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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Author: search.filters.author.Premaratna, R.

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    Factors associated with urinary tract infections caused by extended spectrum beta-lactamase (ESBL) producing organisms in Sri Lanka
    (Elsevier, 2016) Fernando, S.; Luke, N.; Wickramasinghe, S.; Sebastiampillai, B.; Gunathilake, M.; Miththinda, N.; Silva, S.; Premaratna, R.
    BACKGROUND: Urinary tract infections (UTI) caused by extendedspectrum beta-lactamase (ESBL)-producing organisms are a major burden in clinical practice. Hospitalization in the past 3 months, antibiotic treatment in the past 3 months, age over 60 years, diabetes mellitus, Klebsiella pneumoniae infection, previous use of second or third-generation cephalosporins, quinolones or penicillins are known associations and risk factors for ESBL-UTI. METHODS & MATERIALS: A descriptive study was conducted over a period of 6 months from January - July 2015 recruiting patients with UTI caused by ESBL producing organisms, who were admitted to the Professorial Medical unit, Colombo North Teaching Hospital, Ragama Sri Lanka in order to identify risk factors and associations. Data were obtained using a pre-tested interviewer administered questionnaire and from relevant medical records after obtaining informed written consent. RESULTS: 52 patients were recruited; males 30 (57.7%), mean (SD) age 64.1(.12.6)years. Of them, 46 (88.5%) had diabetes mellitus, 32 (61.5%) had hypertension and 10 (19.2%) had chronic liver disease as comorbidities.20 (38.5%) had ultrasonographic evidence of acute pyelonephritis. At presentation16 (30.8%)had biochemical and/or ultrasonographic evidence of chronic or acute on chronic kidney disease. History of constipation was observed in 18 (34.6%), hospitalization during the past 3 months was seen in 24(46.2%)and history of urinary catheterization in 16(30.8%). Features of obstructive uropathy such as hydronephrosis, hydroureter and prostatomegaly were seen in 4 (7.7%) patients each. Antibiotic treatment within the past 3 months was observed in 32(61.5%);penicillins in 18(34.6%), 3rd generation cephalosporins in 16(30.8%),quinolones in 14(26.9%) and 2nd generation cehalosporins in 12 (23.1%). 18 (34.6%) had received more than one antibiotic within the past 3 months. 8(15.4%)patients studied were on prophylactic antibiotics for recurrant UTIs. None of them had recent Klebsiella pneumonia. CONCLUSION: Similar to other studies,diabetes mellitus, recent antibiotic treatment, hospitalization and catheterization were observed in our patients with ESBL-UTI. The fact that only 53.8% patients had received antibiotics at community level and 38.5% patients had never received antibiotics prior to developing ESBLUTI suggest high prevalence of ESBL producing organisms at community level.
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    Sero-prevalence of rickettsial infections in patients with Parkinson’s disease
    (Sri Lanka Medical Association, 2017) Gunathilake, M.P.M.L.; Luke, N.; Benedict, S.; Wickremasinghe, S.; Ranawaka, U.K.; Premaratna, R.
    INTRODUCTION & OBJECTIVES: Role of infections in Parkinson’s disease (PD) pathogenesis has been proposed. A patient who had features of PD during scrub typhus infection fully recovered following treatment. Two years later, he developed features suggestive of early PD and raised the question, whether rickettsial infections could trigger development of PD. METHODS: In order to study the sero-prevalence of rickettsioses, a descriptive cross-sectional study was carried out in patients with diagnosed PD. Their IFA-IgG titres against O. tsutsugamushi (IFA-IgG-OT) antigens at 1:32 and 1:128 dilutions were compared with the population seroprevalence. Statistical analysis was performed using SPSS. RESULTS: A total of 35 patients; 20 (57.1%) males [mean age 62 years (SD 8.8)], 15 (42.9%) females [mean age 68.5 years (SD 7.4)]. Mean age at diagnosis of PD; males: 57.2 years (SD 9.7), females: 64.7 years (7.5). 10/35 (29.8%) had IFA-IgG-OT titre 1:32 (p=0.19 compared to population sero-prevalence of 19.8%) and one had a titre 1:128 (2.8% compared to population prevalence of 3.17%). At the time of assessment for sero-prevalence of rickettsioses, the mean (SD) duration of diagnosis of PD between IFA-IgG +ve vs IFA-IgG –ve were 4.3(3.9) vs 4.2(4.4) years. CONCLUSION: Although patients with PD had a higher percentage sero-prevalence compared to the population, it was not significantly different. The drawback of this study was the long duration of PD at the time IFA-IgG levels were done. Following up of patients who present with extrapyramidal features due to acute rickettsioses and assessing whether they later develop PD would help to arrive at conclusions.
