Leishmaniasis — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsLeishmaniasisSCE Infectious Diseases

A patient has a large monoarthritis of the knee, positive two-tier Lyme serology and epidemiologically credible tick exposure. There is no neurological or cardiac disease. Which first-line oral course follows NICE?

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Correct answer: B — Doxycycline 200 mg daily for 28 days

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

C is correct. Lyme arthritis requires a longer course than erythema migrans or stable carditis: NICE recommends doxycycline for 28 days, with amoxicillin 1 g three times daily for 28 days as an alternative and ceftriaxone 2 g daily for 28 days as a further option. The shorter oral courses are insufficient, while six weeks of parenteral therapy is excessive. Synovial-fluid evaluation may still be necessary to exclude septic or crystal arthritis; a positive serology alone should not override an incompatible clinical context.

Reference: NICE NG95: Lyme disease recommendations: https://www.nice.org.uk/guidance/ng95/chapter/Recommendations