organization has been following a group of twenty-or-so Neglected Tropical DiseasesIn the Developed World, these conditions are largely unknown to the general public, and even to physicians working in fields outside of Epidemiology and Infectious Diseases. In only three months, the list of neglected diseases has grown to include more than 360 infectious conditions – all because of a single new viral disease called COVID-19.

As of this morning, 287 cases of COVID-19 had been reported in the DRC (Democratic Republic of Congo) resulting in 23 deaths. How many are aware that this same country is in the midst of a massive outbreak of Ebola – which has claimed 3,457 cases and 2,266 deaths to date. Since January 1, nearby Nigeria has reported 188 deaths from Lassa fever, compared to only 13 deaths from COVID-19. 

Saudi Arabia is currently experiencing a massive outbreak of coronavirus infection, but not the one you’ve been reading about. For more than seven years, infection by MERS-CoV (a close “relative” of the COVID-19 virus) has infected 2,044 Saudis and claimed the lives of 821. Compare this to the current COVID-19 outbreak, which has killed “only” 83 Saudis as of today. Any patient who walks into a clinic in Rio, Paris or New York, and says that he has a cough and fever, will be rushed into an isolation room by a group of people draped in masks, gowns, goggles, and gloves. After all….what else could this be?! The answer to that question becomes apparent in the following list, generated by GIDEON.

Note in this screenshot that I’ve asked the computer to list all possible diseases that could explain the presence of fever, cough, and pneumonia in a group of American adults. The GIDEON program tells me that COVID-19 is “number one” on the list, with a statistical likelihood of 83%. But no less than 65 other diseases also appear on this list, including, as you might expect, Influenza and a variety of common viral conditions.

The message here is simple: in the era of COVID-19, not every disease IS COVID-19.

Outbreak of Toxoplasmosis Associated with Ingestion of Venison

Recently, ProMED reported an outbreak of severe febrile illness 5 days following ingestion of venison (http://www.promedmail.org/post/20171026.5405515 )  In the absence of gastrointestinal symptoms, these features are compatible with only a handful of infectious diseases. In 1980, a similar outbreak among American hunters was ascribed to acute toxoplasmosis. [1] The decision support module in Gideon (https://www.gideononline.com) also assigns a high ranking to toxoplasmosis.

Reference
———
1. Sacks JJ, Delgado DG, Lobel HO, Parker RL: Toxoplasmosis infection associated with eating undercooked venison. Am J Epidemiol. 1983; 118(6): 832-8; https://www.ncbi.nlm.nih.gov/pubmed/6650484

Note featured on ProMED

Varicella vs. Monkeypox

Outbreaks of varicella and monkeypox in Africa are occasionally mistaken for “smallpox”   The following table was generated by an interactive tool in Gideon (www.GideonOnline.com) which allows users to generate custom charts that contrast clinical features, drug spectra or microbial phenotypes.

 

 

 

South Sudan: Unknown Hemorrhagic Illness

Regarding an ongoing outbreak of hemorrhagic illness in South Sudan, a differential diagnosis list generated by Gideon [Global Infectious Disease & Epidemiology Network]https://www.gideononline.com, includes 2 lesser-known pathogens which have been associated with single small clusters of hemorrhagic fever in Africa: Bas-Congo virus (rhabdovirus) and Lujo virus (arenavirus). In 2008, 4 of 5 patients died of Lujo virus infection in a South African hospital, following transfer of an index patient from Zambia. The following year, 2 of 3 villagers in DR Congo died in an outbreak of Bas Congo virus infection. If tests for other pathogens continue to be negative, these 2 agents might be considered.

Cited on ProMED

Outbreak at Konkut University: MERS-CoV infection ?

An outbreak of pneumonia has been associated with The School of Veterinary Medicine at Konkut University.  This institution is surprisingly close to Konkut University Hospital, where a number of patients were recently treated for MERS CoV infection.   In the following campus map, the Veterinary School and Hospital are denoted by numbers 15 and 30, respectively; and number 12 identifies the Animal Science School.

Konkut

Significantly, a paper published by the school in 2007 suggests that at least some of the veterinary staff have been involved in work with camels. [1]

Have these patients been tested for MERS CoV infection?

 

Reference:
1. Abd El-Aty AM1, Goudah A, Shah SS, Shin HC, Shimoda M, Shim JH.  pharmacokinetic variables of moxifloxacin in healthy male camels following intravenous and intramuscular administration. J Vet Pharmacol Ther. 2007; 30:586-91

Webinar replay and GIDEON demo

Dr Steve Berger presents a background on Infectious Diseases and using GIDEON as a decision support tool during a webinar earlier today.

