239.3 🩺 內科專科考前版

239.3.0.1 1⃣ Pre-Onchocerciasis-MDA Screening for Loa loa

  • RAPLOA (Rapid Assessment Procedure for Loa loa) — community-level screening
  • CFA testing at individual level
  • Where Loa loa endemic + onchocerciasis endemic overlap (Central Africa):
    • High MF load → pre-treatment albendazole or apheresis
    • Or skip individual + community-level MDA
  • 公衛 challenge for elimination programs

239.3.0.2 2⃣ Onchocerciasis Eye Disease Workup

  • Slit-lamp examination
  • Visible microfilariae in cornea + anterior chamber (diagnostic)
  • Punctate keratitis early → sclerosing keratitis late
  • Posterior segment changes
  • Ophthalmology + ID consultation
  • Treatment + slow visual improvement

239.3.0.3 3⃣ Travel + Returning Loa loa

  • W + C Africa rainforest travel + eye worm episode → diagnosis
  • Blood smear (daytime)
  • Serology
  • Pre-treatment MF count → guides treatment
  • ID + ophthalmology + possibly tropical specialist

239.3.0.4 4⃣ Lymphedema Management

  • Limb elevation + hygiene + skin care + compression
  • Antibiotic prophylaxis for recurrent cellulitis (PCN G monthly etc.)
  • Decongestive therapy (manual lymphatic drainage, pneumatic devices)
  • Surgery for severe hydrocele
  • Lifestyle support + psychosocial

239.3.0.5 5⃣ Doxycycline for Filariae

  • Anti-Wolbachia mechanism
  • 100 mg PO daily × 6 weeks for individual treatment of onchocerciasis
  • 200 mg/d × 4-6 weeks for LF
  • Long course
  • Slow onset of effect (months) but kills adult worms
  • Combine with ivermectin or DEC

239.3.0.6 6⃣ MDA Implementation Challenges

  • Loa loa coendemic areas (Central Africa)
  • Compliance + access in remote areas
  • Funding sustainability
  • Mectizan Donation Program (Merck) has been game-changing
  • Carter Center + other NGOs partners

239.3.0.7 7⃣ Filarial Vaccines in Development

  • Onchocerca volvulus subunit vaccines in Phase 1-2
  • LF vaccines researched
  • mRNA helminth vaccines emerging
  • 10+ years to clinical use

239.3.0.8 8⃣ Returning Traveler Filariasis

  • Rare in short-term travelers
  • Higher risk in long-term residents (expat, missionary, military)
  • Detailed exposure history
  • Blood smear (timing important — periodicity)
  • Serology
  • ID consultation

239.3.0.9 9⃣ 健保 / Taiwan

  • 眕芋 endemic
  • 通報 mandatory
  • 健保 DEC + ivermectin + doxycycline limited availability
  • Travel medicine awareness

239.3.0.10 10. Onchocerciasis Elimination Latin America

  • Colombia, Ecuador, Mexico, Guatemala eliminated onchocerciasis
  • Venezuela + Brazil Amazon foci remaining
  • Major public health victory
  • Mectizan Donation Program key factor
  • Africa progressing