233.3 🩺 內科專科考前版

233.3.0.1 1⃣ HIV + Chronic Diarrhea Workup

  • Multiplex GI panel (BioFire) — Giardia, Cryptosporidium, Cyclospora, etc.
  • Modified acid-fast for Cryptosporidium + Cyclospora + Cystoisospora
  • Modified trichrome for Microsporidia
  • Stool C. difficile (post-antibiotic)
  • Colonoscopy + biopsy if persistent
  • ART optimization

233.3.0.2 2⃣ Cryptosporidium + ART

  • Immune reconstitution = primary cure mechanism
  • Nitazoxanide adjunct (helps but doesn’t cure alone in HIV)
  • Some patients improve with ART alone
  • Persistent diarrhea = poor prognosis

233.3.0.3 3⃣ Milwaukee 1993 + Water Treatment

  • Largest waterborne outbreak USA history
  • 400,000+ cases
  • Failure of water treatment
  • Reinforced filtration + UV requirements
  • Cryptosporidium awareness in water treatment

233.3.0.4 4⃣ Cyclospora Foodborne Outbreaks (Ongoing 2024)

  • USA seasonal outbreaks
  • Imported produce
  • FDA + USDA surveillance + import alerts
  • Public education: wash produce, traveler precautions

233.3.0.5 5⃣ Microsporidia + Ocular Disease

  • Post-corneal trauma in healthy
  • HIV-disseminated
  • Treatment: albendazole + topical (fumagillin eye drops)
  • Ophthalmology consultation

233.3.0.6 6⃣ Giardia + Post-Infectious Lactose Intolerance

  • Common (50%+ patients)
  • Lasts weeks-months
  • Lactose-free diet temporarily
  • May persist long-term in some
  • Consider in chronic post-Giardia symptoms

233.3.0.7 7⃣ Nitazoxanide Spectrum

  • Cryptosporidium, Giardia, Helminths, Norovirus, Influenza (off-label)
  • Broad antiparasitic + antiviral + antibacterial
  • Pediatric + pregnancy categories
  • Limited resistance

233.3.0.8 8⃣ Stool Multiplex Panel Era

  • BioFire FilmArray GI Panel — 22 pathogens (bacteria + virus + parasite) in 1 hr
  • Includes Giardia, Cryptosporidium, Cyclospora, Entamoeba
  • Faster, more sensitive than traditional O+P
  • Cost considerations

233.3.0.9 9⃣ 健保 / Taiwan

  • 通報 outbreaks
  • 健保 nitazoxanide, TMP-SMX, metronidazole for confirmed indications
  • BioFire panel in select tertiary centers
  • Travel + immigration awareness

233.3.0.10 10. Future + Vaccines

  • Cryptosporidium vaccines in research
  • Better diagnostic + treatment for Microsporidia
  • mRNA approaches for parasitic vaccines