Diseases That Have Defied Diagnosis

　　无视诊断的疾病

　　Diagnosing a patient is, in a lot of ways, like detective work. And over the years, as one medical mystery is solved—such as when germs and not an imbalance of bodily humors were found to cause disease—others crop up. Here are nine diseases or syndromes that historically baffled epidemiologists and physicians alike. Some, like syphilis, are today easy to diagnose and cure (especially when caught early), while others, like chronic fatigue syndrome or fibromyalgia, have raised more questions than answers.

　　从多种途径医治病人就好像福尔摩斯办案一般。多年以来，当一个医学之谜被解开，比如当发现是细菌而不是人体体液导致疾病的，往往其他的难题就接踵而来了。这里有9种疾病综合症曾经长期共同困扰过流行病学家和内科医生。有些疾病像梅毒这样的，在今时今日已经很容易诊断和治愈（特别是感染初期），而另一些比如慢性疲劳综合征和慢性肌痛没给出多少解答，却带来了更多的难题。

　　And then there are illnesses like Lyme disease (transmitted in some situations by the deer tick, shown here), in which a combination of misinformation and potentially unclear diagnostic tests can lead to patient suffering, excessive treatments, and even medical fraud.

　　其后还有一些疾病如莱姆症（在一些情况下由鹿蜱叮咬传染，如图所示）一些错误信息的混淆和一些盲目诊断检查可能会使得患者被过度诊治，承受不少痛苦，甚至还要面对医疗欺诈。 （来源：译言网 MarkTwain个人空间）


　　Lyme Disease

　　莱姆症

　　First presenting itself as a mysterious cluster of juvenile-arthritis cases in 1975, Lyme Disease continues to fool patients and physicians alike. It has been called a "great imitator" because of the wide range of symptoms it is responsible for, and the fact that these symptoms can overlap with those of causes as diverse as the common cold, normal aches and pains, and serious illnesses like multiple sclerosis or Alzheimer"s. The good news is that active Lyme Disease is effectively treated by standard antibiotic therapies that are generally easy to tolerate, and is efficiently diagnosed by infectious-disease specialists experienced in treating the disease. Here, the pathogen that causes Lyme Disease is shown in human blood. 　　首先是在1975让自己看起来是一组青少年关节炎的病例， 莱姆症就这样持续的愚弄着病患和医生。因为它所带来的症状表现样式很广， 莱姆症曾被称为“厉害的模仿者”。而事实上，这些症状会和很多病引起的症状看起来很像，诸如一般的感冒、一般性的肌肉酸痛头痛，还有一些像多发性硬化症和老年痴呆症这样的重病。好消息是显性的 莱姆症克能够由标准抗生素疗法治愈，并能够被传染疾病方面临床经验丰富的专家诊治出来。这张图片显示了莱姆病原体在人类血液中的样子。

　　Multiple Sclerosis (MS)

　　多发性硬化症

　　One of the difficulties in diagnosing MS is that early signs can take any number of neurological forms (from muscle weakness to fatigue and bladder difficulties), and it can either build gradually or come in "attacks" that go through phases of relapse and remission. Another difficulty in understanding MS—though the disease was first described in the mid-1800s—is that there is no consensus as to what causes it; the prevailing theories suggest a complex, yet not understood, set of interactions between genetic susceptibility, environmental exposure, and infectious triggers. Once the disease progresses it can be devastating; Debbie Purdy, shown here, has become well known as both a person with MS and a right-to-die advocate. 　　诊断 多发性硬化症的困难之一是，在早期可能有任意种神经形式的症状（从肌肉无力到膀胱告急），而且它能够缓慢潜伏滋长也可以经过复发和缓解阶段来直接“进攻”。通过19世纪中叶对该症的初步描述来看，另一个了解 多发性硬化症的难题是没有造成病因的唯一原因；当时的理论认为病因是一种复杂的但尚不清楚的综合作用的结果，其中包括了遗传易感性，环境暴露和感染发病源之间的交互作用。一旦疾病发作就是毁灭性的，这里的图片显示了Debbie Purdy，她也是众说周知的身患 多发性硬化症和死亡权力的拥护者。

