Uncle Maimaiti's house next door was in chaos.

The two-year-old grandson is crying, and the family is in a hurry.

The door was open, and Lin Xiaoxiao and Shen Yuqi symbolically knocked on the door and entered directly.

The little grandson was held in his mother's arms, his face was sallow, and his nostrils were bloody.

There were also blood-stained tissues on the ground.

"What's wrong with the kid?" Lin Xiaoxiao asked worriedly.

"Suddenly I had a high fever and nosebleeds. "The child's mother was teary-eyed, and the six gods had no owner.

Uncle Maimaiti knew that the four new girls who came today were studying medicine and might be helpful, so he explained carefully: "The child has not been very well recently, he doesn't like to eat, he has a fever from time to time, he has a fever after taking some medicine, and he will have a fever every once in a while, and he still has a rash on his body at the beginning, so he bought skin ointment and applied it for a few days to get better, but he didn't expect to start having a fever again tonight, and he had a nosebleed." ”

Lin Xiaoxiao carefully examined the little boy, he was in a state of weakness, his crying was intermittent, his forehead was hot, but his hands and feet were cold.

Lymph nodes are palpated, and the inguinal lymph nodes are swollen.

Lin Xiaoxiao checked the medicine and ointment that the little boy had taken before, all of which were fever-reducing and hormone-reducing drugs, which treated the symptoms but not the root cause.

But what is the cause?

"When did the child start to have a rash and fever?" Lin Xiaoxiao asked.

"About a month ago, I usually went to the township health center to see a doctor and get medicine. ”

It's October, and I started the disease more than a month ago, at the end of August.

It was hot at that time, could it be the cause of the disease?

What disease lasts for more than a month and gets worse?

From skin symptoms to swollen lymph nodes, from irregular fever to blood clotting disorders, there are a variety of possible causes from symptoms alone.

There are no relevant test results, and the cause cannot be determined from the symptoms.

"The child is in serious condition and is now being taken to the city hospital. Lin Xiaoxiao suggested.

"To the city, now?" the child's father asked.

Southern Xinjiang has a vast area, and there are more than 100 kilometers from Baren Township to the city hospital.

Now it takes nearly 4 hours to call an ambulance back and forth, and I can only drive to the hospital by myself.

Maimaiti filled up his van, and his wife stayed at the homestay to watch the store, and took his son, daughter-in-law, grandson, Lin Xiaoxiao and Shen Yuqi to the city.

At night in autumn in southern Xinjiang, the weather has become cold, with a difference of more than ten degrees from the daytime temperature.

Lin Xiaoxiao was still shivering from the cold when she sat in the car wrapped in her coat, and the child cried twice from time to time because she was uncomfortable, and Lin Xiaoxiao and Shen Yuqi helped take care of it.

It was difficult to walk at night, and after more than two hours, at four o'clock in the morning, the minivan arrived at the city hospital.

The conditions of the city hospital are much better than the county hospital.

After an examination by an emergency doctor, the child is admitted to the hospital.

Admitted to the Department of Hematology.

This was followed by a series of tests: blood count, ultrasound, CT, bone marrow aspirate, ......

The next morning, the results came out one after another.

The doctor's diagnosis also came out - hemophagocytic syndrome.

Hemophagocytic syndrome?!

Lin Xiaoxiao suddenly thought of Aunt Li who met on the train.

She was also diagnosed with hemophagocytic syndrome by doctors.

Poor appetite, pale complexion, dark skin, irregular fever without obvious cause, nosebleeds...... Similar symptoms, same diagnosis.

Do the two have the same cause?

Is it endemic? Or is it an infectious disease?

"Doctor, I want to see the detailed test report. Lin Xiaoxiao asked the attending doctor.

The report sheets were all taken, and Lin Xiaoxiao stood in the hospital corridor outside the ward, looking at them carefully one by one.

When she saw one of the microscopic photographs of a bone marrow smear, her eyes froze.

Proliferative bone marrow with phagocytic histiocytes.

