166.3 🩺 內科專科考前版

166.3.0.1 1⃣ BioFire FilmArray GI Panel

  • 22 pathogens (bacteria + virus + parasite) within 1 hr
  • 倧幅枛 work-up time
  • Cost > traditional culture, but fast result → faster targeted therapy
  • 泚意: positive 䞍䞀定 = 臎病 (colonization, mixed)
  • IDSA 2017 guidelines support use in moderate-severe / immunocompromise

166.3.0.2 2⃣ HUS — Recognition + Management

  • 5-10% STEC infections develop HUS (兒童 > 成人)
  • Triad: hemolytic anemia (schistocytes) + thrombocytopenia + AKI
  • Onset: 5-13 days after diarrhea onset
  • Treatment: supportive — RBC + platelet transfusion, dialysis
  • Eculizumab (anti-C5 mAb) in atypical HUS (familial complement dysreg) — but not for STEC-HUS routinely
  • aHUS vs STEC-HUS 區分: aHUS lacks diarrhea prodrome
  • 通報 + Public Health source trace

166.3.0.3 3⃣ Antibiotic-Associated Diarrhea (AAD)

  • ~ 5-25% 抗生玠䜿甚 → AAD
  • C. difficile = 䞻芁 culprit (Ch 160)
  • Other: AAD due to flora disruption (mild self-limit)
  • Most common abx: clindamycin > FQ > 3rd ceph > broad penicillin

166.3.0.4 4⃣ Immunocompromised 病人

  • 鑑別 broader: CMV, MAC, Microsporidia, Cyclospora, Cystoisospora, Strongyloides
  • Stool C. diff, BioFire panel, AFB stain, microsporidia spores
  • Empirical abx + early ID consult

166.3.0.5 5⃣ 旅遊回國 work-up

  • Hx: 國家 + 食氎 + 蚊 + 動物 + 接觞
  • Routine: stool + GI PCR panel + O+P × 3
  • Specific: Plasmodium smear (malaria), enteric fever (Salmonella Typhi), schistosoma (Africa), strongyloides (chronic), amebiasis
  • ID specialist consult if confused

166.3.0.6 6⃣ Probiotic / Microbiome 角色

  • Saccharomyces boulardii, Lactobacillus rhamnosus GG — 郚仜 evidence 圚 AAD prevention
  • Severe immunocompromise — caution probiotic (rare sepsis cases reported)
  • AAP recommend in pediatric AAD prevention; adult mixed

166.3.0.7 7⃣ 健保 / Taiwan

  • 通報 (notifiable): 食物䞭毒 outbreaks, cholera, typhoid, 腞出血 E. coli
  • 健保 BioFire panel 有 ID indication / immunocompromise (還未 universal)
  • 健保 azithromycin / FQ for diarrhea covered if culture + or risk
  • ORS sachet 自費 䜆 cheap

166.3.0.8 8⃣ ASP — Diarrhea Stewardship

  • 䞍 routine antibiotic for healthy adult diarrhea
  • 培逊 + → de-escalate
  • 短 course (3-5 d most pathogens)
  • Don’t combine antimotility + 抗生玠 in dysentery