143.3 🩺 內科專科考前版

143.3.0.1 1️⃣ 22E 更新

• PCR multiplex (FilmArray ME): 1 hr panel including HSV / VZV / cryptococcus — reduces empirical antibiotic overuse
• PCT-guided antibiotic decision in suspect viral
• Vaccine impact: Hib eliminated in vaccinated populations; PCV13/15/20 reduce S. pneumoniae meningitis
• MenB outbreak control: vaccine in college / military
• Mpox CNS involvement (rare): tecovirimat

143.3.0.2 2️⃣ Complications & Sequelae

• Hearing loss (especially S. pneumoniae) — audiology evaluation post-Tx
• Cognitive impairment, seizure
• Hydrocephalus → consider VP shunt
• Subdural empyema / cerebritis → MRI
• Septic arthritis, IE (especially N. meningitidis)
• Adrenal insufficiency (WFS) — meningococcus

143.3.0.3 3️⃣ 台灣 context

• PCV in 兒童 routine → S. pneumoniae meningitis 大幅 ↓
• Hib vaccine → Hib meningitis 罕見
• Meningococcal: 散發 cases; outbreak rare
• 健保 dexamethasone, antibiotics broadly available
• ID consult routine for severe / complicated

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