Gundersen Libraries News: VisualDx: Lyme Disease, Mobile App, and More

Thursday, July 23, 2015

VisualDx: Lyme Disease, Mobile App, and More

AN 18-YEAR-OLD woman went to an emergency department in Georgia with several lines of red pustules on her feet and lower legs. She was out walking in a park and suddenly felt terrible stinging sensations that started on her on her feet and quickly moved upward, as though she was being bitten many times. She fled the area quickly without seeing what was biting her.

Can you diagnose the patient? Use the Differential Builder in VisualDx to help you. HINT: Start with the “Adult Skin – Bites, Stings & Infestations” clinical scenario, then add other key findings.

Look for the answer on our Facebook page on Tuesday, July 28.

WHILE AWARENESS OF Lyme disease is widespread, new research shows that a majority of Americans do not routinely take any personal prevention steps against tick bites during warm weather.(1) Transmission of Lyme disease, a tick-borne zoonosis caused by the spirochete Borrelia burgdorferi, occurs most commonly in spring and summer. Within North America, Lyme disease incidence is highest in the Northeastern, Mid-Atlantic, and North Central United States.(2)

Lyme disease classically causes an expanding targetoid, erythematous rash called erythema chronicum migrans, but 20% to 30% of patients with Lyme disease present without the classic targetoid, or “bull’s-eye,” rash.(3) Many erythema migrans lesions are uniformly erythematous.(4) Accordingly, physicians must maintain a high level of suspicion when evaluating a patient presenting with nonspecific constitutional symptoms suggestive of Lyme infection.

Because tick-borne disease prevention measures are relatively infrequent among the US public, remind your patients to take precautions if they know that they will spend time in tick-infested areas where Lyme disease is common. Precautions include wearing long-sleeved shirts and pants, showering within 2 hours of potential exposures to ticks, using DEET products, and inspecting for ticks after spending time in wooded areas.

Patients who are not responding appropriately to therapy (ie, severe or prolonged infection, persistent fever, or prolonged cytopenias) may need evaluation for coinfection with other tickborne pathogens common to the tick vector Ixodes. Potential coinfections include anaplasmosis, babesiosis, deer tick virus infection, Borrelia miyamotoi infection, and ehrlichia species Wisconsin infection.

To see more than 25 photos of variations in erythema chronicum migrans, follow the link to VisualDx.

References:
1. Hook SA, Nelson CA, Mead PS. U.S. public's experience with ticks and tick-borne diseases: Results from national HealthStyles surveys. Ticks Tick Borne Dis. 2015;6(4):483-488.

2. Mead PS. Epidemiology of Lyme Disease. Infect Dis Clin North Am. 2015;29(2):187-210.

3. Steere AC, Sikand VK. The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med. 2003;348(24):2472-2474.

4. Shapiro ED. Lyme disease. N Engl J Med. 2014;370:1724-1731.

VISUALDX DEVELOPERS WORK tirelessly to create mobile apps that are stable. However, despite efforts at extensive testing, users can sometimes alert us to issues we didn’t encounter. Right now we are specifically looking for feedback on the recent update to our Android app.

If you experience a hang or crash while using the VisualDx Android app, please click on the “Report” button in the pop-up box. That report will be sent to Google and made available to VisualDx. It contains very valuable information that will help us correct program errors and enhance your VisualDx experience. (You may also be presented with a screen that asks for additional details, which you can feel free to disregard.)

Rest assured that the information we receive from Google contains no user identification whatsoever.

Don’t forget to visit Google Play and rate the VisualDx app today! Thank you for helping us to perfect VisualDx.

In a story that made headlines in late June, a Colorado teen named Taylor Gaes contracted septicemic plague, most likely via a bite from an infected flea off a dead animal on his family’s land. His family believed he simply had a case of the flu. He died just 4 days later as his mother drove him to the hospital.¹

The general public may consider the plague a disease of medieval times and not even be aware that it still persists around the world. Although cases of plague in the United States have decreased overall in the last 20 years, according to the CDC, there are still an average of 7 cases per year.

Most US plague cases occur in western and southwestern states, primarily in northern New Mexico, northern Arizona, southern Colorado, southern Oregon, and far Western Nevada.² Transmission of the plague occurs through the bite of an infected flea, contact with the body fluid or tissue of a plague-infected animal (eg, a hunter handling an animal without precautions), or breathing infectious droplets.³

The three types of plague – bubonic, septicemic, and pneumonic – can all initially present with fever, chills and weakness, and a patient might easily mistake them as symptoms of a common illness like influenza. There may be no obvious signs pointing to plague, but it is reasonable to consider plague in the differential diagnosis of any sick patient who lives in or has recently traveled to the western United States. Patients with rapid onset of illness and worsening symptoms should be encouraged to seek medical care right away. Early treatment is crucial to a full recovery.

If the plague is suspected, antibiotic treatment should begin immediately. Diagnosis can be confirmed with laboratory testing. The drugs of choice for all three types of the plague are streptomycin or gentamicin, but tetracyclines, fluoroquinolones, and chloramphenicol are also effective. Post-exposure prophylaxis is indicated for persons with known exposure to bubonic plague, such as direct contact with infected body fluids or tissues.

For more clinical information and images of the plague, follow these links to VisualDx: bubonic plague, septicemic plague, and pneumonic plague.

References:
1. Pohl J. Officials: Rare form of plague killed Colorado teen. USA Today. June 22, 2015. http://info.visualdx.com/e/11412/killed-colorado-teen-29056459-/38r5rv/583624493. Accessed July 21, 2015.

2. Plague: Maps and statistics. Centers for Disease Control and Prevention Web site. http://info.visualdx.com/e/11412/plague-maps-index-html/38r5rx/583624493. Updated June 16, 2015. Accessed July 21, 2015.

3. Plague: Ecology and transmission. Centers for Disease Control and Prevention Web site. http://info.visualdx.com/e/11412/plague-transmission-index-html/38r5rz/583624493. Updated June 13, 2012. Accessed July 21, 2015.

WHAT ARE THE BEST APPS for clinicians? What types of apps are available for clinical reference, patient engagement, and monitoring and/or communicating with patients? How can you be sure which apps to trust? We're back in September with a new webinar by Dr. Mathew Devine from the University of Rochester, who will share some of the best apps available and how to make the most of them in your daily workflow.

Watch for more details in the next VisualDx Minute newsletter and on Facebook and Twitter.