It took Sun Lien less than a second to recognize the identity of this thing. In the next second, he and Dr. Dong Xin diagnosed Todd's disease type in unison, "Lyme disease!"

Lyme disease is a tick-borne disease in which Borrelia burgdorferi is the causative agent. Neurological damage is the most important clinical manifestation, while encephalitis and meningitis are the most important manifestations of neurological damage. It was first discovered in 1975 in the American town of Old Lyme, hence its name. The first time such diseases were detected in China was in the forest area of Heilongjiang Province in 1986. Due to the relatively low number of tick bites detected in cities, for a long time, Lyme disease and other related tick-borne diseases were effectively regarded as special occupational diseases only faced by forestry workers.

Because ticks are often active in late spring to summer, Lyme disease often occurs in the summer and early fall. But not everyone realizes they've been bitten by a tick – nearly 50% of people diagnosed with Lyme disease can't recall being bitten by a tick. Therefore, the diagnosis of Lyme disease is mainly based on its unique symptom - chronic erythema migrans of the skin.

Skin lesions are a common presenting symptom, and some of these red macules or papules may expand into interethnic annular lesions. Because of the horseshoe-shaped lesions that resemble syphilis, they are occasionally mistaken for syphilis. Even nowadays, when you search on some search engines, you can see questions like "Lyme disease is actually syphilis, right?"

But the reason why the disease is so difficult to diagnose is precisely because of this wonderful misunderstanding. The standard treatment for Lyme disease is penicillin, which happens to be the standard treatment for syphilis. Borrelia burgdorferi, which causes Lyme disease, and Treponema pallidum, which causes syphilis, are biological pathogens that lie between bacteria (lower organisms) and protozoa (higher organisms). This will indeed lead to a deep-rooted misunderstanding among many people who do not know much about medical knowledge.

However, Lyme disease progresses more rapidly than syphilis, and there is uncertainty about how its symptoms manifest. As with recorded recall of tick bites, not all patients will present with and notice this chronic erythema migrans. Todd was apparently not found to have such symptoms. This may be because he didn't pay attention to it, or it could be that Dr. Pascal mistook it for some kind of allergic reaction that wasn't very serious, or maybe it didn't even occur at all.

In short, Lyme disease manifests as meningitis in Todd, and this meningitis is menacing.

Thinking of this, Sun Lien suddenly frowned.

"It's also possible that it's forest encephalitis. "Now that tick-borne diseases are in mind, forest encephalitis should be put on an equally important point of view for differential diagnosis. Dr. Dong Xin fully showed a good trait, before Sun Lien asked a question, he first raised his suspicions, "His body temperature is not very high, but it may be because of ......" He pointed to the wet marks on Todd's body, "because of this cooling measure." ”

Sun did not have any doubts about the diagnosis of Lyme disease, and he believed that Todd had Lyme disease rather than forest encephalitis for two reasons.

First, there is a symptom of peripheral neuritis on the status bar. And this tip happens to be the most direct difference between Lyme disease and senli encephalitis. Although the arbovirus group B encephalitis virus that causes forest encephalitis is a neurotropic virus, it has rarely been recorded to attack the nervous system other than the central nervous system. Facial nerve palsy is a rare complication of forest encephalitis, and it usually occurs in the late or even terminal stages of forest encephalitis.

Secondly, forest encephalitis has a relatively obvious first symptom, and patients will have obvious muscle weakness in the upper limbs (especially in the neck). And when Sun Lien saw Todd, he was holding his head hard, writhing in pain on the hospital bed. If it was forest encephalitis, he shouldn't have twisted it so ...... Hard.

However, the second reason can still be put on the table, and the first reason owes a lot of credibility. Sun Lien thought about it, and first explained the reason with what he saw with his own eyes. He then continued to struggle with whether it was necessary to continue the ventricular puncture when Lyme disease could be diagnosed.

"Alright, go ahead and finish shaving your hair, I'll get the tick later." The excellent actor Dr. Dong Xin waved his hand and asked Sun Lien to continue working. "High intracranial pressure leads to brain herniation symptoms, which you can't get through with some antibiotics in your internal medicine. This cranial flap should be taken or should be taken. ”

Sun Lien looked at Todd with some sympathy, and suddenly asked, "Then what are you going to do after that?"

"Not anytime soon. Dr. Dong Xin stretched out his arm, "Children's skulls will grow up slowly. Titanium mesh does not grow in size as the skull develops. The most common way is to wait until he is eighteen years old to make up for it with titanium mesh. ”

In other words, Todd not only had to face the serious consequences of having his hair shaved completely, but also maintained the cruel status quo of missing a piece of his head throughout his adolescence. Sun Lien felt a little uncomfortable when he thought of this, he was only nine years old.

A nine-year-old boy suddenly encountered such a huge change. It was devastating, both physically and psychologically. What will happen in the future?

Although Sun Lien himself understands that if this operation is not done, Todd is likely to have no "future" in the future. But he was still a little hesitant and a little ...... I can't bear it.

The psychological hesitation and reluctance did not disappear, but Sun Lien's movements were still very fast. Three times five divided by two, and all the hair on Todd's head fell out. He shaved back and forth on it a few more times with a clipper, making sure that every strand of hair was cut short to the shortest possible point. Try not to negatively affect the surgery with these hairs. He then handed the fader to the instrument nurse on the side, and quickly turned around and walked out of the operating room.

Just like Xu Yourong couldn't personally perform this operation, Sun Lien couldn't watch the head of a child who was very familiar with him being cut open in the operating room - this has nothing to do with professional quality, it is purely a matter of habit to be born.

Leaving the operating room, Sun Lien took off his surgical gown in silence, and then saw Dr. Pascal sitting on a bench without saying a word in the lounge next to him.

Dr. Pascal had clearly seen Sun as well, but he only moved slightly, and then went back to his previous form.

"Todd was in the operating room, his cranial pressure was so high that he needed to remove a bone flap to relieve pressure. Sun Lien sighed in his heart, but decided to say something straight, "We found a tick on his head, it should be Lyme disease." ”

Dr. Pascal froze, then his eyes widened. Then, he held his head with trembling hands.

"I shouldn't have stopped the property manager from spraying insect repellent into the yard. His remorseful voice came through the cracks in his hands, and with a self-reproach that was so thick that it could not be dissolved, "Why am I so stupid?"