Micro-check

GeneXpert is a fully automatic integrated real-time fluorescent quantitative PCR instrument, of which GeneXpertMTBRIF is a kit for the detection of Mycobacterium tuberculosis, which can directly detect Mycobacterium tuberculosis in a patient's sputum sample in about one and a half hours, and can detect the Whether rifampicin resistance.

The pathogenic bacterium that causes tuberculosis is Mycobacterium tuberculosis, which grows very slowly. If it is to be cultured, it takes about a week to see the bacteria on a solid medium, and it takes about a month for the colonies to grow. Obviously; with liquid culture, it takes at least a week before the grown bacteria can be used for subsequent detection.

Because of the characteristics of this pathogenic bacteria itself, if it does not use molecular biology methods, but uses traditional methods, it often takes a very long time to detect its drug resistance.

It is necessary to culture the patient's sputum sample first, and then do the drug resistance test. Even the liquid culture method that takes the shortest time takes half a month to a month, while the longer solid culture method requires nearly two weeks. month time.

Therefore, the examination by molecular biology method can get the result within a few hours, which is obviously the benefit brought by scientific and technological progress to patients.

However, the detection of molecular biology methods is now on the market, and hospitals can use and report. The GeneXpert MTBRIF method can only detect rifampicin resistance, while other methods such as linear probes and gene chips, etc. Resistance to two drugs, rifampicin and isoniazid, can be made.Although the method of liquid culture and solid culture takes a long time, it can test the drug resistance of more than a dozen drugs, and can analyze more drug resistance of bacterial samples, which can provide patients with more personalized and precise treatment. Chemotherapy.

The reason why the GeneXpertMTBRIF method is currently on the market can only be used for rifampicin is because the mechanism of rifampicin resistance and the gene mutation site are the most thoroughly studied, and it is possible to judge whether the bacteria are resistant to it by detecting the gene mutation site of the bacteria. Rifampicin, the accuracy can reach more than 90%.

In addition to this reason, another reason is that today's Mycobacterium tuberculosis has the highest drug resistance to rifampicin.From an economic analysis, the detection of rifampicin resistance is the most cost-effective, so the research on rifampicin resistance is also the most.

Rifampicin is a semi-synthetic antibiotic that can inhibit bacterial DNA transcription and synthesis of RNA. It has a bactericidal effect, so it is widely used, and because the drug is cheap, the side effects of the patient are small, and it is also the best choice for non-drug-resistant patients.

If the patient is already resistant to rifampicin, the drug cannot be used anymore, and if the patient is resistant to rifampicin, there may be resistance to other drugs, and future treatment will be troublesome.

The treatment period is longer, the drug costs are more expensive, and the side effects are also greater.

Although Zhou Xun received many kinds of disease samples every day, he would not link each pathogenic bacteria with a real person for a long time, but only conduct testing and research on the pathogenic bacteria themselves, but this time is different. The result corresponds to a real person he knows, and he feels the weight right away.

But he quickly came back to his senses, put down his chopsticks, and asked, "Ke Mei, whose is the strong positive, and what about the other?"

Ke Mei said: "The one with Fei is strongly positive and resistant to Rifampicin, and the other is negative. However, the two sputum samples you sent are not very good, and the other one is negative, which is probably a sputum sample. No, so it wasn't detected. Did they do PPD and chest X-ray first?"

Zhou Xun replied: "We did PPD, but it hasn't been 48 hours yet, and the results haven't come out yet. They haven't had a chest X-ray yet, so they don't know the condition of their lungs. Both of them have cough symptoms."

Ke Mei said: "This is the result here. For the clinical diagnosis, let them go to a clinical doctor. Let the clinical diagnosis and the pathogenic diagnosis be combined to make a judgment. Or let them send a better sputum sample, and I will give it to the doctor. They do it once."

Zhou Xun sighed with a heavy heart, and said, "Well, okay."

Ke Mei said, "That Fei, is that the child?"

Zhou Xun said, "Yes."

Ke Mei said: "If the diagnosis is really confirmed, I think their family must notify the school and do close contact screening. He is now strongly positive, and he should have been infected for a while. It is very likely that he had a long history of infection in the school before. He has a history of coughing. Maybe his classmates are also infected. If we don’t deal with it, it may infect many people. We have dealt with tuberculosis in a school before, and five active tuberculosis were detected in that class , and some were infected, but did not get sick. This is a very serious epidemic. Besides, he is still a drug-resistant strain. If the infection is really spread, the impact will be too bad. Which school is that child, I see To see which district it belongs to, ask the district’s CDC to send someone to their school to have a look. If the district has no way to deal with it, we will deal with it.”

Zhou Xun also knew that the situation was serious. Hearing what Ke Mei said, for some reason, he suddenly understood what Teacher Peng said before, "If you have children, you will understand..." A child who feels a little autistic and has this disease, as a source of infection, or he is also infected by other people at school, will be treated like an enemy by everyone, which is really unacceptable for a while.

No matter what his feelings are, Zhou Xun's rationality can gain the upper hand in an instant. He said: "I remember that he is a student of the middle school affiliated to the school, but maybe his family can find a way to transfer him to a better school, thank you Alright, Ke Mei, I'll contact his family right away."

"No matter what the result is, you must tell me in time. They will start school in a few days. If he is really diagnosed, he must not be allowed to go to school. He must suspend school. This is not a joke. Nowadays, children go to school in the daytime every day, do homework at home at night, or just play with mobile phones and computers. Many of them have poor physical fitness, low immunity, and are prone to infection. After infection, they are also easy to get sick. , the students in the school sit in one classroom, and there is no ventilation, so it is easy for one to ten, ten to one hundred. We have dealt with several tuberculosis outbreaks in the school last year, let alone some that we did not deal with , It was dealt with by the disease control below." Ke Mei's tone was severe, not at all relaxed and mischievous when she was usually joking.

Zhou Xun said: "I understand, don't worry. Their school requires students to check the PPD when they start school, and they have to take the inspection report back to report. He came to me for the inspection because of this incident."

Ke Mei sighed: "It is because there are always epidemics in schools now that we require schools to screen students for tuberculosis. First, it is not easy for schools to organize screenings to collect money, and the schools themselves are unwilling to pay. The first reason is that they are afraid of unifying the organization. After the investigation, other students will see the results, which will have a bad influence on the children with positive results. Thirdly, if something goes wrong, the school is unwilling to take responsibility, so they came up with this method to let the students Go to the hospital for an investigation by yourself, and just take the results back. Of course, some parents are afraid of delaying their children’s studies, and even if they are positive, they go to their acquaintances to fake it. There are tens of thousands of people, and in many cases, it is not as strict and precise as the experiment.”

After hanging up the phone with Ke Mei, I went to look at his bento, and Xiao Yuan had already eaten it all.

Seeing him looking over, Xiao Yuan immediately held Zhou Xun's lunch box and said flatteringly, "Brother, I'll wash the lunch box for you."

If it was before, Zhou Xun wouldn't bother her, but he was going to call Teacher Peng, so he waved to Xiao Yuan: "Okay. Wash it clean."

"Okay!" Xiao Yuan happily went to wash the lunch box.