內科專科醫生題庫下載題庫

1. B. 咬傷傷口的感染通常是動物的口腔菌，例如，針對老鼠咬傷，在美國最常見的菌種為Streptobacillus moniliformis（屬於革蘭氏陰性桿菌）；在亞洲最常見的菌種為Spirillum（螺旋體）。此外，Pasteurella multocida（屬於革蘭氏陰性球桿菌）也存在於家庭動物的口咽部。
   Generally, the microflora of bite wounds reflects the oral flora of the biting animal. Small rodents, including rats, mice, and gerbils, as well as animals that prey on rodents may transmit Streptobacillus moniliformis (a microaerophilic, pleomorphic gram-negative rod) or Spirillum minor (a spirochete); these organisms cause a clinical illness known as rat-bite fever. The vast majority of cases in the United States are streptobacillary, whereas Spirillum infection occurs mainly in Asia.

Pasteurella multocida is a fastidious, bipolar-staining, gram-negative coccobacillus that colonizes the respiratory and gastrointestinal tracts of domestic animals; oropharyngeal colonization rates are 70–90% in cats and 50–65% in dogs.
Generally, the microflora of bite wounds reflects the oral flora of the biting animal. Most members of the cat family, including feral cats, harbor P. multocida

C. 正確
S. moniliformis grows slowly. As a result, the clinical microbiology laboratory should be notified if there is clinical suspicion for the disease so that cultures can be held for up to seven days to allow identification.

D. Pasteurella multocida is susceptible to penicillin, ampicillin, ampicillin/sulbactam, second- and third-generation cephalosporins, tetracyclines, and fluoroquinolones. β-Lactamase-producing strains have been reported.

E. 鉤端螺旋體 （Leptospirosis）是人畜共同傳染病，其中嚙齒動物是最重要的自然宿主。臨床診斷應建立在有適當的暴露並使加上典型表現（例如：非少尿性低血鉀腎功能損傷。確定診斷需要培養出病原菌、或PCR陽性、或抗體從陰轉陽或抗體力價上升。在臨床強烈懷疑的病人，需要抗體力價1:200–1:800。抗體力價上升4倍以上更好。需注意抗體力價在感染後兩週內可能都還測不到且會受到使用抗生素影響。