Wasp sting is not an uncommon incident. Around 56% to 94% of the population is stung at least once in their lifetime by a member of the order Hymenoptera which includes wasps, bees, and ants. The response to a wasp sting may vary from mild local reaction to severe systemic and anaphylactic reactions. The clinical picture and mortality rate tend to be more severe in adults compared to children. We present a 32-year-old agricultural worker who was bitten by multiple wasps while on a coconut tree. In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis. However, a delayed reaction did occur within 48 h in the form of severe multi-organ dysfunction. There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize. This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.

Acute febrile illness (AFI), the initial diagnosis of whose cause is often presumptive, can sometimes be a challenge for the treating physician. To address this issue we carried out a hospital- based descriptive study. More than half (51.5%) of the patients were presumed to have viral fever. Most of the patients (60%) were in the productive phase of life (age range, 18-45 years). The outcome was worst among those aged over 65 years. A definite seasonal trend was observed with a peak in incidence with the arrival of the monsoon in Kerala. Public awareness regarding fevers in the pre-monsoon season should be heightened. Special care should be given to the elderly as they are often the most vulnerable. The use of the proposed locally based algorithm may avoid unnecessary investigations and treatment.

Background: Acute respiratory distress syndrome (ARDS) owing to leptospirosis is associated with a high mortality. This is in spite of mechanical ventilation in a critical care setting. ARDS by its very nature, asso ciated with economic constraints in our patients has made treating these patients a challenge. Objective: To study if combination of methylprednisolone and noninvasive ventilation is life-saving in ARDS owing to leptospirosis. Design: Interventional pilot study. Setting: Medical intensive care unit of a rural medical college hospital. Participants: Eight patients diagnosed to have ARDS owing to leptospirosis. Main out come indicator: Survival. Results: Seven out of eight patients who were treated with methylprednisolone and noninvasive ventilation recovered fully to resume normal life. Conclusion: Methylprednisolone with noninvasive ventilation is life-saving in ARDS owing to leptospirosis.

Objective Since 2005 there have been several reports of hepatitis B outbreak in the state of Kerala in southern India. Objective of this study was to analyze such outbreaks and to explore hypothesis pertaining the transmission mode. Methods Retrospective observational study involving cases of acute hepatitis B acquired between 1 January 2015 and 31 December 2015 and their family members residing in Mazhuvanoor village in Ernakulam district of Kerala State in southern India. Results 59 houses were included in the survey. The number of patients diagnosed to have acute viral hepatitis B was 59. Majority (66.10%) were over 50 years old. There were no cases below the age of 15 years. All 59 patients claimed to have been bitten frequently by a fly which was identified as “deer fly” belonging to the genus Chrysops. Conclusion Given the current understanding of mechanical transmission of pathogens in both humans and animals by insects belonging to the Tabanidae family which also includes Chrysops, it is plausible that the same mechanism may hold true for hepatitis B also. However this needs to be proven in further studies both at the laboratory level and at field studies.

Acute febrile illness with varied aetiology but similar symptoms is common in tropical countries. This prospective, multicentre study was conducted in selected centres in the province of Kerala in India principally to analyse the aetiology of acute febrile illnesses in adult patients over the course of one year. Overall, 1324 patients were included in the study. The most common cause was dengue in 576 patients (43.5%). In 396 (29.9%), the exact aetiology could not be identified. Other causes, in order, were leptospirosis, enteric fever, malaria, respiratory tract infection, urinary tract infection and typhus. When such a wide variation with a significant number of 'indeterminate' cases exists, especially in such a small area and with limited resources, the onus is on public health authorities to draw up an 'easy-to-use algorithm' to tackle epidemics of febrile illness, particularly in the monsoon season.