- "Boom boom! ”
——“401！ Is there anyone in the 401 family? Trouble open the door, we are the CDC! ”
——" There is a suspected case of measles in this building, because it is a respiratory infectious disease, and everyone in the same building must be vaccinated. ”
——“301！”
——“302！”
……
On weekend mornings, when countless people were still immersed in the happiness of "returning to the cage", the people of Happy Garden 5 were woken up by the staff of the CDC.
At the same time, Xinran, who lives in 402, that is, the suspected measles case mentioned by the CDC staff, is working with his family to be investigated by the staff and community doctors: the scope of recent social activities, the means of transportation taken, who contacted... Happily, who was isolated at home with the "Ice Treasure Sticker" on his head, instantly felt that he had stabbed Lou Zi and tired the entire building.
It all started with the "single trip" at the beginning of the month.
Glad to enter the palace of marriage with her boyfriend Wenhui soon, she has seen on several public accounts that she must come to a trip with her girlfriend before getting married - after all, such opportunities after marriage are basically zero. After everyone cobbled together the holiday and discussed the strategy, the girlfriend group's trip to Myanmar opened in the thoughts of happy parents and Wenhui.
The stupa in Bagan, the sunset over the Ubon Bridge, the puppet show in Mandalay, the carriage of Bin Ullen... Exotic scenery brings a whole new experience, but these new experiences also include seeing the power of flower-footed mosquitoes in the chalet hotel.
The Chalet Inn was carefully selected after reading a lot of guides. The interior decoration is not bad, but at night, all kinds of mosquitoes launch a seamless offensive. In the morning, everyone was bitten out of the "galaxy" by mosquitoes, itching to doubt life. Fortunately, the local tour guide gave them a green anti-itch ointment, which is said to be a local specialty, and after applying it, it was not so itchy, and the group continued to devote themselves to the trip with great joy, but the photo should be taken with a thicker filter to cover the mosquito blocks that have been connected.
The seven days flew by quickly, and after returning home, I gladly began to prepare for the wedding. After staying up late, she felt a little dizzy, but she didn't care too much; in the evening, she gladly began to have a high fever, shivering, body pain, and nausea and vomiting. Wen Hui accompanied him to the emergency department of a nearby hospital. The doctor gave her a blood test and found that only the white blood cells were slightly higher, and the others were basically normal. The doctor said it was a common cold, and prescribed "cephalosporin" and cold medicine to let her go home and rest more.
When I got home and took the medicine, I gladly still had a high fever and couldn't eat anything.
Three days have passed, and there is still a body temperature of 39 ° C.
Seeing that the wedding was about to take place in three weeks, the bride-to-be could not afford to be sick, and her parents and boyfriend Wenhui were panicked. The second into the hospital, the last doctor, the doctor carefully inquired about Xinran's condition, gave Xinran a review of the blood routine, found that three days ago there was a slight increase in white blood cells, this time significantly reduced, took a chest X-ray and did not see obvious inflammation. For the sake of insurance, the doctor prescribed Penicillin hanging water to Xinran, hoping to be better than taking medicine faster.
After hanging water for two days, I gladly still had a fever. At night, the burned-up Glad struggled to get up and go to the bathroom—she didn't ask her parents for help, they were too tired to take care of her during the day. The moment I opened my nightgown, I couldn't help but scream!
I don't know when it started, the belly is already red, the thighs are the same, the whole person is like a ripe shrimp. The already burned legs were so weak that he almost fell to the ground. Her parents who heard the noise rushed to help her get up and entered the hospital three times a night.
In the emergency room, the doctor again took stock of Xinran's condition, considering that there may be an allergic reaction to penicillin, but it cannot be ruled out that it is measles. Because measles is a national statutory infectious disease, in addition to letting Xinran wear a mask, do not go out unless necessary, and go to the designated hospital as soon as possible, he also reported to the CDC according to the regulations, so there was a scene of the weekend morning staff visiting the door.
In fact, Xinran's mother wondered in her heart: they all said that measles only happened once, and if Xinran had measles when she was a child, how could she get it again? But Xinran has used penicillin many times before, and has never been allergic...
"In view of the fact that China's health administrative departments are paying more and more attention to the construction of infectious disease disciplines, the first issue of the column "Into the Department" selected the Department of Infectious Diseases of Zhongshan Hospital Affiliated to Fudan University as the reporting object... There are many stories in the Infectious Disease Department, welcome to learn about our work and update our image..."
Infectious disease department? Focus on a fever that can't be cured? Wen Hui, who was feeding her water, just heard the introduction of the infectious disease department on tv, and suddenly thought that it was just the right way to go to this department to see a doctor. With the idea of trying it out, the four of them came to the outpatient clinic of Professor Hu Bijie of the Department of Infectious Diseases of Zhongshan Hospital.
