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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  [48 journals]
  • Editorial

    • Abstract: No abstract Published on 2016-04-28 00:00:00
  • Dengue control in Sri Lanka - improvements to the existing state of the
           art in the island

    • Abstract: Dengue is an acute viral or viral haemorrhagic fever caused by a flavivirus of four well-known serotypes (DENV-1, DENV-2, DENV-3 and DENV-4). Aedes aegypti and Aedes albopictus mosquitoes transmit DENV, which causes symptomatic dengue in some infected individuals and asymptomatic infection in others. Although Sri Lanka has been experiencing dengue outbreaks since 1960, the disease burden and severity has increased in the last two decades, contributing to significant morbidity and mortality in the island. Innovative strategic methods must be planned and implemented for effective dengue control, targeting dengue vectors via multiple methods. Some recent developments in vector control include the use of insecticide-treated long lasting mosquito nets, lethal ovitraps, spatial repellents, genetically modified mosquitoes and Wolbachia-infected Aedes. Some of these new methods might play an important role in the long-term prevention and control of dengue. The current review highlights the importance of pooling existing knowledge and resources to work on capacity building using all available human and financial resources to optimize the vector control programme. These efforts would facilitate and improve regional cooperation, foster networking and encourage sustainable co-ordination to retain effective control methods. Motivated staff working on vector control, prediction models such as geographic information systems (GIS) to detect future dengue outbreaks and coordination of control methods in risk areas within a country or implementing country-wide specific strategic control measures will be crucial to reduce the existing dengue burden Published on 2016-04-28 00:00:00
  • Rhinocerebral mucormycosis : a case report

    • Abstract: Rhinocerebral mucormycosis is a life threatening fungal infection occurring in humans, which is caused by the ubiquitous saprophytic fungi of order Mucorales. A timely diagnosis in patients with predisposing factors leading to immunosuppression is of great importance in reducing mortality and morbidity. We describe a patient presenting with typical clinical manifestations of rhinocerebral mucormycosis involving the paranasal sinuses and the orbit.   Published on 2016-04-28 00:00:00
  • Detection of Biofilm formation in device associated clinical bacterial
           isolates in cancer patients

    • Abstract: Introduction:
      Biofilm is a community of bacteria that are attached to a substratum or surface. Bacteria in biofilm are embedded in extracellular polymeric matrix produced by the bacteria. Biofilm formation on indwelling medical devices such as catheters poses a critical medical problem. Both Gram-negative and Gram-positive bacteria can form biofilms on indwelling medical devices.Objectives:
      To determine the potential relationship between colonization of different medical devices by various clinical bacterial isolates and to determine the differences in biofilm formation in different conditions and to determine the minimum time and conditions necessary for the development of a homogenous and mature biofilm layer.Method:
      The study sample consisted of 50 clinical strains isolated from different medical devices and another 50 strains (control group) isolated from swabs taken from peripheral and central catheter insertion sites. All isolates were characterized to species level using commercial identification cards (GN ID,GP ID; Biomerieux, France) on an automated ID AST system . Biofilm formation and quantification of activity was assessed using a microtitre plate assay Results:
      Of the 50 clinical isolates, 42 were biofilm producers and 5 of the 50 surface swab isolates were weak biofilm producers. Of the 42 clinical isolates which produced biofilms, 24 were strong producers, 15 were moderate and 3 were weak producers.  Catheter blood yielded the highest number (19/50) of biofilm producers. Acinetobacter spp. (15/50), Klebsiella pneumoniae (11/50), Pseudomonas  aeruginosa (8/50), Staphylococcus spp. (7/50), and E. coli (6/50)  the most common isolates. Twenty hours incubation time was found to be optimum for detection of biofilms produced by bacteria. Concentration of glucose also played an important role in formation of biofilm with more biofilm formation in 0.25% glucose in tryptic soya broth.Conclusion:
      The current study shows that biofilm producing Gram negative bacilli are present in vascular catheters. Methods that detect and quantify biofilms on the inner (luminal) as well as outer surfaces of catheters will provide the only true picture of biofilm colonization.
      Published on 2016-04-28 00:00:00
  • Reliability of cold agglutinin test (CAT) for the detection of patients
           with Mycoplasma pneumoniae pneumonia

