194.2 📚 國考版

194.2.0.1 必背 — Spectrum

• Tuberculoid (TT): strong CMI, few well-defined lesions, paucibacillary
• Lepromatous (LL): weak CMI, many lesions, multibacillary, leonine facies + saddle nose + madarosis

194.2.0.2 必背 — Clinical Triad

• Hypopigmented anesthetic skin lesion + peripheral nerve thickening + AFB+ slit-skin smear

194.2.0.3 必背 — Nerves Often Affected

• Ulnar (claw hand), common peroneal (foot drop), great auricular (palpable in neck), supraorbital, posterior tibial

194.2.0.4 必背 — Treatment (WHO MDT)

Form	Regimen	Duration
PB (TT/BT)	Rifampin monthly + Dapsone daily	6 months
MB (BB/BL/LL)	Rifampin monthly + Dapsone daily + Clofazimine monthly+daily	12 months

194.2.0.5 必背 — Reactions

• Type 1 (Reversal): T-cell, inflamed lesions + neuritis; steroid
• Type 2 (ENL): immune complex, nodules + fever + neuritis; prednisolone + thalidomide

194.2.0.6 必背 — PEP

• Single dose rifampin 600 mg for household contacts (2018 WHO)
• Reduces incidence ~ 50%

194.2.0.7 必背 — Cannot Culture In Vitro

• Only armadillo + mouse footpad
• Diagnosis: clinical + slit-skin smear + biopsy

194.2.0.8 必背 — Armadillo Reservoir

• USA southern (TX, LA, FL, MS, AR)
• Some autochthonous cases

194.2.0.9 必背 — Dapsone + G6PD

• Hemolysis risk
• Screen G6PD before starting

---