Errors in Diagnosing Infectious Diseases: A Physician Survey

Background: Infectious diseases are commonly missed or misdiagnosed. Errors in diagnosing infectious diseases not only affect the patient but also the community health.Objectives: To describe our investigation on the most common errors in diagnosing infectious diseases and their causes according to the physicians' reports.Methods: Between August 2018 and February 2019, specialist physicians and residents across Mashhad, Iran were invited to participate in a survey to report errors they had made or witnessed regarding the diagnosis of infectious diseases.Results: Overall, 465 cases were reported by 315 participants. The most common infectious diseases affected by diagnostic errors were upper respiratory tract infections (URTIs) (n = 69, 14.8%), tuberculosis (TB) (n = 66, 14.1%), pleuro-pulmonary infections (n = 54, 11.6%), central nervous system (CNS) infections (n = 51, 10.9%), and urinary tract infections (n = 45, 9.6%). Errors occurred most frequently in generating a diagnostic hypothesis (n = 259, 55/7%), followed by history taking (n = 200, 43%), and physical examination (n = 191, 41/1%). Errors related to the diagnosis of TB (odds ratio [OR]: 2.4, 95% confidence interval [CI]:0.9–5.7; P value: 0.047) and intra-abdominal infections (OR: 7.2, 95% CI: 0.9–53.8; P value: 0.02) were associated with more-serious outcomes.Conclusion: A substantial proportion of errors in diagnosing infectious diseases moderately or seriously affect patients' outcomes. URTIs, TB, and pleuropulmonary infections were the most frequently reported infectious diseases involved in diagnostic error while errors related to the diagnosis of TB and intraabdominal infections were more frequently associated with poor outcomes. Therefore, contagious and potentially life-threatening infectious diseases should always be considered in the differential diagnosis of patients who present with compatible clinical syndromes.

Malignant pericardial effusion as a primary manifestation of metastatic colon cancer: a case report

Background Pericardial neoplastic involvement is rarely related to primary tumors of the pericardium and is most often caused by spread from other primary sites, such as lung and breast carcinomas, hematological malignancies (lymphoma and leukemia), and melanoma. Although pericardial metastasis from infradiaphragmatic tumors (such as colon cancers) are rare and poorly described in literature, any neoplasm has the potential to metastasize to the pericardium and heart by either contiguity, lymphatic, or hematological spread. Case presentation A 44-year-old previously healthy male Causasian patient had a sudden onset of dyspnea and wheezing. During investigation with echocardiogram, computed tomography and repeated pericardiocentesis, the cause of malignant pericardial effusion was confirmed as primary manifestation of metastatic colon cancer. The patient was treated with appropriate chemotherapy and presented satisfactory disease control. Conclusions This report emphasizes the importance of considering the diagnostic hypothesis of occult neoplasia in a patient with pericardial effusion.

Maxillofacial Radiology 192

A 64-year-old male patient, who is human immunodeficiency virus (HIV) positive on treatment, presented with atwo-year history of a painful swelling involving the left parotid gland. Cone beam computerised tomographic (CBCT) imaging was performed (Figures A-D). What are the pertinent radiological findings and your diagnostic hypothesis?

Uncommon differential diagnosis of a breast ulcer: a case study

Introduction: Spider bites are common worldwide. Frequently symptoms resolve without any adverse outcome, but in rare cases the bite can cause severe morbidity. The most typical presentation of Mediterranean recluse spider (Loxosceles Rufescens) bite is a dermatonecrotic lesion of the skin (skin loxoscelism). When the only manifestation of a spider bite is an ulcerated skin lesion, clinical suspicion and differential diagnosis strongly depend on its site. We present the case of an ulcerated wound of the breast, diagnosed as a Mediterranean recluse spider bite. Case presentation: A 79-year-old woman presented a 10cm-wide soft tissue ulceration of her left breast. At first, the diagnostic hypothesis of an ulcerated cancer was ruled out. Two family members revealed a recent history of Mediterranean recluse spider bite and the same clinical diagnosis was made for our patient. A wide excision was performed, with complete resolution of symptoms. Discussion: No specific diagnostic criteria for spider bites are available. Diagnosis is usually clinical. Skin loxoscelism could be easily mistaken for cellulitis, various types of skin infections, cutaneous anthrax, vasculitis, scorpion sting, pyoderma gangrenosum, erythema migrans of Lyme disease or prurigo nodularis. A thorough anamnestic interview is fundamental to raise the diagnostic hypothesis. When possible, a biopsy is recommended and it is extremely important when the ulcer can mimic a cancer, as is the case in breast tissue. Conclusion: We recommend a wide excision of the wound after failure of conservative treatment, in order to obtain local control and to perform histological examination on a more representative specimen.

Pediatric Cutaneous Leishmaniasis in a Private Clinic of Abidjan, Ivory Coast: A Case Report

Introduction: Cutaneous Leishmaniasis (CL) is a zoonotic disease with global distribution, especially in underdeveloped countries. This parasitic disease is caused by the bite of an infected sandfly. Case Report: We report here the first case of cutaneous leishmaniasis discovered incidentally in an 11-year-old child in a private clinic. He is a primarian boy who had a wound located on his left leg. On questioning, we ascertained that the wound was not the first one and had been present for about 2 months. The cutaneous lesion was painless but itchy. The location, the crateriform appearance, and the chronic nature of the wound led us to suspect a case of cutaneous leishmaniasis. Methods: Microscopic examination of cutaneous exsudation’s smears of lesions revealed amastigote forms of leishmania, confirming our diagnostic hypothesis. The child was placed under Imidazole-based treatment associate cloxacilline. The child also received local gentamycin-based dressings. Results: The child was cured after one month. The diagnostic issues of cutaneous leishmaniasis constitute a great challenge for practitioners in endemic zone. Also, a systematic differential diagnostic should be required in the face of chronic wounds. Conclusion: The integration of the screening and management of cutaneous leishmaniasis against Buruli ulcer are eagerly waited as a future work.

