231.2 📚 國考版

231.2.0.1 必背 — Pathogen + Vector

• Trypanosoma cruzi (Latin America)
• Triatomine “kissing” bug
• Bug feces transmission (NOT bite)
• Latin America endemic; spreading to migration destinations

231.2.0.2 必背 — Other Transmission Routes

• Transfusion
• Vertical 5-10%
• Oral (food/juice contaminated bug feces — açaí outbreaks)
• Organ transplant

231.2.0.3 必背 — Acute Chagas

• Romaña sign (eye periorbital edema) pathognomonic
• Chagoma at skin site
• Mostly mild / asymptomatic
• 100% progress to chronic without treatment
• 80-100% cure with treatment

231.2.0.4 必背 — Chronic Cardiomyopathy

• 30% of chronic develop
• RBBB + LAFB earliest
• Dilated cardiomyopathy + HF
• LV apical aneurysm + mural thrombus
• Sudden cardiac death (VT/VF)
• Decades after acute

231.2.0.5 必背 — Chronic Digestive

• Megaesophagus (dysphagia, regurgitation)
• Megacolon (chronic constipation, volvulus)
• 10-20% Brazil/Southern Cone

231.2.0.6 必背 — Diagnosis

• Acute: blood smear + PCR + buffy coat
• Chronic: 2 different serology tests required (IFA, ELISA, IHA, recombinant antigen)

231.2.0.7 必背 — Treatment Indications

• All acute, recent, vertical newborn
• Chronic indeterminate < 18 yr (definitely)
• Chronic 18-50 yr (shared decision)
• Pre-immunosuppression / pre-transplant
• HIV / reactivation

• 50 + advanced CM: limited benefit (BENEFIT trial)

231.2.0.8 必背 — Treatment Drugs

• Benznidazole 5-7 mg/kg/d × 60 d first-line
• Nifurtimox 8-10 mg/kg/d × 90 d alternative
• Side effects: dermatologic, neuropathy, GI

231.2.0.9 必背 — Reactivation

• HIV, transplant, immunosuppression
• Myocarditis + meningoencephalitis severe
• Pre-immunosuppression screening essential

231.2.0.10 必背 — Public Health

• Vector control + housing improvement
• Blood donor screening (USA mandatory since 2007)
• Maternal screening
• Newborn treatment (90%+ cure)

231.2.0.11 必背 — WHO 2030 Goal

• Elimination as public health problem
• Vertical transmission elimination

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