237.2 📚 國考版

237.2.0.1 必背 — Adult Tapeworms Summary

Worm Source Distinctive
Taenia saginata Beef > 12 uterine branches per proglottid
Taenia solium Pork (adult worm); cysticercosis from eggs 7-13 branches; cysticercosis risk
Diphyllobothrium Freshwater fish B12 deficiency, megaloblastic anemia
Hymenolepis nana Person-to-person fecal-oral Pediatric / crowded

237.2.0.2 必背 — Praziquantel for Adult Tapeworms

  • 5-10 mg/kg single dose for T. saginata, T. solium, Diphyllobothrium
  • 25 mg/kg single dose for H. nana (higher dose; repeat if needed)
  • Niclosamide alternative

237.2.0.3 必背 — Cysticercosis

  • Ingestion of T. solium eggs (not pork — egg-contaminated food/water/fingers)
  • Tissue cysts in muscle + brain + eye
  • Autoinfection in tapeworm carriers
  • Latin America + sub-Saharan Africa + S Asia endemic

237.2.0.4 必背 — Neurocysticercosis

  • Cause of new-onset epilepsy in adults from endemic regions
  • MRI brain: viable (T2 hyper + scolex), transitional (ring enhancement + edema), calcified (CT)
  • Serology: EITB Western blot most specific
  • Treatment: albendazole 15 mg/kg/d × 10-15 d + dexamethasone + anticonvulsants
    • praziquantel for high cyst burden
  • Calcified only: anticonvulsants only (no antiparasitic)

237.2.0.5 必背 — Neurocysticercosis Forms

  • Active (viable + no enhancement)
  • Transitional (ring-enhancing degenerating)
  • Calcified (inactive)
  • Extraparenchymal (cisternal, ventricular)

237.2.0.6 必背 — Echinococcosis Species

Species Disease Definitive Host Geography
E. granulosus Cystic (CE) — unilocular fluid cyst Dog Worldwide (Mediterranean, ME, S America, China)
E. multilocularis Alveolar (AE) — infiltrative tumor-like Fox + dog Arctic + Central Europe + W China

237.2.0.7 必背 — CE (Cystic Echinococcosis)

  • Liver 70% + lung + brain + bone + spleen
  • “Daughter cysts” within mother (hydatid sand)
  • Asymptomatic many years
  • Rupture = anaphylaxis + dissemination
  • WHO classification CE1-CE5 (active to inactive)
  • Treatment: albendazole + PAIR (accessible cysts) + surgery + observation (CE4-CE5)

237.2.0.8 必背 — AE (Alveolar Echinococcosis)

  • Infiltrative tumor-like (mimics cancer)
  • Mostly liver, can metastasize
  • Fatal if untreated
  • Treatment: surgical R0 resection + albendazole lifelong + liver transplant (rare)

237.2.0.9 必背 — Albendazole

  • Anti-cestode + many helminths
  • 15 mg/kg/d divided for tissue infections (cysticercosis, echinococcosis)
  • Long course (3-6+ months for CE)
  • LFT monitoring

237.2.0.10 必背 — PAIR

  • Puncture-Aspiration-Injection-Reaspiration
  • For accessible CE1, CE3a cysts (liver primarily)
  • Pre-procedure + post-procedure albendazole
  • Not for bone, lung, brain
  • Not for AE (infiltrative)

237.2.0.11 必背 — Symptomatic Adult Cysticercosis

  • Adult onset seizures, especially endemic + immigrant
  • MRI + CT
  • Family screening for tapeworm carriers