Judging from this film alone, the diagnosis of hemophagocytic syndrome is not wrong.

However, Lin Xiaoxiao always felt that something was wrong.

"Are there any other pieces of the bone marrow smear?" Lin Xiaoxiao asked the attending doctor.

"Yes, but they are all in the laboratory department, and if you want to see the original film, you need to go to the laboratory department to find it. ”

Normally, the hospital does not allow the patient's family to enter the laboratory department, but the attending doctor also had doubts about his diagnosis and decided to go and see it himself.

In the laboratory department of the hospital, the examiner finds the child's bone marrow smear.

Under the microscope, the nearly fragmented cells have a black outline.

Lin Xiaoxiao's mind flashed through the pictures he had seen in parasite class, which were very similar to one of them.

Protozoa!

What exactly is a protozoa?

I also thought of the experience from yesterday to now, a large number of flying insects smaller than mosquitoes in the livestock shed, the back of the hand that bites the lotus seed, the leper dog at the door of the neighbor's homestay, the fat pet dog with pus in the eyes of Uncle Li's family, the child with swollen lymph nodes in the rash, and the old man with black skin and irregular fever......

Sandflies!

That's right! The small flying insect that bites the back of the lotus seed in the livestock shed of the B&B is the sandfly!

Sandflies spread kala-azar!

Uncle Maimaiti's youngest grandson was infected with kala-azar.

The causative agent of kala-azar is Leishmania donovani.

At this moment, the black dots in the bone marrow smear under the microscope are Leishmania donovani.

"It's kala-azar!" Lin Xiaoxiao said with certainty.

The attending doctor was slightly stunned, and after watching the film in person, he asked the family about the epidemiological history of the patient, "The child has been bitten by sandflies before?"

"There are a lot of mosquitoes in the countryside, and you may have been bitten. "The child's mother is not sure.

The doctor also seemed to be aware of the fact that there was no one in the countryside who had not been bitten by mosquitoes in the summer.

It's just that kala-azar has disappeared in Baren Township for decades, how could it suddenly appear?

This problem is more serious.

Antimony treatment is the usual treatment because kala-azar has been gone for many years, the hospital does not have a stockpile, and it is necessary to contact another hospital.

The attending physician changes the diagnosis, changes the treatment plan, urgently contacts the drug.

There is a doctor staring at Maimaiti's little grandson, and Lin Xiaoxiao is worried about Aunt Li.

"Doctor, the patient's neighbor's aunt may also be infected with kala-azar. Lin Xiaoxiao took the initiative to report the situation.

"Oh, you told her to come to the hospital for a check-up as soon as possible. ”

Doctors are already busy caring for patients in the hospital, and they simply can't take care of people who are not diagnosed outside the hospital.

How do I inform Aunt Li?

Kala-azar is endemic and contagious, are there any people in the neighborhood around Maimaiti who are also infected with kala-azar?

The hospital doesn't care about this matter, but the CDC will manage it.

Kala-azar is a notifiable Class C infectious disease and is within the scope of disease control and surveillance.

Lin Xiaoxiao used the mobile phone network to find the phone number of the local disease control and called to explain the situation.

As soon as the phone hung up, my roommate Lingling called.

Over there, Shen Yuqi also received a call from her roommate Lianzi.

"Hey, Xiaoxiao, where are you and Boss Qi now? ”

"City hospital, accompany Uncle Maimaiti to see his grandson, we left a note on your door when we left, didn't you see it?"

"I just woke up and saw it. ”

"Two sisters, it's ten o'clock now, and you don't get up yet?"

"Time difference, now it's just equivalent to eight o'clock in the morning in our Yunhai City, it's normal to get up at this time on the weekend, and it's very tiring to take the train for two days and one night!

"The cause has been found, the condition is stable, but it is ......"

Lin Xiaoxiao hesitated.

"Xiaoxiao, just what? Isn't the situation optimistic?"

"It's not. ”

"What is the child's illness?"

"Kala-azar disease. ”