A resident of a village near the Kanha National Park who had a small farm which had sheep, goats, buffaloes, horses and dogs. He had diffuse abdominal pain since six weeks, not responding to antacids or antispasmodic drugs. CT scan abdomen is shown in the following slide. Fluid was aspirated and the following structures were seen in multiple fields upon direct microscopy. What is the likely bug and its drug?

•A group of tourists was exploring the jungle; they also went for a dive in the seawater. One of them slipped in the water and hurt her hand on a rock. She developed progressively worsening lesions on that hand, as shown in the picture. She developed high grade fever with chills the very next day. Urgent debridement was done and advice regarding treatment was sought.

•What is the likely bug and its drug?

•A villager living in the outskirts of the forest near a riverbank, presented with complaints of low grade fever for the last two months with weight loss and decreased appetite. On examination he had hepatosplenomegaly. CBC showed pancytopenia, and to explore this a bone marrow biopsy was performed, which showed the following picture.

•What is the likely condition and its drug?

•An HIV positive patient presented with high grade fever and headache for three days followed by progressively worsening altered level of consciousness. Lumbar puncture revealed thick, purulent cerebrospinal fluid. CSF findings included highly elevated TLC with >90% neutrophils, high protein and very low glucose levels. Microscopy revealed the following picture.

•What is the likely bug & its treatment drug?

•A local farmer who works in field near lake barefooted complaints of an abscess in right foot since 2 months that is draining pus persistently. Pus was sent for culture that is showing growth of gram negative rods which is oxidase positive as shown in picture.

•Identify the bug & drug.

•A farmer near the Daintree forest was sick with a history of fever and productive cough for three weeks, for which he had taken amoxicillin clavulanate empirically for 2 weeks. Symptoms did not resolve, and chest X ray showed cavitatory pneumonia. He was now also having hemoptysis. Sputum microscopy showed intracellular organisms that were coccoid and some elongated/club shaped. They were weakly acid fast and MTB geneXpert was negative. Sputum culture yielded growth of colonies that were initially cream colored but developed a pigment in 3-4 days.

•What is the likely bug and its drug?

•The Forest Keeper at the Rainforest park had developed a firm nodule on his right hand, that eventually ulcerated. He recalled having a thorn prick at the site of lesion about two months ago. He then developed another lesion on his right forearm. There was an enlarged axillary lymph node on examination. There was no fever, chills or other constitutional symptoms. The lesion did not respond to topical or systemic antibiotics, nor to topical steroids. Bacterial, AFB and fungal cultures were sent. Fungal culture at 25 degrees yielded filamentous growth while that at 37 degrees yielded yeast like colonies.

•What is the likely bug and drug?

•We encountered a traveler with an abscess under his big toe and multiple ulcers around it. He informed us that this condition started as a localized swelling with a black dot in the centre and was progressively increasing in size. Initially he didn't notice the lesion, but with the passage of time it worsened and multiple abscesses and necrotic ulcers developed. Incision and drainage was done. Culture of abscess resulted in growth of Staphylococcus aureus.

•Identify the disease and its treatment.

50 years old gentleman who is an agricultural laborer by profession presented with complaints of fever, cough and shortness of breath since 2 months. he was in frequent contact with numerous domestic animals, livestock and fresh water sources. 2 weeks back he developed some facial lesion involving perioral skin and mucosa as shown in picture. Biopsy was taken from lesion which is shown in picture. What is the likely bug & drug?

•Our tour guide for the forest while showing us some white tailed deer told us that he was a substitute for the previous tour guide who was currently at home suffering from an acute febrile illness. We went to see him and found out that he was a known case of Celiac disease. He was suffering from high grade fever with chills and body aches, and on examination was found to be pale and icteric with periorbital puffiness. Please see the peripheral smear.

•What is the likely bug and drug?

•A tourist who has been camping in forest for the past 10 days developed high grade fever, myalgia and headache. He is alcoholic and IV drug abuser. On examination he has generalized macular rash on body that started from palms and soles . On close examination he has a blackish lesion on his right arm that is there since 10 days as evident in picture.

•What is the likely bug & its treatment drug?

•A group of hunters who recently had undercooked bear meat started complaining of fever and body aches. Some hunters also had facial puffiness and/or periorbital edema. All the hunters had a history of diarrhea with or without abdominal pain one week prior to these symptoms. CBC showed eosinophilia. One hunter eventually developed severe myalgias and seizures. His muscle biopsy is shown to you.

•What is the likely bug and its drug?

•A fisherman presented to us with complaints of abdominal pain and noticed red colored urine since a few weeks. Urine examination showed hematuria and some parasite eggs as shown in the picture.

•What is the likely bug and its drug?

•A renowned Japanese ornithologist returning from the US, where he was invited to investigate a recent acute increase in bird deaths  developed fever, nausea, vomiting and fatigue one week after his return. Today while walking in the forest he developed sudden weakness in both lower limbs and was rushed to the emergency. After initial investigations were reported as normal, he was sent for an MRI. It showed the following picture.

•What is the likely bug and its drug?