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Chapter 804 Without respiratory symptoms... lung fluke?

Since joining the Fourth Academy, Yuan Ping'an has been used by Sun Lien as a particularly convenient document search engine.And Yuan Ping'an's performance is indeed worthy of Sun Lien's "expectation".After receiving Sun Lien's request, Deputy Chief Physician Yuan gave a list within ten minutes.And he also added a paragraph at the end of the document very "proudly", "I have made a lot of lists, all of which are lists that you may need to use, Dr. Sun. I am still studying how to use the database recently. When the time comes, I will say It may not be possible to sort out relevant information through fuzzy searches.”

Sun Lien was somewhat embarrassed to force an excellent emergency doctor into a programmer.But this embarrassment was quickly swept away by the excitement of seeing the list.

Leaving aside the common parasites in the list, the situation in various places is actually not much different.However, Sun Lien saw some unusual content on the side of multiple parasites.

Schistosoma, liver fluke, lung fluke.These three are the most important trematodes in the local area.Moreover, there is only one kind of fluke disease in Sichuan that has a relatively high incidence rate in the whole country-paragonimiasis.

Malaria and kala-azar in the classification of protozoan diseases are obviously not compatible with Qian Ziwen's symptoms, and malaria itself has not been reported locally in Sichuan since 2011.Several sporadic cases were caused by infection outside the province, and the disease occurred after returning to Sichuan.Kala-azar is mainly concentrated in the Southwest.Including Wenchuan, Lixian, Maoxian and other places in Aba Prefecture, as well as Beichuan County and Pingwu County in Mianyang City.In other regions, there are basically only sporadic reports of the disease.

Neither Qian Ziwen's symptoms nor his previous place of residence matched the protozoan disease.The more common nematode disease was even more incompatible with his symptoms.Then, the only type of disease that can be suspected is fluke.

The number of schistosomiasis patients in Sichuan Province is not too many.There are more than 1700 patients with advanced stage.Moreover, no acute cases of local infection have been found for ten consecutive years, and no local infected patients and sick animals have been found for five years.Since 2015, all 63 endemic counties (cities, districts) have reached the schistosomiasis interruption standard.Although Qian Ziwen still has the possibility of suffering from schistosomiasis, but this possibility is not too great.

Judging from the symptoms, the suspicion of schistosomiasis cannot be ruled out.Fever is the main symptom of schistosomiasis in the acute phase, accompanied by gastrointestinal symptoms, hepatosplenomegaly, and pulmonary symptoms.At present, Qian Ziwen only has a fever.Therefore, schistosomiasis cannot be ruled out, but the risk is not too great.

The incidence rate of liver fluke is not high either. According to the survey report in 04, the infection rate and standardized infection rate in Sichuan population were 0.21% and 0.18%, respectively, and the infection rate in the whole province was at a relatively low level.But the main geographic range of the liver fluke is in the area north of the Yangtze River, which happens to be the area where Qian Ziwen and his grandmother lived.

From the geographical area of ​​residence, Qian Ziwen is also at risk of liver fluke infection.But his symptoms didn't match up.

There are seven main types of liver flukes, but almost all of them are symptoms related to digestion and nutrition.Hepatitis type, cholangitis type, gastroenteritis type, and liver cirrhosis type are symptoms related to the digestive system.Children who develop severe infections may be classified as dwarfs.The hidden type and the mixed type are obviously not in line with Qian Ziwen's repeated fever without inducement.

Sun Lien drew a line on the printed list with a pen, and Qian Ziwen was less likely to be infected with liver fluke than he was infected with schistosomiasis.

Look at it this way... the most likely thing is that paragonimiasis is the only one left.

Sun Lien scratched his head with his pen, and decided to skip the description and look at the diagnosis plan first.

"Ask the child if he has a history of living or traveling in endemic areas such as Jiangsu, Zhejiang, Sichuan, and Yunnan. Whether he often goes to streams and ditches to catch stream crabs and crayfish, etc.; whether he drinks stream water, eats raw, pickled or undercooked crabs Crawfish." The first item in the diagnosis guideline caught Sun Lien's eyes.

According to Grandma Qian Ziwen, there is a stream behind her house.This is a place where nearby residents often play in the water to cool off.Putting an umbrella in the shallow stream, and then setting up tables and chairs in the stream to play mahjong is one of the main entertainment activities in the local summer.

Then, if a four-year-old child does not play in the water to catch shrimps and crabs in this environment, something is wrong.And after catching these little things, it seems to be a very reasonable entertainment behavior to use them for tooth-beating festivals.

Sun Li'en raised his eyebrows, and then simply found out the diagnosis guideline for paragonimiasis from the computer, and began to study it carefully.

In fact, if we really want to study it carefully, the hypothesis of paragonimiasis is still somewhat untenable.After all, Qian Ziwen has not yet experienced symptoms such as coughing or hemoptysis.During the physical examination at the hospital, no active mass was found under his skin.

But paragonimiasis looks at least a little more likely than schistosomiasis and liver fluke.Sun Li'en pondered for a while, and then decided to have a checkup.

Do an ELISA right away?It seems that some don't take their father's wallet seriously.Then do an imaging test?But there is only fever, which probably shows that the lung fluke is not serious enough to cause infiltrating lesions and cavities in the lungs.Even if the inspection is done, it may not be able to find valuable results.

Sun Li'en was suffering from a headache. Yuan Pingan rushed to the office at a trot. He opened the door and asked, "Doctor Sun, what's going on? Do you have any idea?"

"A little bit." Sun Li'en nodded, and then said, "I feel that paragonimiasis is a bit similar, but there is no evidence to support this assumption. And schistosomiasis cannot be ruled out."

"His symptoms are not too many... why don't you have a B-ultrasound." Yuan Pingan came over, and then suggested, "Pargonimiasis generally does not cause hemolysis or bleeding, right? Then his hemoglobin is low, it is likely It's some sort of liver-related hematopoietic disorder -- lung flukes attack the liver."

Sun Lien patted his thigh, "That's right! He just has a fever! Anemia is also a symptom!"

Lung flukes aren't picky parasites that only stare at the lungs.They're actually not picky eaters at all—liver, lung, or even nervous system.They drill everywhere they get the chance.

The most common paragonimiasis is of course the thoracopulmonary type.This is the most common type.Patients often present with symptoms such as cough, sputum production, shortness of breath, and chest pain.And the cough appeared the earliest, and there were very obvious signs of "heaviest in the morning".

Abdominal paragonimiasis accounted for about 30% of the total incidence.Patients may present with dull pain in the entire abdomen or right lower quadrant.When the worms migrate to the liver, a liver abscess can form.The main manifestation of this abscess is an increase in liver volume.

This is why Yuan Ping'an suggested doing a B-ultrasound.There is no small possibility that lung flukes can invade the liver, and this invasion manifests itself in patients, which may lead to recurrent fever and anemia.The examination to determine whether lung flukes have invaded the liver is also very simple-after lung flukes have moved into the liver, abscesses will definitely form.Once an abscess is found, there are many reasons for further diagnosis of paragonimiasis.

　The data in this article comes from the article "Epidemic Characteristics and Prevention and Control Experience of Human Parasitic Diseases in Sichuan Province" published in "Health Statistics" in July 2018.Author Gong Xi, Wang Guangxi.

　　
　
(End of this chapter)