I can see the status bar

Chapter 642 Significant Progress

What does it mean?A blind cat meets a dead mouse?Sun Lien was shocked and speechless.Every doctor can be sure that the "tuberculosis cannot be ruled out" in the previous consultation is purely a cover-up to make the "opinion" without opinion look less pale.

But in this case, it was tested positive for tuberculosis antibodies.Sun Li'en couldn't accept such a result no matter what - it wasn't because he had any personal ego.

He jokingly said, "Be careful when a meteorite falls from the sky and kills you", but a meteorite fell down and killed someone with incomparable precision. Who would accept such a thing?

"The possibility of false positives must be considered." After a long silence, Sun Lien made a decision, "Take blood and run a PCR to check for tuberculosis."

A positive tuberculosis antibody does not directly mean that the patient has had or is being infected with tuberculosis.The clinical significance of this indicator is not particularly great.Especially after the widespread vaccination with BCG.

The gold standard in tuberculosis will always be sputum culture.Below that, patients need to show typical TB symptoms and be supported by other strong evidence to be diagnosed.

"He is 25 years old. Even if he has been vaccinated with BCG, he should have just been born." Dr. Jiang frowned. This age shows positive antibodies, I think it should be taken seriously.”

"Didn't I take it seriously?" Sun Li'en glanced at Dr. Jiang, "Why don't you run a PCR to see - it's unrealistic to wait for a sputum smear now. And he doesn't have typical symptoms of tuberculosis."

"What I mean is, take rifampicin and isoniazid first." Dr. Jiang said seriously, "His condition is relatively serious. If he starts antibiotic treatment earlier, the condition may be brought under control earlier."

Now it was Sun Lien's turn to hesitate.In all fairness, if this happens in the fourth hospital, it is absolutely necessary to give the patient anti-tuberculosis drugs for experimental treatment while perfecting the examination.But Kobayashi Kaoru's condition is different, his symptoms are a bit severe - at least more serious than ordinary tuberculosis patients.

Should he use anti-tuberculosis drugs according to experience, or should he follow the principle of "evidence-based medicine" and maintain the current treatment plan until the treatment is perfected?
"Give it to him." After thinking for a while, Sun Li'en decided to agree with Dr. Jiang, "But PCR still needs to be done..." He thought for a while, pretending not to care, and continued, "Since the antibody has been checked, then Check all other antibodies."

"Others are already under investigation." Dr. Jiang showed a smile of "Shanren has his own tricks", "I saw that there were quite a lot of blood samples sent, so I prescribed anti-nuclear antibody, anti-phospholipid antibody and other tests. "

Sun Lien breathed a sigh of relief. In this way, at least the two prompts on the status bar can be clarified.At least there is a reason for mentioning the anti-β2-GP1-Ab antibody later.

However, there are still many things that Sun Li'en can't figure out.At least he still couldn't figure out why Kaoru Kobayashi's infection showed such a strange state-why was his tuberculosis antibody positive?

If you can't figure it out, ask for help.It doesn't matter if Sun Li'en can't figure it out by himself, isn't there still an immunology expert who is popular and drinks spicy food in the fourth courtyard?

Dr. Pascal was in the office and received a call from Sun Lien.

"I heard that you have withdrawn?" Dr. Pascal connected the phone the moment he saw the caller number, and asked eagerly, "How is your situation now? Is it safe?"

"We are now on the hospital ship of the Navy, so we must be safe." Sun Lien first thanked his colleague and boss for his concern, and then began to ask questions, "Dr. Pascal, I would like to consult... Tuberculosis antibody positive For this indicator, besides tuberculosis, could other diseases cause this indicator to be positive?"

"Tuberculosis antibody?" Dr. Pascale replied after pondering for a while, "As far as I know, there is."

The human immune system is a very complex system, so complicated that we have not yet figured out its specific operating principle-this conclusion can actually be applied to almost all human body systems.And in some specific cases, the disease can disrupt the body's immune system, throwing this delicate and fierce system into disorder.

"Generally speaking, if this confusion occurs, many other indicators will also appear false positives at the same time. For example, anti-nuclear antibody positive, anti-smooth muscle antibody, anti-mitochondrial antibody and some other rheumatic immune indicators will also appear positive at the same time. ” Dr. Pascal explained, “This disorder is usually caused by autoimmune diseases or allergies. The distinction mainly depends on the clinical manifestations of the patients.”

"In addition to autoimmune system diseases and allergies..." Dr. Pascal continued after a moment of pondering, "as far as I know, some non-tuberculous mycobacteria may also trigger a positive reaction to tuberculosis antibodies. The main reason is that the mycobacteria There are structural and compositional similarities, which also lead to common antibodies."

This is it!Sun Lien was overjoyed. After saying goodbye to Dr. Pascal in a very perfunctory manner, he rushed directly to the cabin where the inspection room was located.

Dr. Jiang happened to be frowning in the examination room, staring at the examination report in front of him with a troubled expression on his face.He kept muttering, "How is this possible? It doesn't make sense..."

"Doctor Jiang!" Sun Lien asked out of breath, "Is it... Is Kobayashi Xun also positive for other antibodies?"

Dr. Jiang glanced at Sun Li'en as if he had seen a ghost, "Yes...there are just two tests, both antinuclear antibody and antiphospholipid antibody are positive."

now it's right!Overjoyed, Sun Lien snatched the inspection report and read it again by himself.At the same time, he said, "Non-tuberculosis mycobacteria may cause false positives for tuberculosis antibodies—no, they should be counted as positives."

"Other mycobacteria and Mycobacterium tuberculosis have the same structure and composition, and they may share antibodies." Sun Lien conveyed the knowledge he had just acquired to Dr. Jiang, "In other words, it should be some kind of bacteria that infected him. Mycobacterium - but definitely not tuberculosis!"

Sun Lien was very sure that Kaoru Kobayashi was definitely not a patient with latent infection of Mycobacterium tuberculosis.There will be no symptoms for recessive infection, and his current symptoms do not match tuberculosis.More importantly, the status bar does not prompt in this regard at all.

Myeloid hyperplasia was obviously active, C-reactive protein increased, fever, cough, rash, antinuclear antibody positive, antiphospholipid antibody positive, anti-β2-GP1-Ab antibody positive.

Among the eight states, the first four can be regarded as a reminder of infection, and the rash may be an infection or an allergy.The latter three positive antibodies should indicate Sun Lien's "non-tuberculous mycobacterium infection".

(End of this chapter)