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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Detection of a case of Brugian Filariasis from Anuradhapura, a non-endemic district of Sri Lanka
(Sri Lanka Medical Association, 2018) Mallawarachchi, C.H.; Gunaratne, I.E.; Ekanayaka, G.M.G.A.C.; Mallawarachchi, S.M.N.S.M.; Chandrasena, T.G.A.N.; Mendis, D.; de Silva, N.R.
INTRODUCTION AND OBJECTIVES: In 2016, the WHO declared that lymphatic filariasis was no longer a public health problem in Sri Lanka. However low-grade persistence of bancroftian filariasis continues in all three endemic provinces, while brugian filariasis has re-emerged. The periodicity pattern of the re-emerged Brugia spp. suggests zoonotic origin. A canine survey done in the district of Anuradhapura found a moderately high prevalence (28.2%) of B. malayi infections in the Thirappane MOH area. Objective of the study was to investigate the threat of zoonotic B.malayi infections to humans in the Thirappane MOH area. METHODS: A cross sectional survey was done among all consenting residents of three randomly selected areas representing the three PHI areas of the Thirappane MOH. Residents were screened between 8.00 pm and 12.00 pm using night blood smears (NBS) and Brugia rapid test (BRT) for presence of anti-Brugia IgG4 antibodies. BRT was done selectively. Ethical and administrative clearance was obtained prior to the survey. RESULTS: A total of 752 individuals were screened by NBS; 176 of them were also screened by BRT. 193, 208 and 351 NBSs were done respectively in Thirappane, Galkulama and Mooriyankadawala PHI areas. One individual, a 25-year-old long-term resident of Mooriyankadawala PHI area was positive for Brugia spp. microfilariae by NBS and by BRT. The microfilariae exhibited nocturnal sub-periodicity. CONCLUSION: Transmission of brugian filariasis appears to occur even outside the traditional endemic belt. The presence of canine reservoirs of infection and water bodies with aquatic vegetation probably favour transmission by Mansonia spp. vector mosquitoes in the study area.
Clinical Charasteristics of paediatric rickettsioses
(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.
INTRODUCTION AND OBJECTIVES: Rickettsioses are re-emerging in Sri Lanka. Both children and adults are vulnerable to these infections. Data on paediatric rickettsioses in the country are sparse. Objectives were to study the clinical characteristics of paediatric rickettsioses based on data received by the Rickettsail Disease Diagnostic and Research Laboratory (RDDRL), Faculty of Medicine, University of Kelaniya, over the last two years. METHODS: All clinical and laboratory data of confirmed rickettsioses were analyzed. RESULTS: Out of 46 requests received by the RDDRL, 22 were positive for acute rickettsioses in diagnostic titres IFA-IgD>1:128 (all>256). Of the positives, 16 were positive for spotted fever group rickettsioses (SFG), 5 for scrub thypus (ST) and 1 for both. 4/5 ST had eschars. The mean age was 56.59 months. (43.9); the youngest affected was aged 5 months. Of the sample 12 (54.5%) were male. Fever was present in all; mean duration was 9.81 (4.5) days; fever intensity was 102.80F (1.03); frequency of spikers per day was 2.33 (0.67). clinical features were headache 12 (54.5%), body aches 9 (40.9%), joint pains 6 (27.3%), cough 14 (63.6%), shortness of breath 5 (22.7%), rash 14 (63.6%); macular popular rash 13, diarrhea 4 (18.2%), lymphadenopathy 7 (31.8%), palpable liver 4, palpable spleen 1. Total WBC 11.1x109/L (SD-4.8); neurophils-84.8% (SD-13.8) lymphocytes 40.5% (17.2). ESR 1st Hr 46.3mm (SD-26.7) CRP 42.1mg/dl (40.6) SGOT 51.2iu/L (32.1) SGPT 50.2iu/L (51.4). ECG was normal in all, Chest x-ray showed patchy shadows in 4. CONCLUSIONS: SFG rickettsioses were commoner than ST, among children living in the Gampaha and Kurunegale districts. Clinical features were similar to adults. Diagnostic investigations were requested late in the febrile illness.
Effect of genotyping on the severity of rotavirus Gastroenteritis
(Sri Lanka College of Paediatricians, 2011) Chandrasena, T.G.A.N.; Rajindrajith, S.; Gunawardena, N.K.; Silva, G.M.K.S.; Pathmeswaran, A.; Kazuhiko, M.; Kamruddin, A.
