Browsing by Author "Bandara, N.K.B.K.R.G.W."

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Comparison of clinical and laboratory parameters between Rickettsiosis positive and negative children
(Sri Lanka Medical Association, 2013) Premaratna, R.; Karunasekara, K.A.W.; Fernando, M.A.M.; de Silva, L.; Chandrasena, T.G.A.N.; de Silva, H.J.; Miththinda, J.K.N.D.; Mufeena, M.N.F.; Madeena, K.S.K.; Bandara, N.K.B.K.R.G.W.
INTRODUCTION AND OBJECTIVES: Identification of clinical or biochemical parameters that differentiate rickettsioses from other fevers would help in clinical practice to reduce morbidity and mortality associated with childhood rickettsioses. METHODS: Clinical and laboratory parameters of 22 confirmed paediatric rickettsioses (SFG-16/22, ST-5/22, Mixed-1) were compared with those of 24 with fever who were negative for rickettsioses, based on data received by the Rickettsial Disease Diagnostic and Research Laboratory (RDDRL), Faculty of Medicine, University ofKelaniya. Results: Comparisons of clinical and laboratory parameters between rickettsioses vs non-rickettsioses were mean(SD); age in months 56.59 (43.9) vs 78.13 (42.08) (p=0.1); fever duration 9.81 days (4.5) vslO.68 days (8.79) (p-0.68); fever intensity 102.80F (1.03) vs 102.440F (1.23) (p=0.4); fever spikes per day 2.33 (0.67) vs 2.68 (0.75) (p=0.186); headache 12/22 vs 11/24 (p=0.64); body-aches 9/22 vs 9/24 (p-0.52); pain in arms and legs 6/9 vs 7/9 (p=0.5); joint pains 6/22 vs 7/24 (p=O.S9); cough 14/22 vs 9/24 (p=0.0*7); shortness of breath 5/22 vs 2/24 (p=0.19); eschar (all ST) 4/22 vs 0/24 (p=0.02); rash 14/22 vs 14/24 (p=0.69); maculo-papular rash!3/14 vs 12/14 (p=0.91); diarrhoea 4/22 vs 4/24 (p-0.89); lymphadenopathy 7/22 vs 8/24 (p=0.913); spleenl/22 vs 5/24 (p=0.18); total WBC 11.U109/L (4.8) vs 9.8xl09/L (4.8) (p=0.36); N-84.8% (13.8) vs 5.4(2) (p=0.29); ESR IstHr 46.3mm (26.7) vs 81.8mm (10.2) (p=0.37); CRP 42.1mg/dl vs 56.7mg/dl (6.7) (p=0.46); SCOT 51.2iu/L (32.1) vs 248.7iu/L (678) (p=0.43); SGPT 50.2iu/L (51.4) vs 170.7iu/L (404) (p=0.44). CONCLUSIONS: In paediatric patients, no clinical or biochemical parameter could differentiate rickettsioses from other aetiologies. Presence of eschars would help to diagnose scrub typhus. However laboratory confirmation is needed to differentiate SFG from other fevers.
Contribution of rickettsioses in Sri Lankan patients with fever who responded to empirical doxycycline treatment
(Oxford University Press, 2010) Premaratna, R.; Rajapakse, R.P.V.J.; Chandrasena, T.G.A.N.; Nanayakkara, D.M.; Bandara, N.K.B.K.R.G.W.; Kularatne, S.A.M.; Eremeeva, M.E.; Dasch, G.A.; de Silva, H.J.
Twenty-eight febrile Sri Lankan patients with undiagnosed fever for 7 days after hospital admission, who responded to empirical treatment with doxycycline, were retrospectively investigated using microimmunofluorescence assay to verify whether they had rickettsial infection. Eleven (39%) patients were confirmed as having spotted fever group rickettsioses and 10 (36%) as having Orientia tsutsugamushi. Seven were negative for all tests. This suggests that greater use of doxycycline appears justified for patients with undiagnosed fever in settings where rickettsial diseases are endemic or re-emerging with inadequate diagnostic facilities.
Evidence of acute rickettsioses among patients presumed to have chikungunya fever during the chikungunya outbreak in Sri Lanka
(Elsevier, 2011) Premaratna, R.; Halambarachchige, L.P.; Nanayakkara, D.M.; Chandrasena, T.G.A.N.; Rajapakse, R.P.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.
