Today I would like to talk about a more horrific case.
The male patient, 38 years old, came to the hospital because of "fever for 5 days".
Originally, he thought it was a common cold, and at home he took some antipyretic drugs, but the effect was not good, the medicine stopped fever and rose again, the maximum body temperature was 38.8 ° C, and there was some cough.
So went to the pharmacy to buy other cold medicines, due to the control of the new crown pneumonia epidemic, he did not dare to say that he had a fever, only said headache, even so, many cold medicines need to register ID cards to buy, under the guidance of the clerk, he bought some headaches (in fact, can also reduce fever, such as acetaminophen), antiviral, cough drugs.
After eating for two consecutive days, it still had no effect.
It was still feverish, and the cough seemed to be getting worse. Cough during the day and also at night.
Looking at the epidemic situation on TV and mobile phones, he was also nervous, and he should not have been recruited himself. Thinking that in recent times, he often goes to crowded places, especially hotels, supermarkets, and theaters, and he often goes, and he is not so honest when wearing a mask, often covering his mouth and exposing his nose. Sometimes I even feel that I don't wear it at all.
The more I think about it, the more scared I become.
If it is a common cold, it is fine, stay up for a few days to pass, the problem is now almost 5 days, before the cold is 2-3 days is good, now 5 days is not good, still fever, he is indeed afraid. If it is really new crown pneumonia, it is difficult to get seriously ill, it will be a life.
Rushed to the hospital.
Fever clinics in hospitals.
The doctor heard that he had a fever, and that he had a fever for more than 5 days, and he was immediately alert. I asked him about his recent epidemiological history, whether he had been to high school risk areas, whether he had been vaccinated, and so on.
He thought about it carefully, and indeed he had never been to a high-risk area.
But it just so happened that during that time, there was an outbreak in a city, dozens of cases were confirmed a day, and some cases may flow to the city, so doctors dare not be sloppy.
Immediately did the new crown pneumonia, and at the same time admitted to the hospital.
After admission to the hospital, a routine examination was done, the body temperature was 38.4 ° C, the vital signs were stable, but the doctor could hear abnormalities in the lungs of the patient on auscultation, and there was a little wet rale in the lower lungs, which meant that the patient may have pneumonia.
In this sensitive period, having pneumonia is something that should not be taken lightly. There are thousands of pathogens of pneumonia, the most common is bacterial, and bacteria are divided into many kinds. Then there are viruses, fungi, etc., of which there are also many kinds of viral pneumonia, and what everyone is most afraid of at present is the new crown pneumonia virus, because this is highly contagious, and it spreads without paying attention.
In the afternoon, the new crown pneumonia nucleic acid results came out, negative.
But a negative can not mean that the patient is not a new crown pneumonia, must strengthen the test, tomorrow this time to repeat the examination, the superior doctor to explain. If the throat swabs at intervals of 24 hours in a row are negative for the nucleic acid test of new crown pneumonia, it is much more reassuring.
Everyone saw that the new crown pneumonia nucleic acid was negative, and they were slightly relieved. If he is positive, it will be the first case in the city in this round of the epidemic. In addition to being a disease problem, this is also a political problem, which the whole city will attach great importance to.
At the same time as doing the new crown pneumonia nucleic acid test, the doctor also arranged a chest CT examination for the patient, because the tube bed doctor auscultated the patient's lungs with a little wet sound, which may be pneumonia, since it is pneumonia, it is necessary to do a CT, CT can see more details.
At the same time, tests for common respiratory pathogens were done, and the results were negative.
The results of the blood draw came out, indicating that the white blood cell count was mildly decreased and that the hemoglobin was a little lower than normal.
The tube bed doctor wondered, generally if it is bacterial pneumonia, the patient's white blood cell count (mainly neutrophils) will be elevated. The absence of elevated white blood cells means that either the patient is viral pneumonia or the patient is infected with severely suppressed immunity, resulting in a decrease in the white blood cell count.
Either way, antivirals and antibacterial drugs come first.
Soon the chest CT results came out.
The CT film made the doctors present take a breath of cool air. Why? Because CT sees that the patient's lungs are diffuse with ground glass shadows, especially the double upper lungs, there are local changes.
This is certainly not bacterial pneumonia, the superior doctor said, it should be a viral pneumonia. From an empirical point of view, ct of bacterial pneumonia is not like this, and the patient's white blood cell count is not high but low, which is very strange.
Did the patient's second COVID-19 result come out? The superior physician asked solemnly. His biggest concern is the new crown pneumonia, although the patient has been negative once, but a negative is not 100% can be ruled out.
The tube bed doctor was also worried, he also noticed the patient's difference early in the morning, at this special juncture, there was such a special pneumonia, he did not dare to relax in the slightest. Before this, he had seen many new crown pneumonia patients, some of whom were still seriously ill, and the CT film changes of these patients had a more obvious feature, that is, the ground glass shadow changes.
But the glass shadow change can only be said to be caused by a virus, not necessarily the new crown pneumonia virus.
Having said that, no one dares to underestimate it.
