249.2 📚 國考版

249.2.0.1 必背 — Sporotrichosis

• Sporothrix schenckii complex; “rose gardener’s disease”
• Traumatic inoculation (rose thorn, sphagnum moss, cats — Brazil epidemic)
• Lymphocutaneous pattern (multiple nodules in lymphatic chain)
• Asteroid body (Splendore-Hoeppli reaction)
• Treatment: itraconazole 200 mg bid × 3-6 mo; potassium iodide alternative; AmB severe

249.2.0.2 必背 — Chromoblastomycosis

• Dematiaceous (pigmented) fungi: Fonsecaea, Cladophialophora
• Tropical
• Traumatic inoculation → verrucous cauliflower-like skin lesions
• Sclerotic bodies / Medlar bodies / muriform cells on histology — pathognomonic
• Treatment: itraconazole + terbinafine combination × months-years; cryotherapy; surgery

249.2.0.3 必背 — Mycetoma

• Triad: tumor + sinus tracts + grains
• “Madura foot”
• 2 categories:
  • Eumycetoma (true fungi — Madurella; black grains): itraconazole + surgery
  • Actinomycetoma (filamentous bacteria — Nocardia; white/yellow/red grains): TMP-SMX + dapsone / rifampin

249.2.0.4 必背 — Histology Pathognomonic Findings

• Sporothrix: asteroid body + cigar-shaped yeast
• Chromoblastomycosis: sclerotic / Medlar bodies / muriform cells
• Mycetoma: grains (color + composition by type)

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