Diagnosis Support for Ebola through GIDEON

The Diagnosis module of Gideon is designed to generate a ranked differential diagnosis list for any Infectious Diseases scenario. In recent weeks, we’ve been running simulations of Ebola. The following link will access a Power Point “show” demonstrating one such scenario. Ebola case (Powerpoint)

Equine Encephalitis in Argentina

Several equine viral agents with potential for human infection have been reported in Argentina.. The following background information is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]

1. TOGAVIRIDAE
A. Eastern equine encephalitis:
Seropositivity toward eastern equine encephalitis virus was demonstrated in wild and domestic birds, wild mammals, and horses during 1977 to 1980.
– The principal mosquito vector is Aedes (Ochlerotatus) taeniorhynchus.
– Additional vectors include Culex nigripalpus, C. caudelli, C. spissipes and C. taeniopus.
– Eastern equine encephalitis has been reported from Buenos Aires.

Notable outbreaks:
1981 – An outbreak if eastern equine encephalitis was reported among equines in Santiago del Estero Province.

B. Western equine encephalitis:
An epizootic was reported during 1982 to 1983, with continued cases to 1986.
– Ochlerotatus (Aedes) albifasciatus is the presumed vector in Argentina.
– During the epidemic of 1982 to 1983, WEE virus was also demonstrated in Anopheles albitarsis, Mansonia species and Psorophora pallescens.

C. Venezuelan equine encephalitis
Complement-fixing antibodies toward Venezuelan equine encephalitis virus have been demonstrated among humans in Corrientes and Chaco (1983 publication)
– Related agents, Pixuna and Rio Negro viruses, have been identified among rodents in Tucuman Province.

Seroprevalence surveys:
51.6% of persons on General Belgrano Island, Formosa Province (NT, 1993 publication)
30% to 70% of persons on General Belgrano Island, Formosa Province (NT, 2003 publication)

2. RHABDOVIRIDAE
A. Calchaqui virus:
Seropositivity of humans and horses toward Calchaqui virus has been demonstrated in Santa Fe Province. Calchaqui virus has also been identified in a local mosquito.

B. Rabies (an extensive note regarding rabies in Argentina is available on request)

C. Vesicular stomatitis virus infection has been reported among animals in Argentina (2011 publication)

3. BUNYAVIRIDAE
A. Cache Valley, Kairi and Bunyamwera viruses:
Seroprevalence surveys:
5.7% of human sera in Cordoba are seropositive toward Cache Valley virus and 5.92% toward Kairi virus (2004 to 2005)
13.3% of horses in Santa Fe and Cordoba are seropositive toward Kairi virus , and 40% toward Cache Valley virus (1983 to 1984)
6.6% of free-ranging birds in Cordoba City were seropositive toward Bunyamwera virus in 2004, 13.8% in 2005

4. FLAVIRIDAE
A. West Nile fever virus:
West Nile fever virus was detected for the first time in Argentina in 2006 – two horses in San Antonio de Areco and one in San Isidro, Buenos Aires Province.
– Infection was documented in free-ranging birds during 2005 to 2006.
– The country’s first cases of human infection were reported in 2006 – one case in the city of Marcos Juarez in Cordoba Province and 3 additional cases in Chaco province.

References:
1. Berger SA. Infectious Diseases of Argentina, 2011. 417 pp, 96 graphs, 1516 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-argentina/
2. Berger SA. Equine encephalitis: Global Status, 2011. 38 pp, 17 graphs, 282 references. Gideon e-books, https://www.gideononline.com/ebooks/disease/equine-encephalitis-global-status/

New GIDEON Diagnosis Module Video

Following up on the post announcing the new GIDEON diagnosis module, there is now a video demonstration by Dr. Steve Berger:

Wishing you all a happy 2010!

New GIDEON Diagnosis module

GIDEON’s redesigned Infectious Diseases Diagnosis module has been launched (screenshot). There are many new features, including

  • Suggestions
  • Dynamic diagnosis
  • Usability improvements

Suggestions

Diagnosis suggestions snapshotUntil 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.
Diagnosis results buttonsThe familiar buttons: Compare, Why Not, Open case, Save case, Remove All, Print, Email are all in the Diagnosis Results area.

Usability improvements

Country selection and Incubation period entryCountry 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 Minimize button to the left title.

Mouse overs
Mouse over check boxMore 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
Probability sort arrowDiagnosis 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.

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