BACKGROUND: Chikungunya fever (CGF) and rickettsioses are known to cause acute onset febrile illnesses associated with severe arthritis. Rickettsial arthritis is curable with the use of appropriate anti-rickettsial antibiotics, however the arthritis of CGF tends to have a prolonged course leading to protracted disability. The aim of this study was to investigate the contribution of CGF and rickettsioses to cases of fever and arthritis during a presumed CGF outbreak in Sri Lanka. METHODS: Fifty-eight consecutive patients with presumed CGF were further investigated to determine the occurrence of rickettsioses among them, and to identify differences in clinical, hematological, and biochemical parameters between the two diseases. RESULTS: Nearly a third of the patients had serological evidence of rickettsioses accounting for their illness. The presence of a late onset major joint arthropathy sparing the small joints of the hands and feet, and the occurrence of a late onset discrete maculopapular rash over the trunk and extremities, suggested rickettsioses over CGF. White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and liver function tests were not helpful in differentiating rickettsioses from CGF. Patients with rickettsioses and arthritis who received an empirical course of doxycycline recovered faster than those who did not receive specific treatment. CONCLUSIONS: The establishment of rapid diagnostic methods able to differentiate the etiological agents of fever and arthritis, such as CGF and rickettsioses, would be beneficial in endemic settings
A Patient with spotted fever group rickettsiosis mimicking connective tissue disease
(Sri Lanka Medical Association, 2012) Premaratna, R.; Liyanaarachchi, E.W.; Rajapakse, R.P.V.J.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.
Prevalence of rickettsial infections in acute coronary syndromes in Sri Lanka: a case control study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Mettananda, K.C.D.; Danansuriya, D.S.T.; Bandara, N.K.B.K.R.G.W.; Premaratna, B.A.H.R.
Background: Place of infection in atherosclerosis and or coronary heart disease has recently drawn interest. Rickettsiae are a group of obligate intracellular pathogens who invade vascular endothelial cells leading to vasculopathy. A study conducted in Thaiwan, scrub typhus was found to increase the risk of acute coronary syndromes (ACS) by 37% compared to general population after adjusting for age, sex and other known independent risk factors. Objective: To assess the prevalence of Rickettsial infections in patients with ACS residing in Western province, Sri Lanka. Methods: Patients admitted with ACS to Professorial-Medical-unit, were studied for serological prevalence of Rickettsial infections and were compared with a matched control group; who had no fever or ACS. 2ml serum samples were obtained at enrolment and 2weeks after and were assessed for IFA-IgG antibody titres against Orientiatsutsugamushi (OT) and Spotted-fever-group-rickettsioses (SFG). An IgG titre>1:128 or a rising/declining titre were considered positive for acute rickettsioses. A static titre was considered to be due to previous exposure to rickettsioses. Results: 46 ACS patients (males-23.9%, mean age 61.1 [SD=13.1] years) and 52 controls (male-50%, mean age 56.0[SD=13.6] years) were studied. None had evidence of acute Rickettsiel infection. Sero-prevalence of IgG-OT was 6.4% and IgG-SFG was 15.2% among ACS patients. Same for control group were 3.8% and 11.5% respectively. There was no significant difference in sero-prevalence of OT [OR =0.74; CI: 0.28-10.93; p=0.66] or SFG [OR=1.376; CI:0.43-4.44; p=0.59] in patients with ACS compared to controls. Conclusions: No significant difference was observed in sero-prevalence of rickettsioses in patients with acute coronary syndromes compared to controls in this study.
Progress report of Rickettsial disease diagnostic and research laboratory (RDDRL), Faculty of Medicine, University of Kelaniya
(Sri Lanka Medical Association, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Bandara, N.K.B.K.R.G.W.; Rajapakse, R.P.V.J.
INTRODUCTION: RDDRL was established at Faculty of Medicine, University of Kelaniya (FMUK) in June 2008 in collaboration with Centers for Disease Control and Prevention, Atlanta, Georgia, USA and Faculty of Veterinary Medicine, University of Peradeniya. OBJECTIVES: We present the contribution of RDDRL towards the diagnosis of ricketsioses over the 5 months since its inception. RESULTS: 84 acute serum samples were analysed [56 from Colombo North Teaching Hospital (CNTH), 4 from Teaching Hospital Jaffna (THJ), 7 from Base Hospital Kamburupitiya (BHK) 3 from Lady Ridgeway Hospital (LRH), 2 from Infectious Disease Hospital (IDH), 2 from Colombo South Teaching Hospital (CSTH), and 10 from the private sector hospitals (PVT)]. 48/84 (57%) had diagnostic titers; 31 (65%) for Rickettsia conorii (RC) and 17 (35%) for Orientia tsutsugamushi (OT). The total (%) positives for each hospital were; CNTH: 22/56 (39%), BHK: 7/7 (100%), Jaffna: 3/4 (75%), LRH: 1/3 (33%), IDH: 1/2 (50%), CSTH: 0/2(0%) and PVT: 8/10 (80%). The district total (ROOT); Gampaha: 33 (26:7), Matara: 7 (3:4), Jaffna: 3 (0:3), Puttlam: 5 (2:3). The mode (range) duration of febrile illness at the time of request was 14 (3-90) days and 6 samples were from severe complicated patients; 2-encephaiitis, 2-'Neuroleptic malignant syndrome', 1-muiti-organ failure and 1-severe gastroenteritis. CONCLUSIONS: Out of the clinically suspected patients, 57% were positive for rickettsiosis; 65% caused by R. conorii and 35% by O. tsutsugamushi. However, the request for serological diagnosis was made after a considerable delay in the majority of cases.
