I can see the status bar

Chapter 183 Three Years of Latent
Allogeneic bone marrow transplantation is one of the important means to treat certain types of leukemia.And this treatment process mainly uses bone marrow mobilization agents to promote the donor's hematopoietic stem cells into the blood.Then, through blood collection and centrifuge separation with less volume than ordinary blood donation, about 10ml of hematopoietic stem cell solution is extracted, and then intravenously injected into the recipient.And this hematopoietic stem cell solution is actually a blood product.Blood products, of course, are likely to spread various diseases.

"According to general principles..." Dr. Pascal frowned and thought for a long time. "Bone marrow transplantation should be non-infectious."

General allogeneic bone marrow transplantation generally occurs among relatives of the recipient.And most of them are immediate family members.Some unlucky patients may not be able to match with relatives.At this time, hematopoietic stem cell donation is needed to treat the disease.Bone marrow mobilizers require a minimum of four consecutive injections.From the moment the donation is confirmed, the donor will undergo a considerable number of disease checks to ensure that the hematopoietic stem cells he donates will not lead to the spread of disease.Moreover, even if there is any newly infected disease, the donor will show some clues during the four-day mobilizing agent injection process.

"What about non-general principles?" Sun Lien also knows that the inspection before donation is very important and very strict.But that doesn't mean there won't be some impersonal omissions—after all, accidents are unexpected.

"Maybe there will be some pathogen transmission from unconventional inspection items?" Speaking of this, Dr. Pascal is not very sure.He just made a guess based on his own research experience and research direction. "Maybe there are some viruses with no specific antibodies and no specific symptoms?"

Sun Li'en rolled his eyes, he had no specific antibodies and no specific symptoms.If there is such an infectious disease, and it can behave like Yang Jianqiang, then all doctors and medical scientists can wash their necks and wait to die-how excited are the doctors when they encounter rare cases? You can probably know the medical record reports in the journals published every month.

However, there is indeed nothing wrong with Dr. Pascal's inference.Without specific antibodies, it is possible to bypass the pre-donation inspection.If there is no specific performance, it is possible for the donor and the doctor to ignore the performance at the same time.If Lin Jianqiang's current cause of disease comes from donated bone marrow, then only pathogens that meet these two conditions can do it.

"The MRI results are out." The two were staring at the door, and Liu Pingchuan walked out of the room with the newly released MRI image, his brows were deeply wrinkled, and there were layers of gullies in the middle of some whitish eyebrows. "Xiao Sun, come and see this."

Those eight edematous areas were obvious on MRI, and the most noticeable one was the edematous area near the basal layer, although it looked a little blurry, it was indeed a roughly round gray spot.

"MRS showed that the metabolic level of Cho increased, while the metabolic level of NAA decreased." Liu Pingchuan estimated that Sun Lien could only watch the excitement, but could not see the specific way.So he explained, "Cho represents the degradation product of myelin sheath, which is related to maintaining the integrity of myelinization. The decrease in NAA metabolism suggests that brain cells are damaged."

"From early to now, there has been such a big change..." Sun Lien frowned and asked, "Could it be herpes simplex encephalitis?"

Herpes simplex encephalitis is a relatively common type of viral encephalitis, and its biggest feature is its rapid progression.But this conjecture was rejected by Dr. Pascal, "Herpes simplex encephalitis first occurred in the temporal lobe, and this patient had multiple episodes. And there was no evidence of gyral edema."

"What about cryptococcal infection?" Dr. Pascal asked after pondering for a moment, "The onset of this infection is hidden..."

"There is no soap bubble cyst." Liu Pingchuan also joined the discussion. "And cryptococcus isn't invisible - it's not going to change so quickly in the morning."

"So, there are three things we need to figure out now." Sun Lien made a summary of the statement, "First, why the disease progressed so quickly. Second, what caused his symptoms. Third, brain cells Damaged and polyedema, whether it is a direct manifestation of the disease he suffers from."

Pascal nodded thoughtfully.The first two questions raised by Sun Lien are very simple and direct, while the third question has some deep meaning in it.If we blindly think in terms of infectious diseases, we may misdiagnose some autoimmune diseases with less obvious features as infectious diseases.Considering that the patient's condition changed after adjusting the immunosuppressive regimen, this possibility also needs to be taken into consideration.

"Take mannitol first to lower the pressure on your brain." Sun Lien shook his head.He originally thought that this imaging examination could provide some direct clues to assist in the diagnosis, but he did not expect that after going around in a circle, the diagnostic thinking returned to the original point.

The current plan...is to stabilize the patient's condition first.Sun Li'en looked at Yang Jianqiang who was pushed back to the emergency room, and suddenly felt a little irritable.

That's what it's really like to be a doctor.The salary is not high, and I am exhausted.It is commonplace to be misunderstood and wronged by patients.And what can make doctors feel that their work is meaningful... is actually diagnosing intractable diseases in patients and curing fatal diseases.

