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 Clinical and histopathological characteristics of cutaneous leishmaniasis in a group of military personnel in Sri Lanka(American Society of Tropical Medicine and Hygiene, 2015) Manamperi, N.H.; Fernando, C.S.; Pathirana, A.; Abeyewickreme, W.; de Silva, V.C.; Karunaweera, N.D.Cutaneous leishmaniasis (CL) is a newly established vector-borne parasitic disease in Sri Lanka. Military personnel have an occupational risk for CL due to being stationed in endemic areas and exposure to vectors outdoors. This study describes the clinical and histopathological features of CL in a group of military personnel. Thirty five patients with smear positive for Leishmania amastigotes were included, their data analyzed for clinical features and skin biopsies processed routinely for histology, examined at a conference microscope and classified into 4 groups using modified Ridley criteria for Leishmaniasis as: I-parasitized macrophages with variable lymphocytes and plasma cells; II-parasitized macrophages with lymphocytes, plasma cells and ill formed histiocytic granulomata; III-a mixture of macrophages (with or without parasites), lymphocytes, plasma cells and epithelioid granulomata; IV-epithelioid granulomatous response with a few lymphocytes and plasma cells but no amastigotes. Lesions were categorized by duration, as acute (< 6 months) or chronic (> 6 months). Study group composed of all males with a mean age of 32.6 years (range 22-47) and lesion duration of 5.6 months (range 1-24). Number of lesions varied from 1 to 6 with majority (71.4%, n= 25) having a single lesion. Nodular (37.1%, n=13) and nodulo-ulcerative (25.7%, n=9) lesions in upper limbs (68.6%, n=24) was the commonest presentation. Twenty nine (82.9%) of the biopsies were positive also by histology. Twenty two (62.9%) were acute and 13 (37.1%) chronic. Group I, II, III and IV patterns were seen in 14 (40%), 12 (34.3%), 5 (14.3%) and 4 (11.4%) respectively and 9 (40.9%), 9 (40.9%), 2 (9.1%) and 2 (9.1%) of acute lesions and 5 (38.5%), 3 (23.1%), 3 (23.1%) and 2 (15.4%) of chronic lesions respectively. Necrosis was not seen in any of the lesions. Majority in this group of military personnel with CL had single lesions affecting the upper limbs and sought treatment within 2 years of appearance of lesions. The histological picture varied from diffuse infiltration of parasitized macrophages admixed with chronic inflammatory cells to ill-formed histiocytic granulomata.Item Clinical outcome of infection with L.donovani in Sri Lankan patients(Sri Lanka Medical Association, 2008) Siriwardana, H.V.Y.D.; Sirimanna, G.; Udagedara, C.; Chandrawansa, P.H.; Wickremasinghe, A.R.; Karunaweera, N.D.OBJECTIVE: To describe the clinical profile of leishmaniasis in Sri Lanka. DESIGN, SETTING AND METHODS: This prospective descriptive study was conducted on incident cases of suspected cutaneous leishmaniasis (CL) referred to the Department of Parasitology, Faculty of Medicine, Colombo over 4 years. An interviewer administered questionnaire was administered to obtain clinical information. Diagnosis was confirmed with microscopy and/or PCR. RESULTS: Four hundred and one (401) patients with 549 lesions were studied. Over 70% lesions were parasitologically confirmed and further analyzed. The majority were soldiers (57.4%). The male to female ratio was 4:1. The majority were single lesions (73.9%) on exposed areas (forearms/hands- 44.1%), face/head/neck/pinna region-30.1%). Lesion included: papules (23.4%), nodules (25.4%), ulcerating nodules (19.6%), ulcers (23.7%), plaques (6.4%) and other types (1.7%). Non ulcerative lesions (NUL) were the commonest type observed up to 6 months. After 6-9 months, the proportion of ulcerative lesions was almost twice as that of NUL (60.8% vs 31.4%), Parasite positivity was highest in nodules (n=100, 75.5%), and in lesions of 5-9 months duration, and lowest in ulcers (n=92, 65.8%). After 12 months, the majority of leishmanial skin lesions either showed complete ulceration (44.1%) or remained non ulcerative (47.1%). Lesions in their 3rd year were mainly papules (42.9%) or ulcers (35.7%). Chronic lesions (>lyear) were mainly single. Sporo-trichoid spread (n=44, 11.9%), satellite lesions (n=35, 8.9%) and lymphatic spread (n=109, 27.7%) were observed. CONCLUSIONS: CL affects many provinces of the country, with most patients referred to this department from northern and southern provinces. Males comprised the majority of cases probably due to their higher risk due to exposure to outdoor biting habits of Phlebotomus sp. sand flies as an occupational hazard. The clinical spectrum of CL in Sri Lanka is wide. Parasitological confirmation of the diagnosis is important and investigations performed between 5-9 months of duration of a lesion may have higher chances of detecting parasites/parasite DNA.Item Integrated school-based surveillance for soil-transmitted helminth infections and for lymphatic filariasis in Gampaha district, Sri Lanka(American Society of Tropical Medicine and Hygiene, 2013) Gunawardena, N.K.; Gunawardena, S.; Kahathuduwa, G.; Karunaweera, N.D.; de Silva, N.R.; Ranasinghe, U.S.; Rao, R. U.; Rebollo, M.; Weil, G. J.The Sri Lankan Anti-Filariasis Campaign (AFC) conducted 5 rounds of annual mass drug administration (MDA) with albendazole and DEC in 2002-2006 in 8 districts that were endemic for lymphatic filariasis (LF) (target population approximately 10 million). AFC conducted transmission assessment surveys (TAS) in 2012, about 6 years after the last round of MDA. This study explored the practicality of integrating surveillance for soil transmitted helminth (STH) infections with TAS for LF in Gampaha district (population 2.3 million). The district was divided into two Evaluation Units (EUs), coastal and inland. Each TAS tested 1st and 2nd grade school children drawn from 30 randomly selected schools (N=1,462 inland, 1,642 coastal). Tests included the ICT card test for filarial antigenemia (performed by AFC personnel) and the Kato-Katz test for detection of STH ova (performed by university personnel). ICT rates were 0% and 0.1% (0.01-0.3% CI) in the inland and coastal EUs, respectively. These results suggest that LF transmission rates are very low in Gampaha District. The STH survey was conducted at the same time as the TAS in the inland EU (955 stools from 1,211 children) and several weeks after the TAS in the coastal EU (927 stools from 1,586 children). STH infection rates and stool sample participation rates were 0.8% and 79% in the inland EU and 2.8% and 58% in the coastal EU. Most of the STH infections detected were lowintensityTrichuris (present in 73% of positive stools). The low STH rates are probably due to the country’s national school deworming program (mebendazole in grades 1, 4, and 7) and relatively good sanitation in Gampaha district. The cost for STH testing was approximately $5,000 per EU. These results suggest that it is feasible for national NTD programs to integrate school based surveillance for STH and LF. Further work is needed to streamline procedures and to determine optimal sampling strategies for STH surveys, because these may not require as many samples or sampling sites as TAS.Item Cost analysis of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river bed pools below the major dams in Sri Lanka(Sri Lanka Association for the Advancement of Science, 2004) Kusumawathie, P.H.D.; Wickremasinghe, A.R.; Karunaweera, N.D.; Wijeyaratne, M.J.S.