142.3 🩺 內科專科考前版

142.3.0.1 1⃣ 22E 曎新

  • Autoimmune encephalitis recognition: > 10 specific antibodies described; panel testing essential
  • Metagenomic NGS (e.g., Chan Zuckerberg Biohub clinical mNGS): identifies rare/unknown pathogens — used at major centers for unknown encephalitis
  • EEG in HSV encephalitis: PLEDs (periodic lateralized epileptiform discharges) — characteristic
  • Tecovirimat for mpox encephalitis (rare CNS involvement)

142.3.0.2 2⃣ Clinical Approach

142.3.0.2.1 經驗 management at admission
  1. Acyclovir 10 mg/kg q8h IV ASAP (HSV)
  2. Empirical bacterial meningitis cover: ceftriaxone + vancomycin (until LP rules out)
  3. Anti-seizure (levetiracetam) if seizure
  4. ICU if severe (intubation, ICP management)
  5. HSV PCR + viral panel + autoimmune Ab panel + MRI + EEG
142.3.0.2.2 When to stop acyclovir
  • HSV PCR negative × 2 (48-72 hr apart) + clinical improvement + alternative diagnosis confirmed → stop
  • Otherwise complete 14-21 days

142.3.0.3 3⃣ 台灣 context

  • JEV endemic — vaccine in childhood schedule
  • Enterovirus 71 encephalitis (兒童) — 1998 epidemic; supportive
  • Dengue encephalitis: rare but reported in severe cases
  • Tick-borne encephalitis: not common in Taiwan
  • Rabies: 自 2013 起野生動物 (錬獟) rabies 回流; post-exposure vaccine 匷烈掚薊