Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Dengue fever presenting as acute appendicitis(Sri Lanka Medical Association, 2007) Premaratna, R.; Bailey, M.S.; Fernando, M.J.; Rathnasena, B.G.N.; de Silva, H.J.INTRODUCTION: Dengue-fever (DF) is known to present with surgical emergencies, including acute pancreatitis and acalculous cholecystitis. CASE RECORDS: During 2006, 12 patients [5 males, mean age 28(SD 4.6) years] presented with features of acute appendicitis and were later diagnosed as having DF. Seven were admitted to surgical casualty and referred for medical opinion due to thrombocytopenia (one following appendicectomy). Five were first seen by physicians and referred for surgical assessment. The mean time from onset of fever to abdominal pain was 2.2 days (SD 0.9). Clinical features at presentation included: right iliac fossa tenderness in 12 (100%), rebound tenderness in 9 (75%), vomiting in 9 (75%), erythematous rash in 8 (67%), arthralgia/myalgia in 8 (67%), headache in 6 (50%), diarrhoea in 3 (25%) and palatal petechiae in 3 (25%). All patients had CRP <12 mg/1 and DF was confirmed on IgM/IgG ELISA (Panbio, Australia). Leucocytopenia and thrombocytopenia occurred in 8 (67%) and 10 (83%) on admission and in 11 (95%) and 12 (100%) during hospital stay. Seven (58%) had free fluid around the appendix on ultrasound scan. Histology in one showed non-specific lymphoid-follicular hyperplasia. Only one patient (who underwent appendicectomy) received IV antibiotics. The mean duration for disappearance of abdominal pain and severe tenderness from the time of first examination was 1.8 days (SD 1.3). Discharge diagnoses were: classical DF in 3(25%), DHF (platelets <100xl09/iitre) in 7(58%) and DSS in 2(17%). Conclusions: DF may present as acute appendicitis. An early blood count and C-reactive protein can help to differentiate dengue fever from acute bacterial appendicitis.Item Antibiotic use and antimicrobial activity in urine of febrile patients(Sri Lanka Medical Association, 2007) Wijesuriya, M.T.W.; Bailey, M.S.; Premaratna, R.; Wuthiekanun, V.; Peacock, S.J.; Lalloo, D.C.; de Silva, H.J.OBJECTIVES: Prior antibiotic use may decrease sensitivity of bacterial cultures leading to diagnostic difficulties. Our objectives were to detect antimicrobial activity in urine of patients presenting with fever and to correlate urine antimicrobial activity to blood culture results and antibiotic history. DESIGN, SETTING AND METHODS: This is carried out as part of a fever study during a one-year period. A sample of urine is collected within 24 hours of admission before antibiotics from consenting, febrile (>38°C) patients. Antimicrobial activity in urine is detected by applying urine-soaked discs onto agar plates inoculated with standard bacterial cultures. All patients have extensive microbiological investigations including high-quality blood cultures (with leptospiral cultures), dengue and other viral serology. RESULTS: From 117 patients recruited in 4 months, 76(65%) reported taking medication for their fever, of which 40(53%) said this was an antibiotic. Standard E. coli and S. pyogenes cultures detected antimicrobial activity in 32(27%) and 25(21%) of urines respectively. Using both strains together increased detection to 39%. Only 19(47.5%) reporting prior antibiotic use had urine antimicrobial activity. From 41 denying prior medication, 8(20%) had urine antimicrobial activity. From 43 suspected of having bacterial infection, 46% had urine antimicrobial activity. No patients with positive bacterial cultures had detectable urine antimicrobial activity, whereas 53% of negative bacterial cultures had positive urine antimicrobial activity. CONCLUSIONS: Clinical history is unreliable in assessing prior antibiotic use. Detectable urine antimicrobial activity may lead to negative blood culture results. Therefore in suspected bacterial infections, an assessment of urine antimicrobial activity along with microbiological cultures will reduce the diagnostic dilemma.Item A fever study at the Colombo North Teaching Hospital (CNTH)(Sri Lanka Medical Association, 2007) Bailey, M.S.; Wijesuriya, T.; Premaratna, R.; de Silva, N.R.; Wuthiekanun, F.; Peacock, S.J.; Lalloo, D.G.; de Silva, H.J.OBJECTIVES: To determine the aetiology of febrile illnesses at CNTH, to identify effective laboratory tests for their confirmation, and to develop clinical prediction rules that will assist diagnosis. DESIGN, SETTING AND METHODS: A prospective cohort of in-patients is being studied during a one-year period. Patients with oral temperatures >38°C are eligible for inclusion unless they are aged <16 years, have been admitted for >24 hours or have received antibiotics in hospital. Written consent is obtained and a structured questionnaire is completed. Blood is taken for cultures, biochemistry assays, serology and PCR tests. Urine is taken for assays to detect antimicrobial activity. RESULTS: During the first 4 months, there were 180 eligible patients of whom 138 (77%) were recruited. The mean age was 36 years, the male:female ratio was 2.1 and 90% were from Gampaha district. There were no significant differences regarding age or sex in comparison to patients not recruited. Infections were unlocalised in 67% (50% unconfirmed, 43% dengue fever, 3% leptospirosis, 3% scrub typhus, 1% malaria). Localised infections were respiratory (9%), urinary tract (8%), neurological (4%), gastrointestinal (3%) and skin (2%). Non-infectious causes accounted for 3% of febrile patients. Bacteraemia was found in only 4% despite every patient having 2 high-quality blood cultures. Leucopenia or neutropcnia were useful early markers of dengue fever. CONCLUSIONS: Non-bacterial agents cause most febrile illnesses in Gampaha district. New laboratory tests and clinical prediction rules are required for their diagnosis.