163.2 📚 國考版

163.2.0.1 必背 — H. influenzae 鑑別

Type	臨床
Hib (type b)	Pre-vaccine: 兒童 meningitis #1, epiglottitis, cellulitis; post-vaccine 罕見
NTHi	AOM, sinusitis, COPD exacerbation #1, CAP elderly
H. parainfluenzae	HACEK IE
H. ducreyi	Chancroid (痛 ulcer + LAP)

163.2.0.2 必背 — Hib Vaccine

• Conjugate, 2/4/6/12-15 mo
• 1990s onwards 99% reduction
• 高 risk: 無脾, HIV, transplant, antibody def — 補種 if not received

163.2.0.3 必背 — Epiglottitis

• Cherry red epiglottis, drooling, tripod position, voice change
• Don’t examine pharynx (airway spasm)
• Lateral neck X-ray: “thumbprint sign”
• Treatment: airway management (intubate / trach) + ceftriaxone IV
• Pre-vaccine era — now mostly adult (GAS, Strep, S. aureus instead)

163.2.0.4 必背 — Moraxella catarrhalis

• AOM, sinusitis, COPD exacerbation
• 100% β-lactamase positive → amox-clav
• 鑑別 Neisseria: DNase + + 室內 cold growth +

163.2.0.5 必背 — Chancroid

• 痛 genital ulcer + tender suppurative LAP
• Azithromycin 1 g × 1 OR Ceftriaxone 250 mg IM × 1

163.2.0.6 必背 — HACEK IE

• Subacute, 牙齒 source, blood cx 5 days
• Ceftriaxone 4 wk (native) / 6 wk (prosthetic)

---