"Nontuberculous mycobacteria are mostly conditionally pathogenic. Dr. Jiang frowned and thought about it, and decided not to dwell on why Kaoru Kobayashi was infected with a conditional pathogenic bacterium, "The specific type identification and diagnosis will be left to the laboratory department." Is the treatment plan going to be adjusted?"

"Nontuberculous mycobacteria are mostly sensitive to rifampicin, but have some resistance to isoniazid. Sun Lien had already had a general understanding of the mycobacteria before he came, "The current expert opinion is to use a combination of rifampicin, ethambutol and isoniazid. ”

"I'll check the information...... "Doctor Jiang didn't dare to listen to Sun Lien's opinion directly. After all, not long after Sun Lien got his medical practitioner's certificate, even if he is talented in diagnosis, he will inevitably lack experience in clinical treatment. For this kind of major event, Dr. Jiang really didn't dare to listen to Sun Lien's opinion directly.

"Oh yes......" Sun Lien not only did not have any dissatisfaction with Dr. Jiang's attitude, but also nodded. "If it is a rapid growth of mycobacteria, Mycobacterium ulcerans may be completely resistant to the drug......

"Buruli ulcer?" Dr. Jiang suddenly fell silent, and after pondering for a while, he asked cautiously, "But...... His symptoms don't look like ah. ”

This time it was Sun Lien's turn to be stunned, Buruli ulcer? What is that?

Looking at Sun Lien's sluggish expression, Dr. Jiang was stunned as if he was also infected, "Don't you know that Buruli ulcer is a disease caused by Mycobacterium ulcers infection......

Two goose-headed geese, you look at me, I look at you, after a while, the two of them let out a burst of laughter together.

"I thought you knew!" Dr. Jiang smiled as he wiped the tears from the corners of his eyes that were squeezed out of the smile, "You all know about Mycobacterium ulcers, why haven't you even heard of Buruli ulcers?"

Sun Lien smiled and replied with difficulty, "You know about Buruli ulcer, why didn't you think of it at first?"

"I can't help it. Dr. Jiang straightened up and shook his head as he replied, "His symptoms are so atypical, who can think about that?"

Buruli ulcer is a rare and endemic disease that occurs mainly in the rainforests of West and Central Africa. Although it has been established that Mycobacterium ulcerans is a pathogenic bacteria, there is still no knowledge about the natural host and transmission route of this bacterium. The only plausible speculation is that the bacterium may have lived in the soil of tropical rainforests or on insects, and was most likely transmitted through insect bites.

The main reason why Dr. Jiang didn't think of Buruli ulcer at first was because Kaoru Kobayashi's symptoms almost did not bear any resemblance to Buruli ulcer. He had a high fever, lymphatic masses in his armpits, and no lesions typical of Buruli ulcers, which would be a hell to think about.

After listening to Dr. Jiang's description, the smile on his face gradually disappeared. Everything he knew and learned told him that there might be something wrong with it.

"Buruli ulcer is caused by infection with Mycobacterium ulcerans, which belongs to the fast-growing nontuberculous mycobacteria. Sun Lien slowly sorted out his thoughts, and said while thinking, "The biggest feature of rapidly growing nontuberculous mycobacteria is that they cause skin diseases, and at the same time, they grow rapidly. ”

This is actually a nonsense, just looking at the eleven words "rapidly growing nontuberculous mycobacteria", this bacterium must grow faster than other mycobacteria.

But he's been unwell for the sixth day now. Sun Lien frowned and raised his own questions, "If it is Buruli ulcer, then why does he show symptoms that are completely different from the known Buruli ulcer? He has systemic symptoms, but Buruli ulcer does not, he has lymph nodes, and Buruli ulcer should have subcutaneous nodules, he only has a rash, but the most characteristic of Buruli ulcer is the skin lesion, he does not show it......" Sun Lien paused, "A horse with wings, a pointed beak, and only two paws and feathers...... Shouldn't that actually be a bird?"

This metaphor is a bit abstract, and Dr. Jiang pondered for a while before he understood what Sun Lien was talking about, "Don't you think it's ......?"

"I think it's very unlikely. Sun Lien replied honestly, "A disease that shows one or two rare or even rare symptoms can be excused by 'we don't know enough about it', but this kind of ...... Almost all the symptoms are reversed, so people have to be vigilant. ”

Sun Lien had also vetoed Xu Yourong's diagnosis before. He knows exactly how painful these summaries of the "types of symptoms" that doctors have downplayed. This is not only the hard work of doctors, but also the result of countless patients suffering from illness.

For such an experience, Sun Lien really can't easily ignore it.

To put it another way, as in his wonderful metaphor, something with wings, a pointed beak, and two claws and feathers, if not a bird—it shouldn't be a horse.

"If it weren't for Buruli ......ulcer," Dr. Jiang muttered now, "the symptoms of several other nontuberculous mycobacteria are not the same." ”

Most of the nontuberculous mycobacteria are opportunistic pathogens, and there are only a few that can cure the disease.

"Not Mycobacterium Kansas, not Mycobacterium mari, the patient did not exhibit tuberculosis-like lesions. ”

"Not Mycobacterium scrofulus, he doesn't have submandibular glands and submandibular lymph node swelling. ”

"It's not Mycobacterium avium-intracellular, which can also cause conjugated lesions. ”

Sun Lien and Dr. Jiang looked at the information for almost an hour, but they still couldn't find a match for Kobayashi's symptoms from these currently known pathogenic non-tuberculous mycobacteria.

"No...... If you go on like this, you're looking for a needle in a haystack. Dr. Jiang first decided to give up, "Regardless of what mycobacteria it is, at least most of them are sensitive to a combination regimen of rifampicin, ethambutol and isoniazid." Let's treat him in this way......"

Sun Lien slowly raised his head and twisted his stiff neck, "That's right......" He looked at the information in front of him and hesitated, "But what if...... Isn't it a nontuberculous mycobacteria?"

"Huh?" Doctor Jiang was really a little angry when he heard this, and after tossing for so long, you played this set for me again?"

"I mean......" Sun Lien considered his words, "the ones that can cause a positive reaction of tuberculosis antibodies are all mycobacteria, right?"

"Isn't that what you just said?" Dr. Jiang laughed angrily, "What, there is something wrong with this theory?"

"There's nothing wrong with the theory, but there's something wrong with our perspective. Sun Lien raised the information in his hand and pointed to the item "Mycobacterium marinus". "Look at this. ”

Dr. Jiang looked at the piece of literature that he had almost read rotten, "What's wrong with that?"

"Mycobacterium marinis can cause skin papules, nodules and ulcers, and acid-fast bacteria are found in pathological examination, which is easy to be mistaken for Mycobacterium leprae in clinical practice......," Sun Lien asked after repeating this document, "What about that...... Is it possible that he was infected with Mycobacterium leprae?"