171.3 🩺 內科專科考前版

171.3.0.1 1⃣ FQ R Epidemiology

  • USA ~ 30%, Europe ~ 30%, Asia (India, China, Taiwan) 50-70%
  • Macrolide R still low (< 5%)
  • Empirical → azithromycin first
  • Travel hx important — if Asia traveler return → azithro

171.3.0.2 2⃣ Miller Fisher Syndrome

  • 1-2% of GBS — variant
  • Anti-GQ1b ganglioside Ab
  • Ophthalmoplegia + ataxia + areflexia (with或 without limb weakness)
  • Same Campy trigger common
  • IVIG / PE

171.3.0.3 3⃣ C. fetus Distinction

  • Lower temp grow (37 vs 42°C)
  • Older / atherosclerotic / immuno
  • IE on damaged valve
  • Mycotic aneurysm (atheromatous aorta) — like Salmonella
  • Bacteremia + persistent fever → CT angio aorta
  • Treatment: ceftriaxone / carbapenem; surgical repair if aneurysm

171.3.0.4 4⃣ Hypogammaglobulinemia + Recurrent Campy

  • X-linked agammaglobulinemia, CVID — recurrent Campy infections
  • Chronic / relapsing enteritis + bacteremia
  • IgG replacement + extended azithro

171.3.0.5 5⃣ Pregnancy + Campy

  • Septic abortion risk
  • Treatment: azithromycin (safe pregnancy)
  • 接觞 raw milk / poultry — counseling

171.3.0.6 6⃣ Poultry Stewardship + Public Health

  • Slaughterhouse biosecurity
  • USDA “Salmonella + Campylobacter” reduction goals
  • Antibiotic in livestock — selecting for R (FDA + EU restrictions)
  • Consumer education

171.3.0.7 7⃣ 健保 / Taiwan

  • 通報 (food poisoning if outbreak)
  • 健保 azithromycin / FQ covered
  • GBS — admit + IVIG covered for confirmed GBS
  • 食 safety inspection

171.3.0.8 8⃣ Future / Vaccine

  • Vaccine candidate (CPS conjugate) Phase 2
  • For travelers + military + livestock