138.3 🩺 內科專科考前版

138.3.0.1 1️⃣ 22E 更新

• Multiplex PCR stool panel (BioFire GI): 同時測 20+ 病原 (bacteria, virus, parasite) in 1 hr
• Cholera vaccine (Dukoral, Vaxchora): traveler + endemic
• Azithromycin first-line for travelers diarrhea (cipro resistance Asia + Africa)
• Salmonella XDR (Pakistan H58 lineage): ceftriaxone failure → azithro or carbapenem
• Microbiome restoration: post-antibiotic dysbiosis FMT (recurrent CDI)

138.3.0.2 2️⃣ 台灣 context

• 登革熱季節: 注意非 diarrhea fever 鑑別
• 食物中毒 reporting: 公共衛生 surveillance
• 進口生食 / sushi: parasitic risk (anisakis, fish tape worm)
• 台灣 V. parahaemolyticus 在夏季 + 海鮮 一直前幾名 food poisoning

138.3.0.3 3️⃣ Immunocompromised Diarrhea

• HIV (CD4 < 200): Cryptosporidium, Microsporidia, MAC, CMV, Isospora
• Transplant: CMV colitis (foscarnet / ganciclovir), C. diff, viral (norovirus chronic)
• Workup more aggressive: O&P × 3, AFB, viral PCR, EGD/colonoscopy biopsy

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