Fortunately, the second report of new crown pneumonia nucleic acid came out, and it was still negative.
The crowd was relieved.
The problem is that the patient has been negative for 2 consecutive times the nucleic acid of the new crown pneumonia, combined with the fact that the patient has not been to a high-risk area, the diagnosis of new crown pneumonia can be basically ruled out. What pathogen could cause pneumonia?
Everybody started analyzing.
And it still has to be analyzed from scratch, and the patient's sputum has been left many times for testing, and I have not seen anything valuable. Mycobacterium tuberculosis was not found, and the patient's PPD test was also negative, not like tuberculosis.
Of course, it is not like bacterial pneumonia, because the blood picture is not high, other infection indicators are not very high (PCT is normal), CT is not like, patients do not have purulent sputum, more is dry cough. Especially after a few days of strong antibiotics, the condition did not improve, still fever, more able to exclude bacterial infections.
What about fungal pneumonia? Not good to tell. It does not look like fungal-related indicators from the blood test, because they are all negative. But this thing is difficult to talk about, you can't just look at an indicator, but also have to grasp the overall situation. The superior physician said.
The most likely is viral pneumonia, because chest CT looks like a virus, and the blood picture is not high but low, dry cough and no sputum, which all point to the virus.
As long as it is not a new crown pneumonia, the rest we will do it step by step. The superior doctor spoke, now pushed out to review a chest CT bar, this time to do an enhanced scan, I see that the patient seems to have a little shortness of breath these two days, although the blood oxygen saturation looks fine, but be careful to sail the ship of ten thousand years.
The superior physician is experienced, sometimes the intuition is very accurate, he asked to review the CT, then the review.
The patient was also quite cooperative, after all, he was afraid himself. A chest CT was done that day, and the results came out quickly, and when everyone looked at it, it was another exclamation.
Because the double lung lesion was severe before, especially the double upper lung, it looked whiter.
The speed of this progress is a bit fast, only 2-3 days, there is such a big change, you must first put imipenem / cilastatin (a very broad-spectrum, very efficient antibiotic, for bacteria, not antiviral and fungal) on top, although not like bacteria caused, but at this time no one dare not use antibiotics, rather than let go, probably this meaning.
But imopenem is not omnipotent, there are many pathogens it can not reach the firepower, so the superior doctor let the combination use of moxifloxacin, this antibiotic is slightly weaker, but can cover the atypical pathogen, and the combination with imipenem can play a double sword effect.
There is also oseltamivir, antiviral, plus.
Do you want to use anti-fungal ones? Tube bed doctor asked.
The superior doctor thought about it for a while, and there is no evidence of fungal infection at present, and it is not reported for the time being. After all, drugs have side effects, and too wide-ranging casting of the net is also easy to lead to microbial disorders in the patient's body, which may be self-defeating.
But hormones still have to be on. The superior physician said. From the patient's lung condition, the inflammation is still relatively intense, at this time with the use of hormones, strong anti-inflammatory may be helpful.
However, the use of hormones may cause the infection to spread, in case the patient is a bacterial or fungal infection. There are concerns.
We have used imipenem and moxifloxacin, there are them suppressing the field, with hormones is not a big problem, use it. The superior physician made the decision.
The patient saw that the doctor looked solemn, more nervous, asked what is the cause of the disease, has been feverish, and the cough is getting worse and worse, and sleep badly at night.
Sleep well can add some sleeping pills, the problem is not big. The tube bed doctor said that you are sick now, and you are a little nervous and anxious, and it is normal to sleep well.
What do you do? The superior physician suddenly asked the patient.
I work in a hotel and you've all asked before. The patient answers.
Yes, the bed doctor has asked before, that is, the management cadre of a local hotel. There is nothing special about this job, there is no need to travel back and forth frequently, and I should not have been to the epidemic area.
The superior doctor thought about it a little, and further asked, honestly, whether there have been any unclean sexual behavior in recent years.
The patient tilts his head, not knowing why, what is unclean sex.
It's prostitution, straight enough. The superior physician smiled. At this time, there were no other patients in the ward, all of them were medical staff, so the superior doctors were not.
Oh, this, this, huh. The patient's speech began to be a little prevaricating, as if unwilling to tell the truth.
The superior doctor stared at him and said that this is very critical, it may be related to your illness, you have to tell the truth. Of course, if you don't say it's okay, we can draw blood for tests, which is also a routine examination, and since you are hospitalized, you can't refuse, you must do it.
Turning to the tube bed doctor, did the immunity four items do.
The tube bed doctor sweated wildly and said that he originally wanted to do it when he was admitted to the hospital, but then a tube of blood dissolved, and it was not successful, and this matter fell.
As a result, the superior physician was not satisfied and asked whether the result was done.
Didn't do it. The tube bed doctor is like a child who has done something wrong, with a red face with his head bowed.
Let them (the nurses) draw blood today, and this test must be made up.
Well, tell us well, are there any prostitutes? The superior physician continued to ask questions.