    • Abstract: Introduction:
      M. pneumoniae is one of the causative agents of primary atypical pneumonia.  This infection causes 20-40% of community acquired pneumonia and is associated with an array of extra-pulmonary manifestations. There is a need for a rapid diagnostic test in order to prescribe prompt and appropriate antibiotic therapy. Even though isotype specific antibody testing provides definitive diagnosis, paired sera testing does not help in real time diagnosis. Cold agglutinins detectable by the Cold Agglutination Test (CAT) appear and disappear early in infection compared to long lasting specific antibodies that are detectable by specific immunoassays. Although there are some reports suggesting CAT is unreliable, it is being often used to diagnose M. pneumoniae pneumonia in Sri Lankan clinical settings. The aim of the current study was to  evaluate the use of CAT as a bed-side screening test for early diagnosis of M. pneumoniae pneumonia compared to ELISA for detection of specific antibodies in the Sri Lankan context.Methods:
      Ninety seven clinically and radiologically confirmed patients with pneumonia were enrolled in the study. CAT was performed on acute stage sera. A CAT titer ≥1/32 was considered as positive. Isotype specific M. pneumoniae ELISA with paired sera was compared with CAT results.Results:
      Mycoplasma pneumonia was confirmed in 15 of the 97 patients in the study using Mycoplasma specific IgM and 4 fold rise in titre. Of these, 3 were positive by the CAT. The sensitivity and specificity of the CAT compared to IgM/4fold rise in IgG detection were 20% (3/15) and 81.7% (67/82) respectively.  Negative and positive predictive values of the CAT compared to ELISA were 84.8% (67/79) and 16.7% (3/18) respectively.Conclusion:
      CAT is not a reliable screening test compared to specific antibody detection by isotype ELISA for the detection of M. pneumoniae pneumonia due to its low sensitivity and positive predictive values.  Published on 2016-04-28 00:00:00
  • Identification of Non-tuberculous mycobacteria isolated from patients at
           Teaching Hospitals, Kandy and Peradeniya

    • Abstract: Introduction
      Non-tuberculous mycobacteria (NTM) are known to cause opportunistic nosocomial infections. The aim of the study was to identify NTM using culture characteristics, biochemical and molecular methods (multiplex PCR) from stored mycobacteria isolated from patients presenting with pulmonary and extra-pulmonary tuberculosis at Teaching Hospitals, Kandy and Peradeniya during a 4-year period from 2004 to 2009.Methods
      Forty mycobacterial isolates obtained from 48 samples of sputum, urine, broncho-alveolar lavage and peritoneal fluid were analyzed initially by growth characteristics, followed by biochemical and molecular methods for the presence of NTM. Five main growth characteristics were analyzed, which included rate of growth, growth-temperature relationship, production of pigment, colony morphology and growth on McConkey agar. Species identification of these NTM isolates was by performing biochemical tests. Molecular identification was performed by multiplex-PCR technique on mycobacterial clinical isolates for the rapid identification of NTM.Results
      Of the 40 mycobacterial isolates, 10 were identified as NTM by using culture characteristics and multiplex PCR. All the NTM isolates were identified to species level by biochemical methods and eight species of NTM were identified. These species, obtained from sterile as well as non-sterile clinical samples were identified as M. scrofulaceum, M. haemophilum, M. chelonae, M. kansasii, M. phlei, M. flavescens, M. gastri and M. vaccae. Conclusion
      Non-tuberculous mycobacteria were isolated from a wide range of sterile and non-sterile clinical samples and contributed to 25% of the mycobacterial isolates in this study. The results of culture characteristics were compatible with the molecular identification (multiplex PCR) differentiating Mycobacterium tuberculosis from non-tuberculous mycobacterial strains. M. kansasii and M. gastri were the most common NTM isolated from clinical isolates. Published on 2016-04-28 00:00:00
  • Sternoclavicular Joint Tuberculosis: A rare extra pulmonary manifestation

