194.3 🩺 內科專科考前版

194.3.0.1 1️⃣ Hansen’s Disease in Taiwan

• 罕見 endemic
• 主要 imported (foreign workers, immigrants)
• 公費 leprosy treatment + follow-up
• Hsinchu Leprosarium (歷史 colony)
• 通報

194.3.0.2 2️⃣ Thalidomide for ENL

• Highly effective
• USA: STEPS program (System for Thalidomide Education and Prescribing Safety) — pregnancy registry, monthly pregnancy test in women of childbearing age
• Mechanism: anti-TNF, immunomodulator
• Side effects: peripheral neuropathy, sedation, constipation, DVT
• Pediatric: not approved < 12 yr

194.3.0.3 3️⃣ Steroid for Type 1 Reactions

• Prednisolone 40-60 mg qd × 1-2 wk → slow taper × 12-24 wk
• Aim: prevent permanent nerve damage
• Add immunosuppressant (azathioprine, methotrexate) if steroid-dependent
• Continue MDT

194.3.0.4 4️⃣ Disability Prevention

• Patient education re: foot care (daily inspection)
• Special footwear, glasses for lagophthalmos
• Surgical: tendon transfer, foot drop correction, lagophthalmos (lid weight implants)
• Rehab + occupational therapy
• Psychosocial support

194.3.0.5 5️⃣ Resistance Monitoring

• Emerging rifampin + dapsone R
• Specialized labs for AST
• Alternative: ofloxacin + minocycline + clarithromycin
• Surveillance important

194.3.0.6 6️⃣ Armadillo + Autochthonous USA Cases

• 9-banded armadillo Dasypus novemcinctus
• Naturally infected in S USA
• Possible transmission to humans (rare; landscaping, hunting, gardening)
• ~ 200 USA cases/yr (mostly imported but some autochthonous)
• 通報 mandatory

194.3.0.7 7️⃣ 健保 / Taiwan

• 通報
• 公費 MDT
• ID consult + dermatology / neurology coordination
• Long follow-up for disability + reactions

194.3.0.8 8️⃣ Future

• Whole genome sequencing for AST
• New drugs: clarithromycin, moxifloxacin alternatives
• Vaccine: LepVax (subunit) in trial

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