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Community-acquired infection ´ëÀå°æ Á¤¸®

Septicemia & septic shock, FUO

1. sepsis: i) ±¸°­¿Âµµ 38¡ÉÀÌ»ó or 36¡ÉÀÌÇÏ ii) RR>20ȸ or PaCO2 <32

iii) HR >90 iv) WBC > 12,000 or <4,000 or band >10%

À§ 4°¡Áö Áß 2°¡Áö°¡ Àǽɵǰųª Áõ¸íµÉ ¶§ SIRS(systemic inflammatory response

syndrome)À̶ó Çϸç, ¿øÀαÕÀÌ Áõ¸íµÇ°Å³ª ÀÇ½ÉµÉ ¶§ sepsis¶ó ÇÑ´Ù.

2. severe sepsis: organ dysfunction signÀÌ ÇÑ °³ÀÌ»ó ÀÖÀ» ¶§

= hypoperfusion or hypotension(metabolic acidosis, altered mental status, oliguria or

ARDS)

3. septic shock; fluid resuscitationÈÄ¿¡µµ hypotensionÀÌ ±³Á¤µÇÁö ¾ÊÀ» ¶§

* hypotension: SBP < 90 mmHg or baselineº¸´Ù 40 mmHgÀÌ»ó ¶³¾îÁ® ÀÖÀ»¶§

4. ¼¼±ÕÀÌ ¸¸µé¾î³»´Â °¡Àå °­·ÂÇÑ endotoxin? LPS(lipopolysaccharide)

endotoxin¿¡ ´ëÇÑ host response¿¡ Áß½ÉÀû ¿ªÇÒÀ» ÇÏ´Â cytokines? TNF-¥á

5. major pyrogenic cytokines: IL-1¥á, ¥â, TNF-¥á -> PG E2¸¦ »ý¼º½ÃÄÑ feverÀÏÀ¸Å´

(aspirinÀº Áß°£°úÁ¤ Â÷´Ü)

6. steroid´Â cytokineÀÇ ÇÕ¼ºÀ» °¨¼Ò½Ã۰í Á¶Á÷¿¡¼­ cytokineÀÇ È¿°ú¸¦ °¨¼Ò½ÃŲ´Ù.

aspirinÀº cytokineÀÇ »ý¼ºÀ» °¨¼Ò½ÃŰÁö ¸øÇÑ´Ù.

NSAID´Â ¿­°ú myalgia¸¦ °¨¼Ò½ÃŰÁö¸¸ °£¿¡¼­ÀÇ acute phase response¿¡´Â ¿µÇâÀ»

ÁÖÁö ¾Ê´Â´Ù.

7. sepsisÀÇ Áß¿äÇÑ ÇÕº´Áõ 4°¡Áö

cardiopulmonary(septic shock), renal complication(ARF)

coagulation abnormality(DIC), neurologic(polyneuropathy)

8. sepsis¶§ Ä¡·á

±Õ¹è¾ç°Ë»çÈÄ Áï½Ã °æÇèÀû Ç×»ýÁ¦¸¦ ÃÖ°í¿ë·®À¸·Î »ç¿ë

infection source Á¦°Å(¿¹, catheter remove)

hemodynamic support: vasopressor, fluid replacementÇÏ¿©

PCWP 14-18 mmHg, CVP 10-12 cmH2OÀ¯Áö -> urine output 30 mL/hrÀ¯Áö

9. postsplenectomy bacterial sepsis ¿øÀÎ±Õ 3°¡Áö

S. pneumococcus > H. influenza > N. meningitidis

FUO

10. FUOÀÇ Á¤ÀÇ

1) classic: 3ÁÖÀÌ»ó Áö¼ÓµÈ ¿­, 3ȸÀÇ ¿Ü·¡¹æ¹® ȤÀº ÀÔ¿øÇÏ¿© 3Àϵ¿¾È °Ë»çÇÏ¿© ¿øÀÎÀ»

¾Ë¼ö ¾øÀ» ¶§. infection, malignancy, inflammatory ds, drug fever

2) nosocomial: ÀÔ¿øÈ¯ÀÚ¿¡¼­ ¿­³¯ ¶§, 3ÀÏÀÌ»ó °Ë»çÇØµµ ¿øÀÎÀ» ¸øÃ£À» ¶§

septic thrombophlebitis, sinusitis, C. difficile colitis, drug fever

3) neutropenic: ANC <500ÀÇ È¯ÀÚ°¡ ¿øÀÎ¸ð¸£°Ô ¿­³¯ ¶§, 3ÀÏÀÌ»ó °Ë»çÇØµµ ¿øÀÎÀ»

