对不幸的家人感到同情,发生这样的事谁也不想。虽然本人不清楚整个病情的经过,但是从描述的细节上看,这病人貌似像得了Histoplasmosis (组织胞浆菌病)。这种病很少见, 由呼吸入侵肺部,通过血液传播感染。 一般免疫系统正常的人得了此真菌不会有什么症状,但是免疫系统有缺陷的人(比如艾滋病患者, 先天免疫系统缺陷)的人被感染后会产生严重的肺炎,肝脾肿大,发高烧,还有各项血液指数下降(比如白血球,红血球,血小板),然后休克,多器官衰竭,直至死亡。发病的状况跟上述的案例十分相似。此真菌生活在土壤中,一般常出现在美国中部(多伦多以南)OHIO 和 MISSISSIPPI 的河峡谷区, 加拿大十分少见,只有从美国疫区回来的群众当中才会考虑这种感染的可能性。在未了解病人本身的病史和可能存在的免疫系统缺陷时指责医生失职有失公平。本人也从未见过此病,但内科修传染性疾病时读过这样的案例:24岁男士,艾滋病患者,在Kansas(真菌区)得肺炎,高烧,肝脾肿大,等等,跟此案列非常相似。文中提到医院诊断是真菌感染,并用相应的抗菌药治疗(应该是两性霉素),还送到了深切治疗中心(ICU),就证明医院已经竭尽所能抢救病人。医生不是神,不是所有的生命都可以挽的了,我们追求的是尽力,做到问心无愧,然后只有听天由命了。这位病人很不幸无法战胜病魔,但希望大家能够客观对待病情。
This case most likely represents histoplasma capsulatum, which is a dimorphic fungus most commonly found in mid USA near the Ohio and Mississippi river valleys. We don't see this very often in Canada, mostly in travelers from endemic regions. People get infected with histoplasmosis via inhalation of the fungal spores into the lungs, which then gets disseminated to the body. Most healthy and immunocompetent individuals do not get symptoms. People with HIV/AIDS or some form of immunideficiency can get severe disseminated disease, often presenting with cough, pneumonia, fever, pancytopenia (low white blood count, low hemoglobin, and low platelets), which later develops into septic shock, DIC, and multi-organ failure, which is what eventually claimed the life of this unfortunate young man. I can only suspect that this is the infection responsible for this man's death based on the limited description of his illness from the above article. It seems like St. Michael's Hospitak had indeed diagnosed him with a fungal infection and treated him appropriately, including resuscitation in the ICU. Until we know what his medical history and whether or not he has an undiagnosed immune deficiency (I.e. HIV), it would not be fair to lay all the blame on the medical system. |