226.2 📚 國考版

226.2.0.1 必背 — 4 Parasite Categories

  • Protozoa: malaria, Trypanosoma, Leishmania, Entamoeba, Giardia, Toxo
  • Trematodes: Schistosoma, Fasciola, Paragonimus, Clonorchis
  • Cestodes: Taenia, Echinococcus
  • Nematodes: Ascaris, hookworm, Strongyloides, Filariae, Onchocerca

226.2.0.2 必背 — Eosinophilia + Parasites

  • Tissue invasion / helminth migration
  • Strongyloides, Schistosoma, Toxocara, Trichinella, Filariae, Ascaris, hookworm
  • Differential: drugs, allergy, asthma, ABPA, EGPA, neoplasm

226.2.0.3 必背 — Diagnostic Tests

Test Targets
Stool O+P × 3 days Intestinal protozoa + helminth eggs
Stool antigen Giardia, Entamoeba, Cryptosporidium
Blood smear (thick + thin) Malaria, Babesia, microfilariae
Serology Toxo, Strongyloides, Schistosoma, cysticercosis, Echinococcus, Chagas
PCR Multiple parasites
Tissue biopsy Leishmania, cysticercosis, Echinococcus
Imaging Cysts, abscesses

226.2.0.4 必背 — Key Antiparasitic Drugs

Drug Targets
Artemisinin (ACT) Malaria (first-line uncomplicated P. falciparum)
IV artesunate Severe malaria
Chloroquine P. vivax / ovale / malariae (chloroquine-sensitive)
Primaquine / Tafenoquine P. vivax / ovale radical cure (G6PD test required)
Mefloquine / Doxycycline / Malarone Malaria prophylaxis
Metronidazole / Tinidazole Entamoeba, Giardia, Trichomonas
Nitazoxanide Cryptosporidium, Giardia, broad
Pentavalent antimony Leishmaniasis
Liposomal amphotericin B Visceral Leishmaniasis
Miltefosine Leishmaniasis, free-living amebae
Albendazole Nematodes, Echinococcus, neurocysticercosis
Ivermectin Strongyloides, Onchocerca, Filariasis, scabies (broad)
Praziquantel Schistosoma, trematodes, Taenia, cysticercosis
Benznidazole / Nifurtimox Chagas disease
Fexinidazole / Acoziborole African Trypanosomiasis
TMP-SMX Toxo (alt), PJP, Cyclospora
Sulfadiazine + Pyrimethamine + Leucovorin Toxoplasmosis

226.2.0.5 必背 — When to Suspect Parasites

  • Travel / immigration / occupational
  • Immunocompromise
  • Chronic diarrhea + weight loss
  • Hepatic / splenic enlargement + fever
  • Eosinophilia
  • Skin / CNS / GI atypical

226.2.0.6 必背 — Drug Selection Pitfalls

  • Primaquine + G6PD deficiency — hemolysis (test first)
  • DEC + high Loa loa load — encephalopathy (test first)
  • Albendazole + 1st trim pregnancy — avoid
  • Antimonials + cardiac dysfunction — QTc monitoring
  • Ivermectin + Loa loa — caution high load