228.2 📚 國考版

228.2.0.1 必背 — Species

• B. microti — USA NE/Midwest (Ixodes scapularis, white-footed mouse)
• B. divergens — Europe (cattle, asplenic severe)
• B. duncani — USA W Coast (rare)
• B. venatorum — Asia + Europe (rare)

228.2.0.2 必背 — Vector

• Ixodes scapularis (USA) — same as Lyme + Anaplasma
• Ixodes ricinus (Europe)

228.2.0.3 必背 — Risk Groups for Severe

• Asplenic / sickle cell (severe + high mortality)
• Immunocompromise (HIV, anti-CD20, transplant, malignancy)
• Elderly
• Pregnancy

228.2.0.4 必背 — Clinical

• Fever + chills + sweats + myalgia + headache
• Thrombocytopenia + hemolytic anemia + ↑ LDH + ↓ haptoglobin
• Severe: hemolysis + AKI + DIC + multi-organ failure

228.2.0.5 必背 — Diagnosis

• Thick + thin Giemsa smears — intra-erythrocytic ring forms
• “Maltese cross” tetrads pathognomonic (rare)
• PCR most sensitive
• Serology (IgG) confirmatory

228.2.0.6 必背 — Treatment

Severity	Regimen
Mild-Moderate	Atovaquone + Azithromycin × 7-10 d
Severe	Clindamycin + Quinine × 7-10 d
Refractory / Asplenic / Parasitemia > 10%	+ Exchange transfusion
Immunocompromise	Longer course (6+ wk) + monitor

228.2.0.7 必背 — Co-Infection (Ixodes Tick)

• Lyme + Anaplasma + Babesia + B. miyamotoi + Powassan
• Multiplex PCR panel

228.2.0.8 必背 — Transfusion-Transmitted

• USA NE major concern
• 2024 FDA expanded donor screening

228.2.0.9 必背 — Asplenic Severity

• 20-50% mortality if untreated
• Exchange transfusion for high parasitemia

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