¸øÃ£À» ¶§: perianal infection, aspergillosis, candidiasis

4) HIV-associated: ¿Ü·¡¿¡¼­ 4ÁÖÀÌ»ó, ÀÔ¿øÇÏ¿© 3ÀÏÀÌ»ó °Ë»çÇØµµ ¿øÀÎÀ» ¸øÃ£À» ¶§

MAI infection, Tuberculosis, NHL, drug fever

11. FUO¸¦ ÀÏÀ¸Å°´Â Á¾¾ç

NHL, Hodgkin's disease, leukemia

RCC, hepatoma

12. ¿­À» ¹Ýµå½Ã Á¶ÀýÇØ¾ß ÇÏ´Â °æ¿ì

41¡ÉÀÌ»ó, ¼Ò¾ÆÀÇ febrile seizure, ÀÓ»êºÎ, cardiopulmonary or cerebral functionÀå¾Ö

Infective endocarditis

13. native valve endocarditisÀÇ ¿øÀαÕ:

1) Streptococci(55%): ±×Áß S. viridans(75%), S. bovis(20%)

2) Enterococci

3) Staphylococci

4) HACEK group

14. Streptococcus bovis(Group D streptococcus)¿¡ ÀÇÇÑ native valve endocarditisÀÇ Æ¯Â¡

: ³ëÀο¡ ¸¹°í 1/3À̻󿡼­ malignant or premalignant GI lesion(colon cancer, villous

adenoma or polyp)ÀÌ µ¿¹ÝµÈ´Ù.

15. Enterococci¿¡ ÀÇÇÑ native valve endocarditis

Enterococci´Â GIT, urethra, mouthÀÇ »óÀç±ÕÀÌ´Ù.

µû¶ó¼­ ¸¹Àº ȯÀÚ¿¡¼­ ½É³»¸·¿°ÀÌ »ý±â±âÀü GUT manuplationÀ̳ª trauma, disease

history°¡ ÀÖ´Ù.

16. Group D streptococcus

Enterococci : E. faecalis, E. faecium

Non-enterococci : S. bovis

17. prosthetic valve endocarditis: 60¼¼ ÀÌ»ó ³²ÀÚ¿¡ ¸¹´Ù.

¿øÀαÕ: Staphylococci(S. epidermidis > S. aureus)

18. prosthetic valve endocarditis °æÇèÀû Ç×»ýÁ¦

: vancomycin + gentamicin + rifampin

19. infective endocarditis¶§ immune complex¿¡ ÀÇÇØ ¾ß±âµÇ´Â ¸é¿ªÇö»ó

: GN, arthritis, vasculitis(splinter hemorrhage, Roth spot, Osler node, Janeway lesion,

petechiae) sterile meningitis, RA factor(+)

20. ½É³»¸·¿°¿¡¼­ ½ÉÀâÀ½ÀÌ µé¸®Áö ¾Ê´Â °æ¿ì 2°¡Áö

i) early acute endocarditis

ii) IV drug abuser with rapid tricuspid valve destruction

21. infective endocarditis¶§ º¸Àϼö ÀÖ´Â mucocutaneous lesion

splinter hemorrhage, Osler's node, Janeway lesion, Roth spot, finger clubbing

i) splinter hemorrhage: subungal linear red streaks

ii) Osler's node: finger, toe padÀÇ small tender nodule

iii) Janeway lesion: palm, soleÀÇ small hemorrhage

iv) Roth spot : oral, retinal hemorrhage

v) finger clubbing

22. infective endocarditis°¡ ÀÇ½ÉµÉ ¶§ ¿ì¼± ÇØ¾ßÇÒ µÎ°¡Áö °Ë»ç?

blood culture, echocardiography

23. infective endocarditis¿¡¼­ TEE ÀûÀÀÁõ

i) prosthetic valve

ii) myocardial or valve ring abscess°¡ ÀǽɵǴ °æ¿ì

iii) TTE°¡ ±â¼úÀûÀ¸·Î ¾î·Á¿î °æ¿ì

iv) infective endocarditis°¡ °­·ÂÈ÷ Àǽɵdzª TTE negativeÀÎ °æ¿ì

v) candidate for cardiac surgery

24. S. viridans, S. bovis¿¡ ÀÇÇÑ endocarditisÀÇ Ä¡·á

i) penicillin °¨¼ö¼º(MIC ¡Â 0.1 ug/ml)

