230.2 📚 國考版

230.2.0.1 必背 — 2 Subspecies

Subspecies	Geography	Course	Reservoir
T. b. gambiense	W + C Africa	Slow chronic (months-years)	Anthroponotic
T. b. rhodesiense	E + S Africa	Rapid acute (weeks)	Zoonotic (cattle, wildlife)

230.2.0.2 必背 — Vector

• Tsetse fly (Glossina)
• Both subspecies
• Light clothing + repellent recommended

230.2.0.3 必背 — Clinical Stages

• Stage 1 (Hemolymphatic): chancre + fever + LAP + Winterbottom’s sign (posterior cervical LAP for gambiense)
• Stage 2 (Meningoencephalitic): sleep cycle reversal + behavioral + movement + coma

230.2.0.4 必背 — Antigenic Variation

• Variant Surface Glycoprotein (VSG) switches

• 1000 genes

• Causes recurrent parasitemia + chronic fever

230.2.0.5 必背 — Diagnosis

• CATT (screening for gambiense)
• Thick + thin blood smears
• Lymph node aspirate (gambiense, Winterbottom’s sign)
• CSF for staging (WBC > 5 or trypomastigotes = Stage 2)
• PCR

230.2.0.6 必背 — Treatment 2024

230.2.0.6.0.1 T. b. gambiense

• Stage 1 + Stage 2: Fexinidazole PO 10 days (preferred)
• Acoziborole single-dose Phase 3 success 2024 (regulatory submission)

230.2.0.6.0.2 T. b. rhodesiense

• Stage 1: Suramin IV
• Stage 2: Melarsoprol IV (arsenic, encephalopathy 5%)

230.2.0.7 必背 — Winterbottom’s Sign

• Posterior cervical LAP pathognomonic for T. b. gambiense

230.2.0.8 必背 — Sleep Cycle Reversal

• Stage 2 hallmark (gives “sleeping sickness” name)
• Daytime hypersomnia + nighttime insomnia

230.2.0.9 必背 — Post-Treatment LP at 6 Months

• Confirm cure (CSF normalization)

230.2.0.10 必背 — WHO 2030 Elimination

• T. b. gambiense near elimination
• Mass screening + treatment + vector control
• 2024 acoziborole regulatory submission revolutionary

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