170.3 🩺 內科專科考前版

170.3.0.1 1⃣ MSM-associated Shigellosis

  • HIV +/- both at risk
  • Anal-oral contact transmission
  • 倚 R strains circulating (CDC alerts 2014, 2017, 2024)
  • Azithromycin + ceftriaxone empirically
  • Screen + counsel HIV / STD
  • Outbreak alert system globally

170.3.0.3 3⃣ Reactive Arthritis (Reiter’s)

  • Post-Shigella + Campylobacter + Yersinia + Salmonella + Chlamydia trachomatis
  • 1-4 weeks after
  • HLA-B27 (50% of patients carry)
  • Triad: arthritis (oligoarticular lower-extremity asymmetric) + conjunctivitis/iritis + urethritis (“can’t see, can’t pee, can’t climb tree”)
  • Self-limit 䜆 some chronic
  • NSAID + steroid injection; biologics rare

170.3.0.4 4⃣ HUS in Shigella

  • S. dysenteriae 1 primarily (Stx-2 producer)
  • More likely in children, sub-Saharan endemic
  • Triad: hemolytic anemia + thrombocytopenia + AKI
  • Supportive; eculizumab (atypical HUS) sometimes used
  • Antibiotic controversial — Shigella unlike STEC may not worsen; some give ceftriaxone

170.3.0.5 5⃣ Ekiri Syndrome

  • 兒童 in Asia (Japan)
  • 急 convulsion + coma + hyperthermia + æ­» in hours
  • 真正 cause unclear (cytokine? toxin?)
  • High mortality
  • ICU supportive

170.3.0.6 6⃣ Vaccines in Development

  • WHO priority — > 200,000 child deaths / yr globally
  • Multiple candidates: Sf2a (Sanofi), Wraps, GVGH
  • Phase 2/3 trials ongoing
  • Conjugate or live-attenuated approaches

170.3.0.7 7⃣ 健保 / Taiwan

  • 通報 (notifiable)
  • Rare local in Taiwan; mostly imported S Asia / SE Asia
  • 健保 ceftriaxone / azithromycin / cipro covered
  • 食物䞭毒 outbreak → Public Health investigation
  • Daycare clusters — exclusion + sanitation review

170.3.0.8 8⃣ Outbreak Response

  • WGS for cluster identification + source trace
  • Public Health collaboration
  • Daycare/school exclusion until 2 - stool cx
  • MSM clusters — community education + PrEP discussion