Cyanobacterium marneffei is an opportunistic pathogen that many people have suddenly become aware of recently. Compared with relatively common pathogenic bacteria such as Staphylococcus aureus, its biggest feature is that it has different biological attributes.
fungi.
In the natural environment, C. marneffei is by no means rare. It is widely distributed in subtropical areas of Asia, from the Indian Peninsula to Indochina. This fungus, which was isolated from the genus Penicillium only in recent years, is almost There have been reports of discovery. In my country, C. marneffei has been found especially in Hong Kong, Macao and Taiwan, Guangdong, Guangxi and Jiangxi and Hunan.
It is one of the main pathogens that causes opportunistic pathogens to infect HIV patients, but reports of infections in non-HIV patients are also gradually increasing. Patients with immunodeficiency, patients with autoimmune system diseases, and patients who need to take long-term immunosuppressive drugs are suffering from Mal.
The reports and number of Nephi cyanobacteria are increasing, and some people are even worried that this strange fungus is starting to mutate.
"The biggest feature of this disease is that the symptoms are highly similar to tuberculosis." Yuan Pingan explained to Sun Lien the characteristics and differential diagnosis of C. marneffei in detail, and then asked, "Has the patient eaten bamboo rats or
Sugar cane, bamboo shoots?”
"What?" Sun Lien was stunned, "I know the other two...but what is a bamboo rat?"
"It's just...a rodent. It's quite big. It mainly makes a living by eating bamboo. It looks like a big rat." Yuan Pingan has obviously never eaten this kind of "rodent". His description
It seems a bit general, "It is said that there are many people in Guangdong and Guangxi who eat this kind of animal."
Sun Lien nodded in confusion. No wonder people always joke that Cantonese people eat everything, especially Fujian people.
"If it is really C. marneffei, treatment is not difficult." Yuan Ping'an took the copy of Sun Lien's case, found the medical record number on it, entered it into his computer and started reading. "Take amphotericin.
, it will be cured with continued treatment for about four weeks. However, problems such as bone damage will have to wait for the patient's body to recover on its own..."
While looking at the cases, Yuan Pingan explained to Sun Lien the key points of treatment for cyanobacteria marneffei. The more Sun Lien listened, the more strange he became. He interrupted Yuan Pingan's explanation and asked curiously, "How do you know about this disease?"
of?"
"It's almost the same as the previous one about heparin insensitivity." Yuan Pingan smiled, a little proud but also a little sad, "The earliest paper in China that discovered and summarized the infection of Marneffei cyanobacteria in non-HIV patients was by our colleagues.
Director Wang of the department worked together with the Laboratory Department of the First Affiliated Hospital of the General Hospital of the PLA, as well as Tongxie General Internal Medicine, Respiratory Medicine, and Pathology Departments to make this."
The words "We Tongxie" are easy to say, but when they come from Yuan Pingan's mouth, they have a completely different meaning. He studied at Tongxie and started his career there. Although he transferred from neurosurgery to
He entered the direction of emergency medicine, but at least he achieved the position of chief resident in Tongxie Emergency Department, the number one emergency department in the country.
Yuan Pingan is actually really good.
"Of course, now we have to say 'they were with the Association'." Yuan Pingan seemed to suddenly realize that there was something wrong with the content of his words. He smiled and changed his words, "After this review was published at the time, it attracted a lot of attention from Guangdong and Guangxi areas.
The laboratory doctors discussed that Director Wang was extremely busy in those days and went to work with dark circles under his eyes every day."
Sun Lien nodded and said with some regret, "I was too pressed for time when I went to the Tonghe Association, otherwise I might have been able to meet Dr. Wang."
Yuan Pingan stared at Sun Lien for a while, then shook his head after a moment of silence and said, "I can't see you anymore." After a pause, he continued, "Director Wang suddenly fell ill last year and died."
Sun Lien and Yuan Pingan fell into silence together. Just when the air solidified, Sun Lien's cell phone rang at the right time, breaking the suffocating silence.
"Dr. Cao?" Sun Lien immediately became more energetic when he saw the caller number. He rushed ahead and said, "We have some clues about that patient!"
There is no sound on the phone.
"Hello?" Sun Lien yelled at the phone a few more times. There seemed to be some sound, but it sounded like the meaningless noise caused by the phone rubbing in his pocket.
Sun Lien hung up the phone, frowned and shook his head, "It must be because the phone didn't lock the screen and the call came out, right?"
There was a noise outside the door. The two looked at each other, and Sun Lien had a bad premonition.
"Go out and have a look." Yuan Pingan saw that Sun Lien's expression was not quite right. He stood up from his seat, put on his white coat, and walked out with Sun Lien.
Pushing open the door of the small conference room, a burst of panic and urgent shouts rushed toward the two of them.
"Tourniquet, bring the tourniquet!"
"B blood type, hurry up!"
"Monitors, get out of the way, the monitors are coming!"
"Pressure blood transfusion, push the ecmo over, the technical team will be here soon!"
"Two venous channels are not enough, we need a central venous catheter. Are the people from the anesthesiology department here?"
The emergency room was usually very noisy, but it was as noisy as a vegetable market, and everyone's voices were no longer as calm as before. It was the first time that Sun Lien experienced the panic that almost spread to the entire emergency room.
"What's wrong?" Yuan Ping'an stepped on his feet and looked at the place where a bunch of doctors gathered, while Sun Lien was more direct. He grabbed the little nurse beside him and asked, "A new patient?"
"The doctor in the department of urology was stabbed by a patient!" The little nurse finished her sentence and then got into the crowd, "Make way, make way! We've brought the hemostasis!"
The crowd parted under the scolding of the little nurse. At that moment, Sun Lien saw a familiar and pale face in the crowd. The expression on that face was very helpless, frightened, and painful. His eyes were
Close it tightly and open it occasionally.
This is Dr. Cao.
Sun Lien felt a buzzing sound in his head, and no other sounds could be heard.
"Cao Xin, male, 28 years old. Pericardial filling (00.01.14), penetrating liver injury (00.01.25), open pneumothorax (00.03.11), fourth rib fracture (00.03.35), left limb cephalic vein rupture
,(00.04.31)”
Sun Lien stayed where he was, watching his roommate lying on the rescue bed. His face became as pale as Dr. Cao's. His hands also began to shake.
"What are you doing standing still? Go and save people!" Yuan Pingan looked back and saw that his leader was standing there with a frightened look on his face. He suddenly became anxious. He grabbed Sun Lien's arm, and then
Dragging him to the bed.
"Doctor Sun, Doctor Sun!" He patted Sun Lien on the back several times, waking up his leader from the shock and daze. "What should we do?"
Sun Lien blinked, glanced at Yuan Ping'an, and then at Cao Xin. Dr. Cao's blood pressure on the monitor had dropped rapidly from 110/85 to 85/55, while his heart rate had risen to 138 beats/minute.
Sun Lien grabbed the syringe on the rescue bed and plunged it into Dr. Cao's chest. It hit exactly two centimeters below the fruit knife.
Sun Lien pulled up the push rod on the syringe, and a stream of blood poured into the syringe. As 20 ml of blood was withdrawn, Cao Xin's heart rate immediately dropped to 110 beats/minute, and his blood pressure began to rise.
"Acute hemopericardium." Yuan Pingan knew what was going on at one glance, "Quick, send him to the operating room immediately!"