183.3 🩺 內科專科考前版

183.3.0.1 1️⃣ Taiwan Epidemiology

• 颱風 / 洪水後 surge (Morakot 2009, etc.)
• 農業 + 戶外 occupation
• Predominant serovars (varies)
• 盧醫師 hint: 颱風後 fever + AKI + 黃疸 → 必 leptospirosis workup; doxy / ceftriaxone empirical

183.3.0.2 2️⃣ SPHS (Severe Pulmonary Hemorrhage Syndrome)

• Asia / Pacific variant
• 急 ARDS-like + alveolar hemorrhage
• Mortality 50%+ even with ICU
• High-dose steroid (methylprednisolone 1 g × 3d) — some benefit
• ECMO if severe ARDS
• Plasma exchange under study

183.3.0.3 3️⃣ Uveitis Late Sequela

• Weeks-months after acute
• Anterior, posterior, or panuveitis
• Vision threatening
• Topical + systemic steroid
• Long-term ophthalmology follow

183.3.0.4 4️⃣ AKI Pattern

• Non-oliguric usually early (distal tubular dysfunction)
• Hypokalemia + hypomagnesemia
• Progress to oliguric AKI requiring dialysis
• Resolution slow but typically complete

183.3.0.5 5️⃣ Jarisch-Herxheimer

• Less common than syphilis
• Can occur with PCN
• Supportive

183.3.0.6 6️⃣ Antibiotic Equivalence

• Multiple RCTs: PCN vs doxy vs ceftriaxone — same outcome severe lepto
• Choice based on:
  • Allergy
  • Severity
  • Setting (ICU vs ward)
  • Pregnancy

183.3.0.7 7️⃣ 健保 / Taiwan

• 通報 mandatory
• 健保 doxy / ceftriaxone / PCN covered
• ICU + dialysis + ventilator (case-by-case)
• 颱風後 ED protocol: lepto workup if fever + myalgia + flood exposure

183.3.0.8 8️⃣ Climate Change + Future

• 颱風 / hurricane frequency + intensity increase → more lepto outbreaks
• Urban rat populations expanding
• Surveillance + early treatment
• Vaccine research ongoing (serovar-specific challenges)

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