169.2 📚 國考版

169.2.0.1 必背 — 兩大類

Category	Source	臨床
Typhoid (S. Typhi, Paratyphi)	人傳人 (S Asia, sub-Saharan)	Enteric fever, perforation, carrier
NTS	食源 (poultry, egg, reptile)	Gastroenteritis ± invasive

169.2.0.2 必背 — Typhoid Clinical

• Step-wise fever, relative bradycardia, rose spots, hepatosplenomegaly
• Intestinal perforation 3rd wk (Peyer’s patch)
• 5% chronic carrier (gallbladder)
• Blood cx Week 1 best; stool / marrow later

169.2.0.3 必背 — Treatment Typhoid

• Ceftriaxone or azithromycin
• FQ — 高 R in S Asia
• XDR S. Typhi — Pakistan 2016+, multi-R
• Dexamethasone for severe + perforation surgery

169.2.0.4 必背 — Typhoid Vaccine

• Typbar-TCV (Vi-TT conjugate) — WHO prequalified, ≥ 6 mo, single dose
• Ty21a oral live, Vi-PS IM
• 旅遊 + endemic area children

169.2.0.5 必背 — NTS gastroenteritis NO antibiotic (健康成人)

• Exception: 老/嬰/immuno/sickle/prosthetic/severe → YES

169.2.0.6 必背 — NTS Endovascular

• Aortic mycotic aneurysm in atherosclerotic elderly
• CT angio + TEE if persistent bacteremia
• Surgical repair + 6 wk abx

169.2.0.7 必背 — Sickle cell osteomyelitis = Salmonella

(vs S. aureus in normals)

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