The amazing continent is home to many mysterious pathogens that are not yet known. No one can say when a new disease will be discovered. After Liu Tangchun heard the physician's report, his first reaction was, "This kind of won't really happen to Lao Tzu, right?"

For other clinicians, the discovery of a completely new disease is likely to be a strong support for a later promotion. But for Liu Tangchun, his biggest hope now is that he and the medical team he led can survive the last three months safely. The other Lao Liu didn't want to touch anything.

Why did you find it for the first time? Isn't it safe and sound? The front foot has just been surrounded by the natives, and the back foot has been surrounded by government troops again -- if you encounter some strange first disease, will you have to be surrounded by the WHO expert group again?

Liu Tangchun's thoughts flashed, he forcibly resisted the idea of continuing to diverge his thoughts, and asked instead, "How many smears have been made?

"It's all negative. Two blood smears were done, three for cerebrospinal fluid and sputum. The physician's face was a little excited, "No colonies have been cultured, but the antiviral drugs have no effect after three days...... Director Liu, could it be a fungus?"

"Fungal meningitis?" Liu Tangchun shook his head, "The doctor who conducts the test here is not a fool, the virus can't be seen on the smear, and the fungus can't be seen?"

Including prions, there are six pathogenic organisms that can infect the human body. From small to large, they are prions, viruses, bacteria, fungi, monocytic organisms, and polynucleated organisms. However, doctors cannot simply judge that the patient is infected by other pathogens based on the ineffectiveness of acyclovir. After all, there is no so-called "broad-spectrum antiviral drug" in the world, general

Multinucleated organisms are rarely able to cross the cerebral blood barrier and enter the brain, and cerebral hydatid can be regarded as one of them, but the patient's current symptoms obviously do not support the diagnosis of cerebral echinococcosis. Meningitis caused by monocytes and fungi generally doesn't develop as quickly – and the sequelae they can cause are much more severe.

The patient was admitted three days ago and complained of just a headache and fever. After three days of antiviral treatment, the symptoms worsened to the point of confusion and inappropriate answers. Liu Tangchun frowned and pondered for a long time, feeling that it might still be necessary to organize a plenary consultation.

If you can't do it alone, ask two people to take a look. In the same way, if the internal medicine doctor and the director of the emergency department are not clear about the disease, it is absolutely necessary to organize a group consultation with the entire medical team and brainstorm together.

After Sun Lien received the notice that he was going to hold a collective consultation with the medical team, he was really a little frightened. I know my own affairs, and if I get involved, the devil knows what strange incurable disease will emerge in the end. It's a pity that Sun Lien's worries were not taken to heart by Liu Tangchun at all. In Liu Tangchun's words, "If you are young, what kind of feudal superstition are you engaged in? If you have a hand in rare diseases, then don't be stingy and give full play to your ability!"

Director Liu asked Sun Lien to "give full play to his skills", and Sun Lien really couldn't find any other reason not to participate in the consultation, so when it was time to eat at noon, all the staff of the medical team gathered in a corner of the canteen, and everyone ate on the stainless steel plate in their hands and began a collective discussion.

"The patient complained of headaches that started six days before admission. Dr. Kaminai, who received the consultation, looked a little worried—he didn't even seem to be able to nibble on the chicken legs as quickly as he used to, "The nature of the pain was mainly constant swelling and occasional pinprick pain. Two days before the patient was admitted to the hospital, nausea and vomiting began. The highest body temperature was 39 degrees Celsius three days before admission. ”

A very interesting feature here is that the 23-year-old female patient had asked for help from another medical team before being admitted to the hospital. A civilian medical team from France saw the woman and gave her "infusion anti-infection" treatment. The content of the medication is not clear, but at least from the patient's complaint, the medication has some effect - she at least has less fever.

However, the French medical team is a regional tour, and they are stationed in each region for a relatively short period of time. After two days of continuous treatment, it was time for the French medical team to leave. The doctor in charge of the female patient kindly recommended the Chinese medical team to her and strongly recommended that she go to the Chinese medical team's premises for follow-up treatment as soon as possible.

"We got in touch with the French medical team and they said that ceftriaxone was used for the patient, as well as ...... Ibuprofen. "Dr. Kamisai is weak," we discussed with the French medical team, and they thought the patient had a meningococcal infection. But this is entirely empiric based on the patient's symptoms – they do not do a cerebrospinal fluid smear or other tests on the patient. ”

So, the main factor in the patient's fever reduction is probably ibuprofen, not ceftriaxone, which controlled her infection. Liu Tangchun took a sip of seaweed egg drop soup and said thoughtfully, "Which of the examination items you did for her were abnormal?"

"The cerebrospinal fluid pressure is high, 30% higher than the reference value. Dr. Kaminai counted on his fingers, "Severe anemia, the white blood cell index is one-third of the lower limit of the normal reference value, and the neutrophil percentage is only 40%. ”

"So you suspect it's a viral infection, not a bacterial infection. Liu Tangchun nodded, this idea should be correct. "Acyclovir has been used for three days in a row and it is ineffective, plus the culture is negative, so you are now blind - from the indicators, it should be a viral infection, and from the culture and smear, there is a high probability that it is not a fungal and bacterial infection. Comrade Liu didn't care what other people thought, he pointed at Sun Lien, "Tell me your opinion." ”

Before Sun Lien came to the medical team, he was famous for being a "warm man" and a "little genius in diagnosis". He has been in the medical team for a few days, but he has not been able to show the characteristics of a "little genius in diagnosis" - Manten's diagnosis is actually not difficult, and any doctor can see that he may have rhabdomyolysis. So with Liu Tangchun's roll call, all the doctors in the entire corner cast expectant glances at him.

After thinking about it for a long time, Sun Lien shook his head and said, "There is not enough information now, and I don't have any special ideas." He looked at Liu Tangchun and asked cautiously, "However, I do think that the current data and test results do not necessarily prove that the patient is not infected with bacteria - not all bacteria can be easily cultured, and not all bacterial infections have elevated white blood cells." ”

Liu Tangchun was interested, "Tell me, do you think it's some kind of caustic fungus infection?"

"It's just a guess. "It is not easy to culture caustic or anaerobic bacteria, and the patient's past medical history is unknown, and the treatment content is somewhat strange. He looked at Liu Tangchun and said, "Why do French doctors think that patients have meningococcal infections?"

"They are mainly empiric medication, which means that the initial symptoms of this patient are consistent with the pathogenesis of meningococcal infection...... "The main ones are fever, headache, vomiting, ......" Halfway through speaking, the doctor of the Department of Neurology suddenly slapped his thigh, and then burst into a foul mouth, "!"

Along with him, there was also an immunology and rheumatology expert on the side, he turned his head to look at Sun Lien and said eagerly, "Do you suspect lupus erythematosus?"

Most people with meningococcal infection have transient fine erythema. French doctors may have mistaken lupus lesions for meningococcal lesions. Chinese doctors, on the other hand, have little experience in conducting detailed skin examinations on black patients — the erythema of mild lupus is not easily visible under the cover of black skin.

If the woman does have lupus erythematosus, the likelihood of her being infected with some kind of anaerobic or caustic bacteria quickly and dramatically increases. At the same time, it is also a good explanation for the severe decline in the white blood cell index and the neutrophil percentage is only 40%.