Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Scrub typhus mimicking Parkinson's disease(Biomed Central, 2015) Premaratna, R.; Wijayalath, S.H.N.C.; Miththinda, J.K.N.D.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.Background Scrub typhus is a re-emerging infection in Sri Lanka. It often poses a diagnostic challenge and tends to present as a febrile illness of uncertain origin. Undiagnosed illness may progress to serious multi-systemic complications. Here we report a case of scrub typhus presenting with features of Parkinsonism. Case presentation A 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka presented with high fever with malaise, myalgia and arthralgia for 17 days. On the 5th day of illness he developed intermittent resting tremor in his right arm and leg associated with stiffness, difficulty in carrying out normal work and difficulty in smiling. He denied similar previous episodes. There were no other associated neurological manifestations. Clinical examination revealed a high amplitude low frequency resting tremor in his right hand, a mask-like face and increased muscle tone limited to the right side with normal reflexes. The rest of the system examination was normal except for an eschar over the abdomen. His investigations revealed lymphocytic leukocytosis, high erythrocyte sedimentation rate and immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers. With oral doxycycline and azithromycin his fever settled within 48 h and a complete recovery of Parkinson’s features was observed within 2 weeks. Conclusion Doctors practicing in endemic regions should be familiar with delayed clinical manifestations of scrub typhus and should carefully look for an eschar in order to avoid delay in the diagnosis.Item Scrub typhus pneumonitis(Elsevier, 2013) Premaratna, R.; Ariyaratna, N.; Botheju, W.I.K.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.No Abstract AvailableItem Evidence of acute rickettsioses among patients presumed to have chikungunya fever during the chikungunya outbreak in Sri Lanka(Elsevier, 2011) Premaratna, R.; Halambarachchige, L.P.; Nanayakkara, D.M.; Chandrasena, T.G.A.N.; Rajapakse, R.P.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.BACKGROUND: Chikungunya fever (CGF) and rickettsioses are known to cause acute onset febrile illnesses associated with severe arthritis. Rickettsial arthritis is curable with the use of appropriate anti-rickettsial antibiotics, however the arthritis of CGF tends to have a prolonged course leading to protracted disability. The aim of this study was to investigate the contribution of CGF and rickettsioses to cases of fever and arthritis during a presumed CGF outbreak in Sri Lanka. METHODS: Fifty-eight consecutive patients with presumed CGF were further investigated to determine the occurrence of rickettsioses among them, and to identify differences in clinical, hematological, and biochemical parameters between the two diseases. RESULTS: Nearly a third of the patients had serological evidence of rickettsioses accounting for their illness. The presence of a late onset major joint arthropathy sparing the small joints of the hands and feet, and the occurrence of a late onset discrete maculopapular rash over the trunk and extremities, suggested rickettsioses over CGF. White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and liver function tests were not helpful in differentiating rickettsioses from CGF. Patients with rickettsioses and arthritis who received an empirical course of doxycycline recovered faster than those who did not receive specific treatment. CONCLUSIONS: The establishment of rapid diagnostic methods able to differentiate the etiological agents of fever and arthritis, such as CGF and rickettsioses, would be beneficial in endemic settings