The results of recent clinical trials using novel immunotherapy strategies such as immune checkpoint blockade and adoptive T-cell therapy approaches including CAR T-cell therapy have clearly established immunotherapy as an important modality for the treatment of cancer besides the traditional approaches of surgery, radiotherapy, and chemotherapy or targeted therapy. However, to date immunotherapy has been shown to induce durable clinical benefit in only a fraction of the patients. The use of combination strategies is likely to increase the number of patients that might benefit from immunotherapy. Indeed, over the last decade, the characterization of multiple immune resistance mechanisms used by the tumor to evade the immune system and the development of agents that target those mechanisms has generated a lot of enthusiasm for cancer immunotherapy. But a critical issue is to determine how best to combine such agents. This review will focus on novel immunotherapy agents currently in development and discuss strategies to develop and personalize combination cancer immunotherapy strategies.

Scrub typhus is a potentially fatal infectious disease caused by Orientia tsutsugamushi. We report on a retrospective analysis of clinical manifestations, lab investigations and outcome of patients admitted to our hospital from January 2009 to December 2009 with scrub typhus. The Weil-Felix test was the serological method used to diagnose scrub typhus. A total of 29 patients were diagnosed with scrub typhus and the majority of them presented with fever (100%), headache (51%), myalgia (51%) and gastrointestinal symptoms (44%) as predominant features. Six patients (20%) presented with altered sensorium and signs of meningial irritation. There is an emergence of rickettsial infection in southern India, posing diagnostic difficulty and delay in treatment. Early diagnosis and treatment are important as it prevents serious complications associated with the disease.

In countries like India, where brucellosis and tuberculosis are endemic; rapid, sensitive and highly specific diagnostic methods are required to make early diagnosis and prevent resistance as there is an overlap in therapy.

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