Toxoplasma gondii is an opportunistic parasite. The word "opportunistic" sums it up perfectly - they usually lurk in the human body, until the horn of attack sounds, they suddenly attack, and then take the host's life in a vicious manner.

And this horn of attack is the decline of the body's immune system.

Toxoplasma gondii infection is actually very rare in the general population. They usually occur in people with AIDS. Once the doctor confirms that the patient is infected with Toxoplasma gondii, the first reaction is to check for HIV antibodies. Like Kaposi's sarcoma, the onset of Toxoplasma gondii is basically an exclusive disease of people with AIDS.

For Yang Jianqiang, he is lucky and unfortunate at the same time.

The onset of leukemia forced him to undergo whole-body radiation, which killed all the bone marrow in his body. Without the support and replenishment of hematopoietic bone marrow, the antibodies in his body that had been suppressing Toxoplasma hedii were weak, and it was recorded that after the memory T cells of Toxoplasma gondii antibodies died with the normal apoptosis program, his body lost the ability to recognize Toxoplasma gondii. The donor apparently has never been exposed to Toxoplasma gondii, and his bone marrow is not capable of producing such antibodies. Therefore, Yang Jianqiang unfortunately lost the ability to suppress the toxoplasma gondii in his body. This is his misfortune.

But fortunately, the radiation that cleared his bone marrow also caused a huge kill to Toxoplasma gondii. Toxoplasma gondii is a parasite that is relatively sensitive to radiation. Doses of radiation in excess of 20,000 rads can cause the worm to lose its ability to reproduce. Low doses of radiation also have a strong ability to inhibit Toxoplasma gondii. This is the reason why although Yang Jianqiang lost his immunity, the onset of the disease was a year later.

"It's just writing. After listening to Sun Lien's report in his office, Liu Pingchuan frowned and shook his head, "This is too coincidental." ”

"However, the symptoms are right. Sun Lien is quite confident in his diagnosis. Even though you can pass the PCR test, you will definitely get the results you want when all three diseases are checked. But he still hopes to persuade Liu Pingchuan first and treat Yang Jianqiang one step earlier. Those eight edema areas brought Sun Lien some foreboding.

"If it's really a toxoplasmosis infection, just treat it with a combination of sulfadiazine and pyrimethamine, and you don't need to rush so much. Liu Pingchuan's opinion is conservative, and he does not intend to risk specific treatment of Yang Jianqiang until he has conclusive evidence.

Sun Lien was silent for a while, and Liu Pingchuan's opinion was Lao Cheng's serious path. But he still had some inexplicable worries. Although he himself did not know where this worry came from.

The opinion of the senior physician takes precedence over his or her own opinion. This is a process that every practitioner goes through. For many doctors who have just stepped into the industry, this hurdle must be experienced - it doesn't really matter what you think, what matters is what your senior doctor thinks.

Although this may sound a bit excessive, for the sake of the patient's life, the medical staff must first suffer some grievances. After all, in comparison, the probability of a senior doctor making a mistake is always much lower than that of a small doctor.

Sun Lien left Liu Pingchuan's office, and as he walked towards the consultation room, he looked down and wondered where his doubts came from. Respecting one's senior doctor does not mean that you do not need to think. If this worry is not clarified, Sun Lien is afraid that he will not be able to sleep well tonight.

"You're back to work so soon?" A voice behind him interrupted Sun Lien's musings, and he turned his head to look, only to find that Zhou Ce was nibbling on a slimy hot dog bag and walking towards him.

"Ah...... Right. Sun Lien nodded, the hot dog bag in Zhou Ce's hand looked sticky, and the red ketchup and yellow mustard sauce were all spread on the bread. I really don't know what Zhou Ce did with this bread. "Doctor Zhou, this is going for a consultation?"

Zhou Ce shook his head, "I just finished the outpatient clinic and had lunch by the way." ”

Sun Lien glanced at the time on his phone, it was 5:40 p.m., and it was time to leave work in 20 minutes. "Now for lunch?"

"I don't want to say I'm a wretched man who can't even eat lunch. Zhou Ce smiled, ate the remaining hot dogs in three bites, threw the bag into the trash can next to him, clapped his hands and asked, "@#¥%@#@#!@#@#%...... ）&（*......#￥？”

"You ......," Sun Lien's brows jumped, "Why don't you swallow the contents of your mouth first?" I still have time when you finish eating." ”

Zhou Ce waved his hand, rolled his eyes and swallowed the contents of his mouth, "I see that you have walked around this corridor five times, and I want to ask if you are lost." ”

"Where did all these inexplicable judgments come from?" Sun Lien wiped the cold sweat that didn't exist on his head, "By the way, I seem to have heard you say something about stealing the little nurse's underwear when I was quarantined last time...... He suddenly thought of the first problem that Zhou Ce encountered when he was quarantined. "What's the story?"

Zhou Ce's eyes widened and asked, "You don't know this story?"

"I don't know. Sun Lien shook his head seriously, "If you know, I won't ask you." ”

Zhou Ce laughed and told the story.

