79.3 🩺 內科專科考前版

79.3.0.1 📌 䞀頁重點

  • 22E: letermovir for CMV, isavuconazole for mucor, posaconazole prophylaxis AML, immune-checkpoint inhibitor irAE infectious mimics
  • Taiwan: HBV reactivation preventionlymphoma + rituximab

79.3.0.2 🌟 Pearls (10)

  1. Letermovir replaces valganciclovir for CMV prophylaxis in HSCT
  2. Posaconazole for AML / high-risk MDS antifungal prophylaxis
  3. Isavuconazole for mucor (better tolerated than amphotericin)
  4. Galactomannan + β-D-glucan for invasive fungal monitoring
  5. HBV reactivation with rituximab → entecavir/tenofovir prophylaxis
  6. TMP-SMX for PCP + nocardia + listeria + toxo coverage
  7. Letermovir + posaconazole + acyclovir = HSCT triple prophylaxis
  8. CMV-CMI assay (CMV-specific T cell) emerging
  9. Bacterial multidrug resistance rising → consider stewardship
  10. Filgrastim (G-CSF) for FN — prophylaxis ≥ 20% FN risk regimen

79.3.0.3 📍 Taiwan

  • 健保 antifungal 條件
  • 健保 letermovir for HSCT CMV prevention
  • 健保 G-CSF (filgrastim, pegfilgrastim) FN prophylaxis
  • 健保 HBV nucleos(t)ide for prophylaxis pre-rituximab
  • TMP-SMX 3 次/週 PCP

79.3.0.4 🎓 內專重點

  1. FN management (黃金 1h)
  2. MASCC stratification
  3. Antifungal escalation
  4. PCP/CMV/HSV prophylaxis
  5. HBV reactivation with rituximab (Taiwan!)
  6. G-CSF prophylaxis

⚠ AI 草皿。