165.2 📚 國考版

165.2.0.1 必背 — Clinical Clues

• 嚴重 pneumonia +
  • Fever ≥ 39°C
  • 腹瀉, GI sx
  • Confusion, neuro
  • Hyponatremia (SIADH)
  • AKI, hepatic ↑, CK ↑
• High mortality without treatment

165.2.0.2 必背 — Source

• 水 (cooling tower, hot tub, plumbing)
• Aerosol → inhalation
• NO person-to-person

165.2.0.3 必背 — Dx

• Urinary antigen (serogroup 1 only)
• Culture BCYE
• PCR
• DFA / serology

165.2.0.4 必背 — Treatment

• Levofloxacin (preferred) or azithromycin
• NOT β-lactam
• 7-14 d (immunocompromise / severe 14-21d)

165.2.0.5 必背 — Atypical CAP Coverage Importance

• Empirical CAP regimen 必須 cover atypicals (macrolide / FQ / doxy)
• Reason: Legionella + Mycoplasma + Chlamydia (intracellular, β-lactam no work)

165.2.0.6 必背 — Pontiac Fever

• Self-limited flu-like, no pneumonia
• No abx
• Same Legionella exposure but different pathogenesis (LPS)

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