Today, I will tell you about a real and terrifying emergency department case.

A young patient I was treating started to have a persistent fever after experiencing an online romance, and was worried about contracting an infectious disease. He came to the emergency department for examination, and the results showed that it was one hundred times more terrifying than an infectious disease.

At that time, I was not in the ICU, but in the emergency department. In the evening, a 27 year old male patient arrived.

When the patient arrived, it was quite normal, but there was a slight fever (fever), fatigue, feeling weak all over, and a headache.

But he said that the fever had lasted for several days, but it was intermittent. He took his own temperature, which was only around 38.5 ° C, not too high.

Fever is too common, and thousands of diseases can cause fever. Emergency doctors are most afraid of fever, abdominal pain, and chest pain.

After a brief inquiry about the medical history, I believe it is an upper respiratory tract infection. After completing all the inspections, the results also showed normal.

The blood routine of the blood test has also been obtained, and the white blood cell count is normal.

There are also no significant anomalies in other indicators.

Overall, there is a high possibility of upper respiratory tract infection.

"I prescribed some cold medicine for you. Just go home and rest well and drink plenty of water," I told him while giving the doctor's advice.

He hesitated for a moment and said, "Doctor, there's something I don't know if I should tell you."

He lowered his voice slightly.

"Tell me, what's going on?" I was still giving medical advice and didn't look up at him.

He hesitated for a while before telling me that he had met a female netizen whom he had been talking to for over a year. It wasn't long after we met that something happened, and I don't know if it had any impact.

My thoughts were immediately drawn to him.

"What do you mean, be clear," I looked at him and said.

"That's it. I met a female netizen a month ago and had sexual intercourse. Later on, I started to have a fever and I'm not sure if there might be any infectious diseases."

He spoke a bit uncomfortable.

"But I'm sure we have implemented safety measures. We all wear condoms," he looked at me with a smile on his face.

"I'm worried about contracting sexually transmitted diseases, AIDS, and so on. So today I'm coming to see the emergency department."

I want to laugh a bit, but I definitely can't laugh.

Because it is evident that he is still very worried.

As a professional doctor, no matter how funny a patient's medical history is, they cannot laugh in front of others. Well, I have received professional training, and a serious and calm face is very important.

I said you don't have to be afraid for now. First, you bring a condom, which is almost safe.

However, considering that you have a history of sexual activity (which is a history of unclean sexual behavior. After thinking about it later, having a relationship with female netizens may not necessarily be considered unclean sexual behavior, but there are still risks), you should still be cautious.

In the acute phase of AIDS, symptoms may appear about one month after infection, that is, fever and fatigue.

"If you don't feel relieved, go to the dermatology and venereology department of the outpatient clinic tomorrow to consult about problems related to AIDS examination. These items can't be done here in the emergency department." I gave him advice.

For AIDS related tests, what I can do is to check the four items of immunity, which are AIDS antibodies, but these antibodies take time to produce, and AIDS cannot be diagnosed very early.

I am right. Early AIDS may only have fever and fatigue, which seems no different from the common cold.

His concern is actually reasonable.

I explained to him a few words, prescribed some fever reducing medicine, and asked him to drink more water. He understood and went back.

What surprised me was that he came back the next day.

He is wearing more clothes today than yesterday.

"Is it very cold?" I asked him.

He smiled slightly and said it was okay.

Then he said that after going back yesterday, he took the medicine and the effect was not good. He still had a fever last night and couldn't sleep well. He always felt uncomfortable all over the body.

This sentence made me wary.

It can't really be AIDS, my God!

All the symptoms of AIDS are nonspecific. When the human immune system goes wrong, all kinds of diseases will come. Therefore, AIDS is very easy to be misdiagnosed in the early stage, and can only be eliminated with the help of auxiliary tests.

In fact, there is not much evidence to support him as AIDS, just a "history of unclean sex", and he has taken good safety measures, so the possibility of AIDS infection is not high.

"Did you buy the condom yourself or was it given to you by the other person?" I asked him.

"I prepared it myself, and I often keep it in my bag, so I'm afraid I might need it," he smiled awkwardly.

"So it seems that condoms are intact and safe. There is no possibility of a damaged condom."

Thinking of this layer broadened my mind a bit and I wondered if there were any other possibilities.

Yesterday's chest X-ray, electrocardiogram, and blood routine were all normal. The patient now has non-specific symptoms such as fever, fatigue, and overall discomfort. To further differentiate, new breakthroughs must be found.

