Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Hantavirus Hemorrhagic Fever with Renal Syndrome (HFRS) - Suspected cases in Sri Lanka; clinical picture and epidemiology from 2013-2021(National Institute of Infectious Diseases, 2022) Muthugala, R.; Dheerasekara, K.; Manamperi, A.; Gunasena, S.; Galagoda, G.Hantavirus; Hemorrhagic fever with renal syndrome (HFRS) is an emerging zoonotic disease in Euro-Asia which is clinically indistinguishable from leptospirosis. A total number of 1032 patients were included in the analysis from March 2013 to March 2021 with the clinical suspicion of HFRS-like illness. Of them, 168 patients were positive for hantavirus IgM antibodies. Thirty-one patients out of 35 patients had given a four-fold rise IgG antibody titre with paired serum confirming the acute hantavirus infections. Detected antibodies showed a diverse pattern, strongly cross-reacting with Seoul, Hantaan and Puumala virus antigens. All the IgM positive patients had no serological evidence of acute dengue or leptospirosis and had classical features of HFRS; fever, thrombocytopenia and renal involvement. More than 90% of patients had a history of rodent exposure 2-3 weeks prior to the onset of the fever. The highest number of positive cases were diagnosed from the Western and North-Central Provinces of Sri Lanka during the paddy harvesting seasons. A significant number of patients had developed severe complications with a high mortality rate. Therefore, hantavirus infection should be considered as a differential diagnosis for leptospirosis-like illness in Sri Lanka.Item Hantavirus infection with pulmonary symptoms in north central part of Sri Lanka(Elsevier Ltd, 2021) Muthugala, R.; Dheerasekara, K.; Harischandra, N.; Wickramasinghe, D.; Abeykoon, M.; Dasanayake, D.; Manamperi, A.; Gunasena, S.; Galagoda, G.BACKGROUND: Classical hantavirus infections present as haemorrhagic fever with renal syndrome (HFRS) in Euro-Asia and as hantavirus pulmonary syndrome (HPS) in America. Mixed clinical features have been reported from certain novel hantavirus infections. In the north-central part of Sri Lanka, clusters of patients with fever and non-cardiogenic pulmonary edema have been reported in recent years.OBJECTIVES: To detect hantavirus infection among clinically suspected patients and to describe clinical and demographic features of hantavirus infection in north-central Sri Lanka. STUDY DESIGN: Clinically suspected patients with HFRS and HPS like illness admitted to two leading hospitals in the north-central part of the country from December 2013 to November 2015 and from March 2016 to February 2018 were included in the study. Acute phase blood samples were tested for the presence of anti-hantavirus IgM. Convalescent blood samples were taken from available cases and both acute and convalescent sera were subjected to IgG titre detection. RESULTS: Seventy-two patients were included in the study. Twenty-nine (40.28%) were positive for hantavirus IgM. Of them, 20 (68.97%) presented with pulmonary symptoms with no or mild nephritis. Five (17.24%) had pulmonary symptoms with prominent nephritis and 04 (13.79%) had classic features of HFRS. CONCLUSION: In the north-central part of Sri Lanka, most hantavirus infection was associated with pulmonary symptoms complicated with non-cardiogenic pulmonary edema, which was different from clinical presentation reported previously from other parts of the country. HPS like hantavirus infection in the study area could be due to a Puumala-like virus or a novel virus.Item A Novel reverse transcriptase-polymerase chain reaction based-liquid hybridisation(RT-PCR-LH) assay for early diagnosis of dengue infection(Sri Lanka Medical Association, 2003) Gunasekera, M.B.; Hapugoda, M.D.; Gunasena, S.; Subasinghe, S.A.S.C.; Bandara, K.B.A.T.; Khan, K.B.; Abeyewickreme, W.BACKGROUND: Early definitive laboratory diagnosis of dengue is difficult with the tests in routine use at present. OBJECTIVE: To develop a reverse transcriptase-polymerase chain reaction based liquid hybridisation (RT-PCR-LH) technique for the rapid and early diagnosis of dengue. RESEARCH DESIGN: RT-PCR products of the NS3 gene of dengue virus prototypes and of a few positive sera for dengue virus by culture, were allowed to hybridise in liquid phase with a mixture of dengue specific radio-labelled oligonucleotides. The products were separated by PAGE and visualised by autoradiography. 78 suspected dengue sera were also tested by RT-PCR-LH method, and by IgM-ELISA and HAI tests, for comparison. RESULTS: Two DNA bands (approximately equal to 470 bp and approximately equal to 455 bp) specific to dengue virus, were observed. RT-PCR-LH assay takes only 24 h. Of the 78 suspected dengue acute sera tested, 45/78 were positive by RT-PCR-LH, 31/78 were positive by IgM-ELISA, and 14/78 had a HAI titre > or = 2560. Duration of fever was known in 72 cases, and infection was detected by RT-PCR-LH in 11/22 of cases with < 5 d fever and by IgM-ELISA in 1/22. In cases with 5 to 15 d fever RT-PCR-LH and IgM-ELISA/HAI titre > or = 2560 detected infection in 30/50 and 27/50 respectively. The 10 sera which were negative by RT-PCR-LH, but were positive by either IgM-ELISA or HAI titre > or = 2560 were all > 5 d fever cases. RT-PCR-LH together with IgM-ELISA were capable of detecting dengue infection in 56/78 of the suspected cases. CONCLUSION: RT-PCR-LH assay developed in this study appears to have an advantage over other diagnostic techniques for the early detection of dengue.