: ampicillin or ceftriaxone ´ÜÀÏ¿ä¹ý 4ÁÖ or gentimicinÃß°¡ÇÏ¿© 2ÁÖ

cf. prosthetic valveÀÇ °æ¿ì´Â ampicillin(6ÁÖ) + gentimicin(2ÁÖ)

ii) penicillin ³»¼º(0.1 < MIC < 0.5 ug/ml)

: ampicillin(4ÁÖ) + gentamicin(2ÁÖ) or vancomycin ´ÜÀÏ¿ä¹ý

iii) penicillin ³»¼º(MIC ¡Ã 0.5) : enterococci¿¡ ÁØÇØ Ä¡·á

25. enterococci¿¡ ÀÇÇÑ endocarditisÀÇ Ä¡·á

¸ÕÀú high level aminoglycoside resistance test¸¦ ½ÃÇàÇÑ´Ù.

i) °íµµ³»¼ºÀÌ ¾ø´Â °æ¿ì: ampicillin(vancomycin) + gentamicin 4ÁÖÀÌ»ó

prosthetic valveÀÇ °æ¿ì¿£ 6ÁÖ

ii) °íµµ³»¼ºÀÌ ÀÖ´Â °æ¿ì: ampicillin °í¿ë·® Àå±âÄ¡·á(8-12ÁÖ)

<¾Ï±â> 4 or 2+2 (6 + 2)

4 + 2 (6 + 2)

4 + 4 (6 + 6)

8-12

26. Staphylococcus¿¡ ÀÇÇÑ endocarditis

i) native valve : nafcillin(or cefazolin)(4-6ÁÖ) + gentamicin(3-5ÀÏ)

vancomycinÀº °¡±ÞÀû »ç¿ëÇÏÁö ¾Ê´Â´Ù.

rifampinµµ ÀϹÝÀûÀ¸·Î´Â »ç¿ëÇÏÁö ¾Ê´Â´Ù.

ii) prosthetic valve : nafcillin(6ÁÖ) + gentamicin(2ÁÖ) + rifampin(6ÁÖ)

<¾Ï±â> 4-6ÁÖ (6+2+6)

27. S. aureus¿¡ ÀÇÇÑ endocarditis¿¡¼­ vancomycinÀÌ ¥â-lactamº¸´Ù ÁÁÁö ¾ÊÀº ÀÌÀ¯?

i) unpredictable pharmacokinetics

ii) slower bactericidal activity

iii) poor penetration to vegetation

28. high level of aminglycoside resistance

GM MIC > 2000 ug/ml

SM MIC > 500 ug/ml

=> ampicillin(vancomycin) ´Üµ¶»ç¿ë(8-12ÁÖ)

29. infective endocarditis¿¡¼­ ¼ö¼úÀ» °í·ÁÇØ¾ß ÇÏ´Â °æ¿ì

1) ÇØ¸®½¼

i) Ç×»ýÁ¦·Î ¿ÏÄ¡°¡ ¾î·Á¿ï ¶§

ii) Ä¡·áÁß persistent bacteremia

iii) ÀûÀýÇÑ Ä¡·áÈÄ Àç¹ß

iv) severe valve dysfunction¿¡ ÀÇÇÑ heart failure

v) myocardial or valve ring abscess

vi) ÀûÀýÇÑ Ä¡·á¿¡µµ ºÒ±¸Çϰí recurrent embolism

vii) AV endocarditis with 1st & 2nd degree AV block

viii) valvular dysfunction or dehiscence & myocardial invasion

2) Braunwald

¨ç Absolute indications

i) moderate to severe CHF d/t valve dysfunction

ii) unstable prosthesis

iii) uncontrolled infection: persistent bacteremia, ineffective antimicrobial tx, fungal

endocarditis, relapse after optimal tx(prosthetic valve)