　　Chronic Fatigue Syndrome (CFS)

　　慢性疲劳综合症

　　The Centers for Disease Control notes, "The cause or causes of CFS have not been identified and no specific diagnostic tests are available. Moreover, since many illnesses have incapacitating fatigue as a symptom, care must be taken to exclude other known and often treatable conditions before a diagnosis of CFS is made." Though theories abound—infection from nanobacteria (though it"s not clear such organisms even exist), postviral immune reaction, psychological disorder—nothing conclusive has been determined about the cause or causes of chronic fatigue syndrome. A study published Aug. 23 linked CFS to a class of viruses known as retroviruses (it is the second study to find that result), suggesting that retroviruses may play a key role in curing the disease. But, as doctors are often quick to point out, CFS is real and disabling no matter the cause. Here, a nurse discusses treatment options with Andrea Enright, who suffers from chronic fatigue and other illnesses. 　　美国疾病控制中心指出：“导致 慢性疲劳综合症（CFS）的一种或几种病因还为找到，也没有专门针对该症的诊断测试方法。此外，由于许多疾病也会导致疲劳的症状，必须在确诊CFS之前，对那些已知的以及其他可治愈的情况进行排除。“虽然有毫维细菌传染（甚至不知道这样生物是否存在）、病毒后免疫反映，心理紊乱等大量理论的存在，但是却没有一个结论能够确定慢性疲劳症的病因究竟是什么。一份与8月23日发表的研究将CFS和一类病毒联系起来，并认为该病毒在该症中起到关键作用，这类病毒被称为逆转录酶病毒( 译者：一种致肿瘤病毒)（这是第二个发现这个结果的研究）。但是医生们很快指出不管什么原因造成CFS，它的症状是真实存在的并会导致患者伤残。这幅图中，一位护士在和安德烈恩赖特讨论治疗意见，后者正遭受慢性疲劳和其他疾病的困扰。

　　Fibromyalgia

　　纤维肌痛

　　Much like chronic fatigue syndrome, Fibromyalgia—primarily characterized by muscle and connective-tissue pain, border="1" Heightened sense of pain to touch, and fatigue—is controversial, with some experts blaming it on a biological disorder, some considering it a psychological condition, and some seeing a combination of the two. Both diseases fall under the category of "medically unexplained syndromes," meaning that while the symptoms may be very real, there is no consensus as to the cause of those symptoms and no widely accepted treatment or cure. Here, a doctor checks Fibromyalgia trigger points on a patient, but not everyone who suffers from the condition can find reliable care. In such situations, patients may often be faby the medical establishment or taken advantage of by self-proclaimed experts peddling expensive and potentially unsafe treatments. 　　很像慢性疲劳症， 纤维肌痛主要表现为肌肉和结缔组织疼痛，放大了触摸的痛感和肌肉疲劳。这个病是饱受专家争议的病症，一些专家将他视为生理学的紊乱，另一些认为它是一种精神病症，还有一些觉得前两种的组合。和慢性疲劳症一起进入了“医学上不可解释的症状”分类，那意味着症状是非常真实的，但是没有对导致症状的原因得出一致性的结论也没有对治疗治愈的方法有广泛的认同。图中，一位医生在检查一位病人的 纤维肌痛敏感位置，但是不是每一个这种病的病患都能找到可靠的治愈方式。得了这种病，病患可能经常被医疗机构放弃，或者被那些兜售昂贵且具有潜在危险的蒙古大夫占便宜。

　　Chronic Prostatitis/Chronic Pelvic-Pain Syndrome (CP/CPPS)

