By: Dustin Bassett DO
App Review of Laboratory Diagnosis of Infectious Disease for iOS and Android
A 76 year old California-native hispanic male presents to the emergency department with complaint of feeling short of breath, productive cough, and fevers for the past 7 days. He was recently out in a rural area visiting family when he suddenly came down with the symptoms. He has tried over-the-counter cough medicine such as NyQuil and reports limited relief. His cough is getting worse and he notes increasing dyspnea with exertion. He admits to having chills, wheezing, and chest pain with coughing.
He denies rash, sick contacts, nausea, jaw or arm pain, swelling of his legs, and trauma. His past medical history includes diabetes, hypertension, and benign prostatic hypertrophy. He denies previous surgeries. His vital signs show a fever of 103.0, heart rate of 110, respiratory rate of 22 and he appears to be in mild respiratory distress. His pulmonary exam demonstrates wheezes and rales to his right lower lobe. His heart sounds are normal and are not muffled. He does not have lower extremity edema or evidence of rash.
Chest x-ray shows a cavitary lesion to his right lower lobe. Given the scenario, what sputum tests or blood tests should you order and correctly treat the patient? This may be a common occurrence and is why the app Laboratory Diagnosis of Infectious Disease was created.
Stemming from a collaboration among the American Society of Microbiology, Infectious Disease Society of America, and Stanford the app aims to assist physicians and clinical staff in diagnosis of various infectious diseases.1
With the abundance of infectious organisms, selecting appropriate testing poses a huge hurdle to identifying and treating a given medical condition. In medical school physicians are taught the adage, “when you hear hoofbeats, think horses not zebras” but on rare occasions the affecting organism is not at the top of the differential. This app can assist the clinician in ordering the appropriate test in the correct fashion.
The interface of the app is very user friendly. It permits browsing by the affected organ system to review the most common pathogens for a given clinical condition or, if the pathogen is known it is possible to directly view its information. For our patient above, suspicions were high for a fungal component to his pneumonia and testing was ordered accordingly.
Once a disease is selected, the screen shows a differential of possible pathogens as well as diagnostic procedures, optimum specimen collection, transport issues, and notes pertaining to identification of organisms. This is very helpful in being thorough if the primary suspected organism tests negative.
Back to our case. Appropriate sputum cultures, fungal cultures, blood tests and urine tests were obtained and sent to the lab for processing. The patient was started on empiric antibiotics and antifungals. After several days his condition remained unchanged. His fungal culture grew Coccidioides immitis. Antibiotics were discontinued and antifungals based on culture sensitivities were selected and initiated. The patient gradually improved and was discharged home.
Laboratory Diagnosis of Infectious Disease is very helpful in creating a differential diagnosis for diseases as well as providing direction for proper collection and testing. It is easy to use and comes with significant support by premier societies in the field. It is thorough in detail but its utility is geared more towards physicians not routinely conducting infectious disease work ups or those in early stages of their training in laboratory processing.
References included for clinical information: Yes
Disclaimer included in the app: Yes
Authorship identified: Yes
Conflicts of Interest statement available: Yes
Mechanism for Contacting Developer Included: Yes
- $20.00 per year
- Appropriate method for pathogen collection and identification with poignant comments about false negative or positive test results for specific microorganisms.
- Cost and browsing within a specific medical condition is tedious.
- The app has a wealth of knowledge based on multiple society guidelines, a simplistic user interface, and the potential to be beneficial to inpatient clinicians for diagnosis of infectious disease. It could use improvements to browse more rapidly within a medical condition.
- Overall Score
- User Interface
- Multimedia Usage
- Real World Applicability
- Available for DownloadAndroidiPhoneiPad