¨è relative indications

i) persistent extension of infection

ii) S. aureus endocarditis: AV, MV, prosthetic valve

iii) relapse after optimal tx(native valve)

iv) culture negative endocarditis with persistent unexplained fever(¡Ã10 days)

v) large(¡Ã10mm) vegetation

30. ½É³»¸·¿° Ä¡·áÁß ¾ÇÈ­½Ã °¨º°

i) myocardial abscess

ii) metastatic abscess

iii) drug fever

iv) wrong tx: wrong drug, wrong dose

v) superinfection or nosocomial infection

vi) embolism

31. ½É³»¸·¿°ÀÇ poor prognosis

nonstreptococcal, ³ëÀÎ, CHF, AVħ¹ü, valve ring or myocardial abscess, prosthetic

valveħ¹ü

* ¾î¸°ÀÌ, ¿©ÀÚ´Â ¾Æ´Ô

32. ½É³»¸·¿° ¿¹¹æÀÌ ÇÊ¿äÇÑ °æ¿ì: high & moderate risk

1) high risk: prosthetic valve, previous endocarditis hx(+), complex cyanotic heart

disease, surgically constructed systemic-pulmonary shunt

2) moderate risk: congenital cardiac malformation, rheumatic heart disease, HCM, MVP

with MR

3) low risk: ASD, CABG hx(+), pure MVP, innocent heart murmur,

previous Kawasaki disease without valve dysfunction, pacemaker or ICD

33. ½É³»¸·¿°ÀÇ ¿¹¹æ¾à

1) Ä¡°ú, È£Èí±â: S. viridans°Ü³É

amoxicillin 2g PO(1½Ã°£Àü)

PO¾ÈµÇ¸é 30ºÐÀü ampicillin 2g IM or IV

allergy½Ã clindamycin 600mg PO(1½Ã°£Àü)

2) GU & GI procedure: enterococcus°Ü³É

high risk: ampicillin 2g IM or IV + GM 1.5 mg/kg 30ºÐÀü

ampicillin 1g IM or IV + amoxicillin 1g PO(6½Ã°£ÈÄ)

allergy½Ã vancomycin 1g IV(over 1-2hr) + GM 1.5 mg/kg(30ºÐÀü)

moderate risk: amoxicillin 2g PO(1½Ã°£Àü)

ampicillin 2g IM or IV(30ºÐÀü)

allergy½Ã vancomycin 1g IV over 1-2 hr(30ºÐÀü¿¡ infusion³¡³ªµµ·Ï)

34. ½É³»¸·¿° ¿¹¹æÀÌ ÇÊ¿äÇÑ GU procedure: prostatic surgery, cystoscopy, urethral

dilatation

* ¿¹¹æÀÌ ÇÊ¿ä¾ø´Â procedure: vaginal hysterectomy, vaginal delivery, C/sec,

urethral catheterization, uterine D & C, therapeutic abortion

Infectious diarrhea

35. Clostridium botulinum : neurotoxin ¼³»çº´°ú °ü°è¾ø´Ù.

36. traveler's diarrheaÁß viral etiology: Rotavirus, Norwalk-like virus

36. ½®À½½Ä¿¡ ÀÇÇÑ ½ÄÁßµ¶(±¸Åä): Bacillus cereus

37. Ç×»ýÁ¦°¡ µµ¿òÀÌ µÇ´Â ¼³»ç

i) traveler's diarrhea: quinolone, bactrim

ii) C. difficile-associated diarrhea

iii) amebic colitis: metronidazole

iv) febrile dysenteric diarrhea

v) persistent diarrhea(2ÁÖÀÌ»ó)

PID

38. Chlamydia trachomatis Ä¡·áÁ¦

4+ : doxycycline, azithromycin

3+ : ofloxacin, clindamycin

2+ : ampicillin/amoxicillin

39. PID Ä¡·á

i) doxy + cefoxitin/cefotetan : N. gonorrhea, C. trachomatis

ii) clindamycin + GM : N. gonorrhea, C. trachomatis, anaerobe, GNB

UTI

40. true bacteriuria(=true infection)

i) > 105 CFU/ml

ii) symptomatic pyuria + 102 -104 /mlÀÇ E. coli, Klebsiella, proteus, S. saphrophyticus

iii) asymptomatic pt : 2ȸ ¿¬¼Ó urine culture¿¡¼­ >105 CFU/ml

iv) cath ¡Ã102 CFU/ml

v) suprapubic aspiration : any degree

* 1000¹è ½Ã¾ß¿¡¼­ Àû¾îµµ 2°³ ÀÌ»óÀÇ ±ÕÀ» °üÂûÇÒ¼ö ÀÖÀ¸¸é ÀǹÌÀÖ´Â ¼¼±Õ´¢·Î ¹è¾ç¿¡¼­

105 CFU/mlÀÌ»óÀÏ °¡´É¼ºÀÌ ³ô´Ù.

* 24½Ã°£ ¼Òº¯Àº ±â»ýÃæ °Ë»ç¿¡¸¸ Àǹ̰¡ ÀÖ°í ¼¼±Õ´¢ Áø´Ü¿¡´Â µµ¿òÀÌ ¾ÈµÈ´Ù.

