229.2 📚 國考版

229.2.0.1 必背 — 4 Clinical Forms

  1. Cutaneous (CL) — Oriental sore; Old World mild, New World can progress to MCL
  2. Mucocutaneous (MCL / Espundia) — L. braziliensis complex, mucosal destruction years later
  3. Visceral (VL / Kala-azar) — fatal if untreated; L. donovani + L. infantum
  4. Post-Kala-azar Dermal (PKDL) — after VL treatment, hypopigmented skin lesions

229.2.0.2 必背 — Vector

  • Sandfly (Phlebotomus + Lutzomyia)
  • Smaller than mosquitoes (fine-mesh nets needed)
  • Crepuscular (dusk + dawn)

229.2.0.3 必背 — Visceral Leishmaniasis Clinical

  • Prolonged fever + massive splenomegaly + pancytopenia + hyperpigmentation
  • “Kala-azar = black sickness”
  • 95%+ mortality untreated

229.2.0.4 必背 — Diagnosis VL

  • rK39 rapid test — sensitive + specific
  • Bone marrow aspirate + amastigotes on Giemsa
  • Splenic aspirate highest sensitivity (but bleeding risk)
  • PCR + serology + DAT

229.2.0.5 必背 — Treatment VL

  • Liposomal AmB preferred (10 mg/kg single dose for Indian VL)
  • Miltefosine oral (teratogenic, pregnancy/lactation contraindicated)
  • Pentavalent antimony (cardiac toxicity, increasing resistance India)
  • Paromomycin combinations

229.2.0.6 必背 — VL + HIV

  • More severe + relapsing
  • Atypical presentations
  • Liposomal AmB longer course
  • Maintenance suppression often

229.2.0.7 必背 — Endemic Regions

  • VL hot spots: India, Bangladesh, Nepal, Sudan, Ethiopia, Brazil
  • CL: Brazil, Iran, Peru, Saudi Arabia, Syria, Afghanistan
  • MCL: Bolivia, Brazil, Peru

229.2.0.8 必背 — Cutaneous Leishmaniasis

  • Old World (L. major, L. tropica) — Mediterranean + Mid East + Asia + Africa; mostly self-limited
  • New World (L. braziliensis complex) — Latin America; risk of mucocutaneous progression

229.2.0.9 必背 — Miltefosine

  • Oral leishmaniasis treatment (CL + MCL + VL)
  • Teratogenic + lactation contraindicated
  • 28 days course

229.2.0.10 必背 — Liposomal AmB

  • WHO essential medicine
  • VL preferred
  • Single dose for Indian VL (mass campaigns)
  • Pregnancy safe

229.2.0.11 必背 — rK39 Rapid Test

  • Antibody to L. donovani recombinant antigen
  • Point-of-care
  • Useful for VL field diagnosis
  • Sensitive + specific for Indian + South American VL