170.2 📚 國考版

170.2.0.1 必背 — Bacteriology

• 4 species (A-D), low ID 10-100
• Non-motile (vs Salmonella motile)
• S. sonnei (high-income), S. flexneri (low-income), S. dysenteriae (Shiga toxin → HUS)

170.2.0.2 必背 — 臨床

• Dysentery (血 + mucus + tenesmus + 高 cramping), fever ≥ 39
• Complications: HUS, toxic megacolon, reactive arthritis

170.2.0.3 必背 — Treatment

• Azithromycin 500 × 3d (preferred, 多耐 R 因)
• Ceftriaxone IV for severe
• Cipro / TMP-SMX (where susceptible)
• ALWAYS treat (vs Salmonella healthy adult NO)

170.2.0.4 必背 — 鑑別 from STEC

	STEC	Shigella
Toxin	Shiga toxin from O157 + non-O157	Shiga toxin (dysenteriae 1) + invasion
Fever	NO / low	YES 高
Antibiotic	NO (worsens HUS)	YES
HUS	5-10%	5-10% (S. dysenteriae 1)

170.2.0.5 必背 — MSM cluster shigellosis

• Multi-drug R, FQ-R
• Azithromycin preferred (但 R 也 emerging)

---