161.3 🩺 內科專科考前版

161.3.0.1 1️⃣ Complement Deficiency Workup

• C5, C6, C7, C8, C9, properdin, factor D def → recurrent N. meningitidis
• 第一次 N. meningitidis ≥ 13 yr + 異常 serotype (W, Y) → CH50 + AH50 screen
• 若 CH50 + AH50 兩個都低 → 整 complement def
• 若 CH50 low + AH50 normal → classical pathway issue
• 若 CH50 normal + AH50 low → alternative pathway / properdin
• 盧醫師 hint: recurrent N. meningitidis 或 disseminated N. gonorrhoeae 都 complement screen

161.3.0.2 2️⃣ Eculizumab / Ravulizumab Patients

• aHUS / PNH / gMG / NMOSD anti-C5 mAb
• 阻 terminal complement → high N. meningitidis risk
• 必接 MenACWY + MenB ≥ 2 wk before
• • Daily antibiotic prophylaxis (PCN VK 500 mg bid or cipro) — some centers
• Patient + family education + meningococcal alert card
• 任何 fever → immediate workup + empirical ceftriaxone

161.3.0.3 3️⃣ 流行病學 + Serogroups

Region	Serogroup
Meningitis belt (Sub-Saharan Africa)	A, W, X
USA, Europe	B, C, Y
Saudi Hajj	W (2000 outbreak), now A, C, Y, W
Taiwan	B, C, W sporadic
高 outbreak: 宿舍, 軍	C, B

161.3.0.4 4️⃣ MenAfriVac (Africa Meningitis Belt)

• Conjugate Men A vaccine — 大幅減 Africa epidemics 2010-onwards (Gavi alliance)
• Now extending to W, X coverage

161.3.0.5 5️⃣ Dexamethasone in N. meningitidis Meningitis

• 不像 S. pneumoniae (clear mortality benefit) — N. meningitidis benefit limited
• 但 empirical 不知 cause 時給 dex; 確認 N. meningitidis 可 stop dex
• IDSA 2017: continue dex if started, cover N. pneumo

161.3.0.6 6️⃣ Mortality + Long-term Sequelae

• Mortality 5-15% (meningitis), 20-30% (meningococcemia)
• Sequelae: 聽損, 認知, 神經, 截肢
• 不少病人 amputations from purpura fulminans → 復健 long
• Counseling, psychological support

161.3.0.7 7️⃣ 健保 / Taiwan

• MenACWY 自費 (約 NT$3000-4000)
• MenB 自費
• 公費 limit: high-risk only (無脾 specific indication)
• 出國朝聖 / college overseas — recommend self-pay vaccinate
• 軍營 fever cluster → public health alert

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