What does this mean? The blind cat ran into a dead mouse? Sun Lien was speechless in shock. Every doctor can be sure that the "tuberculosis cannot be ruled out" in the previous consultation is purely a cover to make the "opinion" without an opinion seem less pale.

However, in this case, it was tested positive for tuberculosis antibodies. Sun couldn't accept such an outcome anyway – not because he had any personal conceit.

jokingly said "Be careful of meteorites falling from the sky to kill you", but a meteorite fell directly and killed people with great accuracy, who can accept this kind of thing?

"The possibility of false positives must be taken into account. After being silent for a while, Sun Lien made a decision, "Take blood and run a PCR to check for tuberculosis bacteria." ”

A positive TB antibody does not directly indicate that the patient has had or is currently infected with Mycobacterium tuberculosis. The clinical significance of this indicator is not particularly large. Especially after universal BCG vaccination.

The gold standard for tuberculosis is always sputum culture. And underneath that, the patient needs to behave:

"He's 25 years old, and even if he's been vaccinated with BCG, he's probably just born. Dr. Jiang frowned, "The antibodies produced by BCG are generally only three or four years old, and there should be no protection after the age of twenty." He's showing positive antibodies at his age, and I think it's worth paying attention to. ”

"Isn't that very important to me?" Sun Lien glanced at Dr. Jiang, "Let's take a PCR and see—it's not realistic to wait for a sputum smear now." And he also did not have the typical symptoms of tuberculosis. ”

"I mean, rifampicin and isoniazid first. "His condition is more serious, and it may be possible to control his condition earlier if he starts treatment with antibiotics earlier." ”

This time it was Sun Lien's turn to hesitate. In all fairness, if this happens in the fourth hospital, it is absolutely necessary to improve the examination while giving the patient anti-tuberculosis drugs for experimental treatment. But Kaoru Kobayashi's condition is different, and his symptoms are somewhat more severe — at least more severe than the average tuberculosis patient.

Should anti-TB drugs be used empirically, or should the principles of "evidence-based medicine" be followed and the current regimen should be maintained until treatment is refined?

"Give it to him. Sun Lien thought for a moment and decided to agree with Dr. Jiang's opinion, "But PCR still needs to be done......" He thought for a while, pretending not to care and continued, "Since you have checked the antibodies, let's check all the other antibodies." ”

"The others are already being checked. Dr. Jiang showed a smile that "mountain people have their own tricks", "I saw that there were quite a lot of blood samples sent, so I prescribed antinuclear antibodies, antiphospholipid antibodies and other tests." ”

Sun Lien breathed a sigh of relief, in this way, at least the two prompts in the status bar can be clarified. Later, the anti-β2-GP1-Ab antibody will be mentioned, at least there is a reason.

However, there are still many things that Sun Lien can't figure out. At least he still couldn't figure out why Kaoru Kobayashi's infection was in such a strange state - why was he positive for tuberculosis antibodies?

If you don't know, ask for help. It doesn't matter if Sun Lien can't figure it out by himself, isn't there an immunology expert who eats and drinks spicy food in the fourth courtyard?

Dr. Pascal was in his office when he received a call from Sun Lien.

"I heard you've withdrawn?" Dr. Pascal answered the phone as soon as he saw the caller's number, and asked eagerly, "How are you doing?"

"We're on a hospital ship in the Navy right now, and it's definitely safe. Sun first thanked his colleague and boss for his concern, and then began to throw out questions, "Dr. Pascal, I would like to consult...... Is it possible that other diseases other than tuberculosis infection may cause this indicator to be positive for tuberculosis antibodies?"

"TB antibodies?" replied Dr. Pascal, after a moment's thought, "as far as I know, there are." ”

The body's immune system is a very complex system, so complex that we still don't know how it works – and this conclusion can be applied to almost all human systems. In some cases, diseases can disrupt the body's immune system, causing this delicate and vicious system to go haywire.

"Generally speaking, if there is this kind of confusion, then many other indicators will also have false positives. For example, if the antinuclear antibody is positive, the anti-smooth muscle antibody, anti-mitochondrial antibody and some other rheumatic immune indicators will also be positive. "This confusion is usually caused by an autoimmune disease or allergies. Differentiation is based on the patient's clinical presentation. ”

"In addition to autoimmune diseases and allergies...... Dr. Pascal continued after a moment of silence, "to my knowledge, some nontuberculous mycobacteria may also trigger a positive reaction to tuberculosis antibodies. This is mainly due to structural and compositional similarities between mycobacteria, which also leads to the presence of common antibodies. ”

Sun Lien was overjoyed, and after saying goodbye to Dr. Pascal in a very perfunctory manner, he rushed directly to the cabin where the examination room was located.

Dr. Jiang happened to be frowning in the examination room, staring at the test report in front of him, his face tangled. He kept muttering, "How is this possible? It doesn't make sense......

"Doctor Jiang!" Sun Lien asked breathlessly, "Is it...... Does Kaoru Kobayashi have any other antibodies positive?"

Dr. Jiang glanced at Sun Lien as if he had seen a ghost, "Yes...... This has just come out of two cases, both antinuclear antibodies and antiphospholipid antibodies. ”

That's right! Sun Lien was overjoyed, snatched the inspection report, and read it again. At the same time, he said, "Nontuberculous mycobacteria can cause false positives for tuberculosis antibodies — no, they should be considered positives." ”

"Other mycobacteria and Mycobacterium tuberculosis are structurally and compositionally identical, and they may share antibodies. Sun conveyed to Dr. Jiang what he had just learned, "In other words, it should have been some kind of mycobacteria that infected him - but it could never be tuberculosis!"

Sun Lien is extremely sure that Kaoru Kobayashi is definitely not a patient with hidden infection of Mycobacterium tuberculosis. The latent infection will not have symptoms, and his current symptoms are not comparable to tuberculosis. What's more, the status bar doesn't prompt this aspect at all.

Myeloproliferis is markedly active, C-reactive protein rises, fever, cough, rash, positive antinuclear antibodies, positive antiphospholipid antibodies, positive anti-β2-GP1-Ab antibodies.

Of the eight states, the first four can be seen as signs of infection, while the rash may be an infection or an allergy. The last three positive antibodies should be a reminder of Sun Lien's "nontuberculous mycobacterial infection".