　　慢性前列腺炎/慢性骨盆疼痛综合症

　　According to a 2006 study published in the Annual Review of Medicine, up to 10 percent of men suffer from prostatitis, a disease that affects the prostate (healthy prostate tissue is pictured here). The vast majority (90 to 95 percent) of cases are of unknown, nonbacterial causes. This group of symptoms (mainly pelvic, rectal, and abdominal pain, urinary frequency, and fatigue) has confounded physicians, psychologists, and the men who suffer from it for decades. For the longest time, doctors suspected that the condition was caused by persistent, hidden bacterial infections and sometimes prescribed long-term or open-ended antibiotic therapy. This protocol has fallen out of favor. Though there is no universally known cure, patients seek out treatments as variable as physical therapy, biofeedback, and, in rare cases, surgery. 　　根据2006年公布在医学年度审查的研究表明，高达百分之10的男性患有前列腺炎，一种影响前列腺的疾病（见前列腺组织的图片）。绝大多数病例的病因（90至95姊）是未知的，非细菌性的。这组症状（主要是盆腔，直肠，腹部疼痛，尿频，疲倦）已经困扰了医生，心理学家，以及患了这个病的男人们几十年了。其中维持最长时间的治疗方法是医生怀疑是由于持续的，潜伏的细菌感染，并由此开出长期或者无限期的抗生素药方。这套诊治方法现在已经失宠了。虽然没有普遍已知的治疗，患者仍然在寻求着各种各样的治疗方式，如物理治疗、生物反馈，在极少数情况下，还会进行手术。

　　Syphilis

　　梅毒

　　Perhaps the original great imitator disease, Syphilis used to be widespread (Al Capone, Edouard Manet, and Leo Tolstoy were said to have had it, and this vintage French ad from the 1920s warns against it), in its late stages resembled many other illnesses, and was difficult to properly diagnose. Much like Lyme disease—each is caused by a different type of corkscrew-shaped bacterium known as a spirochete—untreated Syphilis can cause damage to the heart and nervous system. Though it took hundreds of years for doctors to solve the riddle of Syphilis, the disease is now generally easy to diagnose with laboratory tests, and easy to treat with penicillin. 　　也许算是早期的超级模仿型病毒， 梅毒曾经大肆泛滥（AI Capone，Edouard Manet，和Leo Tolstoy 据说都曾得过，这张来自20世纪20年的老式的法语广告证实对人们的发出针对它的警告），它的晚期也会聚合多种其他疾病并且很难找到合适的诊治方法。每一例都是由不同类型的螺旋状被称为螺旋菌的细菌导致，因为和莱姆症很类似，没有治愈的 梅毒能够对心脏和神经系统造成破坏。尽管医生花了数百年来解决 梅毒之谜，当今通过实验室测试已经很容易诊断出 梅毒，通过盘尼西林也很容易将它治愈。

　　Systemic Lupus Erythematosus (Lupus)

　　毒系统性红斑狼疮(狼疮）

　　Lupus is an autoimmune disease with no cure, though it can be managed by treatment of its symptoms. As with many diseases that are difficult to diagnose initially, lupus"s early symptoms (which include fatigue, migrating pain, and cognitive deficits) can lapse and go into remission. Those with the condition may be misdiagnosed with another illness or told their discomforts are just in their heads. Though a traditional sign of lupus is a "malar rash" (a butterfly-shaped red area that covers the cheeks and nose), only about 50 percent of patients with lupus experience this symptom, and full diagnosis is usually based on criteria that include positive laboratory tests, clinical evidence, and ruling out other overlapping causes for similar symptoms. This lupus patient has covered her home with UV-filtering material, since lupus symptoms can be triggered by sunlight. 　　虽然可以对红斑狼疮的症状进行治疗，但是狼疮是不可治愈的自身免疫系统疾病。正如很多疾病在初期很难被检测出来，红斑狼疮的早期症状（包括疲倦、转移疼痛以及认知障碍）可能会消失并进入缓解阶段。那样的情况的病人可能会被误诊为别的病，还会被医生告知那些不舒服只是一些幻觉。尽管传统的红斑狼疮特征是”颧部红斑”（一个蝴蝶型的红色区域覆盖在脸颊以及鼻子上），但是只有50%的狼疮病患会表现出这样的症状。而全面的检查一般是基于一套标准体系包括实验室阳性测试、临床证据以及排除其他类似疾病造成的类似症状的影响。图中，这位狼疮病人将她家中用紫外线过滤材料进行覆盖，因为红斑狼疮会因阳光发作。 Human Immunodeficiency Virus/Autoimmune Deficiency Syndrome (HIV/AIDS)