So I carefully examined his body, from head to toe, and did not find any special abnormalities.

In order to rule out the possibility of sexually transmitted diseases, I had Dr. Guipei close the door, put on gloves, pulled up the curtain, and prepared to carefully examine his genitals and perineum.

At first, he was a bit awkward and unwilling to take off his pants for inspection.

I said there's something here, you have it, and we both have it.

He is willing to cooperate.

At that time, besides suspecting that he had AIDS, what was more important was to see whether there was the possibility of syphilis, gonorrhea and other diseases, which might also lead to fever and fatigue.

I looked carefully and didn't find any abnormalities such as chancre, rash, or ulcer.

"Have you ever vomited?" I asked him after the examination.

"No, but my appetite is not very good. I didn't eat much yesterday."

His eyes are a bit tired, and his lips are very dry. It seems that he really didn't rest well last night.

"What kind of job do you do?" I asked him.

This question should have been asked clearly yesterday, but it was too busy yesterday and I had a preconceived belief that it was a common cold, so I didn't ask.

The nature of the patient's work is sometimes the key to diagnosis.

"I work in sales," he said.

"What are you selling?" I asked.

"The agent for XX beer," he said.

At this moment, the nurse pushed the door in, but he was startled.

Such a strong man, so timid, his pants have already been pulled up, and he is so easily frightened. I feel strange in my heart.

He raised his collar a bit, as if it was a bit cold, and then asked the nurse to close the door, as there was a strong wind outside.

The nurse didn't say anything, but after asking me for something, she casually closed the door and left.

"Are you cold?" I asked him.

"A bit," he said.

"Oh no, there shouldn't be any chills," I thought.

The patient has a fever, chills, and overall discomfort. It doesn't look like a common cold, so it may be an infection from other organs, such as liver abscess, cholecystitis, pneumonia, etc.

But yesterday's blood routine showed that the white blood cells were not high.

And I didn't find any abnormal signs such as liver pain during my physical examination, and the patient didn't mention abdominal pain, chest pain, cough, etc., which I'm a bit confused about.

If it is a serious infection and the patient has sepsis, similar symptoms may also occur. If it is not a prominent infection, it may be a relatively hidden infection, such as deep tissue infection or blood system disease? Leukemia? Lymphoma?

I started brainstorming, and these blood diseases may also have similar symptoms, and the condition may be severe, the prognosis may be poor, and even life-threatening in the short term.

I am becoming less and less careless.

At that time, he was re measured for body temperature, 38.0 ° C, low fever.

"Is there any problem with urination, frequent urination, urgency, or pain during urination?" I asked him.

He said no, so I can basically rule out the issue as a urinary tract infection.

And just checked, the abdomen is also normal, unlike the manifestation of abdominal organ inflammation.

"You look like an infectious diseases, but at present I have not found an infectious focus that can explain the condition well. Further examination is needed," I told him.

"Today we are going to do a chest and abdominal CT scan, retain new blood, perform blood culture and other routine tests. This may require some money."

"How much does it cost approximately?" he asked me.

"More than 1000."

I know this money is not a small amount for him.

But there's no way, these are all necessary tests. Without them, I won't be able to obtain evidence, diagnose correctly, and use medication accurately.

"Do it, you can do it," he whispered, "as long as it is helpful for treating the disease, just open it up and I will cooperate."

I can feel an inexplicable sense of fear in his words, he needs help so much now.

And I am currently the life-saving straw in his hand.

What exactly is his problem? My brain is thinking quickly, but my movements are very slow.

I had a busy day today and didn't drink much water. I took the thermos from the table, opened the lid, and took two gulps.

Something unexpected happened to me!

Just as I was drinking water, he suddenly stood up and took two steps back.

I was bewildered by this sudden change, and I stared at him, wanting to ask him what was wrong.

But when I saw the frightened expression on his face, I suddenly felt a chill behind him.

He stared fixedly at the thermos in my hand, didn't say a word, his throat twitched up and down, and his face began to turn pale.

All of this happened too quickly for me to think.

"What's wrong with you?" I asked him.

I am also amazed.

"Nothing... nothing, water... water..." He began to be a bit incoherent, saying a few words of water.

I want to see the thermos in my hand, but I don't dare to look at it. That's like a child who did something wrong, hiding in a corner, tightening his body.

