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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Molecular characterization of rickettsial agents in ticks (Acari: Ixodidae) from Sri Lanka(Baltimore., 2022) Dasch, G.A.; Eremeeva, M.E.; Zambrano, M.L.; Premaratna, R.; Kularatne, S.A.M.; Rajapakse, R.P.V.J.Because the majority of spotted fever group rickettsiae are transmitted to humans by tick bites, it is important to understand which ticks might play a role in transmission of rickettsial pathogens in Sri Lanka. The purpose of our study was to conduct molecular surveillance of 847 ticks collected in different locations in central Sri Lanka to determine which were infected with Rickettsia and Anaplasmataceae. Molecular methods were used to identify the ticks and the agents detected. Most ticks (Amblyomma, Haemaphysalis, and Rhipicephalus) were collected by flagging, and lower number was collected from dogs, cattle, pigs, a pangolin, and tortoises. Five spotted fever genotypes were identified: a Rickettsia africae-like agent in Amblyomma larvae, Rhipicephalus massiliae and a related genotype identified in association with the tropical type of Rhipicephalus sanguineus from dogs and Rhipicephalus haemaphysaloides from dogs and cattle, and Candidatus R. kellyi and another novel genotype (SL94) in R. haemaphysaloides. Twenty-three ticks were positive for Anaplasmataceae, including one Anaplasma and two Ehrlichia genotypes. Because the sequence database for both ticks and rickettsial agents from Sri Lanka and southern India is not extensive, additional molecular characterization of the tick species of Sri Lanka and their rickettsial agents is required to understand their pathogenic potential more completely. However, several of the agents we identified in this survey may well be pathogenic for humans and domestic animals, and should be considered as a part of epidemiological surveillance and patient management.Item 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.Abstract AvailableItem Progress report of Rickettsial disease diagnostic and research laboratory (RDDRL), Faculty of Medicine, University of Kelaniya(Sri Lanka Medical Association, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Bandara, N.K.B.K.R.G.W.; Rajapakse, R.P.V.J.INTRODUCTION: RDDRL was established at Faculty of Medicine, University of Kelaniya (FMUK) in June 2008 in collaboration with Centers for Disease Control and Prevention, Atlanta, Georgia, USA and Faculty of Veterinary Medicine, University of Peradeniya. OBJECTIVES: We present the contribution of RDDRL towards the diagnosis of ricketsioses over the 5 months since its inception. RESULTS: 84 acute serum samples were analysed [56 from Colombo North Teaching Hospital (CNTH), 4 from Teaching Hospital Jaffna (THJ), 7 from Base Hospital Kamburupitiya (BHK) 3 from Lady Ridgeway Hospital (LRH), 2 from Infectious Disease Hospital (IDH), 2 from Colombo South Teaching Hospital (CSTH), and 10 from the private sector hospitals (PVT)]. 48/84 (57%) had diagnostic titers; 31 (65%) for Rickettsia conorii (RC) and 17 (35%) for Orientia tsutsugamushi (OT). The total (%) positives for each hospital were; CNTH: 22/56 (39%), BHK: 7/7 (100%), Jaffna: 3/4 (75%), LRH: 1/3 (33%), IDH: 1/2 (50%), CSTH: 0/2(0%) and PVT: 8/10 (80%). The district total (ROOT); Gampaha: 33 (26:7), Matara: 7 (3:4), Jaffna: 3 (0:3), Puttlam: 5 (2:3). The mode (range) duration of febrile illness at the time of request was 14 (3-90) days and 6 samples were from severe complicated patients; 2-encephaiitis, 2-'Neuroleptic malignant syndrome', 1-muiti-organ failure and 1-severe gastroenteritis. CONCLUSIONS: Out of the clinically suspected patients, 57% were positive for rickettsiosis; 65% caused by R. conorii and 35% by O. tsutsugamushi. However, the request for serological diagnosis was made after a considerable delay in the majority of cases.Item A Patient with spotted fever group rickettsiosis mimicking connective tissue disease(Sri Lanka Medical Association, 2012) Premaratna, R.; Liyanaarachchi, E.W.; Rajapakse, R.P.V.J.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.Item Contribution of rickettsioses in Sri Lankan patients with fever who responded to empirical doxycycline treatment(Oxford University Press, 2010) Premaratna, R.; Rajapakse, R.P.V.J.; Chandrasena, T.G.A.N.; Nanayakkara, D.M.; Bandara, N.K.B.K.R.G.W.; Kularatne, S.A.M.; Eremeeva, M.E.; Dasch, G.A.; de Silva, H.J.Twenty-eight febrile Sri Lankan patients with undiagnosed fever for 7 days after hospital admission, who responded to empirical treatment with doxycycline, were retrospectively investigated using microimmunofluorescence assay to verify whether they had rickettsial infection. Eleven (39%) patients were confirmed as having spotted fever group rickettsioses and 10 (36%) as having Orientia tsutsugamushi. Seven were negative for all tests. This suggests that greater use of doxycycline appears justified for patients with undiagnosed fever in settings where rickettsial diseases are endemic or re-emerging with inadequate diagnostic facilities.Item Unusual pancytopenia secondary to haemophagocytosis syndrome in rickettsioses(Oxford University Press, 2009) Premaratna, R.; Williams, H.S.A.; Chandrasena, T.G.A.N.; Rajapakse, R.P.V.J.; Kularatne, S.A.M.; de Silva, H.J.We report two patients who presented with a long-lasting febrile illness associated with pancytopenia. Both of them had evidence of hypercellular marrow with haemophagocytosis. They were confirmed as having rickettsial infections by serology and had a rapid haematological recovery with anti-rickettsial antibiotics. We highlight the importance of considering rickettsial infections in patients with such clinical presentations, especially in areas where these infections are endemic or re-emerging. Empirical use of anti-rickettsial antibiotics in such situations could be beneficial, when facilities to diagnose rickettsial diseases are not readily available.Item Rickettsioses presenting as major joint arthritis and erythema nodosum: description of four patients(Springer International, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Rajapakse, R.P.V.J.; Eremeeva, M.E.; Dasch, G.A.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.Erythema nodosum and aseptic arthritis are recognized associations of rickettsial infections. However, they usually present with a febrile illness rather than with severe arthritis. We report three patients who presented with incapacitating major joint arthritis and one who presented with severe spondyloarthropathy in addition to major joint arthritis due to serologically confirmed Orientia tsutsugamushi and Rickettsia conorii infections. All of them had erythema nodosum and low-grade fever. They had rapid clinical response to doxycycline.