There was no prostitution, but I had played with other women in the hotel. The patient is a little embarrassed.
There is nothing to be embarrassed about, the superior doctor said, I see you write 39 years old, not yet married, sex life is normal, but to do a good job of protection measures, wear a good condom, wear it?
not. It's all a whim.
Okay, we get it, let's see the results. The superior physician ended the conversation.
Back in the office, the superior physician opened the patient's blood routine report, meaning that he had ignored that the patient's lymphocyte count was low, and now it seems that it is still of great significance.
Immunization is a routine admission routine, how can it be ignored. He began counting the tube bed doctors. We don't know the growing environment of each patient, we are responsible for his safety, responsible for the safety of us and our colleagues, in case he has AIDS, you often draw blood and injections for him, in case of exposure, what to do? Whose is it?
I could see that the superior doctor was a little angry.
The concerns of superior physicians are not unreasonable. The patient has been fever for more than a week, chest CT suggests that it is a high possibility of viral pneumonia, and now that the new crown pneumonia has been ruled out, no evidence of common viral pneumonia has been found, so it is necessary to be vigilant against a dangerous disease, AIDS.
AIDS in the later stage, the immune function collapses, it is easy to have pathogen invasion to cause fatal infections, such as the common pneumocystis pneumonia, which can also be manifested as fever, cough, chest CT can be the same as the current change, showing is the performance of interstitial pneumonia. The superior physician continued. The identification of these pathogens cannot be seen simply through the film, and pathogen detection must be done, comrades.
The tube bed doctor trembled, he made a mistake, in fact, now the thinking is relatively clear, because the patient has a history of unprotected sex, it is estimated that his usual style of life is like this, saying that there is no prostitution, it may be that there is really prostitution, but it is not easy to admit it, because prostitution is illegal, he does not admit it, but admits to messing with the relationship between men and women, this is a moral issue, not a legal issue.
Since patients have such a situation, it is really impossible not to consider AIDS. Especially seeing such lung changes, it really has to be doubted.
The next morning, early in the morning, I received a call from the laboratory.
Something went wrong.
The patient is positive for HIV antibodies.
When the tube bed doctor heard the news, the whole person was not well.
The superior doctor turned blue in the face, saying that he could have found this condition 5 days ago, but he was delayed for a few days. For a few days, our nurses are at high risk of exposure, and if something happens, we will all have a bad conscience.
Fortunately, everyone knows that although AIDS is terrible, AIDS is a sexually transmitted, blood-borne disease, ordinary contact is no problem, nurses give him medicine, nursing general problems are not big.
The question now is whether this HIV antibody is positive or not reliable. The laboratory department said that it was basically reliable, and more than 98% of them were reliable. But it has to be done again, a review. At the same time, it must be sent to the CDC for control.
When the tube bed doctor told the patient about this, he was instantly paralyzed.
He had heard of AIDS, but had never seen it. This is good, directly provoked. Whoever changed this disease was paralyzed by fright.
The results of the re-examination are still positive.
The results sent to the CDC didn't come down so quickly, but the results sent for lymphoid subtype testing also returned, and the CD4+ lymphocytes were significantly reduced. CD4+ lymphocytes are cells specifically attacked by HIV, important immune cells of the body, and now the number is so small, it must be the result of HIV attack.
I consulted with a doctor in the infectious disease department to confirm that it was AIDS, and then the CDC made up its mind.
It's AIDS.
Finished. The patient's eyes are empty and he looks desolate.
Hospitalized for such a long time, he was alone, no family, no friends, even the payment was done by himself, and the CT was also done alone.
Finally, the patient was transferred to an infectious disease hospital for continued treatment.
The patient had a fever and a dry cough, which was thought to be new coronary pneumonia. Did not expect to inquire about the patient has a history of unclean sexual life, considering the possibility of AIDS, did not expect to be so unlucky, a check is positive, the patient is AIDS caused by pneumonia, is the late stage of AIDS, various complications struck.
Clean yourself.
Real case adaptation, non-hospital case, posted for vigilance.
(End)
Finally, tell everyone that you must clean yourself, and both sides are disciplined and basically unlikely to get aids. Once the mind is dizzy and has done out-of-line behavior, very regretful, afraid that if you have AIDS, you must go to the CDC as soon as possible for examination, generally speaking, about 3-4 weeks can be found to be positive for AIDS antibodies. If you are scared, you can also find a doctor as soon as possible within 48 hours of having a relationship and take AIDS blocking drugs, and the success rate is more than 90%.
AIDS will have an asymptomatic period, there may be a few years or more than ten years of asymptomatic, the patient does not know that they have AIDS, during this period of time if unprotected sex occurs, it is easy to infect others. The earlier the treatment of AIDS, the better the effect, if you can treat it as soon as possible, insist on taking antiviral drugs, the current AIDS can be chronically diseased, does not affect life expectancy. But if there is no treatment until the disease progresses to a later stage, just like the patients in this article, I am afraid that there will be less murder, and the mortality rate of patients in this AIDS period will reach almost 100% within 5 years.