Rickettsial infections in acute coronary syndromes
(Sri Lanka Medical Association, 2013) Mettananda, K.C.D.; Danansuriya, D.S.T.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.; Premaratna, R.
INTRODUCTION AND OBJECTIVES: Rickettsiae are a group of obligate intraceliular pathogens which invade endothelial cells causing vasculopathy. Vasculitis of any cause may result in acute coronary syndromes (ACS). Objectives were to assess the prevalence of Rickettsial infections in patients with ACS from Western province, Sri Lanka. METHODS: Prospective patients from Western province with ACS admitted to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama from April-December 2011 were recruited as the study group. A matched control group was selected from in-ward-patients without fever or ACS. Serum samples (2ml) collected at enrolment and after 2 weeks were analysed. Rickettsial-antibody (IgG) titre >128, or a rising or a declining titre were considered positive for acute rickettsioses. A static titre was considered as previous exposure to rickettsioses (sero-prevalence). RESULTS: Of the 46 patients with ACS 11 (23.9%) were male and of the 52 controls 26 (50%) were male. Mean age was, ACS=60.7 years and controls= 55.98 years. None had evidence of acute rickettsiel infection. In ACS group, 3 and 7 were positive for [gG-OT-Orientia tsutsugamushi (prevalence=0.065) and lg-RC-Rickettsia conori (prevalence=0.152) respectively. In the control group 2 were positive for IgG-OT( prevalence = 0.038) and 6 for IgG-RC (prevalence = 0.115). There was no significant difference in sero-pre valence of rickettsie- antibodies in the study group compared to controls; odds-ratio IgG-OT 1.744 (CI, 0.278-10.928) and IgG-RC 1.376 (CI, 0.427-4.438). CONCLUSION: Sero-prevaSence of Orientia tsutsugamushi was 0.038 while that of Rickettsia conori was 0.115 in the selected population. Rickettsia conori was more prevalent than Orientia tsutsugamushi in the Western province of Sri Lanka. There was no significant association between sero-prevalence of rickettsioses and acute-coronary-syndromes.
Rickettsioses presenting as major joint arthritis and erythema nodosum: description of four patients
(Springer International, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Rajapakse, R.P.V.J.; Eremeeva, M.E.; Dasch, G.A.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.
Erythema nodosum and aseptic arthritis are recognized associations of rickettsial infections. However, they usually present with a febrile illness rather than with severe arthritis. We report three patients who presented with incapacitating major joint arthritis and one who presented with severe spondyloarthropathy in addition to major joint arthritis due to serologically confirmed Orientia tsutsugamushi and Rickettsia conorii infections. All of them had erythema nodosum and low-grade fever. They had rapid clinical response to doxycycline.
Scrub typhus mimicking enteric fever; a report of three patients
(Oxford University Press, 2010) Premaratna, R.; Nawasiwatte, B.M.T.P.; Niriella, M.A.; Chandrasena, T.G.A.N.; Bandara, N.K.B.K.R.G.W.; Rajapakse, R.P.; de Silva, H.J.
We report three patients who presented with fever and late onset diarrhoea mimicking enteric fever. All three patients were diagnosed with an Orientia tsutsugamushi infection and responded dramatically to doxycycline treatment. Clinicians practicing in rickettsial disease endemic areas should be made aware of similar clinical presentations in order to prevent morbidity and mortality associated with rickettsioses.
Scrub typhus mimicking Parkinson's disease
(Biomed Central, 2015) Premaratna, R.; Wijayalath, S.H.N.C.; Miththinda, J.K.N.D.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.
Background Scrub typhus is a re-emerging infection in Sri Lanka. It often poses a diagnostic challenge and tends to present as a febrile illness of uncertain origin. Undiagnosed illness may progress to serious multi-systemic complications. Here we report a case of scrub typhus presenting with features of Parkinsonism. Case presentation A 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka presented with high fever with malaise, myalgia and arthralgia for 17 days. On the 5th day of illness he developed intermittent resting tremor in his right arm and leg associated with stiffness, difficulty in carrying out normal work and difficulty in smiling. He denied similar previous episodes. There were no other associated neurological manifestations. Clinical examination revealed a high amplitude low frequency resting tremor in his right hand, a mask-like face and increased muscle tone limited to the right side with normal reflexes. The rest of the system examination was normal except for an eschar over the abdomen. His investigations revealed lymphocytic leukocytosis, high erythrocyte sedimentation rate and immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers. With oral doxycycline and azithromycin his fever settled within 48 h and a complete recovery of Parkinson’s features was observed within 2 weeks. Conclusion Doctors practicing in endemic regions should be familiar with delayed clinical manifestations of scrub typhus and should carefully look for an eschar in order to avoid delay in the diagnosis.
Scrub typhus pneumonitis
(Elsevier, 2013) Premaratna, R.; Ariyaratna, N.; Botheju, W.I.K.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.
No Abstract Available