　　人类免疫缺陷病毒/自身免疫缺陷综合症（HIV/AIDS）

　　When it first caught the attention of the American medical profession, HIV (shown here under a microscope), the virus that causes AIDS, was a medical mystery. In the early 1980s, physicians began investigating groups of men with rare disorders, primarily opportunistic fungal infections and a type of cancer, that were generally found only in those with extremely compromised immune systems. 　　当HIV第一次在在美国医学界被发现，这个造成AIDS的病毒曾经是医学之谜。（图示显微镜下的HIV）。在20世纪80年代早期，医生开始研究那些类似罕见疾病的人，这些疾病主要机会性真菌感染以及一类癌症，结果发现了这些极度危害免疫系统的病毒。

　　Because some of these early clusters were found among gay men, the unknown, underlying disorder that made them susceptible to opportunistic diseases was, for a short time, called gay-related immune deficiency (GRID)—a rapidly politicized term that soon fell out of use by scientists after it became clear that heterosexual people were also susceptible to the condition, which became known as AIDS. It wasn"t until a few years into a search for an explanation for AIDS that a team in Paris (and a year later a team in the U.S.) isolated the virus we now know as HIV. The epidemic still continues.

　　因为这些病例主要是在同性恋的男子中被发现，这种未知的潜在的疾病会造成这些同性恋男子容易得机会性疾病，在短期内被称为男同性恋免疫缺陷。之后很快的当发现异性恋的人也会发生这样的情况，科学家们开始使用众所周知的AIDS作为它的专业术语。没过多久为了解释AIDS的一只巴黎团队（随后一年后一只美国团队）分离的病毒，即我们现在知道的HIV。这种传染病仍然还在持续。 Puerperal Fever (PF)

　　产褥热 　　As Steven Levitt and Stephen Dubner wrote in Superfreakonomics, PF was a classic medical mystery that helped change our understanding of biology and behavior. The condition, now understood to be sepsis caused by a number of bacterial pathogens, is estimated to have killed hundreds of thousands of women shortly after childbirth in the 18th and 19th centuries and stumped some of the best doctors of the time. (Historians now believe that Jane Seymour, shown here in a painting with husband King Henry VIII, died of PF. Seymour died soon after giving birth to her son, Edward, pictured here as a young man.)

　　在正如Steven Levitt 和Stephen Dubner在魔鬼生态学中写道， 产褥热（PF）曾是一个帮助我们改变对生物和行为认识的经典医学之谜。这种病症现在被理解为一种由一些细菌病原体造成的败血症。在18、19世纪，据估计有约十万妇女在产下孩子不久就因为患这种疾病而死去，难住了许多当时最好的医生。（当今的历史学家认为在图中的国王Henry 8世之妻 Jane Seymour 是死于PF的。Seymour在生下她儿子爱德华（在画中是个年轻xiaoh后很快死去。

　　In the 1840s, a clever Hungarian physician named Ignaz Semmelweis observed that in one ward run by doctors who performed autopsies in the morning and delivered babies in the afternoon, the maternal-mortality rate was many times higher than in another ward where midwives (who did not do autopsies) performed the deliveries. Though Semmelweis presented evidence for his ideas, including a dramatic reduction in mortality rates when certain hygienic practices were put into place, they weren"t taken seriously in the medical community until decades later, when Louis Pasteur and others developed the germ theory of disease.

　　在19世纪40年代，一个名叫Ignaz Semmelweis的聪明的匈牙利医生观察到在一个病房内，有那些早上进行过尸检的医生下午再接生小孩，这个病房中的产妇死亡率总是比另一个助产护士（不做尸体解剖）接生的病房要高出数倍。尽管Semmelweis发表了他想法的证据，包括当在产房规定一些卫生消毒措施所带来的死亡率的戏剧性下降，当时医学社区人却一直没有把他的发现当回事儿，直到Louis Pasteur和一些人发展了疾病细菌理论，但那已经是十年之后。