After the family recounted the ins and outs of the illness for the nth time, the professor read the examination report one by one.
The doctor who copied the prescription in the outpatient clinic whispered: "White blood cells, thrombocytopenia, peripheral blood see abnormal lymphocytes, will it be a tumor of the blood system?" But the rash doesn't feel very easy to explain. ”
Professor Hu looked closely at Xinran's rash and asked, "Have you eaten or been exposed to anything special recently?" Especially if you haven't encountered it before? ”
-- "No, lately I've been mainly busy preparing for the wedding, and I'm tired." Xinran was still running a fever, and he was unable to even speak.
- "Have you ever been exposed to any animals?" ”
"No, I don't usually have pets, and I haven't been to a zoo recently." Wen Hui said.
" So, what about mosquito bites?" ”
- "Yes! Xinran's mother replied, "This child is not obedient at all, he has to engage in some single travel!" I went to Myanmar at the beginning of the month, and when I first came back, I brought a body of mosquito blocks! Xinran's mother was not assured that she would go out of the house before, and when she heard Professor Hu ask, she complained again.
---------------------------------------------------------------------- ”
- "Burma?! Professor Hu suddenly raised his voice, "That may be a disease transmitted by mosquito bites, the weather in Southeast Asia is humid and hot, there are many mosquitoes, it is a high incidence of many infectious diseases, and many diseases will cause you these symptoms of fever, rash and muscle soreness." Look at your rash, it's a bit like dengue fever! Check it out in the hospital. ”
- "Dengue fever?! Is this disease going to... Well...... Will it be damned?! Professor Hu, can this disease be cured? She's not married yet..." Glad Mother's tears were about to fall. Wen Hui clasped His hand tightly, and he also looked remorseful—he was not at ease before they traveled, but he couldn't help it.
- "Don't scare yourself first, there is a cure!" Further examination is still necessary. ”
After admission, the doctor gladly prescribed blood tests and imaging tests. Doctors found that Xinran's white blood cell and platelet levels were lower than before: normal people's platelets were 100-300 *109/L, while Xinran's platelets were only 69*109/L, and according to this trend, nosebleeds, bleeding gums, and even blood in the stool, hematemesis and blood in the urine could occur, and 10% of abnormal lymphocytes were detected in her peripheral blood, liver function was slightly abnormal, and the subsequent imaging tests had no obvious abnormalities.
Professor Hu suspects that Xinran is dengue fever, first, because her rash is very special: although the rash on the abdomen and legs has been connected into large pieces, there are still some normal-colored skin in between, which is obviously different from the rash caused by allergies, measles and other infectious diseases; coupled with the history of Southeast Asian tourism, mosquito bite history, nausea and vomiting, muscle soreness, and blood routine manifestations in the summer, it is highly suspected that Xinran is suffering from dengue fever. Measles is a respiratory infectious disease, which tends to occur in winter and spring, which is also inconsistent with Xinran's condition.
Dengue fever is an infectious disease caused by mosquito-borne dengue virus, which occurs in the tropics or subtropics, especially in summer. Since China is not a high-incidence country for dengue fever, and the relatively high incidence of dengue fever in China is in the areas of Liangguang, Fujian and Hainan, shanghai is not among them, so many doctors are not familiar with the symptoms of dengue fever, especially the characteristic rash, and it is very easy to miss diagnosis.
Because mosquito bites in endemic areas may spread a variety of pathogens at the same time, after being admitted to the hospital, the doctor arranged for her to check for a number of suspected pathogens such as dengue virus nucleic acids and antibodies and rickettsial antibodies at the first time; isolating and preventing mosquito bites so that dengue fever epidemic is also necessary.
On the 4th day of hospitalization, the test of the pathogen was confirmed: dengue virus nucleic acid positive! Positive for IgM! That said, the diagnosis of dengue fever is clear!
Wen Hui, who was at the door of the doctor's office, was the first to learn the news, and after the phone informed Xinran's parents, this one-meter-nine strong man ran to the stairwell alone and couldn't help but cry with joy.
In the basically normal physical condition of the population, dengue fever is a "self-limiting" disease, that is to say, relying on their own resistance will slowly improve the disease, patients only need the necessary symptomatic treatment; but if can not be diagnosed early, patients inevitably have to receive round after round of antibiotic "baptism", including many high-level or even top antibiotics, the possibility of patients with double infection, drug fever or drug allergies is greatly increased.
Fortunately, Xinran did not experience too much of these "wrongful drugs", under the close supervision of medical staff and various symptomatic support treatment, her body temperature slowly stabilized, the fever finally stopped repeating, the rash on her body slowly subsided, and the white blood cells and platelets gradually returned to normal.
After a full 14 days of illness, Xinran finally recovered and was discharged from the hospital. In the days since the ghost gate was closed, she withstood the physical discomfort and psychological pressure, and finally overcame the disease and returned to the trivial and happy daily life of marriage preparation.
