169.3 🩺 內科專科考前版

169.3.0.1 1⃣ XDR S. Typhi (Pakistan 2016-)

  • 抗 ampicillin, chloramphenicol, TMP-SMX, ceftriaxone, FQ — 党郚 R
  • 仍 S to: azithromycin, carbapenem, tigecycline
  • 旅遊 returnee from Pakistan / S Asia with enteric fever → treat as XDR until R/O
  • 通報 + outbreak surveillance

169.3.0.2 2⃣ Typbar-TCV Conjugate Vaccine

  • 2018 WHO prequalified, 掚 endemic countries
  • Pakistan emergency rollout 2019 due XDR outbreak
  • Long protection (decade vs 5 yr Ty21a / 2 yr Vi-PS)
  • ≥ 6 mo (vs Ty21a ≥ 6 yr, Vi-PS ≥ 2 yr) — pediatric option
  • Single dose IM

169.3.0.3 3⃣ Carrier State Eradication

  • ~ 5% acute typhoid → carrier (gallbladder)
  • 慢性 carrier → enteric typhoid spread
  • Treatment: ciprofloxacin 500 bid × 4 wk OR cholecystectomy (gallstone present)
  • Some carriers refractory → continued surveillance + Public Health restrict food work

169.3.0.4 4⃣ Aortic Mycotic Aneurysm Workflow

  • Atherosclerotic 老男 + NTS bacteremia + back pain → suspect
  • CT angiography aorta stat
  • Blood cx × 2 sets pre-abx
  • Cardiothoracic + Vascular surgery + ID consult
  • Empirical: ceftriaxone + vanco (until culture/AST)
  • Definitive: open repair vs EVAR (debated, EVAR good outcome data äž­)
  • 6 weeks IV + 可 oral suppression 埌 (e.g. 終身 PO if EVAR)
  • Mortality high if rupture; missed dx common

169.3.0.5 5⃣ HIV + NTS

  • HIV (esp Sub-Saharan, CD4 < 200) — invasive NTS (iNTS) 高 risk
  • Recurrent bacteremia, mortality 高
  • WHO guidance: empirical ceftriaxone, fluconazole co-infection consideration
  • ART critical (immune recovery)

169.3.0.6 6⃣ Pediatric + Reptile-Associated Salmonella

  • Pet turtle / iguana / snake — recurrent outbreaks
  • CDC 1975 ban on sale of turtles < 4 inches (still violated)
  • 教育 family + hand hygiene

169.3.0.7 7⃣ Cholelithiasis + S. Typhi Carrier + Gallbladder CA

  • 慢性 typhoid carriage + gallstone → ↑ gallbladder CA risk (India, especially)
  • 健康監枬 carrier

169.3.0.8 8⃣ 健保 / Taiwan

  • Typhoid 通報 (rare local; mostly imported S Asia returnees)
  • 健保 ceftriaxone / azithromycin / FQ covered
  • Vaccine 自費 (旅遊 ID 䞭心)
  • NTS gastroenteritis 通報 if cluster / outbreak
  • Sickle cell rare Taiwan (vs Africa), so Salmonella osteo less common