Lianhai First People's Hospital, Department of Infectious Diseases.

Gu Jiashu has received a number of patients from Hetang Village.

One of them, an old man in his 50s named Zhang Youfa, was admitted to the hospital with urgency and pain, and blood in the urine.

After admission, cystoscopy revealed a calcified cauliflower-like mass in the bladder triangle.

Pathological biopsy was performed on some of the masses, and it was found that there were oval-shaped parasite-like substances, calcifications and foreign body granuloma formation in the subepithelial interstitium of the urothelium.

Subsequently, plasma resection of the urethral bladder mass was performed, and postoperative pathological examination showed that multiple well-defined nodules were found in the subepithelial interstitium of the urothelium, and oval parasite eggs were found in the nodules under the microscope.

Another middle-aged woman from Hetang Village, who was transferred from the county hospital, was admitted to the hospital because of paroxysmal epilepsy, and was initially treated with anti-epileptic drugs, but did not improve, and developed a coma.

Gu Jiashu suspected that she might also have a parasitic infection, so she took the large intestine mucosa of a middle-aged woman for testing, and found a large number of parasite eggs under the microscope, which were the same shape as the eggs in Uncle Zhang's hair.

Da Niu, a little boy from Hetang Village, was admitted to the hospital because of blood in his urine, and parasite eggs of the same shape were also detected in the urine sediment.

Gu Jiashu remembered that Lianhai City was a schistosomiasis epidemic area a few decades ago, although the symptoms of these patients from Hetang Village were different, and the symptoms were also different from those of common schistosomiasis patients in China, but parasite eggs were detected in the body, and there was no doubt that they were parasitic diseases.

The specific parasitic disease, whether it is schistosomiasis infection, and whether the detected eggs are schistosomiasis eggs or which kind of schistosomes are inexperienced colleagues in the laboratory department of these hospitals, and need the help of parasitic disease experts from the CDC to confirm the confirmation.

While Gu Jiashu is treating the patient, the police station is dealing with the floating corpse in the lotus pond in Lotus Pond Village.

——

Lianhai City Police Station, Autopsy Room.

The medical examiner is conducting an autopsy on the floating corpse brought back from Hetang Village.

Nan Hanfei watched the whole process from the sidelines.

A colleague from the forensic department was performing an autopsy while explaining, and someone was videotaping it next to him.

"There were no visible injuries on the surface of the body, indicating that the deceased had not fought with anyone during his lifetime.

The deceased's lungs were filled with water and lotus pond silt, which was consistent with the characteristics of drowning death. ”

Nan Hanfei asked on the side, "Check the liver and intestine veins of the deceased to see if there are any parasites." ”

According to Nan Hanfei's request, the forensic doctor specially examined the cancerous mesenteric vein, and found no parasites.

When the genitourinary system was examined, a lot of parasites two centimeters long were found in the veins of the bottom bladder.

The medical examiner removed the parasites from the veins at the bottom of the bladder of the deceased one by one and placed them in a medical tray.

The medical tray contains half a plate of clear saline, and the worm body stretches in the saline, black and white, with a knuckle long.

In the end, a total of more than 30 worms were taken out from the veins at the bottom of the deceased's bladder, and they were densely packed into the medical tray, looking very terrible.

Nan Hanfei approached and observed the insects that had been taken out.

Cotton-thread-like bugs, one milky white and one black-brown, are intertwined, like two black and white cotton threads twisted together.

"It's really a schistosome!" Nan Hanfei was amazed.

The young forensic doctor was also very surprised, "I used to know that Lianhai City was an old epidemic area of schistosomiasis, but decades ago the government announced that the local schistosomiasis here in Lianhai City has been eradicated. ”

"Not necessarily, maybe it's an imported case, but whatever the case is, we don't have to worry about the police, these things are handled by the CDC."

——

Lianhai Center for Disease Control and Prevention, Emergency Office.

Four of the six members of the emergency response team sat in the office, and Zhou Jie and Gao Fei went to the county to participate in the on-site investigation of a hand, foot and mouth epidemic.

Gu Yanan, Gu Qingcen, Lu Li and Wang Xiaoxiao sat in the office.

Gu Yanan is sorting out the sequencing sequences of the strain genes on the computer, and by the way, he is making an evolutionary map.

After the results of the gene sequence comparison came out, Gu Yanan frowned and said to himself, "This sequence must be wrong, what's wrong?" ”

Although Gu Yanan's voice was small, Gu Qingcen, who was sitting opposite her, could still hear it clearly, and raised his head and asked, "What's wrong?" ”

"Do you remember the poisoned cucumber incident before?"

"Remember, it was the one on the farm in the eastern suburbs, it was an enterohemorrhagic E. coli contamination, what? What's the problem? ”

"In the past few days, I took the strains isolated from the epidemic to be sequenced, and the sequencing results just came back today, I did a genetic comparison, and found that the gene sequence is exactly the same as a laboratory strain on the Internet, with 100% homology, which shows that the strain of this epidemic in our Lianhai City is the same strain as the strain in a foreign laboratory thousands of miles away, how is this possible?"

Gu Qingcen also felt strange, stood up and walked to Gu Yanan's computer desk, looking at the comparison results on the computer screen, and sure enough, it was the same as she said, 100% homology, it was the same strain.

A trace of uneasiness flashed in Gu Qingcen's eyes, but after trying his best to stabilize it, he analyzed: "Maybe the sequencing company made a mistake and sent the sequence of the control strain." ”

"Could a sequencing company make such a low-level mistake?"

"Since it's a mistake, there will always be some low-level ones, and if it's not like that, I can't think of any other explanation, isn't our CDC going to get a sequencer? When the sequencer comes, we'll do it ourselves, and then we'll know the results by making a comparison. ”

Gu Yanan originally wanted to change to a sequencing company, but when Gu Qingcen said this, the sequencer from his CDC was coming soon, so it was better to wait and make it more reliable by himself.

"Okay, then wait for our center's own sequencer to come, alas, the current sequencing company, this work attitude needs to be improved."

Gu Yanan rarely complained a few words, and the mobile phone suddenly rang.

Caller ID brother Gu Yoshiki.

"Brother, call me at this time, is there an epidemic?"

"Yes, we have admitted several patients to the infectious disease department of our hospital, and parasite eggs have been detected in the patient's body, but the specific type of eggs is difficult for us to confirm, and we need your parasite experts from disease control to help confirm the diagnosis."

The general parasite diagnosis can be done by the examiners of the hospital laboratory department, and they can't even see that it must be a very poor and rare parasitic disease.

"The laboratory department can't see the type? You should have a general judgment based on clinical symptoms, right? ”

"From the clinical symptoms, it is schistosomiasis, but it is not the same as the symptoms of common schistosomiasis in the past, the common schistosomiasis in China is mainly skin and liver damage, and this time the patient is mainly the damage of the genitourinary system, and there is a case of cerebral schistosomiasis."

Gu Yanan also felt strange, "Schistosomiasis, which mainly damages the genitourinary system, sounds more like it is caused by Schistosoma haematoidum, and the main epidemic in my country is Schistosoma japonica, do all the cases you receive have experience abroad?" ”

"I asked about the epidemiological history in general, and none of them had ever been abroad, which was the most strange thing to me."

"Well, it's really strange, brother, you first let people send the patient's specimen to our laboratory, I will contact the laboratory parasite experts, let them do the egg typing, and I will take the emergency team to the hospital to see the patient."

"Okay, I'll send someone to bring the patient's urine and serum right now."