188.2 📚 國考版

188.2.0.1 必背 — Reservoir + Transmission

  • Cattle, sheep, goats (birth fluids most infectious)
  • Aerosol (highly infectious — 1 organism)
  • 䞍必 direct contact (wind可飛 km)
  • 也 unpasteurized dairy
  • NOT person-to-person

188.2.0.2 必背 — Clinical Spectrum

  • Acute: fever + severe headache + atypical pneumonia + hepatitis (doughnut granuloma)
  • Chronic: culture-negative endocarditis + vascular infection + QFS

188.2.0.3 必背 — Risk for Chronic

  • Pre-existing valve disease (most important)
  • Vascular graft / aneurysm
  • Immunocompromise
  • Pregnancy

188.2.0.4 必背 — Serology Phase Variation

  • Acute: Phase II > Phase I
  • Chronic: Phase I > Phase II
  • Phase I IgG ≥ 1:800-1024 = chronic suggestive

188.2.0.5 必背 — Treatment

  • Acute: doxycycline 100 bid × 14d
  • Chronic: doxycycline + hydroxychloroquine ≥ 18 mo (valve), ≥ 24 mo (vascular)
  • Pregnancy acute: TMP-SMX until delivery

188.2.0.6 必背 — Doughnut Granuloma

  • Liver biopsy in acute Q fever
  • Fibrin ring around central fat vacuole
  • Pathognomonic-like

188.2.0.7 必背 — Culture-Negative Endocarditis

  • Always consider Q fever
  • Bartonella also (Ch 164)
  • Brucella (Ch 164)
  • Tropheryma whipplei
  • All require special serology / PCR