I can see the status bar

Chapter 812 Exclusion

Diagnosing this thing is like reasoning and trying luck.The most terrible thing is that in many cases, doctors can only realize after hitting a wall one after another, as if some key clues have not been found.

What's more, doctors don't know what these missing key clues look like, and in what direction it can lead the entire diagnostic process.How to find this clue, what kind of inspection should be carried out... This is even more unclear.

Other doctors also face the same troubles in their daily work.And their solution is to make a general direction judgment based on the patient's symptoms, and then do as many checks as possible.Finally, find all the abnormal items in many inspections, and then start scratching your hair at these abnormalities, hoping to find an answer to explain all the problems.

This is where Sun Lien's current problem lies.The previous doctors had almost done all the tests.But the inspection didn't give them enough clues.In addition to the increase in white blood cell count, Ji Xiuying's most noteworthy content is a rise in C-reactive protein.But this is not very helpful for diagnosis-it is by virtue of this one that the suspicion of autoimmune disease can be ruled out.

If you only look at this one, the clue may be completely hidden under countless possibilities and never see the light of day.However, Sun Li'en was quite clever, so he decided to change his direction of efforts.

From the nine CT images in five years, he saw a place that caught his attention.

In Ji Xiuying's past five years, the locations of nodules and substantive lesions each time were different from the previous one.

What does this mean?Sun Li'en frowned and looked at them for a while, and then vaguely found a common point - these lesion areas are basically near the bronchi.

This could mean...the pathogen is airborne?Sun Lien watched it for a long time and came to such a conclusion.Then I fell into depression again-what's the use of this?

It seems... not completely useless.Sun Lien worked hard to cheer up. The pathogens transmitted through the air meant that all parasites except Cryptosporidium could be ruled out, but Ji Xiuying's symptoms had nothing to do with the digestive tract symptoms caused by Cryptosporidium infection.If combined with the history of rifampin medication, mycoplasma and chlamydia infection can be ruled out.

At the same time, because rifampicin has been used, and rifampicin has no practical help in killing pathogens.This in turn rules out essentially all aerobic Gram-positive bacteria.And aerobic Gram-negative bacteria such as Neisseria meningitidis, Haemophilus influenzae, Neisseria linbinus and Legionella.

In other words, the only pathogens that cannot be ruled out are anaerobic Gram-negative bacteria and fungi.

Using this method is also helpful!Sun Li'en regained his spirits again.Although it was already two o'clock in the morning that day, with the support of this "spirit", Sun Li'en's sore eyelids seemed to suddenly become less sleepy.

The method of elimination encountered unprecedented difficulties at this step, but choosing one of the two was already a big enough confidence for Sun Lien.

Thinking of this, Sun Lien hurried into the lounge next to the office - Bruen was lying on the bed watching WWE wrestling videos. "Old Bu, let me discuss something with you."

After listening to Sun Lien's explanation of his diagnosis, Brunn expressed his support for his judgment, "It sounds logical and complete, and it really fits the current situation-then what are you going to do?"

The cultivation of Gram-negative bacteria is not a very simple matter.Sputum smears and sputum cultures performed in other hospitals were all inconclusive.Even the biopsy did not clarify exactly what Ji Xiuying was infected with.Under such conditions, it is very difficult to find pathogens.

"I think so." Sun Lien said excitedly, "Sputum smears and cultures are both negative, which may be a hint - this disease cannot be transmitted from person to person. That is to say, compared with those common disease, it is more likely to be an opportunistic pathogen."

This is a somewhat bold speculation.But this speculation is indeed very reasonable.The ultimate purpose of any pathogen parasitic inside the human body is to replicate and spread itself.A pathogen can infect humans through breathing, but it can no longer go from the human body through the respiratory tract to find other sources of infection-this is an illogical thing.

The only exception is parasitic infection-parasites that enter the human body through the skin or digestive tract, it is indeed possible to leave the human body to find a host again through other means, but this possibility has been ruled out by Sun Lien-except Cryptosporidium, No parasite can be airborne through droplets.

Therefore, this unknown pathogen is not very common at the beginning, and it can infect human germs.

"My idea is to carry out confirmatory treatment according to Gram-negative bacteria first-give her quinolone antibiotics to see if the situation will change. If not, then treat it as a fungal infection." Sun Lien said She made her own plan, "Her liver and kidney functions are pretty good now, and the risk of taking antibiotics is very low."

"Of course there is no problem with doing this, but... how can you be sure that the reaction after the drug is because you have indeed found the pathogen, not the... swinging nature of the disease itself?" Bruen asked, "She I have been discharged from the hospital three times in a row, which is a huge mental and financial burden on the patient. It is certainly possible to use this experimental treatment to clarify the nature of the infection, but... how do you determine the authenticity of the effect of this experimental treatment? "

Sun Li'en was questioned now.Although he wanted to say that the patient's hospitalization period could be extended for detailed observation, Ji Xiuying's medical history in the past five years has proved that this way is not feasible-she even had symptoms during ten consecutive months of anti-tuberculosis treatment. It got better, but it rebounded as soon as the drug was stopped.You can't let the patient live in the ward for a year, can you?

"Try antibiotics first. If it's cured, then think about how to verify it. If it's not cured...then find a way to identify the pathogen." Seeing that Sun Lien was really sleepy, Dr. Brunn waved his hand and proposed A compromise was made. "You should really go to sleep—you look like a pediatric doctor right now."

Sun Lien asked back, dumbfounded, "Now tell me this...how can I sleep?" He scratched his head and pondered for a while, then rubbed his stomach and asked, "Are you interested in having a late-night snack? ?”

"If you say this, I won't be sleepy anymore!" Bruen jumped off the bed flexibly, then put his arms around Sun Lien's shoulder and said excitedly, "I heard that there is a roasted oyster with garlic near our hospital." The taste is very good...”

(End of this chapter)