224.3 🩺 內科專科考前版

224.3.0.1 1⃣ HFRS Fluid Management

  • Phase 1 (febrile): standard
  • Phase 2 (hypotensive): IV fluid + pressor — but watch for pulmonary edema (vascular leak)
  • Phase 3 (oliguric): restrict fluid + dialysis if needed
  • Phase 4 (polyuric): replace fluid + electrolyte losses
  • This phase-dependent approach is critical

224.3.0.2 2⃣ HPS Rapid Recognition

  • Prodrome 3-5 days then sudden cardiopulmonary deterioration
  • Time to ECMO: minutes-hours critical
  • Don’t delay
  • ECMO center transfer protocols

224.3.0.3 3⃣ Sin Nombre 1993 Story

  • Spring 1993 Four Corners region (Native American Reservation)
  • Young healthy adults with severe pulmonary illness
  • High mortality
  • CDC investigation
  • Hantavirus identified within months (named “Sin Nombre” — Spanish for “no name”)
  • Deer mouse identified as reservoir
  • Cabin / canyon environments

224.3.0.4 4⃣ Andes Virus Exception

  • S America (Argentina + Chile)
  • Rare person-to-person transmission documented (family + nosocomial clusters)
  • PPE precautions for caregivers
  • Otherwise unique among hantaviruses
  • Reservoir: long-tailed pygmy rice rat (Oligoryzomys longicaudatus)

224.3.0.5 5⃣ Differential Diagnosis Severe ARDS

  • HPS
  • ARDS from sepsis
  • Severe influenza
  • COVID-19
  • Severe leptospirosis (pulmonary hemorrhage syndrome)
  • Severe malaria
  • PE
  • Inhalation injury

224.3.0.6 6⃣ Cabin / Rural Travel Counseling

  • Awareness of risk
  • Inspect for rodent infestation
  • Air out structures before entry
  • Wet down + PPE for cleaning
  • Camping in rodent-burrow-free areas
  • Cabin in Four Corners + similar areas — pre-occupancy precautions

224.3.0.7 7⃣ 健保 / Taiwan

  • 通報 mandatory
  • Taiwan: Seoul virus + rats in urban settings; sporadic cases
  • 衛生局 surveillance
  • Rural / agricultural HFRS surveillance

224.3.0.8 8⃣ Vaccine Development

  • Hantavax (Korea) — HFRS
  • No HPS vaccine yet licensed
  • DNA + recombinant + VLP candidates
  • mRNA candidates
  • Pan-hantavirus vaccines researched

224.3.0.9 9⃣ Bioterror Considerations

  • Hantaviruses Category C bioterror potential
  • BSL-3 lab capability
  • Stockpile preparedness limited

224.3.0.10 10. Climate Change

  • Rodent population dynamics affected
  • Range expansion
  • Potential outbreak risk increases