Rickettsial infections are caused by bacteria of the Rickettsiae family. Several reports in the past decade indicated the presence of disease in various parts of India. We reviewed the rickettsial outbreaks to describe the epidemiology, clinical features, laboratory investigations, entomological investigations, risk factors and treatment. We searched the literature about rickettsial diseases outbreaks in India using web databases. We included research papers about the investigation of rickettsial disease outbreaks during 2000-2011. We included 11 outbreaks from seven Indian states of which four were in a community setting rest were hospital based. There were more than 900 cases and forty two deaths with case fatality ratios 5%-17%. The clinical manifestations were fever, eschar, headache, myalgia, cough and lymphadenopathy. The laboratory diagnosis in 9 outbreaks was based on Weil Felix test either singly (n = 5) or in combination with Micro-immunofluorescence (n = 2) or ELISA (n = 2). Only IgM ELISA was used in 2 outbreaks. Only one of the outbreaks was due to Indian Tick Typhus while the remaining 10 were due to Scrub Typhus. Risk factor and entomological investigations were conducted in few studies. The review of rickettsial outbreaks in the last decade indicates its continued presence in several parts of the India. We recommend use of uniform case definition, capacity building for laboratory confirmation and entomology surveys. Doctors practicing in areas prone to these diseases need to be sensitized to have high index of suspicion while evaluating patients with fever and community should be educated to seek early treatment.

Background: The diagnosis of extrapulmonary lymph node tuberculosis (TB) is made by the demonstration of different cytomorphological tissue reaction patterns on fine needle aspirations (FNA) smears; however, definitive diagnosis is made by demonstration of AFB by culture or Ziehl-Neelsen (ZN) stained smears. This procedure is technically demanding and time consuming, and is liable to fail on occasion for unexplained reasons. If the identification of cytomorphological patterns could predict bacterial density, it would help to improve diagnostic accuracy and also serve as a control on the acid-fast staining procedure. Therefore this study was being undertaken to determine the correlation between bacterial density and cytomorphological patterns in lymph node TB. Materials and Methods: FNA was performed on 505 clinically-suspected lymph node TB patients. May Grunwald Giemsa stained smears were used to analyze cytomorphological patterns and ZN stained smears for acid-fast bacilli (AFB) detection. Bacterial density (BI) was calculated by utilizing Ridley's logarithmic scale. Results: Seven distinct cytomorphological tissue reaction patterns were observed. Pattern 1 was predominantly an exudative response, comprising of neutrophils and mononuclear phagocytes and was the most common tissue reaction pattern, seen in 160 out of 505 patients (31.6%). Pattern 4, epithelioid cell granulomas with necrosis, was the second most common and seen in patients (29.3%). This study showed that multibacillary lesion (BI>1) was more often associated with pattern 1. Although the BI varied significantly across different cytomorphological tissue reaction patterns (P value = 0.004), no specific trend was observed as both paucibacillary as well as multibacillary lesions were noticed with different proportions among all tissue reaction patterns. Conclusion: The present study showed that multibacillary disease is more frequently associated with pattern 1 compared to pattern 4. However, more studies are needed to establish a trend among different cytomorphological tissue reaction patterns.

Melioidosis, also known as Whitmore disease, is caused by the bacterium Burkholderia pseudomallei, a motile, aerobic, non-spore-forming bacillus. The bacterium is known to thrive in tropical climates. However, the worldwide incidence of the disease appears to be increasing as a result of increased travel and epidemiological sophistication. ^[1] We report two patients who were diagnosed to have melioidosis, and the challenges faced in treating them.

Malaria is a vector-borne disease transmitted by the bite of an infected female anopheles mosquito presents with varied clinical manifestations. Neurological manifestations include headaches, confusion, convulsions, hemiplegia, ataxia, cerebral palsy, cortical blindness, and Guillain-Barre syndrome (GBS). We are presenting a case report of acute cerebellar ataxia in a 20-year-old male patient who presented with fever and positive for Plasmodium vivax and Plasmodium falciparum malaria antibodies.