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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The epidemiological trend of cutaneous leishmaniasis in Kegalle district, Sri Lanka: A newly established disease focus and assessment of bioclimatic suitability for disease establishment using ecological niche modelling(Elsevier, 2023) Wijerathna, T.; Wickramasinghe, K.; Gunathilaka, N.; Perera, A.; Bandara, S.Cutaneous leishmaniasis is prevalent in Sri Lanka since 1992. It remains as a health issue with increasing numbers and spreading from endemic to non-endemic areas in the county. Kegalle district is a new disease focus, which notified the first case in 2016. However, there is no documented evidence of the vector distribution, abundance and potential risk factors in this district. Two Medical Officer of Health (MOH) areas (Rambukkana and Warakapola) that had reported the highest numbers of cases in the Kagalle district was selected and recorded cases (2016-2020) were obtained. The patients were visited and socio-economic, demographic, environmental and awareness-related information was collected using an interviewer-administered questionnaire. Entomological surveys were conducted from July 2019- July 2020 using three standard entomological techniques. Bioclimatic suitability for the disease transmission was evaluated using ecological niche modelling. A total of 107 patients were reported from both MOH areas and 88 were recruited for the study. The study showed that leishmaniasis in the Kegalle district progressed to an outbreak level within 3 years after reporting the first case. School students (n = 22, 25%, P < 0.05) and individuals between 11 and 20 years of age (n = 33, 37.5%, P<0.05) were identified as the main risk groups, while the presence of composting sites (n = 65, 73.9%, P < 0.05), abandoned lands (n = 63, 71.6%, P < 0.05) in the surrounding and suboptimal (dark or normal) lighting conditions (n = 87, 98.8%, P < 0.05) in the house were identified as main risk factors. Areas closer to the adjacent district (Kurunegala), which is a known endemic district for leishmaniasis indicated a high probability (0.3-0.5) for disease transmission. Sergentomyia zeylanica (n = 164, 56.94%), was identified as the predominant sand fly species followed by Phlebotomus argentipes (n = 121, 42.01%), Sergentomyia babu insularis (n = 2, 0.69%) and Sergentomyia punjabensis (n = 1, 0.35%). Phlebotomus argentipes was captured mostly for outdoor resting sites and S. zeylanica was recoded from both indoor and outdoor. The presence of vectors that can transmit leishmaniasis in these areas along with the potential risk factors could increase the transmission risk and disease establishment in new areas that are ecologically favourable for disease transmission. Therefore, vector control entities should undertake immediate measures to stop spreading the disease into new areas.Item Population dynamics of phlebotomine sand flies (Diptera: Psychodidae) in cutaneous leishmaniasis endemic areas of Kurunegala District, Sri Lanka(Elsevier, 2022) Wijerathna, T.; Gunathilaka, N.; Gunawardena, K.; Rodrigo, W.Sand flies are the primary vectors of leishmaniasis. Disease management with effective vector control depends on the knowledge of vector population dynamics. In Sri Lanka, despite few isolated entomological collections, long-term studies are not reported to date. In the reported study, monthly entomological surveillance was conducted from May 2017 to December 2018 in Polpithigama, Maho, and Galgamuwa Medical Officer of Health (MOH) areas using standard entomological techniques. Climatic data were collected from the Department of Meteorology, Sri Lanka. Patient records were collected from each MOH office. A total of 38,339 sand flies were collected. The majority were Phlebotomus argentipes (99.50%, n=38,147), while the rest was Sergentomyia punjabensis (0.50%, n=192). Wind speed reduces sand fly abundance (r= -0.519, P<0.05) evidently by limiting the movement. Rainfall increases sand fly abundance (r= 0.842, P<0.05, lag = 6 months) probably by improving favorable conditions in breeding sites. The actual effect of humidity is not conclusive without further research. The observed higher prevalence of leishmaniasis in the study sites could be due to the higher sand fly density in these areas. The number of patients shows a strong positive correlation (r=0.516, P<0.05) to the sand fly abundance with a lag of 7 months. Systematic surveillance of sand flies as a part of general healthcare services is strongly recommended to identify and prevent possible outbreaks through timely planned vector control measures.Item Diurnal adult resting sites and breeding habitats of Phlebotomine sand flies in Cutaneous Leishmaniasis endemic areas of Kurunegala District, Sri Lanka(BioMed Central, 2020) Wijerathna, T.; Gunathilaka, N.BACKGROUND: Sand flies are responsible for the transmission of several disease pathogens including Leishmania. Sand flies breed in habitats with high levels of humidity and organic matter. They are nocturnal in nature and peak activity ranges from dusk to dawn. The scientific evidence on breeding ecology and diurnal resting sites of sand fly fauna are important aspects of planning and implementing vector control activities. However, such fundamental information is grossly inadequate in Sri Lanka to support the control efforts in the country. Therefore, the present study addresses some of the important aspects of sand fly breeding ecology and diurnal resting sites. METHODS: Potential resting sites were thoroughly observed, and sand flies were collected using a battery-operated aspirator and sticky papers when appropriate from three selected Medical Officer of Health (MOH) areas (Polpithigama, Maho and Galgamuwa) in Kurunegala district, Sri Lanka. Soil samples were collected from each potential breeding site. Half of each soil sample was incubated for 45 days. The other half was screened for immature stages. Adult sand flies collected from field and emerged adults at the insectary under confined incubation were identified using morphological characteristics. RESULTS: Pepper bushes and termite mounds were the most notable resting sites while, betel bushes, cattle huts, piles of coconut shells, latrines, manna bushes and tree holes were also positive for sand fly adults. Only two species, Phlebotomus argentipes and Sergentomyia punjabensis, were reported. Soil samples were collected from a total of 432 sites and 7 of them were positive for immature stages. Predominant breeding habitats identified during the present study were mud flats and moist soils of rice paddies, the soil below decaying hay, drying irrigational tank bottom moist soil, and the floors of cattle huts. CONCLUSIONS: This study demonstrates that the potential adult resting sites and breeding habitats are abundant in the Polpithigama, Maho and Galgamuwa MOH areas. Therefore, vector control activities targeting both adult and immature stages of sand flies are recommended. KEYWORDS: Breeding sites; Leishmaniasis; Resting sites; Sand fly; Sri Lanka.