After this adventure, the understanding of her parents and the anxiety of leaving their self-reliance have increased by a few points, and fortunately, Wenhui, who has never abandoned, has been firmly by her side. The reverence and gratitude for life, the attachment and response to family love, and the yearning and expectation for a new life may be the endless driving force for the world to run.
<h1 class="pgc-h-arrow-right" data-track="105" > related cases</h1>
Aunt Miao is retired and can finally travel around. Once, she and her sisters went on vacation to the island, and when she returned, she suddenly began to have a fever and diarrhea. Aunt Miao estimated that she had eaten a bad stomach over there, but the anti-inflammatory drugs she had taken for a week did not get better. After being introduced by a doctor friend, Aunt Miao came to the Department of Infectious Diseases of Zhongshan Hospital for treatment. Because Aunt Miao in addition to fever, diarrhea, headache, there is a significant decline in platelets, before the onset of the disease and island tourism history, the doctor considered that it may be an infectious disease caused by mosquito bites, urgently left blood samples to test dengue virus antibodies and nucleic acid testing, and the test result was positive! After the symptomatic supportive treatment, Aunt Miao was resurrected with blood and could go out to play happily again.
<h1 class="pgc-h-arrow-right" data-track="133" > doctor's reminder</h1>
1. What is dengue fever?
Dengue fever is an acute infectious disease caused by the dengue virus and is mainly transmitted by the bite of mosquitoes (Aedes aegypti or Aedes albopictus). It is endemic to tropical and subtropical regions of the world, most likely in summer. In the past, the sporadic cases in China were mainly imported cases, and the main source was Myanmar, Laos, the Philippines, Thailand and other Southeast Asian countries and regions, and in recent years, there have been local dengue epidemics in Southern provinces such as Guangdong, Yunnan, Fujian, Zhejiang and Hainan. In 2020, due to the novel coronavirus outbreak, cross-border travel decreased significantly, and the number of dengue fever patients decreased significantly.
2. What are the clinical manifestations of dengue fever?
The incubation period of dengue fever is generally 3 to 15 days, and the symptoms usually occur 4 to 7 days after the bite of the virus-carrying mosquito, which can manifest as asymptomatic latent infection, non-severe infection, and severe infection. Dengue fever, also known as "bone pain fever", is an acute febrile disease in which patients may present with fever, headache, retroorbital or eye pain, muscle, bone, and joint pain throughout the body, fatigue, gastrointestinal symptoms, and bleeding manifestations (such as bruising, bruising, nosebleeds, bleeding gums, vomiting blood, blood in urine, and vaginal bleeding). On days 3 to 6 of the course of the disease, a congestive rash or punctate haemorrhagic rash may appear on the extremities of the face. Typical rashes are more common in pinpoint bleeding spots in the extremities and "phi island" (skin of a normal distribution of color scattered in a patchy red rash).
3. What should I pay attention to on a daily basis to avoid infection with dengue fever?
Dengue fever is a mosquito-borne disease that is mainly transmitted by the virus-carrying Aedes mosquitoes, which can also transmit chikungunya and Zika viruses. Therefore, the best way to prevent dengue fever is to protect yourself from mosquito bites.
Anti-mosquito repellent: choose the appropriate anti-mosquito repellent drugs or items, install window screens on doors and windows, etc
Clean up standing water: Clean, scrub, cover or throw away items with standing water on a regular basis (at least once a week) to reduce mosquito spawning in the water
Self-isolation: When suspected of having dengue fever, or within 3 weeks of returning from an area where dengue is endemic, care should be taken to avoid mosquito bites to avoid causing an epidemic of dengue fever
Prompt medical attention: Dengue usually presents within two weeks of being bitten by a mosquito, and if there is a history of presence in an area where dengue is endemic and relevant clinical manifestations occur, visit the hospital in a timely manner
Dengue vaccine: Dengue vaccine has been approved for use in dengue-endemic areas in Europe and the United States, but has not yet been approved for travelers to dengue-endemic areas.
4. Can dengue fever be cured?
Dengue is a self-limiting disease that usually has a good prognosis. Factors influencing prognosis include the patient's previous history of dengue virus infection, age, underlying medical conditions, and complications. Severely ill patients may present with symptoms such as shock, hemorrhage, and impaired consciousness; a small number of severe cases can die due to failure of important organs. A combination of treatments such as early diagnosis, early detection of severe complications, and early organ support if necessary can reduce mortality.
This article was first published in the "Infection Team of Zhongshan Hospital Affiliated to Fudan University (ID: zsgr2020)", the Doctor's Daily has been authorized to publish, and the copyright belongs to the original author!
Author: Zhang Yao Huang Yingnan
Review: Hu Bijie Pan Jue
Editor: Lingling Huang