41. ¿ä·Î°¨¿°È¯ÀÚ¿¡¼­ nitrite test°¡ À½¼ºÀÎ °æ¿ì

i) low dietary intake : low urinary nitrate level

ii) inadequate bladder retention

iii) prolonged storage of samples: nitrite degradationÀÌ ÀϾ

vi) nitrate -> nitrite·Î ÀüȯÀÌ ÀϾÁö ¾Ê´Â °æ¿ì

: E. faecalis, other G(+) organism, N. gonorrhea, M. tuberculosis, Pseudomonas

high urinary level of ascorbic acid

* false (+) : vaginal discharge¿¡ contaminationµÈ °æ¿ì

42. lower urinary tract sx(LUTS) Æò°¡¸¦ À§ÇÑ IPSS(international prostate sx score) Áß

severityÃøÁ¤¿¡ »ç¿ëµÇ´Â Ç׸ñ

: stream force°¨¼ÒÁ¤µµ, intermittency, incomplete emptying, straining

43. renal cortical abscess(renal carbuncle)ÀÇ mc pathogen: E. coli

44. ½Å¼öÁúÀº Ç÷·ù°¡ Àû¾î °¨¿°ÀÌ ¸ÕÀú ½ÃÀ۵ȴÙ(ÇÇÁúº¸´Ù).

45. vagina, distal urethral normal flora

: diphtheroids, streptococci, lactobacilli, staphylococcal spp.

±×·¯³ª S. saphrophyticus´Â 10-20%¿¡¼­ °¨¿°À» À¯¹ßÇÑ´Ù.

46. common bacterial contaminants of urine cultures(= UTI Àǹ̰¡ Àû´Ù)

: S. epidermidis, diphtheroids, lactobacillus, Gardnella vaginalis, anaerobic bacteria

47. ½Å¼öÁú¿¡ °¨¿°ÀÌ È£¹ßÇÏ´Â ÀÌÀ¯

i) 1st parenchymal stop in ascending pathway

ii) relatively low blood flow, O2, pH: phagocytic delivery & activity¡é

iii) medullary hypertonicity: complement activity & phagocytic activity¡é

iv) locally formed ammonia: C4 activity¡é, immunologically-mediated defense °¨¼Ò½ÃÅ´

48. ÀӽŶ§ APNÀÌ Àß ¿À´Â ÀÌÀ¯

i) ureteral tone¡é

ii) ureteral peristalsis¡é

iii) vesicoureteral incompetence

iv) bladder catheterization during/after delivery

49. ´ç´¢È¯ÀÚ¿¡¼­ ¿ä·Î°¨¿° ºóµµ°¡ Áõ°¡ÇÏ´Â ÀÌÀ¯

i) autonomic bladder dysfunction

ii) impaired perfusion

iii) glycosuria

50. ¿ø³»¿ä·Î°¨¿°ÀÇ À§ÇèÀÎÀÚ(=catheter-associated UTI À§ÇèÀÎÀÚ)

i) ¿©¼º

ii) prolonged urinary catheterization

iii) severe underlying illness

iv) faulty catheter care

v) disconnection of cath & drainage tube

vi) lack of systemic antibiotics

51. UTIÀ־ bacteriuria°¡ ¹ß°ßµÇÁö ¾Ê´Â °æ¿ì

i) unusual bacterial agent: M. tuberculosis, fungus, atypical mycobacteria,

Chlamydia trachomatis, ureaplasma urealyticum

ii) bacterial multiplicationÀúÇØ: urine osmolality¡è, urine¿¡ urea concentration¡è

pH¡é, Ç×»ýÁ¦ »ç¿ë½Ã

* sterile pyuria¿øÀÎ

i) infection : Tb, atypical mycobacteria, anaerobic bacteria, H. influenza

ii) antibiotic tx

iii) glucocorticoid tx

iv) acute febrile episode

v) cyclophosphamide administration

vi) pregnancy

vii) renal transplant rejection

viii) genitourinary trauma

ix) prostatitis & cystourethritis

52. catheter associated UTIÀÇ common pathogen: "PPSKE"

proteus, pseudomonas, serratia, klebsiella, E. coli

catheterÀ¯Ä¡ÈÄ ¸ÅÀÏ 3-5%¾¿ °¨¿°À§ÇèÀÌ Áõ°¡ÇÑ´Ù.