INTRODUCTION: Rotavirus is the commonest cause of paediatric gastroenteritis. There remains a controversy regarding disease severity being related to rotavirus genotype G9. OBJECTIVE: Study the genotype related severity of rotavirus gastroenteritis. DESIGN, SETTING AND METHOD: All children under 5 years of age who were admitted with acute diarrhoea to North Colombo Teaching Hospital and submitted a sample of stool for analysis from April 2005 to October 2008 were selected for the study. Clinical information was collected regarding the study group. Acute diarrhoea was defined as passage of 3 times or more stools over a period of 24 hours. Stools were collected from cases with blood and mucus diarrhoea as well. The stool compliance rate was around 75-80%. Faecal specimens were tested and genotyped for rotavirus using the ELISA kit, Rotaclone® (Meridian Diagnostics, Cincinnati) and reverse transcription (RT) PCR respectively. Severity of gastroenteritis was assessed using the 20 point scoring system ofVesikariand Ruuska. RESULTS: The total number of stool specimens collected during the study period was 813 and of this 178 were positive for group A rotavirus; all the rotavirus positive stool specimens were genotyped. The two predominant VP7 genotypes were G9 (76; 42.7%) and Gl (35; 19.7%) followed by G2 (22; 12.4%), G3 (22; 12.4%), G12 (18; 10.1%) and G4 (4; 2.2%) respectively. The mean severity scores of, Gl, G2, G3, G4, G9 and G12 were 12,12,12,14,13 and 13, respectively. Comparison of clinical features between the two common G types, G9 and Gl revealed the following: duration of diarrhoea was longer among G9 (mean 4±2 days) than Gl (mean 2±1 day) and a higher percentage of cases were febrile and had vomiting in G9 (84.9 and 86.3 respectively) than Gl (76.7 and 65.5 respectively) infections (p>0.05). The rest of the clinical features were similar. The percentage with severe disease (score >14) was higher among the G9 (38.4) than among Gl (26.7) infections (p>0.05). CONCLUSION: Although rotavirus G9 genotype was associated with a more severe gastroenteritis than the common Gl genotype, this association was not significant (p>0.05).
Prevalence of enterobiasis among primary school children in Ragama MOH region
(Sri Lanka College of Microbiologists, 2012) Gunawardena, N.K.; Chandrasena, T.G.A.N.; Senarathna, B.P.; Silva, G.M.K.S.; de Silva, N.R.
INTRODUCTION: Although frequently diagnosed clinically, there is only one previously reported survey of Enterobius vermicularis infection among Sri Lankan children, conducted in the 1980s. OBJECTIVES: To determine the prevalence of enterobiasis among Year One school children in Ragama MOH area and investigate association between infection and risk factors. METHOD: A cross sectional descriptive study was performed among Year One children in seven randomly selected schools. Infection was diagnosed using adhesive cellophane peri-anal swabs obtained on two consecutive days. A pre-tested, self-administered questionnaire completed by the mother, identified risk factors associated with enterobiasis. Initial univariate analysis was followed by multivariate analysis with logistic regression. RESULTS: Of 322 children, 276 (male: female ratio 1.1:1, mean age 6 years) returned the swabs and questionnaires (compliance 85.7%). Prevalence of infection by double and single swab examination was 37.5% and 20.1% respectively. Prevalence was significantly lower among children of more educated mothers (34.2%), fathers with permanent employment (28.9%) and those dewormed in the last 30 days (22%) compared to children of less educated mothers (46.5%), fathers with casual (46.9%) or no employment (36.4%) and those not dewormed recently (41.6%)(P<0.05). Infected children belonged to households with significantly more members, siblings and persons sleeping with index child (P<0.05). Multivariate analysis showed that more children in a household and recent deworrning were the only significant determinants of enterobiasis. CONCLUSIONS: Over one-third of primary school children in the Ragama MOH area have enterobiasis. The risk of infection is higher in families with more children and is reduced by regular deworrning.
Lymphoedema management knowledge and practices among patients attending filariasis clinics in the Gampaha District, Sri Lanka
(Sri Lanka College of Microbiologists, 2004) Chandrasena, T.G.A.N.; Premaratna, R.; de Silva, N.R.
