Chapter 117 Diagnosing a Little Genius (July 16, 1/1
The magical Africa has many unknown mysterious pathogens. No one can tell when a new disease will be discovered. After hearing the doctor's report, Liu Tangchun's first reaction was, "I won't really encounter this kind of mess, right?"
For other clinicians, discovering a brand new disease is likely to be a strong support for promotion in the future. But for Liu Tangchun, his greatest hope now is that he and the medical team he led can survive the last three months safely. The other old Liu doesn't want to touch anything.
What should I find out for the first time? Is it safe? I just got surrounded by the natives, but I was surrounded by the government army again. If I encounter some strange first disease, will I have to be surrounded by who's expert team again?
Liu Tangchun's thought flashed, and he forced himself to keep the idea of continuing to spread his thoughts, and asked, "How many smears have you done? They are all negative?"
"All negative. I did two blood smears, and three cerebrospinal fluid and sputum." The doctor's face was a little excited. "The colonies were not cultivated, but the antiviral drugs were not effective after three days... Director Liu, could it be fungi?"
"Fungal meningitis?" Liu Tangchun shook his head, "The doctors who are doing the test here are not fools. The virus cannot be seen on the smear, and the fungus cannot be seen?"
Including prions, there are six pathogenic bodies that can infect the human body. From childhood to adulthood, they are prions, viruses, bacteria, fungi, mononuclear organisms, and polynuclear organisms. However, doctors cannot simply judge that the infecting patients by the ineffectiveness of acyclovir. After all, there is no so-called "broad-spectrum antiviral drugs" in the world. Generally,
Multinucleated organisms rarely pass through the cerebral blood barrier and enter the brain. Echinacea is one of them, but the current symptoms of patients obviously do not support the diagnosis of echinacea. Meningitis caused by monocyte organisms and fungi will generally not occur so quickly - the sequelae they may cause are even more serious.
The patient was admitted to the hospital three days ago, and the main complaint was only a headache and fever. After three days of antiviral treatment, the symptoms worsened to the point where they were unconscious and answered the question. Liu Tangchun frowned and thought for a long time, thinking that it might be necessary to organize a full consultation.
If one person can’t handle things, please ask two people to take a look. Similarly, Shennei, the physician and the director of the emergency department cannot figure out the disease. It is absolutely necessary to organize the entire medical team for collective consultation and brainstorm together.
After receiving the notice of holding a group consultation between the medical team, Sun Lien was really scared. He knew his own affairs, and if he got involved, he would know that some strange and difficult problems would appear in the end. Unfortunately, Sun Lien's concern was not taken seriously by Liu Tangchun at all. In Liu Tangchun's words, "A young man, why are you engaged in feudal superstition? If you have a skill in having rare diseases, don't be stingy with your ability!"
Director Liu called Sun Lien to "use his abilities", and Sun Lien really couldn't find any other reason to not attend the consultation. So when lunch came, all the staff of the medical team gathered in a corner of the canteen, and everyone started a group discussion with the stainless steel plate in their hands.
"The patient's main complaint was that he started a headache six days before admission." The doctor Shennei, who was receiving the hospital, looked a little worried - he even gnawed the chicken legs as fast as before. "The pain is mainly continuous swelling and occasional acupuncture-like pain. Two days before admission, the patient began to experience nausea and vomiting. The maximum body temperature three days before admission was 39 degrees Celsius."
There is a very interesting feature here - this 23-year-old female patient asked for help from another medical team before being admitted to the hospital. A private medical team from France treated the woman and gave her "infusion anti-infection" treatment. The content of the medication is not clear, but at least from the patient's complaint, the drug treatment has some effect - she at least doesn't have a fever anymore.
However, this medical team in France belongs to the regional tour type, and they stayed in each area for relatively short time. After two consecutive days of treatment, the French medical team was about to leave. The doctor in charge of this female patient kindly recommended the Chinese medical team to her and strongly suggested that she go to the Chinese medical team's residence for follow-up treatment as soon as possible.
"We got in touch with the French medical team, and they said they used ceftriaxone and... ibuprofen." The doctor of Shennei was weak. "We discussed with the French medical team, and they believed the patient had a meningococcal infection. But this was entirely an empirical medication based on the patient's symptoms - they did not perform cerebrospinal fluid smears or other tests on the patient."
"So, 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 flower soup and said thoughtfully, "What are the abnormalities in the examination items you did for her?"
"The cerebrospinal fluid pressure is high, 30% higher than the reference value." Doctor Shennei counted with 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 it should be a viral infection, not a bacterial infection." Liu Tangchun nodded. This idea should be correct. "Acyclovir was used for three consecutive days without effect, and the culture was negative, so you are blind now - from the indicators, it should be a viral infection, and from the culture and smears, it is likely not a fungal or bacterial infection." Comrade Liu didn't care what others thought. He pointed to Sun Lien, "Tell me what you think."
Before coming to the medical team, Sun Lien was famous for being a "warm man" and a "diagnostic genius". After several days of coming to the medical team, he has not been able to show the traits of a "diagnostic genius" - Mung Teng's diagnosis is actually not difficult, and even a doctor can tell that he may have rhabdomyolysis. So with Liu Tangchun's name, all the doctors in the whole corner cast anticipational gaze at him.
After considering for a long time, Sun Lien shook his head and said, "There is not enough information now, and I don't have any special ideas." He looked at Liu Tangchun and asked carefully, "However, I think the current data and test results may not necessarily prove that the patient is not infected by bacteria - not all bacteria can be easily cultivated, and not all bacterial infections have increased white blood cells."
Liu Tangchun was intrigued, "Talk about it, do you think it is some kind of harsh bacteria infection?"
"This is just a guess." Sun Lien emphasized, "Crude bacteria or anaerobic bacteria are not easy to be cultivated, and the patient's past medical history is unknown, and the treatment content is also strange." He looked at Liu Tangchun and said, "Why do French doctors think that the patient has meningococcal infection?"
"They mainly use empirical medication, which means that the patient's early symptoms are consistent with the onset of meningococcal infection..." Dr. Shennei explained, "The main ones are fever, headache, vomiting..." Halfway through, the doctor of Shennei suddenly slapped his thighs and then sweared, "Damn!"
The person who swears with him, and the immuno-rheumatologist on the side of him turned his head and looked at Sun Lien anxiously, "Do you suspect it's lupus erythematosus?"
Most of the patients with meningococcal infections will have transient erythema. French doctors may have mistaken the skin lesions of lupus as a precursor to the skin lesions of meningococcals. Chinese doctors lack experience in conducting detailed skin examinations on black patients - under the cover of black skin, erythema of mild lupus is not easily visually discovered.
If this female patient does have lupus erythematosus, the possibility that she is infected with some anaerobic or caustic bacteria will increase rapidly and significantly. At the same time, this can also explain why the patient has a severe decline in the white blood cell index and the percentage of neutrophils is only 40%.
Chapter completed!