Unilateral Nevoid Telangiectasia in a Healthy Man

We report the case of a healthy 26-year-old man presenting telangiectatic macules on the left thorax and arm since childhood. The main diagnostic hypothesis were unilateral nevoid telangiectasia (UNT), hereditary benign telangiectasia, atrial myxoma, segmental serpiginous angioma, circumscribed neviform angiokeratoma, and nevus vascularis mixtus. The diagnosis retained was UNT characterized by congenital or acquired telangiectasia distributed asymmetrically along the upper extremities, or the third or fourth cervical dermatomes. The congenital form is extremely rare, predominant in men, and persists in adulthood. The acquired form is most frequent, affects preferentially women, usually appears at puberty or during pregnancy and tends to disappear. Estrogen excess triggers the formation of telangiectasia. UNT is rarely associated with liver or thyroid disorder. Pulsed-dye lasers and normalization of estrogen are proposed as therapeutic options. We report a rare diagnosis of UNT in a young man with no other underlying condition. We would like to highlight that in the presence of unilateral telangiectasia, a complete clinical examination must be performed to rule out signs of hyperestrogenism in man, ocular or neurological abnormalities, a blood test to exclude pregnancy, hepatic and thyroid dysfunctions, and ultrasonography in case of suspicion of atrial myxoma.

ACOUSTIC SCHWANNOMA WITH INTRATUMORAL HEMORRHAGE –REPORT OF AN UNUSUAL COMPLICATION

Acoustic Schwannoma is a benign neoplasm of the 8th cranial nerve pair, and accounts for 8-10% of all intracranialtumors. Intratumoral haemorrhage is unusual in these tumors and can lead to hydrocephalus or aggravate a preexisting condition. This paper reports a case of acoustic Schwannoma in a child with complication with intratumoral hemorrhage that lead patient to death. Female patient, 9 years old, presented anacusis on the right, sudden, progressing with vomiting, intense headache and vertigo. Magnetic resonance imaging of the skull showed expansive lesion in the cistern of the right cerebellar angle, with content inside the internalauditory canal, with compression of the adjacent brain stem. The diagnostic hypothesis was acoustic Schwannoma. It progressed with worsening of headache, initially controlled with medication and later loss of consciousness. Computed tomography of the skull revealed an expansive lesion in the cistern of the right cerebellar angle with signs of bleeding with extension to the ventricular system. External ventricular shunt was performed, but the patient evolved with several complications, septic shock and death. Intratumoral hemorrhage in the acoustic Schwannoma is a rare event, but its occurrence worsens the clinical picture and may lead to death of the patients due to intracranial hypertension.

Psychiatric Diagnostic Confirmed by Cerebral Simple Proton Emission Computed Tomography (SPECT)

It is usual in psychiatric clinic arise diagnostic hypothesis for the same patient. Take for example the schizophrenia, the classic definition was of a disease of the thoughts, and that no machine explored the thoughts. The advent of cerebral SPECT (single photon emission computed tomography) made it possible the formation of Data Bank. The SPECT when made cerebral images is known as cerebral perfusion scintigraphy, it is done with a drug that in minute fraction is extracted of blood to the interior of the neurons, through the haemato-encephalic barrier, still there for hours. The psychiatry is one of the more needy medical specialities, in terms of complementary examinations, and the cerebral SPECT done with HMPAO could be used to help the clinician in doubt cases. In this work we present two clinical cases where the cerebral SPECT produce a confinable diagnostic about schizophrenia. The mathematical language used by nuclear medicine inform that the obtained image belongs to a psychiatric specific group of diseases.

Rectal Metastases of Breast Carcinoma: A Case Report

The scarcely reported hematogenous rectal metastases from breast cancer are rare and the diagnosis is challenging. They may be recognized before, concomitantly with, or after the diagnosis of the primary site of breast cancer. Invasive lobular cancer is the histological type more frequently described, and most of the affected patients have a late diagnosis. Tardive recognition is associated with poor outcomes, despite the management options. Endoscopic and imaging evaluations, mainly magnetic resonance studies, are useful, but the anatomopathological findings are mandatory to confirm the diagnostic hypothesis. We describe a middle-aged woman with advanced rectal metastases of unsuspected breast cancer found during the evaluation of manifestations due to intestinal implants. One must highlight long-term follow-up of breast cancers even if seeming in remission. The aim of this report is to enhance the suspicion index of primary health care workers.

Towards Similarity-based Differential Diagnostics For Common Diseases

Ontology-based phenotype profiles have been utilised for the purpose of differential diagnosis of rare genetic diseases, and for decision support in specific disease domains. Particularly, semantic similarity facilitates diagnostic hypothesis generation through comparison with disease phenotype profiles. However, the approach has not been applied for differential diagnosis of common diseases, or generalised clinical diagnostics from uncurated text-derived phenotypes. In this work, we describe the development of an approach for deriving patient phenotype profiles from clinical narrative text, and apply this to text associated with MIMIC-III patient visits. We then explore the use of semantic similarity with those text-derived phenotypes to classify primary patient diagnosis, comparing the use of patient-patient similarity and patient-disease similarity using phenotype-disease profiles previously mined from literature. The results reveal a potentially powerful approach that can be applied to a variety of clinical tasks, such as differential diagnosis, cohort discovery, document and text classification, and outcome prediction.