226.4 📌 章末速蚘

  • 4 categories: protozoa, trematodes, cestodes, nematodes
  • When to suspect: travel / immigration / immunocompromise / eosinophilia / chronic GI / hepatosplenic / atypical
  • Diagnosis: O+P × 3 + smears + serology + PCR + imaging + biopsy
  • Eosinophilia = tissue / helminth invasion clue
  • Anti-malarials: ACT first-line; IV artesunate severe; chloroquine vivax/ovale; primaquine/tafenoquine radical cure (G6PD test); Malarone/doxy/mefloquine prophylaxis
  • Antiprotozoals: metronidazole, nitazoxanide, pentavalent antimony, liposomal AmB, miltefosine, paromomycin, TMP-SMX, sulfadiazine+pyrimethamine
  • Anti-helminthics: albendazole, ivermectin, praziquantel, niclosamide, triclabendazole, DEC
  • MDA programs: LF, onchocerciasis, STH, schistosomiasis
  • Pre-treatment screening: G6PD (primaquine/tafenoquine), Loa loa (DEC), Strongyloides (pre-immunosuppression)
  • Pregnancy: most agents 1st trim avoid; praziquantel + chloroquine safer
  • 2024 updates: Tafenoquine single dose, acoziborole single dose for African Trypanosomiasis
  • 盧醫垫 hint: 旅遊 returnee + chronic symptoms + eosinophilia → 必 parasite workup; immunocompromise + endemic country origin → Strongyloides screen