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 A Descriptive Study on Antibiotic Resistant, Clinically Significant Coliform Species Isolated from the Patients at Colombo North Teaching Hospital (CNTH), Ragama, Sri Lanka(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Namalie, K.D.; Sunil-Chandra, N.P.Introduction: Antibiotic resistance (AR) is a great therapeutic challenge globally and locally today. The rate of development of AR is far ahead compared to the discovery of a new class of antibiotics, which has not been successful in last three decades. Of the antibiotic resistant coliforms, extended spectrum beta-lactamase producers (ESBLP) play a key role in life threatening infections. Moreover, emergence of carbapenem-resistant Enterobacteriaceae (CRE) has further limited the effective therapeutic options. Objective: To investigate the AR of clinically significant Enterobacteriaceae isolated from patients in a tertiary healthcare setting. Method: A descriptive, cross-sectional study was conducted involving patients with coliform infections at CNTH from 01/03/2018 to 31/08/2018. Demographic details, clinical data & antibiotic sensitivity test (ABST) patterns were analyzed. ABST was performed according to John-Stokes method & ESBLPwere identified by the keyhole method. Resistance to either meropenem or imipenem is used to identify CRE. Statistical analysis was done via R programming language (level of significance P<0.05). Results: Of the 200 coliforms, 85.5% (171/200) were from inpatients & the rest were from outpatients. Of the studied patients, 53.5% (107/200) were females & 46.5% (93/200) were males. Of the Enterobacteriaceae spp isolated, 48.5% (97/200) were from urine, 34.5% (69/200) from pus / wound swabs, 9.5% (19/200) respiratory samples, 3% (6/200) sterile fluids & stents, & 3% (6/200) from blood & CVP tips. As per ABST, about 90% were resistant to ampicillin. Resistance was 61-70% against cefuroxime (oral), ciprofloxacin & nalidixic acid, 60% for amoxiclav, 41-50% for cefotaxime, cefuroxime (intravenous), co-trimoxazole, levofloxacin, norfloxacin & ofloxacin, 31-40% for cefepime, ceftazidime, ceftriaxone & nitrofurantoin, 21-30% for gentamicin & piperacillin tazobactam & 0-10% for amikacin & meropenem. Of the coliforms, 29% (58/200) were ESBLP & 8% (16/200) were CRE. None of the ESBLP was CRE. Of CRE, 37% (10/16) were resistant to amikacin. However, 93.8% (15/16) of CRE were colistin sensitive. Conclusion: Majority of the isolates represented infections of the inward patients & there was no statistically significant difference between male & female proportions. Coliforms were detectedmostly from urine. Majority (>50%) of clinically significant Enterobacteriaceae were resistant to most of the oral antibiotics namely cefuroxime, ciprofloxacin, nalidixic acid & amoxiclav. Of the oral antibiotics, nitrofurantoin has the lowest resistance against Enterobacteriaceae. None of the antibiotics had 100% sensitivity against Enterobacteriaceae. Results indicate that ESBLP can be safely treated with carbapenems. Colistin will be an effective empiric antibiotic for CRE.Item Comparison of Three Carbapenemase Producing Enterobacteria (CPE) Detection Methods(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Kumudunie, W.G.M.; Wijayasinghe, Y.S.; Wijesooriya, W.R.P.L.I.; Sunil-Chandra, N.P.; Namalie, K.D.Introduction: The emergence of carbapenem resistant enterobacteria (CRE) is a critical and growing health threat, causing a failure of almost all the available antibiotics and limiting the effective therapeutic options. CRE has been reported all over the world including Sri Lanka. The carbapenem resistance in enterobacteria is mainly occurred due to the production of carbapenemases, the carbapenem inactivating enzymes. Therefore, accurate and timely detection of CPE is an important aspect to streamline the empiric antibiotic therapy. In this study, three CPE detection methods namely, Carba NP-rapid biochemical test, modified carbapenem inhibition method (MCIM) and modified Hodge test (MHT) were compared for the detection of CPE. Carba NP test is a rapid biochemical test that requires 2 hours or less. However, both MCIM and MHT require incubation of 18 – 24 hours. Objective: To compare theCarba NP-rapid biochemical test with the MCIM and MHT for the detection of CPE. Methodology: Fifty-eight clinically significant CRE isolates were recovered from clinical specimens from patients attended to North Colombo Teaching Hospital (NCTH)during December 2017 – February 2018. Antibiotic sensitivity testing for the screening of CRE was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Enterobacteria, resistant to at least one carbapenem antibiotic were considered as CRE. Carba NP test, MCIM and MHT were carried out for CRE isolates according to the CLSI guidelines. Statistical analysis was done using R programming language (level of significance P<0.05). Results: Of 58 CRE, 94.82% (55/58) were confirmed as CPE via both MCIM and MHT while 77.58% (45/58) were revealed as CPE by Carba NP test. There was a significant reduction of CPE detection by Carba NP method compared to MCIM and MHT(P=0.007). Conclusion: Of the three CPE detection methods, sensitivity was higher in MCIM and MHT compared to Carba NP – rapid biochemical test. Acknowledgement: Financial assistance