    • Abstract: The sternoclavicular joint is a rare site for extra pulmonary tuberculosis. Diagnosis may be delayed because of its rarity and unusual clinical presentation. Early diagnosis and prompt treatment with standard antituberculous agents would hasten complete recovery. We report a patient with sternoclavicular joint tuberculosis in association with pleural effusion. Published on 2016-04-28 00:00:00
  • Successful treatment of prosthetic joint infection with
           multidrug-resistant Acinetobacter species with debridement and retention:
           a case report

    • Abstract: Acinetobacter spp. is mainly addressed in the entity of healthcare associated infections. The organism has developed substantial antimicrobial resistance, making treatment of infections attributed to A. baumannii more difficult to manage. Prosthetic joint infection caused by Acinetobacter spp. is uncommon and only few case reports were found in the literature. This case alerts clinicians regarding the unusual aetiology of a prosthetic joint infection caused by multidrug resistant Acinetobacter spp. In such situations early institution of appropriate antibiotics is of utmost importance to combat the infection. Published on 2016-04-28 00:00:00
  • Analysis of urine culture isolates from seven laboratories of Sri Lanka:
           National Laboratory Based Surveillance of Sri Lanka College of
           Microbiologists in 2014

    • Abstract: Introduction:
      National Laboratory Based Surveillance of Antimicrobial Resistance in urinary isolates conducted by the Sri Lanka College of Microbiologists was started in 2011 in collaboration with the Ministry of Health of Sri Lanka.Methods:
      Pooled susceptibility data of urine culture isolates with a colony count of ≥105 CFU/ml from samples of non-catheterised patients received in 2014 were analysed using WHONET 5.6 software.Results:
      The majority of the isolates (3975/4979:79.8%) were Gram negative enteric organisms, commonly known as coliforms. The other bacterial isolates identified were Enterococcus spp. (254), Pseudomonas spp. (194), coagulase negative staphylococci (59), Staphylococcus aureus (36), Acinetobacter spp. (35) and Group B β-haemolytic streptococci (18).The coliforms isolated from adults attending outpatient clinics (n=277) had 55.2% susceptibility to cephalexin and cephradine, 54% to amoxycillin/clavulanic acid, 65.1% to nitrofurantoin, 48.3% to norfloxacin, 63.4 % to cefotaxime, 86.4% to gentamicin, 97.4% to imipenem and 100% to meropenem.The isolates from adult hospitalized patients (n=1297) had 39.5% susceptibility to cefotaxime, 87.9% to meropenem, 62.6% to gentamicin and 31.9% to ciprofloxacin. Coliforms isolated from paediatric outpatients (n=182) had 58.5% susceptibility to cephalexin and cephradine, 58.5% to amoxycillin/clavulanic acid, 80% to nitrofurantoin, 85% to cefotaxime, 86.5% to gentamicin and 89.7% to meropenem. Those from paediatric hospitalized patients (n= 663) had 64.6% susceptibility to cefotaxime, 90.5% to meropenem and 80.2% to gentamicin.Conclusion:
      Coliforms, the commonest category of organisms isolated had high resistance rate in hospitalized patients whereas the resistance was less in outpatients, especially in the paediatric age group.  Published on 2016-04-28 00:00:00
  • Human metapneumovirus associated pneumonia and severe bronchiolitis in a
           9-month-old infant admitted to a Sri Lankan hospital

    • Abstract: Human metapneumovirus (hMPV) has been shown to cause acute respiratory tract infections (ARTI) in children since its first detection in 2001 in the Netherlands. Globally, hMPV accounts for 2-10% of childhood ARTI. hMPV associated ARTI has not been reported in Sri Lanka. We report a case of hMPV infection in a nine-month-old infant with respiratory illness admitted to the paediatric ward of the Anuradhapura Teaching Hospital. Published on 2016-04-28 00:00:00
School of Mathematical and Computer Sciences
Heriot-Watt University
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