184.3 🩺 內科專科考前版

184.3.0.1 1⃣ B. miyamotoi Distinction from Lyme

  • Same Ixodes tick → confusion
  • B. miyamotoi: higher fever, less rash, no migrans rash
  • Often co-infection with Lyme (same tick)
  • PCR distinguishes
  • Treatment overlaps (doxycycline)

184.3.0.2 2⃣ Refugee / Migration Surveillance

  • Ukraine war + East Africa conflict → louse-borne disease re-emerge
  • WHO / UNHCR alerts
  • Crowded camps + scarce water = louse outbreak
  • Active surveillance + mass delousing + treatment

184.3.0.3 3⃣ Cabin / Cave Exposure History

  • Patient with relapsing fever + recent cabin (rodent-infested)
  • W USA areas (mountain, desert)
  • Ornithodoros ticks at night while sleeping
  • Spelunkers, hunters, hikers

184.3.0.4 4⃣ 鑑別 from Malaria

  • 兩者 cyclic fever
  • Malaria: longer cycles (48-72 hr), travel history (sub-Saharan)
  • Borrelia: shorter cycles + clinical setting (refugee/cabin)
  • 兩者 peripheral smear visible
  • 兩者 doxycycline works (so empirical sometimes covers both)

184.3.0.5 5⃣ Jarisch-Herxheimer Management

  • ICU-level for LBRF
  • Pre-medicate: acetaminophen, IV access, fluids ready
  • Anti-TNF approaches: meptazinol, pentoxifylline (limited evidence)
  • Steroid not effective for Herxheimer
  • 4-6 hr post-dose intensive monitoring

184.3.0.6 6⃣ Pregnancy + Relapsing Fever

  • Doxycycline contraindicated
  • Erythromycin / azithromycin alternatives
  • High-risk for maternal + fetal complications
  • ICU monitoring

184.3.0.7 7⃣ 健保 / Taiwan

  • 眕芋 endemic; mostly imported / military / cave exposure
  • 旅遊 medicine consultation
  • 通報 if confirmed
  • 健保 doxy / ceftriaxone covered