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 ¾ÇȽà °¨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..