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    Rickettsial disease IFA-IgG titres in Auto-Immune diseases; what do they imply?
    (Sri Lanka Medical Association, 2016) Balasooriya, B.L.P.P.; Bandara, N.; Chandrasena, N.; Premaratna, R.
    INTRODUCTION: Rickettsial infections are known to present mimicking autoimmune disorders. The gold standard diagnostic test for rickettsial diseases is based on the detection of IgM and or IgG antibodies against these infections by immuno-fluorescent technique (IFA). During the IFA test, patient sera containing anti rickettsial antibodies are made to react with rickettsial antigens that are grown in cell culture media. However, presence of nuclear material in these cell cultures may react with anti-nuclear antibodies that are produced in autoimmune disorders and cause a false positive immunofluorescent signal. OBJECTIVES: To evaluate the reactivity of rickettsial disease among patients with auto immunity diseases. METHOD: In order to evaluate the reactivity of rickettsial disease IFA-IgG test [IFA-IgG-OT (Orientia tsutsugamushi) and IFA-IgG-SFG (spotted fever group)] among patients with autoimmune diseases, an analytical cross-sectional study was carried out using sera of 38 patients with confirmed auto-immune diseases. RESULTS: The 38 patients included 15 systemic lupus erythematosus (SLE), 5 autoimmune-thyroiditis, 13 idiopathic-thrombocytopenia (ITP), 4 autoimmune-haemolytic-anaemia (AIHA), 1 polymyositis, 1 polyglandular syndrome and 1 Anti-phospholipid syndrome. The IFA-IgG reactivity of ≥ 1:128 was noted in 14/38 (37%); IFA-IgG-SFG in 7, IFA-IgG-OT in 3 and for both in 4. Of the 14 patients who had shown reactivity to IFA-IgG 2 had a titre of 1:128, four had a titre of 1:256, five had a titre of 1:512, three had >1: 1024 . 57% among the 14 who had shown reactivity were diagnosed as SLE, 21.4 % had ITP, 14.3% had AIHA, and 7.1% had polymyositis. None were diagnosed with thyroiditis. CONCLUSIONS: There was a significant reactivity of Rickettsial disease IFA-IgG assay in auto-immune diseases. Further studies are needed in order to ascertain whether this is due to recent rickettsial infections, false positive cross reactivity of autoimmune antibodies with rickettsial antigens or with cell culture nuclear antigens.
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    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.
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    Occurence of tick bits and serological evidence of exposure to rickettsioses among Sri Lankan military personnel
    (International Society for Infectious Diseases, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Nawasiwatte, B.M.T.P.; Kulasiry, K.I.R.; Rajeev, S.; Bandara, K.B.K.R.G.W.; Rajapakse, R.P.V.J.; Kularatna, S.A.M.; de Silva, H.J.
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    Predicted cost benifits of establishment of Ricckettsial didease diagnostics in Sri Lanka
    (American Society of Rickettsiology, 2008) Premaratna, R.; Dissanayake, I.; Chandrasena, T.G.A.N.; Attanayake, N.; de Silva, H.J.
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    Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: A hospital based study
    (American Society of Rickettsiology, 2007) Premaratna, R.; Loftis, A.D.; Chandrasena, T.G.A.N.; Dasch, G.A.; de Silva, H.J.
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    The role of antioxidants in filarial infection
    (Royal Society of tropical medicine and Higiene (RSTMH), American Society of tropical medicine and Higiene(ASTMH), British Society for Parasitology, 2000) Premaratna, R.; Chandrasena, T.G.A.N.; Senarath, S.; Chandrasena, L.G.; de Silva, N.R.; de Silva, H.J.