Saved a life and gained self-satisfaction.This is the main driving force that supports most doctors to work hard every day.

But now... It seems that it has become more difficult to obtain this motivation.Sun Li'en was not only a little irritable, but even a little angry.

"What should we do next?" After calming down for a while, Sun Lien asked Dr. Pascal, "Do you have any suggestions?"

"I think..." Dr. Pascal thought for a while, and put forward his own idea, "Let's do a PCR test of blood and cerebrospinal fluid."

"What item to check?" Sun Lien asked with a frown. PCR detection is generally a detection method used to verify pathogen conjecture.Conducting PCR testing without even a reliable guess is purely a provocative way to find fault and fight with the laboratory.

"Let's check the more common infections after bone marrow transplantation first." Dr. Pascale spread his hands, "Parasites that can cause symptoms of the central nervous system include strongyloidiasis and toxoplasmosis. For viruses, VZV (herpes zoster) virus) we have just ruled out. EBV (Epstein-Barr virus) course of disease is not so fast. The possibility of JC polyomavirus (JC polyomavirus) currently looks the most.”

"Progressive multi-focal leukoencephalopathy?" Liu Pingchuan understood the direction of Dr. Pascal's guess. "This disease is very rare."

"But it can detect the changes of Cho metabolites, and it is also a subacute onset." Dr. Pascal seemed very confident in this guess.But then his slightly excited expression cooled down again, "But... the prognosis of this disease is not very good."

Not only is it not good, it is simply too bad. Progressive multifocal leukoencephalopathy caused by JC polyomavirus has no effective treatment so far.Ordinary antiviral therapy has very poor effect on JC polyomavirus, and the only way to improve symptoms is to enhance immunity.

For Yang Jianqiang, if he was really infected with JC polyomavirus, it would basically be a death sentence.Boost your immunity, and you'll trigger an inflammatory storm, and he'll die.If the immunity is not enhanced, the JC polyoma virus will continue to develop, and more and more white matter of the brain will be damaged, and he will still die.

"This..." Sun Lien held his breath in his chest, he really didn't expect such a result.After holding back for a long time, he sighed and suggested, "Let's check everything. I hope it's not JC."

Liu Pingchuan was going to the emergency room to talk to Zhou Jun, and the matter of explaining the patient's condition to Zhou Jun was naturally taken over by Vice President Liu.And Dr. Pascal returned to the outpatient clinic with a gloomy expression on his face.Sun Lien stood alone at the door of the Imaging Department, crossing his arms and meditating.

Dr. Pascale's diagnosis was clear, and he narrowed his initial suspicions to two parasites and a virus.An experienced veteran doctor is indeed much better than a stunned young man like Sun Li'en.But Lengtouqing vaguely felt that something was not quite right in the narration just now.

According to Dr. Pascal's explanation, JC polyomavirus mainly affects the brain, but the onset is mostly chronic or acute.If Yang Jianqiang's onset time is counted from the beginning of blurred vision, it is not a problem to count it as a subacute onset.However, imaging examinations proved that Yang Jianqiang's condition suddenly accelerated today.If we speculate according to this logic, the diagnosis of JC polyomavirus seems somewhat untenable.

Moreover, the characteristics of imaging do not seem to match.Sun Lien thought of the results of the imaging examination he had just seen.The location distribution of the eight edema areas is scattered.But most of them are located at the junction of gray matter and white matter.Since the disease caused by JC polyomavirus is called "progressive multifocal leukoencephalopathy", it is presumed that the main part involved should be the white matter of the brain, not the junctional area.

But if it wasn't for JC... Sun Lien's eyes widened suddenly.

"Before I met... Lao Yang should have raised a dog." "He said that his grandma used to raise a white cat. It was a big white cat with blue eyes, and it was very beautiful. But it was almost 30 years ago. before."

The patient has a history of close contact with cats and dogs!There was a bang in Sun Lien's head.He was suddenly full of gratitude for his trip to the capital.If he hadn't seen Tongxie's case writing level, he would not have found the connection so easily.Only by recording all the information in detail, will it be possible to find the basis and answer for the diagnosis from it!
Sun Lien's diagnosis was that Yang Jianqiang suffered from cerebral toxoplasmosis.But his brain toxoplasmosis did not come from a bone marrow donation, but from eggs that had been dormant in his body long ago.He is a latent infection of brain toxoplasmosis!
　Entrusted by someone, I will give you a new book.

　　"Global Spiritual Tide" was launched on Friday, and a wormhole suddenly exploded in the solar system. With the crazy influx of spiritual power, there was also a fleet of blue-blooded men fleeing in embarrassment, followed by Zerg!
　　Will the people on earth rise in the spiritual tide, or perish?
　　In the early days of Chu Xiu's rebirth spiritual tide, he wanted to wipe out this bloody and troubled world!

　　
　
(End of this chapter)