A 32-year-old man presents with high-grade fever, headache, and generalized lymphadenopathy. He recently returned from a forest trek in the Nilgiris. Examination reveals a painless ulcer with a black necrotic centre and an erythematous rim on the anterior abdominal wall. Rickettsial serology is positive. Which is the drug of choice?

• A Azithromycin
• B Metronidazole
• C Ciprofloxacin
• D Doxycycline ✓

Explanation

The eschar with febrile illness after scrub exposure in an endemic region is classic for scrub typhus caused by Orientia tsutsugamushi. Doxycycline is the drug of choice for rickettsial infections. Azithromycin is reserved for pregnancy and doxycycline allergy. Ciprofloxacin has unreliable rickettsial coverage. Metronidazole has zero activity against intracellular organisms.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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