INTRODUCTION: Little information is available on methods of treatment practiced by Sri Lankan patients with filarial lymphoedema. The burden of acute dermatolymphagioadenitis (ADLA) attacks in these patients is also unclear. OBJECTIVES: To determine knowledge, perceptions and practices regarding lymphoedema management and the burden of ADLA attacks among patients with lymphoedema attending filariasis clinics. METHODS: The survey was carried out in the Gampaha district. Semi structured questionnaires were deployed to assess knowledge, practices and perceptions regarding morbidity alleviation in filarial lymphoedema. The burden of ADLA attacks was estimated using one-year recall data. RESULTS: 66 patients (22 males: 44 females) mean age 51.18 years SD 13.9% were studied. Almost two thirds of the population was aware of the importance of skin and nail hygiene, limb elevation and use of footwear. Washing was practiced"bn a daily and twice daily basis by 40.9% and 48.5% respectively. However limb elevation, exercise and use of footwear were practiced by 21 -42.4% (while seated and lying down), 6% and 34.8% respectively. Regular intake of DEC was considered important by the majority (n=61. 92.4%). Most (65.2%) had received health education from the filariasis clinics. Among patients who sought private care (n~48) the average cost of treatment of an ADLA attack was Rs. 737.91. Only 18.2% had feelings of isolation and reported community reactions ranging from sympathy to fear and ridicule. CONCLUSIONS: Filariasis clinics seem to play an important role in the dissemination of knowledge regarding morbidity control. Referral of lymphoedema patients to morbidity control clinics is recommended.
Intestinal parasitic infections among a selected group of institutionalised psychiatric patients
(Sri Lanka College of Microbiologists, 2009) Chandrasena, T.G.A.N.; Gunawardena, N.K.; Imbulpitiya, I.V.B.; Balasooriya, B.A.D.H.; Ariyarathna, W.P.H.; de Silva, N.R.
INTRODUCTION: Patients with chronic psychiatric illnesses are known to be at high risk of intestinal parasitic infections because of poor attention to sanitation and hygiene. OBJECTIVES: To determine the prevalence of intestinal parasitic infections among inmates of a psychiatric institution in Sri Lanka. METHODS: Faecal samples of randomly selected patients at the Half-way Home, Mulleriyawa (HHM) were examined using saline and modified Kato Katz smears. RESULTS: Of 649 female patients at HHM 22% (145) were screened for intestinal parasites. The mean age of study population was 50 years (range 26-75). One or more intestinal parasites were detected in 35% (51/145). Thirty percent (44/145) had only helminth infections, 2.8 % (4/145) were co-infected with helminth and commensal protozoa Entamoeba co//and 2% (3/145) had only E.coli. Of the 48 who had helminth infections 6.8% (10/145) had Ascaris lumbricoides, 10.3% (15/145) had Trichuris trichiura and 15.8% (23/145) had mixed infections of A. lumbricoides and T. trichiura. Proportions of patients with varying intensities of infections with respect to A, lumbricoides and T. trichiura were light in: 51.6% (16) and 55.6% (20), moderate in 45.16% (14) and 44.4% (16) and heavy in 3.2% (1) and 0% respectively. Forty six percent (67/145) and 12.5% (18/145) had been dewormed within one year and three months respectively. Thirty five percent (17/48) of parasite positive patients had been dewormed within one year. CONCLUSION: Although the prevalence of faeco-orally transmitted protozoan infections were scarce, the prevalence and intensity of geohelminth infections were high among the inmates of the HHM mental institution. Improvements in sanitation, provision of safe food and water and regular mass deworming are recommended.
Projected cost- effectivenes of rotavirus vaccination in Sri Lanka
(The Bulletin of the Sri Lanka College of Microbiologists, 2007) Chandrasena, T.G.A.N.; Rajindrajith, S.; Gunawardane, R.; Adhihetty, D.; Ahmed, K.; Pathmeswaran, A.; Nakagomi, O.
OBJECTIVES: The disease and economic burden of rotavirus infection among children hospitalised for gastroenteritis in Sri Lanka was assessed, in anticipation of the availability of new rotavirus vaccines. METHODS: A prospective gastroenteritis case surveillance was conducted between April 2005-October 2006 at the paediatric units of the Colombo North Teaching Hospital. Stool samples of children admitted with diarrhoea were screened for group A rotavirus antigens by enzyme-immuno assay (ElA)(Rotaclone®).Information regarding medical and non- medical costs during the event was obtained among randomly selected rotavirus cases (n=45) through an interviewer administered questionnaire. Cost effectiveness of universal rotavirus vaccination was investigated assuming a cost Of ≤ US$.7 per vaccine dose (two dose regime) in accordance with the World Bank cost effectiveness standard for low-income countries. RESULTS: Total of 606 children (335 males)[ mean age 27.3 months,(range 1-144) were analyzed. 116 (19.1%) had rotavirus antigens. The prevalence among the 0-5 years age group was 20.8. The average cost per episode of rotavirus gastroenteritis was Rs. 3004(US$ 27). Estimated initial and recurrent expenditure of universal vaccination was US$ 23.7 and five million respectively. Costs saved through averting rotavirus diarrhoea hospitaljsations per year (assuming a vaccine of 100% efficacy) were US$ 0.21 million. Deaths averted were eight per year. CONCLUSION: Universal rotavirus vaccination at 5 US$.7 per dose may not be cost-saving in Srilanka. However decisions regarding vaccine use should be based not only on whether the intervention provides cost savings but also on the value of preventing associated morbidity and mortality.
