According to Andy's friend Anna, Andy had the typical clinical manifestations of malaria before he was admitted to the hospital, typical of periodic chills, fever, and sweating.

If Gu Jiashu could have asked more about Andy's symptoms before he was admitted to the hospital, or if she had been to a malaria-endemic area, then there would be no need to do so many tests.

Gu Jiashu sighed in his heart, or that sentence is the most reliable: for fever of unknown cause, you must ask about the epidemiological history.

After learning about Andy's situation and previous epidemiological history with Anna, the hospital laboratory department happened to call, "Hey, Dr. Gu from the infection department?" I just looked at the blood smear, and the field of malaria parasites is full of it, and now the preliminary identification is falciparum malaria, you can deal with it first, and a detailed report will come out tomorrow. ”

With the report from the laboratory department, it can now be confirmed that Andy is infected with falciparum malaria.

Since Gu Jiashu went to the First People's Hospital of Lianhai City to work, this is the first time he has diagnosed malaria patients, because of the geographical location of Lianhai City and the disease prevention work of the Center for Disease Control and Prevention, Lianhai City has not had a case of malaria for many years, and now there is a sudden case, which makes Gu Jiashu feel strange.

In any case, once a case of malaria has been confirmed, treatment should be initiated.

According to guidelines published in WHO2015, the first choice for the treatment of falciparum malaria is artemisinin-based combination therapy.

Gu Jiashu chose one of the combination therapies and gave a doctor's order.

But soon the pharmacist at the hospital called, "Hey, Dr. Gu, this is the medicine store, I'm sorry, the doctor's order can't be carried out, we don't have sodium artesunate here, and there are no other antimalarial drugs." ”

Gu Jiashu was anxious, "Huh? Our hospital does not have a stock of anti-malarial drugs, and now that we have patients, how can we buy anti-malarial drugs? ”

Pharmacist: "In Lianhai City, because malaria is not a common disease, the pharmacy of the general hospital will not have anti-malarial drugs, in case a malaria patient needs to contact the Institute of Parasitic Diseases under the Lianhai CDC with the test report and the doctor's prescription, they have a drug stockpile. ”

Gu Jiashu is very familiar with the people from the Municipal Center for Disease Control and Prevention, especially his sister Gu Yanan.

Gu Jiashu immediately called his sister Gu Yanan, "I have diagnosed a malaria patient here, and the hospital has no reserves of antimalarial drugs, so I want to transfer drugs from your CDC." ”

"Okay, I'm going to contact someone from the Institute of Parasitic Diseases, and you can send me the specific type of medicine you need."

The matter was quickly connected, and Gu Jiashu was going to send an assistant doctor to the Institute of Parasitic Diseases to pick up the medicine, but Gu Yanan felt that this time and forth was very time-consuming, so Gu Yanan decided that she would send the medicine directly to the hospital.

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

Gu Yanan took the antimalarial medicine, rushed to the infection department, and handed it over to Gu Jiashu.

Gu Jiashu handed over the medicine to the nurse and administered it according to the doctor's instructions.

Gu Jiashu: "Little sister, thank you for letting you run in such a hurry." ”

Gu Yanan stood in the corridor outside Andy's ward, looked inside through the glass door of the ward, and said: "This is also my job, I am not only here to deliver medicine, malaria is an infectious disease, since the hospital has found a case of malaria, our CDC is going to conduct an on-site epidemiological investigation, I also came to the hospital to ask Andy about his previous epidemiological history." ”

Gu Jiashu: "Andy is now in a cerebral coma caused by falciparum malaria and can't answer your question, but I have already asked Andy's friend Anna, and she said Andy's symptoms before she was admitted to the hospital, as well as her epidemiological history, I will tell you anything you want to know." ”

"I want to know all you know."

Gu Jiashu retold all the information he heard from Anna to Gu Yanan, and finally concluded: "Andy is a model, and when he went to take a photo shoot in malaria-affected areas in Africa, he was infected with the malaria parasite, and he only began to get sick after returning to China.

When Andy first became ill, he had typical symptoms of malaria, alternating between chills, fever, and sweating.

Andy thought it was a cold and took cold medicine.

Until you meet Andy at the café, she has convulsions because her red blood cells have been destroyed by the malaria parasite.

Andy was taken to the hospital in a coma, and falciparum malaria progressed to cerebral malaria.

In short, Andy is an imported case of malaria from Africa. ”

Gu Yanan gave a thumbs up to Gu Jiashu, "Brother, yes, your epidemiological history investigation is very complete, and this level can reach our disease control." ”

Gu Jiashu smiled slightly, "Just go to your disease control, I think I need me more clinically." ”

Gu Yanan: "Anna and Andy went to the malaria-endemic area in Africa at the same time, Andy was sick, so did Anna check whether she was infected with the malaria parasite?" ”

"Well, this isn't there yet, Anna has been taking care of Andy, I'll remind Anna later, let her do a blood smear of the malaria parasite in the hospital and check it out."

Gu Yanan: "Actually, there is a faster way to check for malaria. ”

"Nucleic acid amplification?"

"The cost of PCR is too expensive, and now there are colloidal gold kits for the detection of malaria parasites, which are cheap and fast, and the only drawback is that the detection rate is slightly worse than PCR."

Gu Yanan and Gu Jiashu were discussing which method to use to quickly and efficiently detect malaria parasites, and the nurse who gave Andy an intravenous infusion in Andy's ward suddenly ran over in a hurry, "Doctor Gu, the patient has soy sauce-colored urine!" ”

Gu Jiashu hurriedly entered the ward, followed by Gu Yanan.

The two saw the urine coming out of the catheter next to Andy's bedside turn dark red like soy sauce.

A word immediately popped up in Gu Yanan's mind - black urine fever.

Gu Jiashu hurriedly said: "Stop using quinine, now we want to be diuretic and alkalize urine." ”

Gu Jiashu was busy changing the treatment plan for Andy, "Artesunate sodium 120 mg, intravenous bolus." ”

The young nurse was a little busy under Gu Jiashu's command.

Gu Jiashu was anxious, and began to take matters into his own hands, opening the artesunate powder injection, mixing it with 5% sodium bicarbonate injection, and then injecting it into 5% glucose injection to dilute it after clarification, and finally slowly intravenous bolus into Andy's blood vessels.

After Gu Jiashu finished the operation, he gave the doctor's order again, "Ten milligrams of dexamethasone, add 500 ml of 5% glucose, and inject it intravenously." ”

The little nurse followed Gu Jiashu's instructions and began to get busy again.

Gu Yanan watched Gu Jiashu and the little nurse deal with Andy, who suddenly turned into black urine fever, and remembered that when he had dinner with Nan Hanfei before, Nan Hanfei had meaninglessly mentioned the Tianqiao murder case, and the deceased Cheng had also had black urine.

Could it be that the deceased in the flyover murder died of malaria?

Gu Yanan immediately walked out of Andy's hospital room and stood in the corridor to call Nan Hanfei on his mobile phone.

The phone was connected, and Gu Yanan's tone was anxious, "Has the autopsy report of the deceased in the Tianqiao murder come out?" ”

Nan Hanfei felt strange, Gu Yanan would never take the initiative to mention the murder case he investigated, how could he suddenly mention it today, and his tone was so anxious?

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