248.2 📚 國考版

248.2.0.1 必背 — Paracoccidioidomycosis

• Latin America (Brazil dominant)
• Adult males predominantly
• Multiple budding yeast (“pilot wheel / Mickey Mouse”) — pathognomonic
• Mulberry-like stomatitis + pulmonary + adrenal involvement
• Itraconazole 6-12 mo or AmB for severe; TMP-SMX alternative

248.2.0.2 必背 — Talaromycosis

• Talaromyces marneffei (formerly P. marneffei)
• SE Asia (Vietnam, Thailand, S China)
• Bamboo rats reservoir
• HIV CD4 < 100 primary
• Umbilicated skin papules (mimics molluscum) — pathognomonic
• Disseminated: fever + hepatosplenomegaly + pancytopenia + skin lesions
• Treatment: liposomal AmB 2 wk + itraconazole 10 wk + maintenance (until CD4 recovery)
• Anti-IFN-γ autoantibodies in adult-onset immunodeficiency (some)

248.2.0.3 必背 — Histology Differentiation

• Paracoccidioides: multiple budding “pilot wheel”
• Talaromyces: yeast with central septum (fission)
• Histoplasma: small intracellular yeast in macrophages
• Blastomyces: broad-based budding yeast
• Cryptococcus: encapsulated yeast (India ink)

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