223.3 🩺 內科專科考前版

223.3.0.1 1⃣ Lassa Returning Traveler Workup

  • W Africa travel within 21 days
  • Fever + symptoms
  • Immediate isolation
  • BSL-4 lab (CDC + WHO)
  • Differential: malaria (rule out + treat empirically), typhoid, Ebola, severe leptospirosis, dengue
  • Ribavirin empirically if high suspicion
  • Public Health notification

223.3.0.2 2⃣ Sensorineural Hearing Loss Mechanism

  • 30% Lassa survivors
  • Often bilateral
  • Often permanent
  • Mechanism: viral infiltration of inner ear vs immune-mediated
  • Audiology follow-up survivors

223.3.0.3 3⃣ Pregnancy + Lassa

  • 3rd trimester: 80%+ maternal mortality
  • Aggressive Tx including ribavirin (despite teratogenicity)
  • Termination of pregnancy considered (historically supported for severe maternal)
  • Vertical transmission high if mother infected
  • ICU + obstetric + ID coordination

223.3.0.4 4⃣ LCMV Congenital — Don’t Miss

  • CMV-negative congenital infection: consider LCMV
  • Maternal pet rodent / mouse exposure history
  • Severe phenotype similar to congenital CMV
  • Multi-disciplinary care
  • LCMV serology + PCR

223.3.0.5 5⃣ LCMV in Transplant Donors

  • Donor screening not routine (low prevalence)
  • Multi-recipient cases reported (single LCMV+ donor infecting multiple)
  • 高 mortality
  • BSL-3 lab for diagnosis

223.3.0.6 6⃣ Junin + Vaccine Success Story

  • Argentine hemorrhagic fever was severe public health issue
  • Candid #1 vaccine developed by Argentina + USA collaboration (1980s)
  • Routine + mass campaigns reduced cases dramatically
  • Now sporadic
  • Model for hemorrhagic fever vaccine development

223.3.0.7 7⃣ Vaccine Development Pipeline

  • Lassa: MVA-LASV (Janssen) Phase 3; rVSV-Lassa Phase 1-2
  • CEPI accelerating
  • mRNA candidates
  • Pan-arenavirus vaccines researched

223.3.0.8 8⃣ Bioterror Considerations

  • Arenaviruses Category A bioterror agents
  • BSL-4 lab capability
  • Stockpile readiness

223.3.0.9 9⃣ 健保 / Taiwan

  • 通報 mandatory
  • Travel medicine awareness
  • No local cases historically
  • Returning traveler workup includes arenavirus consideration

223.3.0.10 10. Public Health Response

  • Rodent control programs
  • Health education in endemic
  • Healthcare worker training
  • Outbreak response capacity
  • International collaboration (WHO, CDC)