53. acute focal bacterial nephritis

: APNÁß pus¸¦ µ¿¹ÝÇÏÁö ¾Ê´Â inflammtory mass»ý±ä °Í

CT»ó wedge-shaped low density lesion

54. ÀӽŽà UTIÄ¡·á

1) acute cystitis: 3-7Àϰ£ amoxicillin, nitrofurantoin, cephalosporin

2) APN : ÀÔ¿øÇÏ¿© IV antibiotics, cepha or extended spectrum penicillin

3) recurrent UTI ; continuous low-dose nitrofurantoin prophylaxis

55. ADPKDÀÇ UTIÄ¡·á

ÀϹÝÀû Ä¡·á¸¦ ¸ÕÀúÇϰí Ä¡·á¿¡ ´ëÇÑ ¹ÝÀÀÀÌ ÁÁÁö ¾ÊÀ»¶§´Â cyst infectionÀ» °í·ÁÇÏ¿© cyst

penetrationÀÌ °¡´ÉÇÑ Ç×»ýÁ¦¸¦ »ç¿ëÇÑ´Ù.

: ciprofloxacin, chloramphenicol, bactrim

56. urologic evaluationÀÌ ÇÊ¿äÇÑ °æ¿ì

i) women with relapsing infection

ii) childhood infection hx(+)

iii) stones or painless hematuria

iv) recurrent pyelonephritis

v) most males with urinary infection

vi) septic shock

57. urologic evaluationÀÌ ÇÊ¿äÄ¡ ¾ÊÀº °æ¿ì

women with recurrent infection

young men who have cystitis associated with sexual activity(uncircumcised, or AIDS)

58. UTI ¿¹¹æ Ç×±Õ¿ä¹ýÀÇ ÀûÀÀÁõ

i) 6°³¿ùÀ̳» 2ȸÀÌ»ó °¨¿°À» º¸ÀÎ ¿©¼º

ii) sexual intercourse¿Í °ü·Ã

iii) chronic prostatitis

iv) patients undergoing prostatectomy

v) pregnant women with asymptomatic bacteriuria

skin, muscle & soft tissue infections

59. erysipelas: S. pyogenes Ä¡·á> penicillin

60. cellulitis in DM

¿øÀαÕ: S. aureus, group A ¥â-hemolytic streptococcus, aerobic GNB, anaerobe

Ä¡·á: augmentin, cefoxitin, cefazolin + amikacin + metronidazole

61. erysipeloid = fish-handler's disease, G(+) rod

Meningitis

62. BBBÅë°ú°¡ ¾î·Á¿î Ç×»ýÁ¦: clindamycin, 1, 2¼¼´ë cepha, EM, 3¼¼´ëÁß¿¡¼­

cefoperazone, vancomycin, aminoglycoside

BBBÅë°ú¸¦ Àß ÇÏ´Â Ç×»ýÁ¦: chloramphenicol, rifampin, sulfonamide

63. steroid°¡ Ç×±ÕÁ¦ÀÇ ¾àµ¿Çп¡ ¹ÌÄ¡´Â ¿µÇâ

: BBB¸¦ ¾ÈÁ¤È­½ÃÄÑ Ç×±ÕÁ¦ ħÅõ¸¦ °¨¼Ò½ÃÅ´

64. septic cavernous sinus thrombosis

: paranasal sinusitis, face & mouth infectionÈÄ,

lateral gaze palsyµî Áõ»ó

¿øÀαÕ: mc= S. aureus

Áø´Ü: MRI

Ä¡·á: nafcillin or vancomycin -> ¹ÝÀÀ¾øÀ¸¸é surgical drainage

65. aseptic meningitisÀÇ ÈçÇÑ ¿øÀÎ ¹ÙÀÌ·¯½º

Enterovirus(polio, coxsackievirus, echovirus), arbovirus, HIV, HSV-2

Prion disease

66. prion disease Á¾·ù

kuru, CJD, GSS(Gerstmann-Straussler-Scheinker syndrome), fatal familial insomnia,

familial progressive subcorticoal gliosis, scrapie..