It is said that seven or eight years ago, when Zhou Ce had just become an ordinary resident doctor, there was an underwear thief in the Fourth Central Hospital. The thief's tactics are not very clever, and he can even be said to be a model of indiscretion - he swaggered into the female nurse's dormitory in the inpatient department at the time of noon, when the crowd was at its highest. Then, in front of the little nurses on the entire first floor, he pushed open the door of a nurse's dormitory. More than a dozen pieces of underwear were stolen from inside.

The result of such a bold and straightforward action was that before the underwear thief walked out of the inpatient department, he was pressed into the elevator by Liang Security Officer with a vote of brothers.

The security department caught such criminals as soon as it began to operate, and originally planned to directly hand over the underwear thief to the nearby police station to enhance the friendship between the two parties, but he didn't expect the college teacher who came in a hurry to find out that the underwear thief was actually a student who came to the college for an internship in the fifth year.

In the spirit of treating the sick and saving people, after obtaining the forgiveness of the stolen nurse, the security department handed over the coadvert to the college teacher. Hopefully this incident is just a joke that is not very funny. Hopefully, under the criticism and education of the teachers, he will be able to realize how inappropriate his behavior is.

Unexpectedly, a week later, the security department recaptured this little bastard - a patient came to the security guard, saying that there was a pervert in the outpatient women's bathroom who peeped into their toilets.

Brother Liang of the security department rushed to the toilet with a vote of brothers, only to find that the prisoner turned out to be the underwear thief who was caught a week ago.

If it's just a pervert, then it's caught. But the pervert is so open-minded, so straightforward and unobtrusive, it's really the first time I've seen the security department.

Brother Liang was ruthless, and was ready to send this unrepentant little bastard directly to the police station. And the academy teacher who picked people up before also had an ugly face, and he didn't understand how this young man, who was usually silent and extremely introverted in school, could do such a thing.

Coincidentally, the floor where the incident occurred happened to be the site of the hepatobiliary surgery. And Director Zhao Chongxi, director of the Department of Hepatobiliary Surgery, came out to see the excitement after watching the outpatient clinic. After hearing what had happened, he muttered for a moment and asked the nurse to draw a tube of blood from the kid and check his liver function.

It doesn't matter if you check it, this kid's blood ammonia is as high as 974μmol/L. When he was sent to the imaging department for examination, he was diagnosed with stage 3 liver cancer.

"He was very agitated at the time, and I wasn't sure what was wrong with him at the time, and there were many symptoms that could simply cause an increase in blood ammonia. I'm afraid of some kind of virulent infectious disease. Zhou Ce explained, "So, at that time, Dean Song slapped the board, put the young man on restraint measures, and locked him in the clean room that had just been renovated. ”

It's a ...... Not very funny story. Sun Lien sighed and asked a question like the rest of the people who listened to the story, "What happened later?"

"Later...... There was no later. Zhou Ce shook his head and sighed, "Stage 3 liver cancer caused hepatic encephalopathy, and that young man's family is also in a bad situation. Later, after the family picked them up, there was no more news. He looked at Sun Lien, "So, what are you hanging around here?"

Sun Lien glanced at Zhou Ce, muttering in his heart whether this strange doctor should feel that he also had a problem, and then replied, "The emergency department picked up a patient, and the situation is quite strange." He told Zhou Ce about the patient's situation he knew, as well as his own inferences.

"Your diagnosis...... Some are too jumpy. Zhou Ce, like Liu Pingchuan, his first reaction was "This is really too coincidental", but then, he slowly tasted the difference. "But...... Makes sense. ”

"If it doesn't make sense, I won't try to mention this to Dean Liu. Sun Lien sighed, "But after listening to Dean Liu's words, I vaguely feel that something is not right." ”

Sun Lien's worries are also Zhou Ce's worries. Nephrology often deals with the Department of Rheumatology and Immunology, and in some hospitals that do not have a separate Department of Rheumatology and Immunology, this part of the treatment and diagnosis is often entrusted to the Department of Nephrology. Zhou Ce, who has the corresponding expertise and vision, immediately found the crux of the problem.

"If it's really a toxoplasmosis outbreak caused by radiotherapy, how can this progression be explained?"

Sun Lien was stunned. Zhou Ce's question is very straightforward, and it is also the weakest link in the whole diagnosis process. His theories could explain why patients develop the disease during immunosuppressive periods without exposure to dogs or cats, but they could not explain why his symptoms progressed so quickly after the onset of illness.

"The specific reason...... I do not know. Sun Lien admits that he doesn't know anything about it. As a regular training doctor, there is no shame in not mastering these professional knowledge. "However, based on the timing and sequence of changes in his condition, I think it may have something to do with the adjustment of his immunosuppression regimen. ”

"The new immunosuppressive regimen is a little weaker in suppressing his immune system. Zhou Ce thought thoughtfully, and then was shocked, "So the reason why he quickly developed symptoms was not because of the increase in Toxoplasma gondii infection, but because of the improvement of immunity?"

Sun Lien stood up suddenly, "I'll go find Dean Liu!" Before the words fell, he ran out of the smoke.

m.