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Chapter 598 Diagnosing the Little Genius

The magical Africa has many unknown and mysterious pathogens.Who knows when a new disease will be discovered.After hearing the physician's report, Liu Tangchun's first reaction was, "Isn't this kind of shit going to happen to me?"

For other clinicians, the discovery of an entirely new disease is likely to be a strong support for later promotion.But for Liu Tangchun, his greatest hope now is that he and the medical team he leads can survive the last three months safely.The other old Liu didn't want to touch anything.

What do you want to discover for the first time?Isn't it safe and sound?The front feet have just been surrounded by indigenous people, and the back feet have been surrounded by the government army again—if you encounter some strange first-episode disease, will you have to be surrounded by the WHO expert group again?
Liu Tangchun's thoughts flashed by, and he resisted the thought of continuing to spread his thoughts, and asked instead, "How many smears were taken? Are they all negative?"

"They are all negative. Two blood smears, three cerebrospinal fluid and three sputum." The physician's face was a little excited, "No colonies were cultured, but antiviral drugs have no effect after three days... ...Director Liu, could it be a fungus?"

"Fungal meningitis?" Liu Tangchun shook his head, "The doctors here are not fools. Viruses can't be seen on smears, but fungi can't be seen?"

Counting prions, there are six kinds of pathogens that can infect the human body.From small to large, they are prions, viruses, bacteria, fungi, monokaryotic organisms, and multikaryotic organisms.However, doctors cannot simply judge that the patient is infected by other pathogens through the ineffectiveness of acyclovir.After all, there are no so-called "broad-spectrum antiviral drugs" in the world.
Multinucleated organisms rarely cross the brain-blood barrier and enter the brain, and cerebral hydatid can be regarded as one of them, but the patient's current symptoms obviously do not support the diagnosis of cerebral hydatid.Meningitis caused by monocytic organisms and fungi generally do not develop as quickly—they may have more severe sequelae.

The patient was admitted three days earlier with complaints of headache and fever only.After receiving antiviral treatment for three days, the symptoms worsened to the point of unconsciousness and the answer was irrelevant.Liu Tangchun frowned and pondered for a long time, and felt that it might be necessary to organize a general consultation.

If one person can't handle something, invite two people to look at it.In the same way, it is absolutely necessary to organize the entire medical team for collective consultation and brainstorm together for diseases that are unclear to the physicians, physicians, and directors of the emergency department.

After Sun Lien received the notice to hold a group consultation with the medical team, he was really a little apprehensive.I know my own affairs, and if I get involved in it myself, who knows what strange and intractable diseases will emerge in the end.It's a pity that Sun Li'en's worry was completely ignored by Liu Tangchun.In the words of Liu Tangchun, "You are young, what kind of feudal superstitions are you engaging in? You are good at rare diseases, so don't be stingy to use your skills!"

Director Liu asked Sun Lien to "use his abilities" by name, and Sun Lien really couldn't find any other reason not to participate in the consultation, so when it was time for lunch, all the staff of the medical team gathered in a corner of the cafeteria, and everyone started working on it. We ate on a stainless steel dinner plate and started a group discussion.

"The patient's main complaint was that he had a headache six days before he was admitted to the hospital." The doctor who received the consultation looked a little worried—he even gnawed chicken legs at a much slower speed than before. "The nature of the pain is mainly continuous pain and occasional acupuncture-like Pain. Two days before admission, the patient began to experience nausea and vomiting. The highest body temperature was 39 degrees Celsius three days before admission."

There is a very interesting feature here-this 23-year-old female patient had asked for help from another medical team before being admitted to the hospital.A civilian medical team from France received the woman and gave her "infusion anti-infection" treatment.The content of the medication is not yet clear, but at least from the patient's complaint, the drug treatment has some effect-at least she doesn't have a fever.

However, this medical team in France is of the regional itinerant type, and the time they are stationed in each area is relatively short.After two days of continuous treatment, it was time for the French medical team to leave.The doctor in charge of this female patient kindly recommended the Chinese medical team to her, and strongly advised her to go to the Chinese medical team's station for follow-up treatment as soon as possible.

"We got in touch with the French medical team, and they said that ceftriaxone and... ibuprofen were used for the patient." Dr. Shennai said weakly, "We discussed with the French medical team, and they thought the patient It was a meningococcal infection. But it was purely empirical based on the symptoms of the patient -- they didn't do a CSF smear or anything."

"Therefore, the main factor for the patient's fever reduction may be ibuprofen, not ceftriaxone, which controlled her infection." Liu Tangchun took a sip of seaweed egg drop soup, thoughtfully, "The inspection items you gave her Here, which ones are abnormal?"

"The pressure of the cerebrospinal fluid is high, 30% higher than the reference value." Dr. Shennei counted on his fingers. "Severe anemia, the white blood cell index is one-third of the lower limit of the normal reference value, and the percentage of neutrophils is only 40%."

"So you suspect that it should be a virus infection, not a bacterial infection." Liu Tangchun nodded, this line of thinking should be correct. "Using acyclovir for three days in a row is ineffective, and the culture is negative, so you are now blind. From the indicators, it should be a viral infection. From the culture and smear, it is most likely not a fungal or bacterial infection." Old Comrade Liu didn't care what other people thought. He pointed at Sun Li'en, "Tell me your opinion."

Before Sun Lien came to the medical team, he was known as a "warm man" and a "diagnostic genius".He has been in the medical team for a few days, but he has not been able to show the characteristics of a "diagnostic genius"-Mounten's diagnosis is actually not difficult, and even a doctor can tell that he may have rhabdomyolysis.So following Liu Tangchun's roll call, all the doctors in the corner cast expectant glances at him.

After deliberating for a long time, Sun Lien shook his head and said, "There is not enough information, and I don't have any special ideas." He looked at Liu Tangchun, and asked cautiously, "However, I think the current data and test results It doesn't necessarily prove that the patient doesn't have a bacterial infection—not all bacteria can be easily cultured, and not all bacterial infections have elevated white blood cells."

Liu Tangchun became interested, "Tell me more, do you think it is some kind of fastidious bacteria infection?"

"This is just a guess." Sun Lien emphasized, "fastidious bacteria or anaerobic bacteria are not easy to cultivate, and the past medical history of the patient is unknown, and the treatment content is also somewhat strange." He looked at Liu Tangchun and said, "Why do French doctors think a patient has a meningococcal infection?"

"They mainly use empirical medication, that is to say, the initial symptoms of this patient are consistent with the onset characteristics of meningococcal infection..." Doctor Shennei explained, "The main symptoms are fever, headache, and vomiting..." Halfway through, the doctor from the Department of Neurology The doctor suddenly slapped his thigh, and then sweared, "Damn!"

The person who was swearing with him, and the immunology and rheumatology specialist on the side, turned his head to look at Sun Lien and said eagerly, "Do you suspect it is lupus erythematosus?"

Most patients with meningococcal infection will have transient erythema finesse.French doctors may have mistook lupus lesions for meningococcal lesions.However, Chinese doctors lack experience in performing detailed skin examinations on black patients—under the cover of black skin, the erythema of mild lupus is not easy to be seen visually.

If the woman does have lupus, the likelihood that she has an anaerobic or fastidious infection increases dramatically.At the same time, this can also explain why the patient's white blood cell index is severely reduced, and the neutrophil percentage is only 40%.

(End of this chapter)