An 18-year-old soldier stationed in a high-altitude border post presents with 6 days of sustained high fever, severe headache, and a macular rash that began on the trunk and spread centrifugally to the limbs while sparing the face. He reports heavy infestation with body lice in his barracks. The most likely diagnosis is:
- A Murine typhus
- B Scrub typhus
- C Epidemic typhus ✓
- D Rickettsialpox
Correct answer: C. Epidemic typhus
Explanation
Rickettsia prowazekii causes epidemic typhus, transmitted by the human body louse Pediculus humanus corporis. The classic rash starts on the trunk and spreads to the extremities, characteristically sparing the face, palms and soles. Murine typhus (Rickettsia typhi) spreads centripetally from the abdomen toward the trunk and is flea-borne. Scrub typhus features an eschar at the chigger bite site. Rickettsialpox produces a vesicular rash and is mite-borne.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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