"Imported cases? The recent imported cases of filariasis are all Roa loa filariasis, and its vector is spotted fly, and there is no natural foci in China, how can there be a cluster outbreak? In Gu Yanan's impression, the recent cases of filariasis reported by the hospital are all imported, and they are all Roa loa filariasis, so there is this question.

"It is true that one imported Roa lois patient was admitted today, but there are many more patients with lymphatic filariasis that was previously common in China, suspected Malary filariasis, or bansoniasis." Gu Jiashu explained anxiously.

"Then it is even more impossible, we in Lianhai City as early as 2001 to meet the criteria for the elimination of filariasis, and in the following years we did population microfilaria monitoring to determine that the disease has been eliminated, how can there be a sudden cluster outbreak?" Gu Yanan was skeptical about the outbreak that his brother Gu Jiashu suddenly reported.

"The patient is swollen all over, especially the edema of the lower limbs, and there are red lines spreading on his body, which are what traditional Chinese medicine usually calls flowing fire, typical filariasis symptoms, and the patients are all from Shajia Village, next to Fairy Lake in Yuntai County."

Yuntai County?!

Gu Yanan's heart trembled, Fairy Lake in Yuntai County was the hardest hit area of the filariasis epidemic in the 70s of the last century, and there were two epidemics of filariasis and Malayan filariasis.

Both filariasis vectors are mosquitoes, of which humans are the sole reservoir for filariasis, but mammals such as cats can also be used as storage hosts for Malayan filariasis in addition to humans.

In the seventies and eighties of the last century, although the prevalence of microfilariae in the population was monitored, cats and other animals were not monitored, and there was still a possibility of a resurgence of Malayan filariasis.

In addition, in 2001, a few years after it was announced that Lianhai City had reached the standard for the elimination of filariasis, microfilariae were monitored, and the carrying rate of microfilariae in the population was still at a certain level.

Eradication refers to the permanent disappearance of an infection caused by a pathogen around the globe through global cooperation.

Elimination refers to the reduction of the infection rate of a disease in a defined area to zero through prevention and control.

There is a risk of a resurgence of the eliminated disease.

Gu Yanan: "How many patients with symptoms of flowing fire have been admitted now?" ”

"There are currently three, but I heard from the patient that there are other villagers in the village with similar symptoms."

Is the emergence of filariasis patients in the old endemic areas of filariasis really a resurgence of filariasis epidemics that have disappeared for decades?

If so, things are tricky.

"Brother, the patient should be isolated and treated first, especially to prevent mosquito bites, and I will bring someone over immediately."

Hanging up the phone, Gu Yanan thought of the best candidate for this partner - Zhou Lao.

Mr. Zhou is the oldest in the entire emergency team, and when he was young, he worked in the old epidemic prevention station, participated in the handling of the filariasis epidemic, and has the best understanding of the situation in the entire filariasis epidemic area of Lianhai City.

——

The First People's Hospital of Lianhai City, Infectious Disease Ward.

Three patients from Shajia Village, near Fairy Lake, were placed in the same ward, with mosquito nets hanging on all three beds and mosquito prevention measures on the doors and windows of the wards.

Gu Yanan and Zhou Lao entered the ward accompanied by Gu Jiashu.

Next to the bedside of patient Sha Hongyu, Gu Jiashu lifted the corners, sleeves and trouser legs of his clothes, and several people could clearly see the red lines spreading on his body.

"Flowing fire?!" Zhou Lao exclaimed, "This kind of red line is flowing fire, I have seen it before, but I didn't expect it to appear again after decades." ”

The symptoms are consistent with the typical symptoms of filariasis, but the diagnosis requires laboratory evidence.

In the past, blood was drawn for chalariasis and microfilariae were detected in the blood, which is a typical test.

Nowadays, PCR technology is advanced, and blood is drawn to check whether the filarial worm gene is in the blood, and further typing can be made to determine which subtype of filariasis it is.

However, this blood collection time is strictly important, and it is best to collect blood between 8 p.m. and 2 a.m. on the second day.

At this time, the microfilariae will enter the peripheral blood, and during the day, the microfilariae are hidden in the capillaries of the lungs, and the wrong time of blood collection will cause false negative results.

Gu Jiashu: "The laboratory department of our hospital did an examination and found that the patient had elevated blood eosinophils, hypergammaglobulinemia, increased serum IgE levels, and positive laboratory tests for anti-filariasis antibodies. ”

Zhou Lao: "You can't do positive blood collection during the day, you have to wait until after 8 o'clock in the evening, it is best between 10 o'clock in the evening and 2 o'clock in the morning, collect blood directly for blood smear, and collect earlobe blood at night time, of course, venous blood is the best." ”

Gu Jiashu: "I asked the nurse on the night shift to collect venous blood at this point in time, and send it to your CDC when the time comes, as for the treatment of patients, we have albendazole and ivermectin here, but for the treatment of lymphatic filariasis, the commonly used drug is pyrimethazine, the trade name is Haiqunsheng, the hospital currently does not have this drug reserve, it is best to use these three drugs together." ”

Zhou Lao: "In the past, in the 80s, this kind of drug was everywhere, but later it was announced that filariasis was eliminated in China, and there was no manufacturer of this drug anymore, but I knew that the parasite should have a reserve of this drug, and I would call later." ”

As he spoke, Old Zhou turned to Gu Yanan beside him, looking worried, "I don't know what the situation is in Shajia Village?" Judging from the current situation, it is really a resurgence of filariasis. ”

"Shajia Village is definitely going to go, first ask about the patient's condition, and wait for the laboratory results." Gu Yanan asked Gu Jiashu beside him again, "Where is the imported Roassiasis patient?" ”

"The next room. Because of the fear of cross-infection, they were placed separately, and the symptoms of the two groups of patients were obviously different. Gu Jiashu explained, and at the same time planned to take Gu Yanan and Zhou Lao to the next ward to have a look.

Zhou Lao whispered: "Although they are all filariasis, the vector of imported Roasworm disease is spotted flies, and the vector of typical filariasis in China is mosquitoes, and there will be no cross-infection between the two." ”

Gu Yanan: "I'm not worried about imported cases infecting local cases, I'm just worried about local cases infecting imported patients, after all, mosquitoes are everywhere in the country, and I don't know which mosquito bites the blood of local cases, so it will spread." ”

After Zhou Lao asked the patient a few questions, he followed Gu Jiashu to the next ward.

In this ward, the patient is receiving deworming treatment, because of the use of anthelmintic drugs, the lumps on his body have begun to increase, and a doctor is helping the patient to collect the worms on the spot.

Accustomed to seeing all kinds of epidemics, seeing the situation in front of them, Zhou Lao and several people still have numb scalps.

After the operation was completed, Zhou Lao and Gu Yanan asked the patient a few questions and left the ward.

Outside the ward, Gu Yanan analyzed with Zhou Lao and Gu Jiashu, "This imported case has no connection with the filaria patients in Shajia Village, Fairy Lake, and it should be just an accidental situation to come to the hospital at the same time. ”

Gu Jiashu: "Are you going now?" It's already afternoon, and when you rush to Shajia Village, it's getting dark. ”

Ordinary doctors don't care about the work schedule of disease control, but Gu Jiashu is Gu Yanan's elder brother, so he is inevitably worried about the safety of his little sister.