by National Research Council, Sri Lanka (NRC 17-055) is acknowledged.Item Viral Zoonoses in Sri Lanka and Public Health Implications(2007) Sunil-Chandra, N.P.Zoonoses have been defined as "those diseases and infections (the agents of) which are naturally transmitted between (other) vertebrate animals and man". These diseases have been in the past and continue to remain in the world causing widespread illness and death among hurnans, In addition to direct transmission to man from animal reservoirs or via animal foods, other animal products and animal wastes, a majority of zoonoses depends totally or partially on arthropod vectors to maintain chain of infection in and between animals and human beings, thereby exposing large numbers of people to the diseases in question, Recent changes in the pattern of human behaviour are allowing increasing number of emerging pathogens in which over 70 per cent of new human diseases are zoonotic in origin including Ebola, Nipha virus and SARS. Zoonoses also undermine animal health and productivity reducing food (meat, milk and eggs) thus contribute to human malnutrition and to lowering the resistance of large numbers of people, particularly children, to infectious diseases of all kinds. Rabies, Japanese encephalitis (JE), and recently re-emerged Chikungunya virus are major viral zoonoses that have been recognized by the public health services of Sri Lanka. These zoonoses have received public attention as they are capable of causing severe disease in humans. Rabies is one of the many zoonoses characterized by sporadic transmission to man and by outbreaks involving only a few persons. Every year over 15,000 people throughout the world die from this most fearful illness, despite benefits of modern medical services. Rabies is endemic in all provinces of Sri Lanka and the dog (76.4%) in particular the stray dog (43.6%) is the main reservoir of the virus. The rest is due to cats and other wild animal exposures. According to studies in Sri Lanka approximately 100,000 persons annually undergo post exposure treatment for rabies in the recent years, resulting in an enormous amount of psychological stress and in the loss of many man-hours work, in addition to which there are at least 50 -100 number of annual deaths from the disease. However, another study carried out in Sri Lanka has questioned the appropriateness of post exposure rabies treatment given to dog bite victims. The number of human rabies deaths declined from 377 in 1975 to 55 in 2005. Highest percentage of human rabies cases in 2005 occurred in the age group 5-19 years and the reported male: female ratio was 4:1. JE is the most common documented cause of viral encephalitis in Asia. The virus was first isolated in 1986. Since then JE has been involved in several outbreaks in various provinces of the country but there were no outbreaks since the introduction of the JE vaccine. Sixty five suspected cases of JE with 6 deaths reported in Sri Lanka in the 2005. The case fatality rate was 9.2 per cent. Therefore, a number of successes have been achieved in zoonosis control in Sri Lanka in the recent years by the wide use of post exposure treatment against rabies and vaccination against Japanese encephalitis. Evidence of Hantavirus infection transmitted by rodents among patients hospitalized with leptospirosis-like illness in Sri Lanka is an example of viral zoonoses in which true public health implications have not been recognised in the country. There are also occasional cases of identified (i.e., Orf virus) and unidentified •pox virus infections among Sri Lankan patients.The zoonotic relationships of some less well-known and milder forms of human enteric virus infections, especially those associated rotaviruses are only now beginning to be understood. Rotaviruses have been associated with enteritis in infants and children and many species of young animals. Several rotavirus serotypes have a high I degree of cross protection. . Studies carried out Sri Lanka on buffalo calf diarrhoeas Baave revealed that they are infected with group A subgroup I rotavirus strains. However, detailed studies are required to understand any zoonotic relationship of these I virus strains. True public health significance of some viral zoonoses in Sri Lanka often remains unclear because of the lack of appropriate national programmes and in particular, of diagnostic services which could elucidate the causes of fevers, nephritis or encephalitis etc. This group of diseases classified as "of unknown aetiology" often contains a high proportion of zoonoses which need to be determined locally. There is also growing concern in Sri Lanka with the emergence of avian influenza A/H5N1 or bird flu in the Asian region. The attempts to isolate and identify the virus so far have not indicated its presence in Sri Lanka. However, serious public health and socioeconomic implications could occur in an event of any introduction of the 'bird flu' to the country. Since the expertise, laboratory and training facilities and other resources are unequally distributed among various parts of the country, it is of paramount importance to ensure interdisciplinary and intersectional cooperation for mobilizing all existing resources with the help of international cooperation for the control of bird flu or any other emerging zoonotic virus.