Suddenly, my thoughts were struck by lightning.

"He shouldn't be afraid of the thermos in my hand, right? He shouldn't be afraid of me drinking water, right?"

He's afraid of water!

If an experienced doctor sees my description, they should be able to guess the patient's illness.

He was very abnormal from the beginning today, wearing two clothes on a hot day with the collar pulled up so high, indicating that he was afraid of the wind. I began to think he was afraid of the cold.

He had a bad appetite, and I began to think it was caused by a fever.

But why are his lips so dry? Didn't I remind him to drink more water when he went home? Why didn't he drink? It seems like he's afraid to drink now.

But all of this is just my guess.

In the disease spectrum, there is only one disease that I know can lead to fear of water, and that is:

Rabies!

I don't want him to have rabies. If it really is, then he will basically be sentenced to death.

But he is indeed afraid of me drinking water. Even if I don't want him to be rabies, I can't change the fact.

What I can do now is to find a way to prove my hypothesis first.

To confirm my hypothesis, I faced him, hesitated for a moment, and took two more sips of water.

I deliberately made a loud noise while swallowing water, and I stared at him tightly to see his reaction.

When I saw his reaction, I regretted it.

Because he appeared extremely uncomfortable, with a twisted expression on his face, appearing very painful and scared.

His dry lips appeared extremely pale, as if he had just come out of the desert, very dehydrated.

I quickly swallowed those two sips of water and placed the thermos in place.

At the same time, my hands and feet also instinctively became vigilant. If he was really rabies, judging from this state, he should be in the excitement period. Patients in this stage may have hallucinations. If he goes insane and attacks me, how should I respond? I even thought of a way at that time.

After I placed the thermos, he gradually recovered, but never dared to approach me again.

I suddenly felt very sad, very desolate, a sense of powerlessness hit me. I wish he weren't rabies.

I have so much inner drama, he naturally doesn't know.

"Have you been bitten by a dog recently?" I asked him cautiously.

He thought for a moment, then nodded slowly, saying that he had been bitten by a small dog in the countryside at the end of January

When he said this, his lips began to tremble, stuttering, and he didn't continue.

"Did you treat the wound and get vaccinated against rabies?" I urgently asked him.

He stuttered and said that he had used some chili pepper to treat the wound and did not receive the vaccine.

My mood has fallen to freezing point.

I quickly calmed him down and then went out to find the director.

The director happened to be away that day, so I had to call him and tell him that a suspected rabies patient had arrived at the consultation room, asking him to come back and take a look.

The rabies virus enters the brain from the wound and follows the nerves along the way, which may damage some structures of the brain, especially the vagus nerve, glossopharyngeal nerve, and sublingual nerve nucleus, leading to spasms in the swallowing and respiratory muscles.

When patients see water, they involuntarily associate it with choking on water and suffocation, resulting in fear of water.

At this time, the patient is very miserable, with a very dehydrated body and a strong desire to drink water. However, they are extremely afraid of water. Even if they hear the sound of water, they may go crazy.

So patients have a mixture of love and hate towards water, and they are constantly conflicted.

Once rabies occurs, it will first go through a prodromal period of several days, just like a cold, and then enter an excitation period. At this time, patients may have fear of water, wind, muscle spasms, or even mental disorders, and this excitation period usually lasts for 2-3 days.

The patient is currently in this excitement period. After these two days, they will soon enter the paralysis period, with respiratory and circulatory paralysis, and will soon die, unable to sustain for a day.

The more I listened, the more scared I became, and I couldn't help but shiver.

If the patient had immediately received the rabies vaccine, they might have escaped the disaster. Otherwise, once the disease occurred, even the Great Luo Immortal could not have done anything about it.

I ran right away.

When I returned to the consultation room, the patient was gone.

I asked the nurse at the emergency desk and said that the patient had just left in a hurry.

I felt lost and lost in thought for a moment.

I thought of calling the patient's phone number, trying to contact him and ask him to go back to the hospital for treatment, but the phone couldn't be reached.

Afterwards, I contacted the infection department and informed them of the situation. They also believed that the diagnosis of rabies was highly possible, but could not be certain. It would be better if there were virus antigen and antibody tests.

But the patient has already left. I don't know why he wanted to leave, and he secretly left without saying a word.

He may have realized the problem, or even knew that the big picture was approaching, especially when I asked him if he had been bitten by a dog, he became even more panicked.

