189.3 🩺 內科專科考前版

189.3.0.1 1⃣ M. pneumoniae 2023-2024 Outbreak

  • Post-COVID “immunity debt” + cyclical timing
  • China: severe pediatric admissions; macrolide R 80%+ → doxy first-line shift
  • Europe: large case numbers; smaller proportion severe
  • USA: increased CAP attributable to mycoplasma
  • ICUs in pediatric centers strained

189.3.0.2 2⃣ Empirical CAP — Mycoplasma Coverage

  • IDSA/ATS 2019: macrolide / doxy / FQ for atypicals (M. pneumoniae, Legionella, Chlamydia)
  • 高 macrolide R region → consider doxy / FQ first-line
  • Severe CAP: combination β-lactam + atypical-cover

189.3.0.3 3⃣ Neurologic Complications

  • Encephalitis — 1-7% of severe cases
  • Mechanism: invasion or post-infectious immune
  • LP: lymphocytic pleocytosis, mildly elevated protein
  • MRI: cerebral edema, T2 hyperintensity
  • Treatment: doxy / FQ + corticosteroids (mixed evidence); IVIG / plasmapheresis if severe
  • Outcome: most recover; some residual deficit

189.3.0.4 4⃣ MIRM Diagnosis + Management

  • Multi-mucosal involvement: oral, ocular, genital
  • Skin: target lesions but less extensive than SJS/TEN
  • Diagnostic: M. pneumoniae confirmed + mucositis pattern
  • Treatment: supportive (mouth care, eye care, hydration), abx for organism, sometimes steroid
  • Better prognosis than SJS/TEN (lower mortality, less long-term sequelae)

189.3.0.6 6⃣ Doxy-PEP + M. genitalium

  • Doxy-PEP for MSM may reduce some M. genitalium acquisition (mixed evidence)
  • Concern: drives doxy R in M. genitalium
  • Active monitoring as Doxy-PEP rolls out

189.3.0.7 7⃣ 健保 / Taiwan

  • 健保 azithro / doxy / levofloxacin covered
  • 通報 cluster outbreaks (schools, military)
  • M. genitalium PCR — 健保限 indication

189.3.0.8 8⃣ Pediatric Considerations

  • Doxy avoided < 8 yr historically; short course OK per recent
  • Macrolide R increasing → doxy + steroid combo in pediatric CAP severe
  • Hospitalization for severe cold agglutinin hemolysis
  • Neurologic monitoring during severe pneumonia