323.2 🩺 國考版

323.2.1 高頻考點

323.2.1.1 Influenza

  • A/B/C, A and B clinically relevant
  • Antigenic drift (seasonal), shift (pandemic)
  • Oseltamivir 75 BID × 5 d (within 48 hr ideal)
  • Baloxavir single dose alternative
  • Annual vaccine

323.2.1.2 Post-Influenza Bacterial Pneumonia

  • S. aureus (often MRSA, PVL+)
  • S. pneumoniae
  • Severe cavitating
  • Vancomycin + standard CAP

323.2.1.3 COVID-19 Treatments

  • Paxlovid (nirmatrelvir/ritonavir) outpatient high-risk
  • Dexamethasone (RECOVERY) if requires O2
  • Tocilizumab + baricitinib (REMAP-CAP) severe + ↑ inflammation
  • Remdesivir for hospitalized on O2

323.2.1.4 RSV (2023-2024 NEW)

  • Adult vaccines: Arexvy (GSK), Abrysvo (Pfizer) for ≥ 60
  • Maternal vaccine: Abrysvo 32-36 wk
  • Nirsevimab (Beyfortus) for infants — long-acting mAb

323.2.1.5 Hantavirus

  • Sin Nombre virus
  • Rodent exposure
  • HPS
  • High mortality
  • Supportive care

323.2.1.6 MERS-CoV

  • Middle East, camels
  • High mortality

323.2.1.7 Long COVID

  • 10-30% of survivors
  • Persistent symptoms > 12 weeks
  • Multidisciplinary care

323.2.1.8 Key Trials

  • RECOVERY (2020): dexamethasone for COVID requiring O2
  • REMAP-CAP: tocilizumab + baricitinib for severe COVID
  • EPIC-HR: Paxlovid outpatient
  • CAP-IT: baloxavir for influenza

323.2.2 易混淆比范

Virus Season Severity Treatment
Influenza Winter Variable; severe in elderly Oseltamivir, baloxavir
RSV Winter Severe in elderly, infants Supportive; nirsevimab infants
COVID-19 Year-round Variable Paxlovid (outpatient), dexamethasone (severe)
MERS Sporadic High mortality Supportive
Hantavirus Rodent exposure High mortality Supportive
Measles Unvaccinated Severe in immunocompromised Supportive, vitamin A

323.2.3 Special Topics

323.2.3.1 Influenza + Pregnancy

  • Severe risk (esp 3rd trimester)
  • Vaccine + oseltamivir safe in pregnancy
  • Threshold lower for treatment

323.2.3.2 COVID-19 + Pregnancy

  • Higher severity than non-pregnant
  • Vaccination recommended
  • Paxlovid OK
  • Remdesivir OK
  • Adequate ART for HIV-positive

323.2.3.3 Viral + Bacterial Co-Infection

  • Often delays / complicates diagnosis
  • Post-influenza pneumonia classic
  • Higher mortality
  • Broad-spectrum coverage if suspected