229.4 📌 章末速蚘

  • Leishmania: sandfly-borne intracellular protozoan
  • 4 Forms:
    1. CL (cutaneous “Oriental sore”) — Old World mild; New World L. braziliensis can progress
    2. MCL (espundia) — mucosal destruction; Latin America
    3. VL (kala-azar) — fatal untreated (95%+); fever + massive splenomegaly + pancytopenia + hyperpigmentation
    4. PKDL (post-kala-azar dermal) — after VL Tx; reservoir
  • Vector: sandfly (Phlebotomus / Lutzomyia); fine-mesh nets needed
  • VL species: L. donovani (India + Africa), L. infantum / chagasi (Mediterranean + Latin America)
  • VL diagnosis: rK39 rapid test + bone marrow aspirate + amastigotes Giemsa + PCR
  • VL treatment:
    • Liposomal AmB preferred (single 10 mg/kg dose for Indian VL)
    • Miltefosine oral (teratogenic, pregnancy contraindicated)
    • Pentavalent antimony (cardiac toxicity, India resistance increasing)
  • CL treatment: many self-limit; pentavalent antimony / liposomal AmB / miltefosine for severe / New World
  • MCL treatment: systemic antimony or liposomal AmB
  • HIV + VL: more severe + relapsing; liposomal AmB longer + maintenance
  • WHO 2030 VL elimination — India near; Africa ongoing
  • 盧醫垫 hint: 移民 / 旅遊 endemic + 慢性 fever + splenomegaly + 党血球 ↓ → VL workup (rK39 + marrow)