240.4 📌 章末速蚘

240.4.0.0.1 Trichinellosis
  • Undercooked pork / wild game (bear, boar); T. spiralis + others (T. nativa Arctic freeze-resistant!)
  • 3 phases: intestinal → muscle invasion (fever + myalgia + periorbital edema + eosinophilia + ↑ CK) → convalescent
  • Myocarditis = main cause of death
  • Albendazole 400 bid × 8-14 d + prednisolone for severe
  • Prevention: cook pork to 145°F + freeze pork (not wild game)
240.4.0.0.2 Anisakis
  • Raw saltwater fish (sushi)
  • Acute gastric / intestinal + IgE allergic
  • Endoscopic removal definitive
  • FDA freezing -20°C × 7 d for raw fish service
240.4.0.0.3 Gnathostoma
  • Raw freshwater fish (Asia)
  • Migratory subcutaneous swellings + CNS + eye + eosinophilia
  • Albendazole + ivermectin
240.4.0.0.4 Angiostrongylus
  • Slug / snail / produce in Hawaii + Caribbean + SE Asia
  • Eosinophilic meningitis
  • Supportive + steroid; albendazole controversial
240.4.0.0.5 Toxocara
  • Dog / cat parasite; soil exposure
  • VLM + OLM in pediatric
  • Albendazole + steroid
240.4.0.0.6 Capillaria philippinensis
  • Raw freshwater fish (Asia)
  • Watery diarrhea + malabsorption; fatal untreated
  • Albendazole
240.4.0.0.7 Dirofilaria
  • Mosquito + dog parasite
  • Pulmonary coin lesion (mimics CA)
  • Surgical resection
240.4.0.0.8 Dracunculus (Guinea Worm)
  • WHO eradication near (< 30 cases/yr 2024)
  • No drug; slow extraction
  • Water filtration
240.4.0.0.9 Eosinophilia Workup
  • Returning traveler / immigrant: Strongyloides, Schistosoma, Filariae, Trichinella, Toxocara, others
  • Comprehensive history + multiple tests
240.4.0.0.10 盧醫垫 hint
  • 旅遊 / 移民 + GI + fever + myalgia + periorbital edema + eosinophilia → Trichinella + pork/game hx
  • Sushi consumption + acute epigastric pain → Anisakis (endoscopy)
  • 旅遊 Hawaii / Caribbean + headache + neck stiffness + CSF eosinophilia → Angiostrongylus
  • Adult-onset eosinophilia + visceral / ocular sx + travel hx → broad parasitic workup