Clinical Case Challenge on Diagnostics and AMR



Antimicrobial resistance (AMR) is one of the biggest threats to global health today. AMR will result in an estimated 10 million deaths globally over the next fifty years. Inappropriate use of antibiotics contributes significantly to this problem. Clinical diagnostics are laboratory tests to aid management and/or guide treatment decisions and can play an important role in combating AMR. However, some medical schools still have gaps in their diagnostics and antimicrobial resistance (AMR) content, and innovative ways are needed to expand AMR and diagnostics training for medical students and physicians.


We proposed a clinical diagnostics and AMR case challenge contest using crowdsourcing methods. The aim was to solicit clinical cases on diagnostic and AMR from medical students, trainees and physicians. This content would then be made available online without any restrictions.


A global steering committee comprised of 19 individuals from all WHO regions, including seven women and 12 men, was established to oversee the contest. The steering committee included experts from medical laboratory science, medicine, public health, health communications and medical education. The call for cases was launched in March 2018 and remained open until 1 May, 2018. The callwas translated into the six official languages of the WHO and disseminated through social media, blog posts, emails, and in-person events. Guidelines and other details on the call for cases were published in a simple website.




At the end of the call, we received 25 cases from nine countries. Seven entries were received from Peru, followed by six entries from the United States. Other submissions were received from Nigeria, China, Australia, Canada, Ethiopia, Paraguay and Zambia.  




A simple and transparent judging system was used to evaluate the entries. All cases were screened for eligibility by two independent individuals. After screening, 23 cases were eligible for the next stage of judging and two entries were excluded for not being relevant to the subject of the call. All eligible cases were then evaluated by at least four physician judges. At this stage, each case was assigned a score between 0 and 10 by the judges. Individual scores were collated and the mean score for each case was calculated. Finally, cases that achieved a mean score of 7/10 or greater had a second level of review with detailed feedback from three independent judges. Out of 23 eligible cases, three cases emerged as finalists with mean scores of seven or above.


This video presents an overview of the case challenge contest.


Finalist cases

The three finalists cases were further reviewed by editors from Partners ID images and final versions of the top three cases were published on the eMicrobes website for crowd voting to select the crowd favourite case. Congratulations to Marion Hemmersbach-Miller, Pierina Vilcapoma-Balbin and Assil Abda for emerging the top three finalists and Pierina Vilcapoma-Balbin for receiving the greatest number of crowd votes. The top cases are outlined below.


CASE 1: A man returning from India with a new liver and an infectious souvenir

A man in his forties, with a history of liver transplantation (recipient CMV IgG positive) performed 4 months prior in India for end-stage liver disease secondary to ethanol abuse, presented in the US with fever, chills, night sweats, malaise, as well as right upper quadrant and epigastric pain….more

CASE 2Fevers after an elective intracranial orbital reconstruction and cranioplasty

A young female toddler with craniosynostosis and sinus hypoplasia underwent an elective intracranial orbital reconstruction and cranioplasty. The patient received surgical antibiotic prophylaxis with cefazolin. The procedure was uncomplicated, apart from an incidental finding of a small dural defect which was repaired……more

CASE 3: Woman with psychiatric disease presenting with abdominal pain, nausea, vomiting and drowsiness

A woman in her thirties with diabetes and psychiatric disease was admitted to an inpatient ward in a general hospital in Lima, Peru with five days of crampy and generalized abdominal pain, loss of appetite, nausea and vomiting. She was noted to be drowsy for two days and developed persistent vomiting……...more

The learning module

The top three finalist cases were integrated into an online CME module for physicians focused on AMR and the use of clinical diagnostics. This module was developed together with UCSF colleagues and presented using Articulate Storyline software.  The module will be launched here by December 31st, 2018. 

Dissemination of challenge contest outcomes


A one-day multidisciplinary symposium was organised in London on November 1, 2018. The symposium described the AMR challenge contest and included presentations from the three challenge contest finalists, in addition to other talks focused on diagnostics, epidemiology, and interventions (Prudent antimicrobial prescription policies using gamified appsPartners ID Images - emicrobes digital library: An educational resourceAntibiotic Prescribing in resource poor settings: A case study from Nigerian HospitalsImplementing rapid molecular diagnostics for HAP-the INHALEprogramme.The symposium also had an expert panel discussion on advancing clinical diagnostics and AMR through challenge contests. The event received a diverse audience including clinical researchers, physicians, public health fellows, medical microbiologists, medical post graduate students and other stakeholders in AMR-related research and programs.


bioMérieux is the sole sponsor of the challenge contest, with an unrestricted educational grant to the London School of Hygiene and Tropical Medicine. bioMérieux was not involved in the challenge design, implementation, or evaluation.