Surveillance of rotavirus in three hospital settings of Sri Lanka 2007 - 2010
(Sri Lanka College of Microbiologists, 2014) Chandrasena, T.G.A.N.; Rajindrajith, S.; Gunawardena, N.K.; Liyanarachchi, N.; Abeysekera, C.K.; Matsomoto, T.; Yahiro, T.; Nishizono, A.; Ahmed, K.
INTRODUCTION: Rotavirus is an important aetiological agent of childhood diarrhoeas in Sri Lanka. OBJECTIVES: To study the rotavirus epidemiology and genotypic diversity of cases hospitalized in three geographical locations of Sri Lanka, Ragama, Galle and Kandy. MATERIALS AND METHODS: The study was approved by the ethical review board of the Sri Lanka College of Paediatricians. Stool samples were collected from children < 5 years, hospitalized at the Teaching Hospitals at Ragama (RTH) (November 2007 - October 2010) Galle (GTH) and Kandy (KTH) (mid and late 2008) respectively for acute gastroenteritis. Rotavirus was detected using EIA kit, Rotaclone®. A subset of rotavirus positive samples was genotyped by reverse-transcription(Rt)-PCR and polyacrylamide-gel-electrophoresis (PAGE). RESULTS: Stool samples of 1245 children (69.2%, 23.3% and 7.3% from RTH, GTH and KTH respectively) were screened for rotavirus. Of them, 476 were positive by EIA. The overall rate of prevalence of rotavirus infection was 38.2%. The median age of infection ranged from 13-20 months. Rotavirus genotyping was done on 375 (78.8 %) samples. G1 [P8] was the overall dominant strain (44.8%) followed by G9[P8] (10.1%), G2[P4] (5.3%), G3[P8] (3.2%), G1[P6] (2.1%), G12[P6] (1.3%), G2[P8] (1.06%) and 0.26% of G4[P6], G4[P4] and G4[P8]. The G or P serotype was untypable in 25.6% of samples and 5.6% were of mixed-G and P type. PAGE yeilded 25 electropherotypes (E1-E12 and E16-E29), with E5 and E20 causing 19 and 14 percent of infections respectively. The electropherotype could not be determined in 26%. CONCLUSIONS: Rotavirus continues to be an important cause of childhood diarrhoreas in Sri Lanka. Strain G1P8 predominated in all areas during the surveillance period with a notable percentage of mixed-G and P infections. Multiple E types identified indicate increasing strain diversity
Toxoplasmosis awareness, sere-prevalence and risk behavior among pregnant women in the Gampaha district, Sri Lanka
(Sri Lanka College of Microbiologists, 2015) Chandrasena, T.G.A.N.; Herath, R.P.; Rupasinghe, J.I.N.; Samarasinghe, S.A.D.B.P.; Samaranayake, W.W.S.R.M.H.; de Silva, N.R.
OBJECTIVES: To determine the prevalence and awareness of toxoplasmosis and to identify risk factors and possible routes of infection among pregnant women in the Sampaha district, Sri Lanka. DESIGN, SETTING AND METHODS: Pregnant women attending obstetric clinics at the Colombo North Teaching Hospital (CNTH) in February -June 2014 were systematically selected and tested for Igondiispecific IgG and IgM antibodies using the OnSite Toxo IgG/ IgM Rapid Test-Dip Strip®. Socio-demographic details and information regarding disease awareness and risk behavior patterns of the partici pants were collected. RESULTS: The mean age of the 293 women tested was 27 years (3D, +/-5.92). Thirty eight percent were primigravidae with a mean gestational age of 16.2 weeks (SD 7). The prevalence of anti-T gondii IgG antibodies was 12.3% (n=36). All participants were sero-negative for anti-T gondii IgM antibodies. Prevalence of anti-T.gont/// IgG antibodies was significantly higher among those eating commercially prepared meals, thrice a week or more (17.3%) compared to once a month or not at all (9.3%) (p< 0.05). No significant relationships were observed with other risk factors (cat-ownership, handling cats, consumption of meat, consumption of unwashed raw vegetables and fruits, handling soil and not washing hands after handling soil). Awareness of toxoplasmosis was 4.4% (n=13); health personnel (46.2, n=6) and media (53.8%, n=7) being sources of information. CONCLUSIONS: The presence of a large population of non-immune women of child bearing age (88%) with Low disease awareness, indicates the necessity of an educational program targeted at this high risk group to avoid exposure to toxoplasmosis during pregnancy. The importance of consuming hygienically prepared meals during pregnancy needs to be emphasized.
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.

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