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Journal Cover Sri Lankan Journal of Infectious Diseases
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2012-8169
   Published by Sri Lanka Journals Online Homepage  [46 journals]
  • Editorial Vol.5(2)

    • Abstract: No abstract Published on 2015-10-29 11:21:45
  • A Review of Hepatitis B Virus Infection in Sri Lanka

    • Abstract: Hepatitis B virus (HBV) infection is a major public health concern in many Southeast Asian, South Asian and African countries. HBV infection is transmitted sexually or by other parenteral routes.  HBV causes an acute viral hepatitis or chronic infection, largely based on the age at which the infection is acquired. In the majority of infected infants, HBV causes a chronic protracted infection for decades without symptoms. After several decades, the infection might flare up to give rise to an active hepatitis followed by sero-conversion to anti-HBs. However, the vast majority of patients with chronic HBV (CHB) infection will have chronic liver disease.  Some with CHB infection develop a primary liver cancer, hepatocellular carcinoma (HCC) later in life. Approximately 25 percent of chronically infected individuals die prematurely of cirrhosis or HCC.The prevalence of HBV infection in Sri Lanka is estimated to be less than 2%. Sri Lanka is therefore considered a country of low endemicity. This prevalence rate of HBV in Sri Lanka is very different to that in many other South Asian countries such as India and Bangladesh.Diagnosis of HBV infection in Sri Lanka is carried out in many private and state laboratories using immunochromatography based rapid assays or ELISAs for HBV surface antigen (HBsAg) detection. Those with latter stages of CHB are treated with currently available nucleotide / nucleoside analogues in some private sector hospitals where testing facilities for virus load during different stages of treatment is available. Sri Lanka has a policy of immunizing healthcare workers (HCW) who are at risk of acquiring HBV occupationally. Sri Lanka included HBV immunization in the Expanded Program of Immunization (EPI) with effect from 2003. In all HBsAg immunization programmes for HCW, testing for the protective anti-HBs response is mandatory in those who receive a complete course of immunization in order to ensure immunity in responders and to re-vaccinate non-responders.  Published on 2015-10-30 07:35:41
  • An Outbreak of Hepatitis B in a Rural Area of West Bengal, India

    • Abstract: Introduction
      There were limited data on outbreaks of hepatitis in rural settings in India. We describe an outbreak of Hepatitis B virus infection to confirm the existence of an outbreak of Hepatitis B in a rural area of West Bengal, India and to determine risk factors for the outbreak and recommend preventive measures.Methods
      We surveyed the entire village retrospectively followed by a cross sectional case control study. We selected Hepatitis B surface Antigen (HBsAg) positive patients as cases and recruited neighbours as controls with a ratio of 1:2.  The study was undertaken between November 2013 and June 2014. We collected blood samples which were sent to the laboratory for virological examination. Data were analyzed with Epi-info and Excel software.Results
      We surveyed 2170 residents.  Of the 1085 residents in the risk population, 54 were tested for hepatitis B and13 identified as hepatitis B positive. Among them 77% (10) were men. Overall attack rate was 0.59% (13/1085). One patient died (Case Fatality Ratio= 7.7%).  Of the tested population, 53% (7) were illiterate and 39% (5) were migrant labour by occupation. Compared with controls, significantly higher number of cases were given injection by local medical practitioners (LMP) (OR 7.50 95% CI 1.19-78.93) and had unsafe sex with sex workers (OR 15.63, 95% CI 1.34-767.41).Conclusion
      Injections given by LMPs and unsafe sex with sex workers were risk factors for the outbreak. Awareness programmes were carried out for LMPs on safe injection practice and villagers on safe sex and blood borne diseases. Hepatitis B vaccination was recommended for infants and adults.  Published on 2015-10-27 04:33:41
  • Typhoid splenic abscess : A rarity in the present era

    • Abstract: Typhoid fever is a major public health problem in South East Asia and has multiple complications involving almost every major organ system of the body. Abscess of the spleen is an uncommon complication of typhoid fever in the present era due to effective use of antibiotics. It is often fatal if not recognized in time. The conventional treatment is surgical drainage of the abscess which is associated with significant morbidity. We present a case of splenic abscess due to Salmonella enterica serotype Typhi, in a previously healthy individual which was managed conservatively by percutaneous aspiration Published on 2015-10-27 04:12:37
  • Clinico-pathological correlation and outcome analysis of disseminated
           histoplasmosis treated with conventional amphotericin B.

