236.4 📌 章末速記

5 species human:
- S. mansoni (Africa + Latin America) — hepatic + intestinal; lateral spine egg
- S. japonicum + mekongi (E Asia) — hepatic + intestinal; round small knob egg
- S. haematobium (Africa + Mid East) — urinary + bladder SCC; terminal spine egg
Snail intermediate host → cercariae penetrate skin in freshwater
3 stages: cercarial dermatitis → Katayama fever (acute, eosinophilia) → chronic complications
Hepatic: Symmers’ pipe-stem fibrosis + portal HTN + variceal bleeding + LFTs preserved
Urinary: hematuria + bladder calcifications + SCC bladder
Neuroschistosomiasis: epilepsy + transverse myelitis (S. japonicum > others)
Diagnosis: stool / urine O+P + serology + eosinophilia + US
Treatment: Praziquantel 40 mg/kg single dose (mansoni, haematobium); 60 mg/kg (japonicum, mekongi); 85-95% cure
MDA programs annual for endemic

Fasciola hepatica: watercress + cattle; biliary; triclabendazole
Clonorchis + Opisthorchis: undercooked freshwater fish (Asia); biliary + cholangiocarcinoma (WHO Group 1); praziquantel
Paragonimus: freshwater crab/crayfish; lung (cough + hemoptysis mimics TB); praziquantel
Heterophyes / Metagonimus: undercooked fish; intestinal; praziquantel

Schistosoma + most trematodes: Praziquantel
Fasciola only: Triclabendazole
盧醫師 hint: Africa traveler / immigrant + hematuria → S. haematobium; eosinophilia + recent travel + freshwater swim → schistosomiasis workup