Chikungunya is an important mosquito borne arboviral disease causing periodic epidemics world over. India also faces the brunt of this disease every few years which is associated with acute as well as long term consequences. The burden of this disease has been ever increasing since the 2006 outbreak, the latest outbreak occurring in 2016. Chikungunya has been typically associated with fever, joint pains and rash but during the last few epidemics, lot of atypical presentations of this common disease occurred. It was thought to be a benign self- limiting disease but in recent time, severe disease with multi-organ involvement requiring intensive care and causing mortality have been reported from India and other countries, especially in patients with co-morbid illnesses. Many patients suffer from chronic consequences of this chronic inflammatory rheumatism lasting for years, affecting the quality of life and productivity of the affected population. This review highlights the epidemiology, the changing clinical spectrum, the available diagnostic modalities and the management of acute and chronic manifestations of this challenging infection.

Snake bite is one of the common public health problems especially in developing countries leading to increased morbidity and mortality. Delay in access to appropriate medical services and increased local practices of envenomation further complicate the scenario. Indigenous treatment systems, quacks and many first handlers in snake bites attribute to significant morbidity, end organ damage, septic complications further causing death, increased hospital stay and eventually increased economical burden on our existing health care system. Alleviation of such practices through stringent law and policy making with increased education and mobilization for appropriate medical management, supportive first aid and regular timely supply of anti snake venom is quintessential and need of an hour to curb the devastating complications due to snake bite and leading to improved clinical outcome.

Histoplasmosis is an opportunistic fungal infection commonly affecting immuno compromised hosts. In HIV patients it usually present as a disseminated form. We hereby report a case of Progressive Disseminated Histoplasmosis in a patient with advanced HIV infection, who presented with prolonged fever and pancytopenia. Bone marrow examination showed yeast forms of Histoplasma capsulatum. Prompt initiation of antifungal therapy and anti-retroviral therapy lead to improvement in her clinical condition. Progressive Disseminated Histoplasmosis is thus an important differential diagnosis to be considered in any HIV patient presenting with prolonged fever and pancytopenia.