    • Abstract: Introduction                                                                                                                            
      Disseminated histoplasmosis is a treatable common opportunistic infection in HIV infected people and not uncommon in others in a tropical country like India. The objective of our study was to evaluate clinical-pathological correlation and treatment outcome of disseminated histoplasmosis treated with conventional Amphotericin B in an endemic area.Material and methods
      This was a retrospective observational study of twenty-two cases of disseminated histoplasmosis admitted to a tertiary care hospital from January 2009 to December 2012 and treated with Amphotericin B followed by oral Itraconazole therapy for one year. Results of treatment outcome including relapse and mortality were analyzed in January 2014.Results
      Histoplasmosis was diagnosed in patients with advanced HIV (72%) illness with a mean CD4 count of 63.43/l. Tuberculosis and diabetes were other co-morbid illnesses and it was less common among immunocompetent patients (9%). Fifty percent of the patients presented with cutaneous lesions along with systemic manifestations while 27% had only mucocutaneous lesions. Adrenal histoplasmosis (18%) was common in HIV negative subjects. HIV positive patients showed excellent response to Amphotericin B followed by Itraconazole therapy. In 27% HIV positive patients, the disease manifested as IRIS (immune reconstitution inflammatory syndrome). Relapse was seen in 2(9%) patients. After one year of completion of therapy 16 patients were cured, 3 patients (13.6%) died in the early part of treatment and one was lost to follow up. Treatment response in HIV infected patients showed excellent results but long term maintenance itraconazole therapy was inevitable (12-32 months).Conclusions
      It is concluded that early diagnosis and treatment can prevent a fatal disease like disseminated histoplasmosis with conventional Amphotericin B followed by Itraconazole. Adrenal histoplasmosis was common among the HIV negative population. Extensive follow up is required to identify early relapse which may need further prolongation of therapy for cure. Published on 2015-10-27 04:55:05
  • Is fungal disease in Sri Lanka underestimated' A comparison of
           reported fungal infections with estimated disease burden using global data

    • Abstract: Introduction
      With an increase in the elderly population and developments in medical care, increased numbers of patients with fungal diseases are expected. This necessitates a new vision for fungal diseases in Sri Lanka, a tropical country with a population of 20 million. The objective of this study was to estimate national fungal infection caseloads using global and national epidemiological datasets.Methods
      We searched national data and surveillance studies published by us and other authors for relevant disease terms. Locally collected incidence data were available for candidaemia, fungal keratitis, cryptococcosis, allergic broncho-pulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS). Global disease estimation was done using international data. Generally, disease estimates were conservative as they assumed the lowest incidence rates reported in the literature and focused only on well-defined risk populations. Results
      Among the 1,317 HIV/AIDS patients (in 2010), there were 639 estimated oral candidiasis cases, 100 oesophageal candidiasis cases and only 13 cases of cryptococcal meningitis. The estimated prevalence of chronic pulmonary aspergillosis (CPA) post TB is estimated to be 1,443 and all forms of chronic pulmonary aspergillosis (including aspergilloma) 2,886 patients.   We estimated 229 cases of invasive aspergillosis and 41 cases of mucormycosis. The projected annual incidence of candidaemia is 507 and an estimated 76 candida peritonitis cases post-surgery.According to our estimates 10,344 patients were suffering from ABPA and 13,654 were suffering from SAFS. The projected annual incidence of fungal keratitis would be 1,277   and tinea infections would affect 50 children. Pneumocystis incidence could not be estimated.Conclusions
      Our estimates suggest that candidaemia and invasive aspergillosis could be the leading causes of fungal-associated deaths in Sri Lanka whereas globally it is due to SAFS, ABPA and CPA. More precise data from the whole country is needed to validate these estimates. Such data would be very useful for developing healthcare policies for prevention, diagnosis and treatment of serious fungal infections. Published on 2015-10-29 10:47:31
  • Transmission of hepatitis B virus infection among family contacts of
           chronic hepatitis B carriers in Sri Lanka

