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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Canine filaria species in selected lymphatic filariasis endemic and non-endemic areas in Sri Lanka(Springer International, 2022) Rathnayake, S.; Chandrasena, N.; Wijerathna, T.; Mallawarachchi, H.; Gunathilaka, N.Subperiodic brugian filariasis and dirofilariasis show a rising trend in Sri Lanka posing a threat to public health. As information was limited on canine filaria species in Sri Lanka, we studied the filaria parasites among dog populations in lymphatic filariasis (LF) endemic and non-endemic regions by microscopy and molecular methods. Thick blood smears (TBSs) were performed among 295 dogs presenting to veterinary clinics for surgical or sterilization procedures in Galle (LF endemic) and Mullaitivu (LF non-endemic) districts, of which 55.6% were positive for any microfilariae. We identified Dirofilaria repens (50.8%) and Brugia spp. (20.6%) by microscopy, which, included mono-infections (D. repens 35.3% and Brugia spp. 5%) and co-infections (15.6%). Infections in Galle and Mullaitivu were 61% and 44.9% respectively. The brugian filariasis rate was significantly higher among canines in LF endemic Galle district (29.9%) than in Mullaitivu (LF non-endemic) (1.1%) (P < 0.001), while D. repens infections were comparable in both districts. Genomic DNA extracted from 10% of microfilariae positive TBSs was amplified using pan-filarial primers targeting the internal-transcriber-spacer region-2 (ITS-2). Sequencing of amplicons confirmed the presence of D. repens (89.28%), Brugia pahangi (7.14%) and B. malayi (3.57%) infections. The phylogeny constructed and analysed in MEGA X indicated genetic variability among D. repens and B. pahangi isolates from Sri Lanka. With this study, we were able to report B. pahangi infections for the first time in Sri Lanka.Item An investigation of a new cutaneous leishmaniasis endemic area in Western Sri Lanka(Oxford University Press, 2021) Mallawarachchi, C.H.; Chandrasena, N.; Wijerathna, T.; Dalpadado, R.; Mallawarachchi, M.S.M.N.S.; Gunarathna, D.G.A.M.; Gunathilaka, N.BACKGROUND: The aim was to investigate an emerging focus of cutaneous leishmaniasis (CL) in Gampaha district, Western Sri Lanka. METHODS: Sociodemographics of CL patients in Mirigama, Gampaha district, were compared with controls using a structured questionnaire. Clinical data and geographic positioning system coordinates of patients were recorded. Sandflies collections were performed in four selected sites using indoor hand collection (162 units) and cattle-baited net traps (n=3). RESULTS: Of 73 patients (mean age 43.6 y; SD 20), 58.9% were males. Lesions consisted of nodules (52.1%) and ulcers (47.9%). Single lesions were seen in 69.9% of patients, while 30.1% had multiple lesions. Except for one mucosal lesion, all the others were cutaneous. Treatment consisted of sodium stibogluconate and cryotherapy (46.6%), sodium stibogluconate (45.2%) or cryotherapy (8.2%). Multiple lesions were more likely to receive combination therapy (p=0.013). The majority of those employed (81.1%; 27/33) were engaged in outdoor work. Male gender, low education attainment and poor disease awareness were significant risk factors for CL (p<0.05). Four households reported multiple cases. Phlebotomus argentipes was detected in all cattle-baited net traps and 35.3% of indoor hand collection units. CONCLUSIONS: CL is emerging in Gamapha district with Mirigama as the epicentre. Case distribution indicates local transmission, with P. argentipes as the probable vector. KEYWORDS: Sri Lanka; cutaneous leishmaniasis; emerging infectious diseases.Item 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.Item Toxoplasmosis awareness, seroprevalence and risk behavior among pregnant women in the Gampaha district, Sri Lanka(London, UK : Maney Publishing., 2016) Chandrasena, N.; Herath, R.; Rupasinghe, N.; Samarasinghe, B.; Samaranayake, H.; Kasturiratne, A.; de Silva, N.R.BACKGROUND: Primary gestational toxoplasmosis can be transmitted to the fetus with deleterious effects on the pregnancy. There is very little information regarding gestational toxoplasmosis in Sri Lanka. This survey was done to determine the prevalence and awareness of toxoplasmosis and to identify risk factors of infection among pregnant women in the Gampaha district, Sri Lanka. METHODS: Women attending obstetric clinics at the Colombo North Teaching Hospital in 2014 were tested for Toxoplasma gondii (T. gondii) specific Immunoglobulins G (IgG) and M (IgM) subtypes using the OnSite Toxo IgG/IgM Rapid Test-Dip Strip®. Disease awareness and risk behaviors of the participants were investigated. RESULTS: Of the 293 participants (mean age 27 years, SD ± 5.92), 38% were primigravidae with a mean gestational age of 16.2 weeks (SD 7). The prevalence of anti-T. gondii IgG and IgM antibodies was 12.3% (n = 36) and zero, respectively. Unadjusted and adjusted odds ratios were calculated to determine risk factors of infection (cat-ownership, handling cats, consumption of meat, commercial meals and unwashed raw vegetables and fruits, handling soil and not washing hands after handling soil). On bivariate analysis, eating commercially prepared meals weekly or more was associated with toxoplasma seroprevalence with marginal statistical significance. On multivariate analysis, none of the considered risk factors were significant. Toxoplasma awareness was 4.4% (n = 13); health personnel (46.2%, n = 6) and media (53.8%, n = 7) being sources of information. CONCLUSIONS: Health education programs to increase awareness of toxoplasmosis is recommended at antenatal clinics.Item What clinicians who practice in countries reaching malaria elimination should be aware of: lessons learnt from recent experience in Sri Lanka(BioMed Central, 2011) Premaratna, R.; Galappaththi, G.; Chandrasena, N.; Fernando, R.; Nawasiwatte, T.; de Silva, N.R.; de Silva, H.J.Following progressive reduction in confirmed cases of malaria from 2002 to 2007 (41,411 cases in 2002, 10,510 cases in 2003, 3,720 cases in 2004, 1,640 cases in 2005, 591 cases in 2006, and 198 cases in 2007). Sri Lanka entered the pre-elimination stage of malaria in 2008. One case of indigenous malaria and four other cases of imported malaria are highlighted here, as the only patients who presented to the Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka over the past eight years, in contrast to treating several patients a week about a decade ago. Therefore, at the eve of elimination of malaria from Sri Lanka, it is likely that the infection is mostly encountered among travellers who return from endemic areas, or among the military who serve in un-cleared areas of Northern Sri Lanka. They may act as potential sources of introducing malaria as until malaria eradication is carried out. These cases highlight that change in the symptomatology, forgetfulness regarding malaria as a cause of acute febrile illness and deterioration of the competency of microscopists as a consequence of the low disease incidence, which are all likely to contribute to the delay in the diagnosis. The importance regarding awareness of new malaria treatment regimens, treatment under direct observation, prompt notification of suspected or diagnosed cases of malaria and avoiding blind use of anti-malarials are among the other responsibilities expected of all clinicians who manage patients in countries reaching malaria eliminationItem Hospital-based study of the severity and economic burden associated with rotavirus diarrhea in Sri Lanka(IOS Press, 2009) Chandrasena, N.; Rajindrajith, S.; Ahmed, K.; Pathmeswaran, A.; Nakagomi, O.