Browsing by Author "Jayasekera, P.I."

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    Neutropenic patient presented with subcutaneous nodules
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, S.H.C.K.; Jayasekera, P.I.; Wanigasooriya, S.; Gunasekara, S.
    BACKGROUND: Fusarium spp. is the second most-common mold infection in immunocompromised patients. Disseminated fusariosis is life-threatening and the outcome is influenced by the host’s immune status. Mortality ranges from 50-80%. Prolonged and profound neutropenia is a major risk factor. We report the first case of disseminated fusariosis with Fusarium aquaeductuum in Sri Lanka. CASE REPORT: A 5 1/2 year old boy with acute lymphoblastic leukemia (ALL) after completing chemotherapy was admitted with a relapse after 6 months. On admission he was asymptomatic. But the absolute neutrophil count was 650/L. He was started with IV vancomycin and IV ciprofloxacin empirically. While on those two antibiotics for 11 days, fever spikes appeared and meropenem and IV fluconazole were added. Fever continued and after 2 days he developed multiple painful subcutaneous nodules about 2cm in radius, mainly on limbs. Blood culture was positive for branching fungal filaments and it was later identified as Fusarium aquaeductuum.IV amphotericin B (conventional) was started and oral voriconazole was added after 2 days and both were continued for a total of 2 weeks after negative repeat blood cultures. CONCLUSIONS: Our patient was started on amphotericin B, with high clinical suspicion. Voriconazole was added due to initial poor response and positive repeat blood cultures. Although the mortality rate following disseminated fusariosis ranges 50% to 80%, with timely management our patient fully recovered.
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    Species distribution and in-vitro antifungal susceptibility pattern of Candida clinical isolates
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sigera, L.S.M.; Jayasekera, P.I.; Shabry, U.L.F.
    BACKGROUND: An increase in incidence of Candida infections and isolation of resistant isolates were common occurrences in recent years due to increase in immunocompromised patients and advances in medical field. OBJECTIVES: To determine the Candida species isolated from various clinical specimens received at the Department of Mycology, Medical Research Institute from 08/08/14 - 25/10/14 and to determine their antifungal susceptibility pattern for commonly used antifungals in Sri Lanka. METHODS: Identification of 90 clinical isolates was done by using conventional methods of Candida identification and API kits. In-vitro antifungal susceptibility pattern of isolates to fluconazole, amphotericine B, ketoconazole, itraconazole, miconazole, nystatin, clotrimazole and voriconazole were determined according to CLSI M44A. RESULTS: Candida tropicalis (37.7%) was the most frequently isolated species, followed by C.albicans (36.6%), C.parapsilosis (24.4%) and C.krusei (1.1%). C.tropicalis was the predominant isolate from blood, sterile fluids and urine specimens. Majority of the isolates from scraping specimens were C.parapsilosis while C.albicans was the commonest in respiratory specimens. Variations in resistance were seen, depending on the species and the respective type of specimens. All Candida isolates were sensitive to amphotericin B. Twenty-three (24.44%) fluconazole resistant isolates were detected from blood, urine, pus, sterile fluids and respiratory and scraping specimens. Variable sensitivity patterns were observed for voriconazole, miconazole, itraconazole, ketoconazole, nystatin and clotrimazole. CONCLUSIONS: All clinical yeast isolates should be identified up to species level and antifungal susceptibility testing should be performed to prevent therapeutic failures. Resistance to fluconazole, is an alarming sign for emerging antifungal resistance in Sri Lanka.