198.2 📚 國考版

198.2.0.1 必背 — Primary Varicella

  • Vesicular rash in successive crops
  • Dewdrop on rose petal
  • Adults > children severity
  • Pregnancy: congenital varicella syndrome (1st trimester), neonatal varicella (late)

198.2.0.2 必背 — Pregnancy + Varicella

  • 1st trimester: congenital varicella syndrome
  • Near delivery (5d pre / 2d post): neonatal varicella, high mortality
  • VariZIG post-exposure
  • Avoid live varicella vaccine in pregnancy

198.2.0.3 必背 — Zoster (Shingles)

  • Dermatomal painful vesicular rash
  • Thoracic most common
  • Hutchinson’s sign: nose tip lesion → eye involvement risk (V1 nasociliary)
  • Ramsay Hunt: VII palsy + ear vesicles + vertigo (geniculate ganglion)

198.2.0.4 必背 — PHN (Postherpetic Neuralgia)

  • Pain > 90 days
  • Common in elderly
  • Gabapentin / pregabalin / TCA / lidocaine patch / capsaicin patch

198.2.0.5 必背 — Vaccines

  • Shingrix (recombinant gE + AS01B): ≥ 50 yr routine + ≥ 19 immunocompromise; 2-dose; > 90% efficacy
  • Varivax (live varicella): childhood 2-dose series; pregnancy contraindicated
  • Zostavax — discontinued

198.2.0.6 必背 — Treatment

Form Tx
Healthy varicella child Supportive (no aspirin!)
Adult / pregnant varicella Acyclovir PO/IV
Zoster simple Valacyclovir 1 g tid × 7d (within 72 hr)
Zoster ophthalmicus Acyclovir IV + ophthalmology
Disseminated / encephalitis Acyclovir IV
PHN Gabapentinoid, TCA, lidocaine, capsaicin

198.2.0.7 必背 — Hutchinson’s Sign

  • Lesion on tip of nose → high risk for eye involvement
  • Nasociliary nerve V1 branch
  • 急 ophthalmology consult

198.2.0.8 必背 — Reye’s Syndrome

  • Aspirin in children with viral illness (varicella, influenza)
  • Hepatic + encephalopathy
  • Don’t use aspirin in children with viral illness