When faced with critical situations, the Center for Disease Control and Prevention www.cdc.gov (CDC) uses telediagnosis to help state and local public health departments identify parasitic organisms and confirm the presumed diagnoses. A fast telediagnosis response can be provided in just minutes or hours using smart phones. One scientist was even able to diagnose an organism using his smart phone while attending an Atlanta Braves baseball game with his family.
CDC finds that the interactive and rapid exchange of information allied with already available diagnostic reference resources greatly increases the capacity to address the global problem concerning parasitic diseases.
To achieve the fastest diagnoses, CDC’s Division of Parasitic Diseases and Malaria (DPDM) www.cdec.gov/parasites maintains a web site called DPDx www.cdc.gov/dpdx with information on diagnosing parasitic diseases, both in the U.S and abroad.
DPDx offers services where all users can browse through concise reviews of parasites and parasitic diseases including an image library. Diagnostic assistance is provided to laboratories and other health professionals on a short timeframe. It is very valuable especially when telediagnosis users are able to send digital images of specimens to be reviewed by DPDx staff
The Parasitic Diseases Branch www.cdc.gov/parasites/lab_science.html serves as a final reference laboratory for state public health departments and laboratories in the private sector. When a laboratory in the U.S or globally requests help from the Branch to identify a parasitic organism or requests confirmation of a presumed diagnosis, then help is on the way via telediagnosis.
Telediagnosis helps laboratories all over the world when presented with cases. In the case of malaria, there are 207 million cases and 627,000 deaths yearly worldwide with most cases acquired in Africa. Over 3.3 million lives have been saved by malaria control interventions since 2000.
Telediagnosis can be highly effective and zero in quickly on a malaria diagnosis. For example, an eight year old child was presented to a hospital with intermittent fevers. The child had recently returned from a trip to Kenya and was not given anti-malarial prophylaxis while traveling. Blood was collected in EDTA and sent for a hematologic work-up.
A BinaxNOW malarial antigen test was performed and the result was negative. Thin smears were also made and stained with Wright-Giemsa. The attending technologist read the smears, took digital images of the findings, and sent them to the DPDx team for a telediagnosis.
The telediagnosis revealed that the child’s illness was malaria caused by plasmodium ovale. The negative result in the BinaxNOW malarial antigen test could have been due to the lower sensitivity of this test for plasmodium ovale than for plasmodium falciparum. Plasmodium falciparum is the dominant species in the world, but plasmodium ovale is found predominately in Sub Saharan Africa.
It was fortunate that the child’s illness was quickly and accurately diagnosed as clinical presentations can vary substantially depending on the infecting species, the level of parasitemia, and the immune status of the patient. It was especially important since untreated malaria can progress to severe forms that must to be treated immediately.