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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 in an urban and semi-urban population(Sri Lanka Medical Association, 2001) Hirimuthugoda, L.; Dassanayake, A.S.; Fonseka, M.M.D.; Tillakeratne, Y.; Gunatilake, S.B.; de Silva, H.J.OBJECTIVE: Though it had been suggested that scrub typhus could be occurring in Sri Lanka, there are no properly documented case series. We document our experience with 17 cases of scrub typhus. METHODS: All patients were admitted to the University Medical Unit in North Colombo Teaching Hospital over a period of 18 months. Diagnosis of scrub typhus was made in febrile patients by the presence of an eschar, raised antibody titres to Proteus OX-K in the Weil-Felix test and the dramatic response to specific treatment with tetracycline. RESULTS: All patients presented with high fever and the duration of the fever before diagnosis varied from three days to 21 days with a mean of 9 days. Headache and myalgia were common to all. Sixteen patients were from urban and semi-urban surroundings. All patients had the eschar and in most it was in the groin and axilla. Generalised or regional lymphadenopathy was present in all patients. In nine patients the Weil-Felix test showed raised titres to Proteus OX-K antigen. Sixteen patients were treated with tetracycline and one pregnant patient with chloramphenicol. All patients responded dramatically with fever settling within 24,hours. CONCLUSIONS: Scrub typhus seems to be commoner than thought and occurs even in urban areas. This condition has to be considered in the differential diagnosis of any patient with fever and especially when the fever is not settling early. Eschar is the most useful diagnostic sign that should be looked for.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.