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Chapter 643 Sun Lien's Wonderful Metaphor

"Most non-tuberculous mycobacteria are conditional pathogens." Dr. Jiang frowned and thought about it, and decided not to worry about why Kaoru Kobayashi was infected with a conditional pathogen. "Specific identification and diagnosis of the species, Or leave it to the laboratory. Does the treatment plan need to be adjusted?"

"Most of the non-tuberculous mycobacteria are sensitive to rifampicin, but they are resistant to isoniazid." Sun Lien had a general understanding of the situation of this mycobacteria before coming here, "The current expert opinion is Combination drugs, rifampicin, ethambutol and isoniazid together."

"I'll check the information..." Doctor Jiang didn't dare to listen to Sun Lien's opinion directly.After all, it wasn't long before Sun Li'en got his medical license. No matter how talented he is in diagnosis, he still lacks experience in clinical treatment.For such a big matter, Dr. Jiang really didn't dare to listen to Sun Lien's opinion directly.

"Oh, by the way..." Not only was Sun Lien not dissatisfied with Dr. Jiang's attitude, but he even nodded.People are also responsible for patients! "Mycobacterium ulcerans may be completely drug-resistant if it's a rapidly growing mycobacterium..."

"Bululi ulcer?" Dr. Jiang suddenly fell silent, and asked cautiously after pondering for a while, "But...his symptoms don't look like it."

This time it was Sun Lien's turn to be dazed, Buruli ulcer?What is that?
Seeing Sun Lien's dull expression, Dr. Jiang was stunned as if he had also been infected, "You don't know about Buruli ulcer? It's a disease caused by Mycobacterium ulcerans infection..."

The two stupid geese looked at me and I looked at you. After a long while, the two laughed together.

"I thought you knew!" Dr. Jiang smiled and wiped away tears from the corners of his eyes. "You already know about Mycobacterium ulcerans. How come you haven't even heard of Buruli ulcer?"

Sun Lien smiled and replied with difficulty, "You know Buruli ulcer, why didn't you think of it at first?"

"I can't help it." Doctor Jiang straightened up, shaking his head while answering, "His symptoms are too atypical, who can think about it?"

Buruli ulcer is an uncommon and endemic disease that occurs mainly in the rainforests of West and Central Africa.Although it has been confirmed that Mycobacterium ulcerans is a pathogenic bacterium, people still don't know anything about the natural host and transmission route of this bacterium.The only reasonable guess is that the bacteria itself may live in the soil of the tropical rainforest or on insects, and it is likely to be transmitted through insect bites.

Dr. Jiang did not think of the main reason for Buruli ulcer at first, because the symptoms of Kaoru Kobayashi had almost no similarity with Buruli ulcer.He had a high fever, lumps in his armpits, and none of the skin lesions typical of Buruli ulcers—which would be a hell of a thing to think about with Buruli ulcers.

After Sun Lien listened to Dr. Jiang's description, the smile on his face gradually disappeared.Everything he knew and learned told him that there might be something wrong with it.

"Burulli ulcer is caused by the infection of Mycobacterium ulcerans, and Mycobacterium ulcerans belongs to the fast-growing non-tuberculous mycobacteria." Sun Lien slowly thought through his thoughts and said while thinking, "The largest rapidly growing non-tuberculous mycobacteria The characteristic is that it causes skin diseases and grows rapidly at the same time."

This is actually a piece of nonsense, just looking at the eleven words "rapidly growing non-tuberculous mycobacteria", it can be seen that the growth rate of this kind of bacteria is definitely faster than other mycobacteria.

"But it has been the sixth day since he was unwell." Sun Lien frowned, and raised his own doubts, "If it is Buruli ulcer, then why is his symptom completely different from the known Buruli ulcer?" The same? He has systemic symptoms, but Buruli ulcer does not; he has lymph nodes, but Buruli ulcer should have subcutaneous nodules; he only has rashes, but he does not show the most characteristic skin lesions of Buruli ulcer ..." Sun Li'en paused, "A horse with wings, a sharp beak, and only two paws with feathers... Isn't that actually a bird?"

This metaphor is a bit abstract, Dr. Jiang pondered for a while before he understood what Sun Lien was talking about, "Don't you think...?"

"I think the possibility is very low." Sun Lien replied honestly, "A disease that shows one or two rare or even rare symptoms can be excused as 'we don't know enough about it', but this... Almost all symptoms come in reverse, so people have to be vigilant."

Sun Li'en also vetoed Xu Yourong's diagnosis before.He is well aware of how painful these summaries of "symptom types" are downplayed by doctors.This is not only the hard work of doctors, but also the result of countless patients suffering from illness.

For such an experience, Sun Li'en really couldn't ignore it easily.

To put it another way, just like his wonderful metaphor, something with wings, a sharp beak, and two claws with feathers, even if it is not a bird-it should not be a horse.

"If it wasn't for Buruli ulcer..." Now it was Dr. Jiang's turn to ponder, "The symptoms of other types of non-tuberculous mycobacteria are also not similar."

Most non-tuberculous mycobacteria are opportunistic pathogens, and there are only a few that can make people sick.

"Not M. kansasii, not M. marinum, and the patient did not show tuberculosis-like lesions."

"It's not M. scrofula, he doesn't have submandibular glands and submandibular lymph node swelling."

"It's not Mycobacterium avium-intracellulare, which also causes combined-like lesions."

Sun Lien and Dr. Jiang looked at the information for about an hour, but they still couldn't find any of the currently known disease-causing non-tuberculous mycobacteria that matched the symptoms of Kaoru Kobayashi.

"No...it's like looking for a needle in a haystack." Dr. Jiang first decided to give up, "No matter what kind of mycobacteria it is, at least most of the mycobacteria are resistant to the combined drug regimen of rifampicin, ethambutol and isoniazid. Sensitive. Treat him according to this method..."

Sun Li'en slowly raised his head and twisted his stiff neck, "That's right..." He looked at the information in front of him and hesitated, "But what if... it's not non-tuberculous mycobacteria?"

"Ah?" Dr. Jiang really got a little angry when he heard this sentence. After tossing around for so long, are you playing this game again? "What could that be?"

"What I mean is..." Sun Lien carefully chose his words, "The ones that can cause a positive reaction to tuberculosis antibodies are all mycobacteria, right?"

"Isn't that what you just said?" Dr. Jiang laughed angrily, "Why, is there something wrong with this theory?"

"There is no problem with the theory, but there is a problem with our perspective." Sun Lien raised the information in his hand and pointed to the item "Mycobacterium marinum". "Look at this."

Dr. Jiang looked at the literature he had almost read, "What's the problem?"

"Mycobacterium maritima can cause skin papules, nodules, and ulcers. Pathological examination shows acid-fast bacteria, which can easily be mistaken for Mycobacterium leprae clinically..." Sun Lien asked after reading this document repeatedly. , "Then... is it possible that what infected him was Mycobacterium leprae?"

(End of this chapter)