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Microbiology
A 50 year old chronic alcoholic male agricultural worker presented with high grade fever of one week duration with spells of chills and rigor. Examination of the respiratory system revealed bilateral crepitations with scattered rhonchi. Multiple subcutaneous nodules were found on the extensor surface of the left forearm, arm and left leg. Direct microscopy of the pus aspirated from the skin nodule revealed plenty of Gram negative bacilli with bipolar staining. Culture revealed distinct rough corrugated grey-white colonies on Blood agar. The organisms were motile and oxidase positive. The most likely diagnosis is
Plague
Melioidosis
Bartonellosis
Actinomycosis
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