    • Abstract: Introduction Hepatitis B virus (HBV) infection is a major global health problem. Incidence of HBV infection in Sri Lanka is low compared to other countries in South Asia. Horizontal transmission among close contacts is a well recognized mode of HBV transmission. A high incidence of HBV infection has been reported among family contacts of chronic HBV carriers from different parts of the world. A study was therefore designed to describe HBV serology markers among family contacts of HBV chronic carriers who were diagnosed and followed up at the Department of Virology, MRI.Methods Serological markers of HBV infection was analyzed in 230 family contacts of 78 chronic HBV carriers diagnosed and followed up at the Department of Virology, Medical Research Institute, Sri Lanka from November 2008 to December 2012.Results Among screened family members, 55 (23.9%) were positive for HB core total antibody, indicating evidence of exposure to HBV at the time of screening. Among them 14 (6.1%) were positive for HBs antigen and serological evidence of past exposure to HBV was found in 41 (17.8 %). At least one member of the family was affected in 40 (51.3%) index cases. HBV infection rate among family members (23.9%) was significant compared to the general population (1.8%) in this study. Screening of family members and vaccination of non immune members should be encouraged to prevent spreading of the infection. Health education and counseling should be given to HBV infected patients and their contacts about the disease, mode of transmission and available preventive measures. Published on 2015-10-29 10:16:29
  • The first case of prosthetic valve endocarditis due to Salmonella enterica
           Serovar Enteritidis infection in Sri Lanka

    • Abstract: Prosthetic  valve  replacement  is   one of  the  predisposing  factors  for  the  development  of infective  endocarditis.  Prosthetic  valve  infective  endocarditis  caused  by  non typhoidal Salmonellae  is  an  uncommon  manifestation.  We  report  a  case  of  a  female  patient  with  a history  of  bioprosthetic  aortic  valve  replacement  admitted  due  to  prolonged  fever   with  diarrhoea.  The  echocardiogram  revealed a prosthetic  valve  vegetation  with  the  etiological  diagnosis  of  infective  endocarditis  by  Salmonella enterica Serovar Enteritidis.  She  had  a  fulminant  clinical  course  and  died  after  6  months  despite  prolonged  antibiotic  treatment. Published on 2015-10-29 10:11:18
  • Contaminated Public well water as a source of sporadic outbreak of enteric
           infection in Northern Sri Lanka

    • Abstract: Introduction
      Incidence of water borne diseases is high in the Jaffna district with ground water being the main source for the Jaffna population. Ensuring the quality of groundwater is therefore mandatory to prevent water borne diseases. This study was designed to describe the level of microbial contamination of public drinking water sources with selected associated factors and to assess the knowledge of the general public on transmission and prevention of waterborne diseases in the Kopay Medical Officer of Health (MOH) area.
      A cross sectional, descriptive study was carried out on the quality of drinking water in the Kopay MOH area. A pretested interviewer administered questionnaire and an observation checklist were used to collect data.  Bacterial studies of well water samples were carried out in the Division of Microbiology at the Faculty of Medicine, Jaffna. Results
      Coliforms and E. coli were found to be above the Sri Lankan Standard (SLS)1 in 90% of the water samples collected from public water sources. Ninety four percent of the wells were unprotected. Of 200 participants, 57.5% (95% CI: 51.6%-65.2%) had poor knowledge on the transmission and prevention of water borne diseases. Of the 200, 174 (87 %,)  (95%CI: 81.8%-91.1%)) used unsafe water for drinking and domestic purposes. The surrounding environment was found to be a significant risk factor for contamination also found (P< 0.001, OR-29.3, 95% CI: 2.0- 423.7).
      The majority (90%) of public water sources were microbiologically unsuitable for drinking in the Kopay MOH area. Most people consume raw water from these unacceptable water sources. It was also found that the surrounding environment is highly conducive for contamination of well water in the study area. The study participants had poor knowledge on transmission of pathogens through water and the prevention of water borne diseases.  Published on 2015-10-27 07:40:24
  • Editorial Vol.5(1)

    • Abstract: No abstract  Published on None
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