156.3 🩺 內科專科考前版

156.3.0.1 1️⃣ 為何 Listeria Important?

• Mortality 高 (~ 20-30% 老人, ~ 50% 新生兒)
• Empirical meningitis 必須 cover (年齡 + 免疫 risk)
• 食源 outbreak 持續 (2011 cantaloupe 33死, 2024 deli/玉米/cookies)

156.3.0.2 2️⃣ Meningitis Empirical Algorithm

Age / Risk	Empirical Cocktail
< 1 mo	Amp + cefotaxime/gentamicin
1 mo - 50 yr healthy	Vanco + ceftriaxone ± dex
> 50 yr / 免疫低下 / EtOH	Vanco + ceftriaxone + AMPICILLIN ± dex
Post-NSGY	Vanco + cefepime/meropenem

156.3.0.3 3️⃣ Rhombencephalitis

• Listeria 特色 (brainstem; 鑑別 Bickerstaff brainstem encephalitis, TB)
• Sx: cranial neuropathy + cerebellar ataxia + altered mentation
• MRI: brainstem T2 ↑
• LP: 可正常 protein/glucose 但 CSF cx +
• 治療 longer (21-28d)

156.3.0.4 4️⃣ Pregnancy

• 通報 Public Health
• Amp ASAP (即使懷疑 — 因 culture 慢)
• Bridge with TMP-SMX 在 1st/3rd trimester 避免 (folate, kernicterus)
• Postpartum 治療 mother + 新生兒 (即使 asymptomatic, sepsis workup)

156.3.0.5 5️⃣ Cephalosporin Intrinsic R

• PBP3 affinity 低
• 經驗式 meningitis empirical 必加 amp (≥ 50 或 risk)
• 不用 ceftriaxone monotherapy

156.3.0.6 6️⃣ Outbreak Investigation

• PFGE / WGS — 連結 cases to source food
• CDC PulseNet system
• Recall + 食品安全 review

156.3.0.7 7️⃣ TMP-SMX in PCN-allergy

• 5 mg/kg of TMP component q6h IV
• BBB penetration 佳
• Synergy maintained vs amp + gent

---