He may not want to die in the hospital, or he may want to go home and seek folk remedies for treatment, no one knows.

This is the second case of rabies I have seen since I started working as a doctor. Of course, this is just a high level of suspicion and has not been diagnosed.

I remember yesterday when he told me about having a relationship with a female netizen, he was so afraid. I used to feel funny. Now looking back, I would rather he was AIDS.

Is AIDS Terrible? Terrifying. However, the incubation period of AIDS is 9 years on average. It is a long process from initial infection to the end stage, which may last 10 years or more.

And now there are more and more drugs to fight against AIDS virus, and many patients can even live with the disease like ordinary chronic diseases.

However, rabies is different. Once it occurs, within 6 days, it will die.

Science Popularization Classroom: A Scientific Approach to Rabies

How long is the incubation period for rabies?

It is generally believed to occur within 1-3 months, with most cases occurring within 3 months after being bitten. But there are also cases where the incubation period can last for more than 10 years. The length of incubation period is related to factors such as age, wound site, wound depth, number and virulence of invading viruses.

What is the process of rabies onset? How many days will it take to die?

Once rabies occurs, most cases will have typical Phase 3 clinical manifestations.

Firstly, during the prodromal phase, there may be low fever, fatigue, headache, nausea, and overall discomfort; Then fear, restlessness, restlessness, insomnia, and sensitivity to stimuli such as sound, wind, and light. This stage lasts for 2-4 days.

Then enter the excitement period, with high excitement, fear and anxiety, fear of water, fear of wind, and high fever. Not every patient may have fear of water. The patient's consciousness is mostly clear, and a few may experience hallucinations. This period lasts for 1-3 days.

Finally entering the paralysis phase, muscle spasms stop, the whole body becomes paralyzed, unconscious, and ultimately respiratory and circulatory failure leads to death. This stage usually lasts for 6-18 hours, not more than 1 day.

The above disease course generally does not exceed 6 days.

Is it true that once rabies occurs, the mortality rate is 100%?

Our country's medical textbook "Infectious Diseases" (8th edition) clearly states that rabies is the most dangerous viral disease among all infectious diseases, and once it occurs, the mortality rate reaches 100%.

When do I need to get vaccinated after being bitten by a dog?

This is the most concerning and crucial issue for everyone. This involves a professional concept: exposure.

Rabies exposure refers to being bitten, scratched, licked, or damaged by rabies, suspected rabies, or host animals that cannot be determined to have rabies, or open wounds or mucous membranes that come into direct contact with saliva or tissue that may contain the rabies virus.

The above is called exposure to rabies. Not everything bitten by a dog is considered exposed. It must be a case of being bitten by a rabid dog, a suspected rabid dog, or not sure if it is a rabid dog. If it is bitten by a small dog from your own family, the dog has always been kept at home and has never been out or in contact with other dogs, then it is impossible to suffer from rabies. At most, being bitten by it is a bite and there will be no rabies. In this case, you do not need to get vaccinated against rabies, as long as you ensure that your dog is innocent.

The 10 day observation method recommended by the WHO and the US CDC does exist and is internationally recognized, but there are many limitations:

(1) The 10 day observation method is only applicable to domestic dogs, cats, etc., and animals that harm humans must have a clear and effective history of rabies vaccination twice, otherwise do not joke with your life;

(2) Can the animal causing the accident be isolated and observed by me? If it's my own dog, it can be observed for 10 days. If it's a stray dog and it bites me, it will still stay there for me to observe for 10 days, won't it?

(3) This is the most important thing. Vaccination should be administered immediately after exposure, and do not wait 10 days before deciding whether to vaccinate, otherwise you may miss the opportunity. But if we can see that the offending animal is still alive after 10 days, then the next 2 injections (on the 14th and 28th days) do not need to be administered.

In summary, everyone must be cautious with the 10 day observation method. The 10 day observation method is scientific, but it must have prerequisites. It doesn't mean that if a dog bites us, we wait for 10 days to see if it dies. If it doesn't die, we won't get vaccinated. If it dies, we should get vaccinated quickly. It's not like that.

Some people question the misuse of rabies vaccines, which is a big problem and involves a wide range of aspects. Dr. Li is unable to conduct thorough research and cannot provide suggestions. It is recommended that everyone analyze specific problems and comprehensively analyze whether to get vaccinated when bitten by a dog