230.4 📌 章末速蚘

  • HAT (Sleeping Sickness): tsetse-borne protozoan; Trypanosoma brucei
  • 2 subspecies:
    • T. b. gambiense (W + C Africa, anthroponotic, slow chronic)
    • T. b. rhodesiense (E + S Africa, zoonotic cattle, acute fatal)
  • Vector: tsetse fly (Glossina)
  • 2 stages:
    • Stage 1 (Hemolymphatic): chancre + fever + LAP + Winterbottom’s sign (posterior cervical LAP)
    • Stage 2 (Meningoencephalitic): sleep cycle reversal + behavioral + movement + coma
  • Antigenic variation: Variant Surface Glycoprotein (VSG) switching = chronic relapsing
  • Diagnosis: CATT screening + blood/LN smears + CSF staging
  • Treatment 2024:
    • T. b. gambiense both stages: Fexinidazole oral 10 days
    • Acoziborole single-dose oral Phase 3 success 2024 (regulatory submission)
    • T. b. rhodesiense: Suramin (Stage 1) + Melarsoprol (Stage 2, arsenic, 5% encephalopathy)
  • WHO 2030 elimination T. b. gambiense as public health problem (near)
  • No vaccine (VSG variation)
  • Sleep cycle reversal = pathognomonic Stage 2
  • Post-treatment LP at 6 mo for cure confirmation
  • 盧醫垫 hint: African game park returnee + fever + neuro / LAP → HAT consideration