Doctor: It's reasonable to perform surgery on yourself.

What is the reason for the recurrence of the disease?

It's an infection!

Unexplained infection!

The patient has been troubled by unknown infections since admission, until sepsis, and subsequently septic shock.

Including today's explosive watery diarrhea, in fact, it is also inseparable from infection.

As long as the cause of the infection is not clear, even if it is temporarily stabilized, it is actually just hiding a time bomb.

"The key to the problem is infection!"

Shi Lian's eyes brightened and he continued: "That brings us back to the original question...the reason why the patient had diarrhea for many days in a row!"

With explosive watery diarrhea, the key is the outbreak.

This is completely different from the patient's initial diarrhea.

If you are not aware of this and think about it along the lines of explosive watery diarrhea, the focus may be completely different.

"Diarrhea... I have done routine stool tests before, and no pathogens that can cause diarrhea were found," Jiang Mai said.

Hearing this, everyone once again fell into brief thought.

This type of severe diarrhea generally has relatively typical characteristics.

The pathogen cannot be found in the stool routine. Is it because the sample is missing or the cause is not in the stool?

Yang Yuen guessed: "Maybe the pathogen is atypical?"

Shi Lian gave another possibility, saying: "We cannot rule out parasitic infection."

Jiang Mai suddenly thought of something and said: "One more thing, the patient's situation is actually very special. He is a person who uses immunosuppressants and is a special patient!"

Immunosuppressants…

Shi Lian nodded. This was actually a point that he had been struggling with in the previous exam questions.

Whether to stop immunosuppressants is one of the difficulties in this question... Judging from the fact that they have not been eliminated, the "complete withdrawal of immunosuppressants" that I chose was the right approach.

Thinking of this, Shi Lian didn't feel anything was wrong and continued to struggle with how to identify the cause of the infection.

But suddenly she seemed to think of something and said: "How did the patient's diarrhea go after he was admitted to the hospital?"

Jiang Mai said subconsciously: "The diarrhea got better after being admitted to the hospital, but this is not a good thing, because the cause of the diarrhea has not been identified, and the symptoms are very mild."

"I know the reason!" Shi Lian said suddenly.

These words made everyone in the clinic raise their heads and look at Shi Lian in surprise and surprise.

"After the patient is admitted to the hospital, the biggest difference from before is not antibiotics, ventilators, CRRT and other measures, but immunosuppressants!"

If it were normal times, Shi Lian might have tried a few tricks to guide his colleagues to follow his ideas.

But time was very urgent at the moment and she had no time to delay.

Shi Lian continued without any pause: "To be precise, before being admitted to the hospital, the patient had been taking immunosuppressants. At this time, the diarrhea was very severe, and could occur more than a dozen times a day.

After admission, we considered stopping all immunosuppressants. I guess the hospital in the question has chosen the same approach.

At this time, the patient's diarrhea was slightly relieved. Before the diagnosis results were clear, the symptoms almost disappeared, and the patient was successfully transferred from the intensive care unit to the general ward.

However, on the day of entering the general ward, the hospital considered that the patient's infection was under control and resumed the use of immunosuppressants... At this time, explosive watery diarrhea occurred! "

At this point, even the dullest person can understand where the problem lies.

Even with the stupidest method of controlling variables, immunosuppressants can be locked in!

But Jiang Mai shook his head violently: "No, it's impossible. If it's an infection, it can't be so fast!"

The use of immunosuppressants can indeed directly lead to a decrease in white blood cells, which in turn can lead to a decrease in the body's immune ability.

However, whether it is bacteria or fungi, any pathogen is unlikely to cause explosive harm when immunity has just declined.

Even if you talk less, you have to hibernate for three or four days.

This is also the time when pathogens reproduce and grow.

After hearing this, the hope that had just been ignited in everyone's eyes was extinguished again.

At this time, Shi Lian asked: "I said that parasitic infection cannot be ruled out... what if the pathogen is a parasite?"

As soon as these words came out, the conference room fell silent again.

But the eyes of Jiang Mai, Yang Yuen and others also lit up immediately.

Bacteria and fungi take time to grow and reproduce.

But if it is a parasite, as long as the immunosuppressant is stopped and the body's immunity is reduced, it may quickly cause infection.

In other words, parasites have always existed.

It's just that when the patient's immunity is strong, the damage caused by parasites to the body is masked.

When immunosuppressive drugs are used again and the immune function is weakened, hidden infections come like a torrent.

"Wait, if that's the case, then it can be explained!" Jiang Mai suddenly figured it out.

There is actually a huge difference between having diarrhea before and after.

Before, I just had frequent diarrhea.

However, after becoming seriously ill, immunosuppressants were used again, and the patient immediately developed explosive watery diarrhea.

This is because the parasites have been multiplying in the patient's body and then migrated into the gastrointestinal tract and abdominal cavity.

When the immunity declines and all these parts suddenly become infected, there will be a second explosive watery diarrhea!

"Parasite, parasite..." Shi Lian's mind was racing.

She seemed to remember something and suddenly said: "Cryptosporidium!"

"How do you know?" Jiang Mai was a little confused.

Cryptosporidium is a small coccidia parasite, which can be transmitted through a wide range of ways, such as unclean food, swallowing pool water while swimming, not cleaning after touching pets, etc. Various daily unhygienic behaviors may spread it.

The symptoms are not very specific, just the symptoms of acute gastroenteritis, and are often treated clinically as ordinary diarrhea on the spot.

Moreover, this disease is mostly self-limiting and can heal itself in a week or two.

Many patients may be infected with Cryptosporidium, but they treat it as ordinary diarrhea, take medicine to control diarrhea, wait for a while, and Cryptosporidium will heal itself... From beginning to end, the patient does not even know that he has experienced a round of parasitic infection.

However, the so-called "self-limiting disease" is only for patients with normal immunity.

Like this patient now, he himself has undergone organ transplantation and is taking immunosuppressants, and his body resistance is already very weak.

If you are really infected with Cryptosporidium, or any other self-limiting disease, it is basically impossible to heal yourself, and you can only rely on drugs to control it.

"Cryptosporidium infection, the symptoms are watery stools with mucus. There are also abdominal pain, nausea, low fever, etc., which are consistent with the patient's symptoms. But many parasites have similar symptoms." Jiang Mai frowned and thought.

Now he can confirm with a high probability that the patient has a parasitic infection.

As for what kind of parasite it is, he has no clue.

However, if you want to proceed to the next step of the examination, it may not be enough to just do a large parasite screening. After all, the requirements of the question are there...