226.3 🩺 內科專科考前版

226.3.0.1 1⃣ Eosinophilia Workup in Returning Traveler

  • Stool O+P × 3 days
  • Strongyloides serology (essential — most missed)
  • Schistosoma serology (if freshwater exposure)
  • Filariae serology if tropical regions
  • Imaging (US liver/abdomen)
  • Detailed travel + dietary history

226.3.0.2 2⃣ Strongyloides Hyperinfection

  • Risk groups: corticosteroid use, immunocompromise, HTLV-1 infection
  • Pre-immunosuppression screening in patients from endemic areas (S Asia, Africa, Caribbean, South America)
  • Ivermectin 200 µg/kg × 1 or repeat for treatment
  • Disseminated → high mortality (gram-negative bacteremia)

226.3.0.3 3⃣ Tafenoquine vs Primaquine

  • Single dose tafenoquine (300 mg) easier than 14-day primaquine
  • Both require G6PD testing (hemolysis risk)
  • Tafenoquine: methemoglobinemia + psychiatric (less common)

226.3.0.4 4⃣ Acoziborole — African Trypanosomiasis Breakthrough

  • Single-dose oral
  • Phase 3 success 2024 (T. b. gambiense)
  • Will replace fexinidazole as first-line if approved
  • Game changer for African Trypanosomiasis elimination

226.3.0.5 5⃣ DEC + Loa loa Encephalopathy Risk

  • High Loa loa microfilariae load (≥ 8,000 per mL) → DEC can cause severe encephalopathy
  • Pre-treatment Loa loa screening required in Central Africa
  • Use albendazole alone or staged ivermectin if high load

226.3.0.6 6⃣ Antimony + Cardiac Monitoring

  • QTc prolongation common
  • Daily ECG during treatment
  • Cardiac risk factors → switch to liposomal amphotericin B

226.3.0.7 7⃣ Mass Drug Administration Programs

  • Onchocerciasis (ivermectin): Mectizan Donation Program (Merck) — > 4 billion doses since 1987
  • Lymphatic Filariasis: albendazole + ivermectin or DEC
  • STH school deworming: > 800 million pediatric doses/yr
  • Schistosomiasis: praziquantel
  • Programs reducing global parasitic disease burden

226.3.0.8 8⃣ 健保 / Taiwan

  • 健保 standard antiparasitics
  • Specialized drugs (miltefosine, antimonials, fexinidazole) — ID consult / specialty
  • 通報 mandatory many parasites
  • Travel medicine + ID consultation

226.3.0.9 9⃣ Travel Medicine + Prophylaxis

  • Malaria prophylaxis selection by region
  • Pre-travel ID consultation
  • Vaccines + chemoprophylaxis
  • Insect repellent + bed nets

226.3.0.10 10. Drug Resistance

  • Artemisinin resistance (SE Asia, expanding) — kelch13 mutations
  • ACT failures rare so far
  • Chloroquine resistance widespread in P. falciparum
  • Praziquantel resistance emerging in Schistosoma