A 24-year-old trekker returns from Uttarakhand with five days of high fever, severe myalgia, an eschar over his ankle and diffuse lymphadenopathy. Platelet count is 88,000/mm3. Which single agent is the treatment of choice?

• A Azithromycin 500 mg daily for 5 days
• B Gentamicin 5 mg/kg once daily for 7 days
• C Metronidazole 400 mg thrice daily for 7 days
• D Doxycycline 100 mg twice daily for 7 days ✓

Explanation

An eschar with fever, thrombocytopenia and lymphadenopathy after rural exposure is scrub typhus due to Orientia tsutsugamushi, an obligate intracellular rickettsial organism. Doxycycline is the time-honored drug of choice and defervescence typically occurs within 24 to 48 hours. Azithromycin is a second-line alternative in pregnancy or doxycycline intolerance, while metronidazole and gentamicin have no activity against intracellular rickettsiae.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.