Aim: To identify scrub typhus infections and study their clinical manifestations, trend, outcome and the role of hypoalbuminemia as a predictor of complications for all confirmed cases admitted to a tertiary care hospital in Rural Bangalore. Materials and Methods: All cases of febrile illness diagnosed as scrub typhus based on a Weil-felix cut-off of >1:320 or a starting titre of 1:80 with a four-fold rising titre. Results: 63 cases of scrub typhus were seen over a period of 18 months (November 2015 to April 2017). Most of the cases occurred between November and January (83.3%). Common symptoms were high grade fever of 7-14 days duration, myalgia, headache, cough, vomiting and abdominal pain. Rash was seen in 31.7% cases and eschar in only 4.7% cases. Leucocytosis was seen in majority of cases79.1% and thrombocytopenia in 63.4%. Liver enzymes were elevated in 77.7%. Complications like Meningoen cephalitis in 4.7%, non-oliguric ARF in 12.6%,pleural effusion in 7.9%, acalculous cholecystitis in 3.1% and acute liver cell failure in 1.5%.Hypoalbuminemiais a powerful predictor of complications like acute renal failure, meningoencephalitis and acute cholecystitis in patients with Scrub typhus in our study. There was a dramatic response to doxycycline in nearly all the patients. Conclusion: Scrub Typhus is a re-emerging infection in India and is difficult to diagnose because of nonspecific signs, nonspecific symptoms and nonspecific presentation and the classical eschar is rarely seen. Complications of scrub typhus were significantly higher in patients with hypoalbuminemia as compared to normoalbuminemia. Doxycycline is very effective in scrub typhus, as most of our cases responded to it.

Renal transplantation has been an ever advancing field due to the improvements that have happened in the last decade, illustrating a few like, unleashing the barriers in transplant immunology, advances in induction and maintenance immunosuppression, advances in surgical techniques, so on and so forth. This article highlights the recent advances in renal transplantation.

Pulmonary embolism (PE) and Acute coronary syndrome (ACS) are both life threatening conditions. The ECG as much as it has great utility, unfortunately lacks sensitivity and specificity, providing findings that might serve as red herrings to the unsuspecting physician by suggesting an alternative diagnosis. We report a case of 65 year old male patient, who presented with chest pain and breathlessness and the ECG showed ST-T segment changes suggestive of ACS, but eventually was found to have a sub-massive PE.

We report a case of middle aged male who presented with swelling of the neck since 2 months and shortness of breath since 1 month without any antecedent illness. Clinical examination was suggestive of diffuse neck swelling with left massive pleural effusion. USG neck revealed bilateral IJV thrombosis with diffuse neck cellulitis. Chest x-ray PA view showed homogenous opacity in the left upper and lower zone with obliteration of the costophrenic angle suggestive of left massive pleural effusion. CECT neck was done which suggested thrombosis of bilateral IJV with subcutaneous oedema with fat stranding noted in the neck with loculated abscess. CECT thorax revealed left massive pleural effusion with passive atelactasis of left lung. Pleural fluid cytology was suggestive of lymphoproliferative disorder. He was initially treated with antibiotics and anticoagulants. Patient was later referred to Oncology department for further management. Conclusion: Bilateral IJV thrombosis is a rare condition and also life threatening. It has been associated with various etiologies especially malignancies. Thus the diagnosis of bilateral IJV thrombosis needs extensive workup for any internal malignancies. As early detection and appropriate management can be lifesaving.

A myocardial infarction mimicker by ECG can cause diagnostic dilemma. A case of aluminium phosphide poisoning is described in an young man who developed an ST elevation myocardial infarction pattern.

The presence of right heart thrombus complicating pulmonary thromboemboli carries with it an increased mortality rate compared to pulmonary thromboemboli alone, but little is known about the optimal management of this difficult clinical situation. We report a case of bilateral pulmonary thrombo -embolism with right heart thrombi treated successfully by thrombolysis with streptokinase.

Tuberculosis is a disease affecting many persons around the world, especially those living in developing and under developed nations and associated with high percentage of morbidity and mortality making it a disease of Public Health importance. It affects many organs of the body. For many years, sputum microscopic examination, culture and X - ray are the good old cost-effective methods used to diagnose Tuberculosis. Though it appears simple, some times it is challenging even to the most experienced physician as well as a laboratory personnel. Limitations of microscopic diagnosis of tuberculosis includes :

1. It requires trained personnel and
2. requires the bacteria to be present in good numbers (5000 - 10000 per ml of sputum). Under this situation, quality of the sputum must be of good quality. But many a time, instead of sputum, the sample would have more saliva.
3. Conventional Culture method has been replaced by newer methods mainly to reduce the cultivation time. In addition, the newer methods are also providing testing opportunities for understanding drug resistance among mycobacteria.

This has lead to the development of better techniques that includes simple modification method using Auramine as a fluorescent dye and LED bulb to give better illumination and also to excite the fluorescent dye to make things visible. In addition, there have been improvements in culture techniques. During the long association of these bacteriawith man, the bacteria have developed drug resistance (MDR-TB and XDR-TB). To address this problem, scientific development is also going hand in hand with the development of newer diagnostics, which includes, development of nucleic acid detection tests. Additional diagnostic needs have come from the need for better understanding of the organism such as speciation, detection of the organism in various body fluids, etc. All these tests require proper development of quality assessment tools to maintain the quality of the laboratory. This article describes the various diagnostic tools used in Mycobacteriology