236.3 🩺 內科專科考前版

236.3.0.1 1⃣ Travel-Acquired Schistosomiasis

  • Freshwater swimming in endemic (Africa, Latin America, Asia)
  • 4-8 weeks post-exposure: Katayama fever
  • Years later: chronic complications
  • All travelers from endemic with eosinophilia → schistosomiasis screen
  • Stool / urine O+P + serology

236.3.0.2 2⃣ Symmers’ Pipe-Stem Fibrosis

  • Characteristic of S. mansoni / japonicum / mekongi
  • Periportal fibrosis with intact hepatocytes
  • “Pipe stems” of dense periportal connective tissue
  • LFTs preserved
  • Variceal bleeding from portal HTN

236.3.0.3 3⃣ Bladder Cancer + S. haematobium

  • Chronic inflammation + fibrosis → SCC (squamous cell carcinoma)
  • WHO Group 1 carcinogen
  • Egypt + sub-Saharan Africa
  • Cystoscopy + biopsy in chronic urinary schistosomiasis
  • Treatment: cystectomy + chemotherapy + continued schistosomicidal therapy

236.3.0.4 4⃣ Neuroschistosomiasis

  • S. japonicum (more common) > S. mansoni > S. haematobium
  • Cerebral: epilepsy, focal mass
  • Spinal: transverse myelitis, paraplegia
  • Praziquantel + high-dose steroid
  • Anticonvulsants + supportive

236.3.0.5 5⃣ Genital Schistosomiasis

  • S. haematobium primarily
  • Female: cervical/vaginal lesions, infertility, enhanced HIV transmission
  • Male: hematospermia
  • Important public health link to HIV epidemic in Africa

236.3.0.6 6⃣ Pediatric MDA

  • Praziquantel mass distribution to school-age children
  • Annual treatment in endemic
  • WHO + Schistosomiasis Control Initiative
  • Praziquantel tablet difficult for young — pediatric formulations in development (orodispersible)

236.3.0.7 7⃣ Cholangiocarcinoma + Asian Liver Flukes

  • O. viverrini (NE Thailand) + C. sinensis (China)
  • Chronic biliary inflammation
  • Increases CCA risk 6-25×
  • Public health priority in endemic
  • Treatment + screening + dietary education (no raw/pickled fish)

236.3.0.8 8⃣ Fasciola Resistance

  • Triclabendazole only effective; resistance emerging in sheep + cattle (worry for human spillover)
  • WHO essential medicine
  • Limited availability some countries

236.3.0.9 9⃣ 健保 / Taiwan

  • 眕芋 endemic (Schistosoma not Taiwan); mostly imported
  • 健保 praziquantel + triclabendazole limited availability
  • 通報
  • Travel + immigration awareness

236.3.0.10 10. Future + Vaccine

  • Schistosomiasis vaccine in trials (Sm-TSP-2, Sm14, Sh28GST)
  • Phase 2 with mixed results
  • Hopes for clinical use 2028-2030