230.3 🩺 內科專科考前版

230.3.0.1 1⃣ Fexinidazole — 2019+ Game Changer

  • First oral treatment for HAT both stages (WHO 2019)
  • Approved EMA 2019
  • 10-day regimen
  • Reduces need for hospitalization + IV access
  • Massive simplification vs NECT (10-day eflornithine IV + 10-day nifurtimox PO)
  • Safety: GI, headache, sleep disturbances, hepatic
  • Take with food

230.3.0.2 2⃣ Acoziborole 2024 Breakthrough

  • Single dose oral (~ 480 mg)
  • Phase 3 trial Africa

  • 95% cure rate (both stages T. b. gambiense)

  • Will replace fexinidazole as first-line if approved
  • Patient-friendly + game-changing for elimination

230.3.0.3 3⃣ Melarsoprol Toxicity

  • Arsenic-based
  • 5% encephalopathy mortality
  • Painful injection
  • “Bayer 205” historical name
  • Replaced by NECT in 2009 WHO; now further replaced by fexinidazole + acoziborole for gambiense
  • Still used for T. b. rhodesiense (no alternative yet)

230.3.0.4 4⃣ T. b. rhodesiense — Special Concerns

  • Zoonotic — affects travelers (game park visits, etc.)
  • Acute fatal course (weeks)
  • Lower threshold for treatment
  • Suramin + melarsoprol remain primary
  • Fexinidazole + acoziborole in trials for rhodesiense

230.3.0.5 5⃣ Returning Traveler from Africa

  • Fever + neuro signs + LAP → consider HAT
  • Travel hx (game parks, rural travel)
  • Game park hunters / wildlife workers higher risk
  • Lab: CATT + smears + LP + ID consult

230.3.0.6 6⃣ Vector + Climate Considerations

  • Tsetse range stable
  • Climate change implications limited but monitored
  • Continuing vector control essential

230.3.0.7 7⃣ 健保 / Taiwan

  • 眕芋 endemic; imported
  • 通報 mandatory
  • 健保 fexinidazole for confirmed (limited availability)
  • Travel medicine awareness

230.3.0.8 8⃣ Future + Vaccines

  • Vaccines difficult due VSG variation
  • New drugs in pipeline beyond fexinidazole + acoziborole
  • Combination + simplification regimens

230.3.0.9 9⃣ Elimination Strategy

  • Active surveillance + early detection
  • Mass screening with CATT
  • Treat all positives → reduce reservoir
  • Vector control combined
  • Acoziborole simplifies treatment dramatically
  • WHO 2030 elimination near

230.3.0.10 10. Returning Traveler Workup

  • Stage assessment essential (lumbar puncture)
  • Drug treatment selection by subspecies + stage
  • Hospitalization for Stage 2 + severe
  • Post-treatment 6-month LP for cure confirmation