Melioidosis — DTM&H MCQ

Correct answer: B — Intravenous ceftazidime or meropenem then eradication therapy

The correct answer is B, intravenous ceftazidime or meropenem then eradication therapy, because this vignette describes melioidosis (Burkholderia pseudomallei infection), a disease strongly associated with monsoonal flooding, soil and water exposure in northern Australia and Southeast Asia, and with diabetes as the dominant host risk factor. The combination of severe pneumonia and multiple small abscesses in the liver and spleen reflects haematogenous dissemination, a hallmark of severe melioidosis. Current guidance mandates an intensive intravenous phase with ceftazidime or a carbapenem for at least 10 to 14 days to control the acute sepsis, followed by a prolonged oral eradication phase (typically co-trimoxazole) for several months to prevent relapse, because the organism can persist intracellularly. Missing either phase risks treatment failure or recurrence, which is why the answer specifies both components rather than a single short course. Why the other options are wrong: E. Praziquantel: this treats trematode and cestode infections such as schistosomiasis or liver flukes, not a bacterial infection with no evidence of parasitic exposure here. D. Metronidazole: effective against anaerobes and amoebae (for example amoebic liver abscess), but Burkholderia pseudomallei is an aerobic Gram-negative bacillus intrinsically resistant to metronidazole. C. Chloroquine: an antimalarial with no activity against bacterial pathogens; malaria does not produce multiple visceral abscesses in this pattern. A. Oral amoxicillin alone: inadequate for severe, disseminated melioidosis; oral agents alone risk treatment failure in the acute septic phase, and amoxicillin without clavulanate lacks reliable activity against this organism's inducible beta-lactamase. Key point: severe pneumonia with multifocal hepatosplenic abscesses in a diabetic after monsoon flooding in northern Australia is classic for melioidosis, requiring IV ceftazidime or meropenem followed by prolonged oral eradication therapy.

Reference: UKHSA, Management of Melioidosis (clinical guidance), UKHSA Research Portal: intensive intravenous ceftazidime or carbapenem for at least 10-14 days followed by prolonged oral eradication therapy, https://researchportal.ukhsa.gov.uk/en/publications/management-of-melioidosis/