Is it really this fungus?

This case is the home of the Department of Infectious Medicine and the Department of Respiration, and all the bigwigs have their eyes on the directors of these two departments.

The old lady director of the respiratory department had already put down the teacup that had not left her hand, and frowned at this time.

"Haven't used antifungal drugs before?"

Zhang Tianyang nodded, "Yes, I haven't used it." ”

He turned the PPT to the page where the patient took the medication and pointed to the data on the screen to explain.

"Teachers, please look here, the patient has been on strong antibiotics in the past, here. ”

Zhang Tianyang pointed to the screen, "But according to what I learned from my family members yesterday, the patient's condition worsened in a short period of time after taking strong antibiotics." ”

"Here, after using hormones, the condition has also worsened in a short period of time. ”

"My thinking is that the use of strong antibiotics does not hit the pathogenic bacteria, but rather causes the normal microbiota of the human body to be imbalanced, thus allowing the pathogenic bacteria to take advantage of the deficiency. ”

"It's the same with hormones, which attack the patient's immune mechanism and allow pathogenic bacteria to take advantage of the opportunity. ”

The red-faced bigwigs who had just quarreled below nodded their heads in approval.

The most embarrassing thing about this incurable disease is that there is no direction, but if someone can come up with a direction that is sufficient to explain the development of all diseases, then the next problem will be well solved.

The bald professor of the Department of Internal Medicine frowned, and his heart told him that the young doctor might be right.

But after two quarrels and no wins, he also has his own pride.

"Again, how do you explain the problem that anti-tuberculosis treatment was effective at the beginning and then failed?"

Zhang Tianyang smiled and typed the PPT to the one with the previous case at the beginning.

"Of the seven previous non-HIV patients infected with Penicillium marnefi, two were misdiagnosed with TB, one of which was effective but quickly relapsed and the other was ineffective. ”

"I think it may be just a plateau during the treatment period that coincides with the proliferation of Penicillium marnefi and does not prove that anti-TB drugs are effective. ”

"Moreover, the rate of rapid deterioration of the condition after one month of anti-tuberculosis treatment is also consistent with this principle. ”

He glanced at the bigwigs who were listening carefully below, and expressed his opinion again in a strong and affirmative tone.

"I would like to emphasize that in the above seven cases, four of them ended up with antifungal drugs, and the outcome was improvement and cure. ”

"Three of them, who had never used antifungal drugs, ended up dying. ”

He looked down at the tragic chest X-ray on the table at the front, and his fists trembled a little.

"Smack, smack, smack"

Professor Zhu suddenly began to applaud, followed by the director of the Department of Respiratory Medicine.

Professor Zhou, the director of the Department of Cardiology, also applauded, and his interest in Zhang Tianyang grew more and more.

"I thought I could try. ”

The big guy in the laboratory department groaned and spoke.

"Penicillium marnefi does have special conditions for growth, and the growth rate is very slow under culture conditions, and its red color is really easy to confuse with tuberculosis. ”

"It was really difficult to cultivate when I didn't have a direction before, but now that I know this possibility, if I specialize in cultivation, I may be able to see it. ”

Professor Zhu asked the practical question, "Can you do it?"

The director of the laboratory department smiled awkwardly, "It didn't work before, but recently I have cooperated with Jinyu Inspection, and I can send it over to do it." ”

"How long?"

"A conservative estimate is that the results will come out in a week. ”

"It's too slow!"

The old lady director of the respiratory department directly interrupted the director of the laboratory department, "When the results come out, this little girl's organ damage will be aggravated, let's go to treatment first!"

The head of the dermatology department agreed.

"Yes, I also think that we should go to the treatment first, our department and orthopedic department will first treat the pustules of the bone and skin to prevent further deterioration, and then see the effect of treatment. ”

The head of the Department of Orthopedics said succinctly, "OK!"

The bald director of the Department of Infectious Medicine frowned and looked at the bosses in each department who agreed, and even began to discuss the follow-up treatment plan, but at this time he finally stopped talking.

"Well, Doctor Bed, you're called ...... Oooh, Dr. Zhang. ”

Under Professor Zhu's reminder, the bald professor finally looked at Zhang Tianyang's name and began to ask questions.

"Doctor Zhang, since you think it's a fungal infection, how are you going to specify a treatment plan?"

Zhang Tianyang was prepared.

"The four cases that have improved and recovered in the past have all been treated with amphotericin B, and the treatment effect is good. I think this patient can also start with amphotericin B and then adjust the medication according to the effect of subsequent treatment. ”

"Okay, I don't have any doubts. ”

The bald professor raised his hands and smiled in agreement.

"I don't have any doubts. ”

"Seconded!"

"Me too!"

"Me too!"

The incurable diseases that have been diagnosed and treated for five years rarely have a new direction, and the bigwigs are in a good mood and even joke.

A group of bigwigs laughed at each other and walked out, without the tension of the whole hospital consultation at the beginning.

Chen Shishi hid at the back of the conference room, watching Zhang Tianyang's performance and the reactions of the bigwigs, and stood up unconsciously and opened her mouth wide.

"It's the first time I've seen the bigwigs listen to the words of the junior doctors!"

Senior Brother He smiled, patted his ass and stood up, "Who isn't?"

He looked at Zhang Tianyang, who was packing up his things at the front, with a smile in his eyes, and sighed in his heart.

"The back waves of the Yangtze River push the front waves!"

......

Outside the conference room, Professor Zhou from the Department of Cardiology waited for the bald director of the Department of Infectious Diseases.

"The doctor who just did the case debriefing, your new resident?"

"It's not. ”

The bald director obviously sighed a little, "It's Professor Zhu, I heard that it's a new intern this year." ”

"Eight-year?"

"Five-year program. ”

Professor Zhou of the Department of Cardiology turned around and glanced at Zhang Tianyang's back from a distance.

"What a seedling......"

......

At noon, Zhang Tianyang was rushed to the outpatient pharmacy by the little nurse and took back all the orders that were prescribed at half past eleven.

"Doctor, haven't you taken these medicines before?"

The woman was holding the newly issued pills, a little confused.

They have used all kinds of antibiotics, but the name of this medicine in their hands, amphotericin B, is not known at all.

"Also, the anti-tuberculosis drug was not given today, was it not prescribed?"

"This is an antifungal drug, don't take the tuberculosis drug from today. ”

Zhang Tianyang looked at the girl on the hospital bed gently, "The dermatology department and the orthopedic department will operate on her in the next two days to deal with some infection foci, and the rest depends on this medicine." ”

"In the past two days, you should pay attention to it, and if there are side effects of the drug, such as nausea, vomiting, diarrhea, allergies, etc., tell us immediately. ”

Zhang Tianyang explained the precautions and walked back step by step.

The woman looked at the medicine she had never seen before, and her hard heart gradually became soft and warm.

"Ahhh......h

On the hospital bed, the girl could not speak, only to make a few sounds.

But the woman read her eyes.

"Daughter, keep persisting. ”

She hurriedly poured water and fed medicine to the girl on the hospital bed.

"This time, maybe, what if you can?"

"Mom, I want to believe in a miracle again. ”

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