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    The Recto-Anal Inhibitory Reflex (RAIR): abnormal response in diabetics suggests an intrinsic neuro-enteropathy
    (BMJ Publishing, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.
    INTRODUCTION: The recto-anal inhibitory reflex (RAIR) is characterized by reflex relaxation of the anal canal in response to electrical stimulation of the rectal mucosa, and is mediated by nitrergic neural plexuses within the gut wall. Impairment of this reflex may lead to incontinence. AIM: To measure anal canal pressures, anal mucosal electrosensation and RAIR in diabetic patients and correlate these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male:Female=13:17, median age 57 years (range 37- 70)], and these data were compared with similar data obatained from 22 age and sex matched 'healthy' controls [Male:Female= 9:13, median age 51 years (range 19 - 65 )]. Median duration of diabetes was 8 years (range 3 -30 ). 12 (40%) of the 30 diabetics had impaired continence for gas (n=12) and liquid faeces (n=3). None ofthe controls had incontinence. RESULTS: Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30mmHg (20-75) vs. Controls 40mmHg (20-105), P=0.61. Maximum squeeze pressure (MSP) [median (range)]: Patients 65mmHg (30- 150) vs. Controls 84mmHg (35-230), P=0.59. Threshold rectal mucosal eletrosensation (RMES-T) [median (range)]: Patients 27 mA (5-40) vs. Controls l3mA (5-28), P=0.03. Maximum tolerable rectal mucosal electrosensation [median (range)]: Patients 40 mA (20-60) vs. Controls 20 mA (10-30), P=0.042 (all comparisons using Wilcoxon rank test). RAIR was present in 8, abnormal in 5 (1 with incontinence), and absent in 17 (II with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (test of proportion, P=0.03 I). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.
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    Etiology of fever of unknown origin in a selected group of Sri Lankan patients with prompt responses to Doxycycline
    (Centers for disease control and Prevention, 2008) Dasch, G.A.; Premaratna, R.; Rajapakse, R.P.; Chandrasena, T.G.A.N.; Eremeeva, M.E.; de Silva, H.J.
    BACKGROUND: Most patients with long duration of fever go undiagnosed in settings where diagnostic facilities are inadequate. Untreated rickettsial infections cause extended fevers; while both scrub typhus and tick typhus are re-emerging diseases in Sri Lanka, laboratory facilities to specifically diagnose rickettsial infections in Sri Lanka are not available. METHODS: We collected 2 ml venous blood from febrile patients who had no etiological diagnosis after 7 days of hospital admission, but who showed rapid clinical response to doxycycline, to verify whether they had experienced a rickettsial infection. Acute serum samples were analysed using IFA for rickettsial infections caused by Orientia tsutsugamushi, Rickettsia conorii and Rickettsia typhi. A positive IgG IFA titer >1:128 was used to define a probable case of rickettsial infection. RESULTS: 28 patients [15 males, mean age 32.5 (SD 9.2 yrs)] were studied. Mean duration of fever at admission was 6.1 days (SD 3.1). Two patients had features suggestive of encephalitis and two had erythema nodosum. Others had no specific clinical features. Routine investigations were inconclusive and blood cultures were negative. IgG-IFA titer of >128 was found in 10 for R. conorii, 6 for O. tsutsugamushi and 6 for both R. conorii and O. tsutsugamushi. None were positive for R. typhi. Six were negative for all tests. One patient with encephalitis and one with erythema nodosum had high titers for R. conorii. CONCLUSIONS: The majority of Sri Lankan patients with undiagnosed fever responding promptly to doxycycline had a rickettsial etiology. Patients with rickettsioses exhibit varied clinical presentations so greater use of doxycycline for patients with extended fevers in rickettsial-endemic settings with inadequate diagnostic facilities appears warranted. The high proportion of patients with tick typhus and antibodies against both spotted fever and scrub typhus rickettsiae was unexpected based on previous studies of patients from the same region who were confirmed to have scrub typhus by serology and by the presence of the classic eschar. It is unknown whether the etiology of tick typhus and vector(s) transmitting this agent on the Western lowland region of Sri Lanka are the same as those responsible for spotted fevers in the central hill country of Sri Lanka.