Matthias L., a German medical student, shares his story about using VisualDx.
“I am a sixth year German medical student currently doing a rotation in pediatrics. Due to the ongoing influx of refugees from central and northern Africa, our department is assigned to provide vaccinations and a screening for infectious diseases in young refugees.
A group of four teenage patients came to our department for vaccination and initial infectious disease screening. All four said they were in good health. There was no history of pain, fever, coughing, diarrhea, exanthema or pruritus. They fled as a group from Eritrea and stayed in Libya for about half a year. Then, two months ago, they crossed the Mediterranean Sea.
In the physical examination all four showed multiple (2-5) circular papulo-ulcerative skin lesions with indurated borders and hyperkeratotic eschar covering the central ulcus. The lesions were mainly located at the extremities and indolent. All of them were less than 1cm in diameter. There was no mucosal involvement. According to the patients, the lesions were in remission over the last 1 to 2 months. The patients reported no signs of neuropathy around the lesions, showed no fever, and tuberculosis and HIV were excluded in the standard screening process.
To assist my differential I entered ‘North Africa’, ‘ulcer’, ‘eschar, and ‘arm/lower legs’ as location of the skin lesions into VisualDx. The differential builder listed cutaneous leishmaniasis, leprosy, and sporotrichosis as the top results. This gave me the necessary hint to consider the correct spectrum of differentials which eventually led to the diagnosis of cutaneous leishmaniasis. Having little experience and training in tropical and subtropical medicine, VisualDx helps me to fill this gap now that I am confronted with this new spectrum of diseases. Thus, it does not only help our patients but it also makes me look smarter than I am.”
*Cutaneous leishmaniasis pictured on patient’s palm is not patient in this story.
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