20 years old boy diagnosed as case of un-complicated malaria on MP smear which had trophozoites of P. falciparum and MP ICT was positive for P. falciparum. You treated this patient with arthemeter-lumefantrine. On therapy he became afebrile MP smear was repeated after 3 days which is again positive and has gametocytes of P. falciparum. What would you do now?

•A tertiary care center in Peshawar has been reporting several cases of sepsis in the ICU due to an unidentifiable yeast. On the other hand, patients were dying, not responding to fluconazole.

•They sent a culture of the yeast to another laboratory, where it was identified as Rhodoturola, Candida haemulonii, and Candida famata on different systems.

•Susceptibility testing showed that the organism had higher MICs to azoles and amphotericin. The only antifungal it had lower MICs with was caspofungin. What do you think is the likely organism?

A 70 year old male was admitted in the CCU of a tertiary care hospital. He has a Foley's catheter, central line and ventilator in place. He started spiking fever and pan cultures were sent. He was started on I/V meropenem and vancomycin. Blood and tracheal aspirate cultures were negative, urine culture showed growth of Klebsiella pneumoniae which was found to be resistant to meropenem. Which enzyme/gene do you think is involved in this resistance, and how will you treat it?

A 61 year old female from the community presented to the ER with high grade fever, cough and shortness of breath. Chest X ray showed lobar pneumonia. Culture of sputum was sent, and gram stain showed that it was a good quality sample with numerous pus cells. Intracellular diplococci were present in the neutrophils. Which organism/antibiotic combination do you think is most appropriate here?

25 year old male status post aortic valve replacement 6 months ago presented with history of low grade fever for a month along with lethargy. Suspecting endocarditis, three blood cultures collected in an hour were sent, two of which were positive for gram positive cocci in clusters, later identified as Staphylococcus aureus, resistant to methicillin. How would you treat this patient?

•An asymptomatic patient came to us who had a history of syphilis 2 and a half years ago and self medicated with some antibiotic he can't recall now. His friends had scared him about improper treatment and reactivation of the disease, so he had himself retested and got the following results: RPR: negative, TPHA: positive. What stage of syphilis do you think he is in and which treatment should be offered?

•A 40 yr old man with poorly controlled diabetes mellitus presented with intermittent low grade fever and recurrent multiple draining sinuses on his back during the previous four years.

•CT chest: left paraspinal collection with bony erosions.

•Antituberculous treatment: 9 months, no improvement and new abscess in axilla

•6 kg weight loss during the previous two months

•Blood cultures grew gram negative bacilli with shiny colonies on MacConkey agar

•Pus culture was sterile, no granules or debris observed

•What is the likely diagnosis?

•40 years old non-pregnant lady presented 1 month back to a local GP with fever & chills. Malarial Parasite was positive. Started on anti-malarials, to which she responded well and became afebrile.

•Urine CS showed >100,000 cfu/mL of E. coli that was sensitive to ciprofloxacin, ceftriaxone, nitrofurantoin, fosfomycin, imipenem, amikacin. Rx: P/O ciprofloxacin 5 days.

•Urine culture was repeated a week later: >100,000 cfu/mL E. coli with same sensitivity. Rx: Ciprofloxacin was given for 10 days. Patient: afebrile, no urinary complaints.

•3rd urine culture: E coli, resistant to Ciprofloxacin, urine DR: numerous pus cells.

•What would you do?

A 21 year old member of a scientific team on expedition had developed ear discharge and didn't notify anyone. 2 weeks later, he started complaining of unilateral weakness and low grade fever. The medical team over there diagnosed a brain abscess, and decided to start him on antibiotics then send him back. Which antibiotics should be started?

•50 years old gentleman presented with a two-week history of fevers, which were initially intermittent but progressed to daily fevers with chills. He reported a weight loss of more than 18 kilograms over six months, with gradually worsening fatigue and malaise, but no night sweats. Had massive splenomegaly with moderate hepatomegaly

•Labs show pancytopenia, HIV tested positive with CD4 count of 54/mm3

•Bone marrow aspirate is shown

•What is the likely diagnosis?

•A middle aged female had history of high grade fever since 5 days, tests for dengue and malaria along with a blood culture were ordered to identify the cause. Her dengue antigen results came positive, as did the blood culture after two days.

•This is the blood culture report: Coagulase negative Staphyloccus epidermidis, sensitive to clindamycin, erythromycin, vancomycin, trimethoprim-sulfamethoxazole. How will you treat this patient?

A family had COVID in January 2021. They now want to know if they can get vaccinated, and if any vaccine should be avoided. The 70 year old grandfather is diabetic, hypertensive, has ischemic heart disease and bedridden. The mother is expecting again. Which of the family members can be vaccinated safely?

•An elderly female on immunosuppressive therapy (for psoriatic arthritis- 10 months) presented with cough, dyspnea, malaise and low grade fever for two weeks.

•CXR: bilateral interstitial infiltrates

•Bronchoalveolar lavage was done, microscopy of which showed the following:

•A 64 year old male had a history of episodes of high grade fever and lower back pain for 3 weeks. MRI spine showed discitis L4-L5, with epidural abscess. There was no contact or prior history of tuberculosis, IGRA was negative. CT guided pus aspiration was done and sent with blood cultures to the microbiology laboratory. Blood culture became positive after the 5th day of incubation, gram stain showed gram negative coccobacilli. These were catalase and oxidase positive. A test done for urease turned positive in two hours. What is the most appropriate bug and drug?

•A patient presented to the ER with a positive COVID PCR and a history of fever, shortness of breath, SaO2 85% on room air, and bilateral peripheral infiltrates (>50%). A local GP had started him on amoxicillin clavulanate, azithromycin and levofloxacin two days ago. What changes would you make to the antibiotic treatment?