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Chapter 611 Chinese Doctor

What Sun Lien and Hu Chunbo suspected at the same time was a rare disease called "primary amebic meningitis".

Primary amoebic meningitis is a brain-wide neuroinflammatory response triggered by free-living amoebas that penetrate the nasal mucosa and invade the brain through the olfactory nerve.Strictly speaking, the brain structures affected by primary amebic meningitis are not limited to the meninges.But because the disease will show obvious meningeal irritation, it was named "meningitis".

So far, this rare disease has been reported all over the world.However, all of them are sporadic cases, and cases of mass disease are rare.If it can be confirmed that the high-mortality meningitis that broke out in the American camp is indeed primary amebic meningitis, then this case is definitely a major discovery that can be published in the four major journals and even "Nature" and "Science".The fact that Naegleria fowleri, once thought to pose no threat to a wide range of populations, could cause such a large-scale infection would cause a stir in the medical community.

However, what Sun Lien and Hu Chunbo are struggling with now is not which journal such a case report should be published in.What they are worried about now is the high fatality rate of this "meningitis".

A total of three cases of primary amebic meningitis caused by Naegleria fowleri have been reported in China.Three case reports spanned more than 30 years.Among the patients infected with the disease, two were soldiers of the People's Army and one was a young farmer.But all three patients had one thing in common-the treatment was ineffective, and the condition deteriorated rapidly and then died.

Globally, the mortality rate of primary amebic meningitis is as high as 97%.There is no cure, no proven treatment.Based on this global statistical rate, among the 28 people who fell ill in the American camp, if one person survived, it would be considered a high incense.

Due to the small number of case reports, doctors around the world have not yet concluded a set of effective treatment options for primary amebic meningitis.Some in vitro studies have shown that amphotericin B and gentamicin are effective against Naegleria fowleri.But it is almost impossible for these drugs to cross the brain-blood barrier and achieve effective concentrations in the brain.The only method of drug delivery that seems promising is through intrathecal injections, which infuse the drug into the patient.

The reason why it "looks promising" is also because this treatment does not increase the chances of survival for many patients.At least not all patients who survived the treatment received this treatment.

It can be said that the current situation is not optimistic at all-even if evidence of primary amebic meningitis is found, there is still a possibility that none of the more than 20 people will survive.

But after figuring out the reason, you can at least try to save lives.That's what a diagnosis is about.

The samples sent by Sun Lien were released almost at the same time as the autopsy results from Hu Chunbo.Naegleria fowleri was present in the lake water, and amoeba trophozoites were indeed found in the brain tissue of the cadavers.

"The diagnosis can be confirmed." Sun Li'en and Hu Chunbo checked the test results again, and then nodded, "The source of infection has been found, and the pathogen has also been found. Let's treat it according to primary amebic encephalitis."

Liu Tangchun was a little surprised when he got the diagnosis result, "Are you sure? They are all primary amoebic meningitis?"

"This is the only reasonable explanation. And so far, the evidence is sufficient." Sun Lien took the initiative to stand up and explained to Liu Tangchun, "We don't have time to do cerebrospinal fluid smears on every patient, but we do intrathecal injections. At that time, by the way, take a smear of cerebrospinal fluid and it will be clear."

Ms. Iweala, who was called to hear the results, also seemed a little hesitant, "But... this disease has always been sporadic. Since it was discovered, there has never been a record of mass disease."

"It is impossible for us to find the second possibility in a short time." Hu Chunbo is very confident in his autopsy, "At least the corpse I examined must have died of occipital enlargement caused by primary amebic encephalitis. Foramen hernia. So many patients with the same experience showed the same or very similar symptoms, and it is against the principle of Occam's razor to say that they were not infected with primary amebic encephalitis."

Using philosophical viewpoints to guide practical operations is sometimes error-prone.But in the current situation, Hu Chunbo's words are very convincing.At least Ms. Iweala couldn't think of any other possibility.

"It makes sense." Liu Tangchun completely changed his angle at this moment, and began to help Hu Chunbo speak.He said seriously to Ms. Iweala, "I think, in the absence of any other evidence, at least we should treat according to the diagnosis of Dr. Hu and Dr. Sun. Even if we find other patients during the treatment How about changing the treatment method? According to the existing data, if there is no treatment, these patients who have already developed the disease will die in a short time. Intrathecal injection of high concentration amphotericin B may be able to Save one or two."

Ms. Iweala was silent for a while, then nodded and said, "This seems to be the only way." She said to Hu Chunbo and Sun Li'en beside her, "Then treat it according to primary amebic encephalitis." After finishing speaking, she turned to Liu Tangchun and said, "I need to report this diagnosis to the CDC. They may still be infected in China."

Liu Tangchun had no objection to this request, and he asked kindly, "Can your existing doctors be qualified for treatment? If there is a shortage of manpower, I can call back the members of our medical team."

Intrathecal injections are a treatment that needs to be done by a doctor.At least in the domestic medical system, this operation must be done by doctors.Both Hu Chunbo and Liu Tangchun had experience in intrathecal injections, but Sun Lien had only drawn cerebrospinal fluid.To perform multiple intrathecal injections on eight patients, Liu Tangchun and Hu Chunbo alone would feel a little nervous.

"If you don't delay your trip, it would be best to get help from the Chinese medical team." Ms. Iweala smiled very reluctantly, "Our two medical teams have a total of [-] doctors, and only eight of them are not sick now. , Two of them are from the laboratory..." She sighed, "And there are six people who left the camp without permission last night. They should be looking for you, right?"

"Yes." Of course, Liu Tangchun has nothing to hide about this kind of thing-it's not that I, Liu Tangchun, poached six doctors from your medical team. "If I were you, I would give them a big thank you. If they hadn't hiked more than ten kilometers to get help last night, we might not even know what happened here. These 28 patients don't even have the correct diagnosis. I can’t get it.” He said seriously to Ms. Iweala, “No matter whether the reason why you refused us to enter the camp was for your own safety, or to keep us away from this unknown severe infectious disease at that time—you first We must remember that we are doctors, Chinese doctors who come to Africa for humanitarian assistance. No Chinese doctor will desert before infectious diseases, this is our professional requirement and our belief.”

Liu Tangchun took a deep breath and said seriously, "When unknown diseases that threaten human health strike, you can always trust Chinese doctors."

(End of this chapter)