239.4 📌 章末速蚘

239.4.0.0.1 Lymphatic Filariasis
  • Wuchereria bancrofti + Brugia (mosquito); Africa, Asia, Pacific
  • Lymphedema + elephantiasis + hydrocele
  • TPE (hyperreactive form, S Asia)
  • Nocturnal blood microfilariae + CFA ICT
  • MDA: albendazole + ivermectin (Africa); albendazole + DEC (Asia); triple IDA
  • Doxycycline targets Wolbachia → kills adult worms
239.4.0.0.2 Onchocerciasis (“River Blindness”)
  • Onchocerca volvulus (Simulium black fly); sub-Saharan Africa
  • Skin disease + nodules + eye disease (visual loss)
  • Skin snip + slit-lamp diagnostic
  • Ivermectin annual (kills MF, not adults; Mectizan Donation Program free)
  • Doxycycline × 6 wk kills Wolbachia → adult worms die
  • Combination for individual treatment
  • Loa loa pre-screening before MDA in Central Africa
239.4.0.0.3 Loiasis
  • Loa loa (Chrysops deer fly); W + C African rainforest
  • Visible eye worm + Calabar swellings + daytime microfilaremia
  • Daytime periodicity (Chrysops daytime biter)
  • DEC treatment with CAUTION for high MF load (> 8000 MF/mL = Mazzotti encephalopathy)
  • Pre-treatment albendazole + apheresis for high MF load
  • No routine MDA (encephalopathy risk)
239.4.0.0.4 Wolbachia Endosymbiont
  • Bacterial endosymbiont of most filariae
  • Doxycycline targets → kills adult worms over months
  • Major treatment target
239.4.0.0.5 MDA Elimination
  • WHO + Mectizan Donation Program + Carter Center
  • LF + onchocerciasis 2030 elimination goals
  • Major public health success
  • Implementation challenges in Loa loa coendemic areas
239.4.0.0.6 盧醫垫 hint
  • Tropical Africa returnee + eye worm / Calabar swellings → Loiasis (pre-treatment MF count critical)
  • Visual loss in patient from sub-Saharan Africa → onchocerciasis workup
  • Lymphedema in tropical region resident → filariasis workup
  • Eosinophilia + nocturnal asthma + S Asian origin → TPE → respond to DEC