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  Sri Lankan Journal of Infectious Diseases
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2012-8169
   Published by Sri Lanka Journals Online Homepage  [45 journals]
  • Toxocara canis (Ascaridida: Nematoda): Mitochondrial gene content,
           arrangement and composition compared with other Toxocara species

    • Authors: S Wickramasinghe, L Yatawara, T Agatsuma
      Abstract: Introduction: The complete mitochondrial (mt) genomes of nematodes sequenced thus far are circular and small in length, containing 37 genes, including 12–13 protein-coding genes: namely, cytochrome oxidase subunits 1–3 (cox1–3), nicotinamide adenine dinucleotide dehydrogenase subunits 1–6 and 4L (nad1–6 and nad4L), ATP synthase subunit 6 and 8 (atp6 and 8), cytochrome b (cytb), small subunit ribosomal RNA gene (rrnS), large subunit ribosomal RNA. The aims of the present study are to determine the gene order, composition, codon usage pattern, and translation initiation/termination codons of the mt genome of Toxocara canis found in Sri Lanka and to compare those findings with other Toxocara species. Methodology: Toxocara canis worms used in the present study were obtained from Sri Lanka. The total genomic DNA was extracted using a part of a single worm using an Easy-DNATM Kit. PCR reactions were performed as described previously by Wickramasinghe et al., (2009). Nucleotide sequences were determined with an ABI PRISM 3100 Avant DNA sequencer using a Big Dye Terminator v3.1 Cycle Sequencing Kit. The open-reading frames and codon usage profiles of protein-coding genes were analyzed using the program DNAsis and GENETYXMAC (ver. 6.0). Results: The partial mt genome of T. canis is 9611 bp in length. This partial mt genome contains 9 protein-coding genes (cox1-3, nad2-5, atp6 and cytb), 14 transfer RNA (tRNA) genes and one ribosomal RNA gene. All genes are transcribed in the same direction as found in other members of the genus Toxocara. The nucleotide compositions of the obtained partial mtDNA sequences for T. canis is biased toward A and T, with T being the most favored nucleotide and C the least favored, in accordance with mt genomes of other nematodes. The content of A+T is 67.48% for T. canis (19.9% A, 47.5% T, 23.3% G and 9.3% C). The start codons we inferred in T. canis were ATT, GTG, ATA, GTT, TTG and ATG. Stop codons were TAG, TA and T. Six of the 8 protein genes used TAG as a translation termination codon and the other two genes (atp6 and nad2) used TA and T respectively. The length of 14 tRNAs is ranging from 52 bp to 68 bp and 8 more tRNAs remain to be sequenced and identified. The rrnL gene of T. canis was identified by sequence comparison with other Toxocara species. The rrnL is located between tRNA-His and nad3. The rrnL gene is 958 bp in length. A non-coding region is located between nad4 and cox1. The length of this region is 112 bp in T. canis. Conclusion: The present study determined the partial mt genome sequence of T. canis obtained from a dog in Sri Lanka. This study provides molecular markers for studying the systematics, population genetics and ecology of the nematodes of socioeconomic importance. Furthermore, we observed a significant difference in nucleotide length of the mitochondrial protein-coding genes, tRNAs, rrnL and non-coding regions of T. canis from three different geographical locations, Sri Lanka, China and Australia. These variations should be further investigated in future studies. Note: Nucleotide data reported in this paper is available in the GenBankTM, EMBL and DDBJ databases under the accession number JN593098.
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):90-98
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • Validity of a commercially available IgM ELISA test for diagnosing acute
           leptospirosis in high endemic districts of Sri Lanka

    • Authors: SB Agampodi, V Thevanesam, T Senaratne
      Abstract: Background
      Lack of point of care diagnostics is a major challenge for control of human leptospirosis. Immunoglobulin M enzyme linked immunosorbent assays (IgM ELISA) have been widely used for the diagnosis of leptospirosis. The purpose of the present study was to determine the validity of IgM ELISA in the diagnosis of leptospirosis in a Sri Lankan context. Methods
      Confirmed cases of leptospirosis from the 2008 Sri Lankan outbreak of leptospirosis and a group of leptospirosis excluded febrile patients were selected for the validation study. Disease confirmation and exclusion was carried out using either paired sample MAT (optimized for the region) or qPCR or both. A commercially available IgM ELISA kit was used and the procedure performed according to the manufacturers’ instruction in the Department of Microbiology, Faculty of Medicine, University of Peradeniya. Results
      The study sample included 88 confirmed cases of leptospirosis and a comparison group of 71 acute fever patients.  Of the 88 confirmed cases selected, 53 reacted in IgM ELISA and of the comparison group, 38 gave a positive reaction. *MAT was carried out among acute and convalescent samples where the acute sample was obtained within the first 10 days of illness and the convalescent sample after the day 14. A regionally optimized MAT panel with 21 serovars were used for MATSensitivity and specificity of IgM ELISA, as a point of care diagnostic test for patients in this sample with acute leptospirosis, was 60.23% (95% CI 49.78, 69.82) and 46.48% (95% CI (35.36, 57.96) respectively. Diagnostic accuracy of the test was 54.09% (95% CI 46.34, 61.65 %). The ROC (Receiver-operator characteristic curve) curve for the IgM ELISA showed a value of .669 for area under the curve. Optimal cut off points were not detected due to the poor test parameters in this sample. Conclusion
      This study shows the poor diagnostic capabilities of IgM ELISA during the acute phase of leptospirosis in high endemic settings
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):83-89
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • Editorial Vol.4(2)

    • Authors: Vasanthi Thevanesam
      Abstract: No abstract
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):55
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • The evolution and role of interferon gamma release assays (IGRAs) in
           moderate and low income settings.

    • Authors: C N Ratnatunga
      Abstract: The interferon gamma release assays have been extensively evaluated in the diagnosis of latent tuberculosis infection as well as in diagnosis of active pulmonary and extra-pulmonary tuberculosis since their introduction just over a decade ago. The results and recommendations published are confusing to say the least. The performance of these tests vary according to the population they are used in, including age, BCG vaccination status and immune status, the commercial test used, the TB burden of the country/ region and other factors intrinsic to the tests themselves. This review attempts to summarize the evolution of the IGRAs, particularly in the context of moderate and low income settings where a large question about their use still remains. Much work needs to be done before definitive recommendations about their role in the diagnostic algorithms of low and middle income countries can be made, but problems associated with the tests including cost and interpretation issues may limit the amount of work that can be invested productively in this evaluation.
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):56-66
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • The challenge of establishing an evidence-based and migrant sensitive
           approach to tuberculosis screening of inbound migrants to Sri Lanka

    • Authors: S Samaraweera, K Wickramage
      Abstract: Limited attention has been made by countries of ‘new immigration’ to define an immigration medical examination requirement of inbound migrant flows. Importation of TB through inbound migration routes have been a largely neglected strategy in TB control in Sri Lanka despite increasing migrant flows from endemic regions. We contend that establishing a health assessment for those long stay resident visa applicants to Sri Lanka may be useful in mitigating the spread of TB. However the approach should harness a ‘rights based’ approach to health assessment, and also be linked to the national health system. In this way the assessment becomes a vital mechanism for global public health good rather than be perceived as a tool for discrimination or immigration control. Migrants need to be included in national and global TB control strategies, especially since mobility is a key feature of the post-2015 Millennium Development Goals agenda.
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):67-76
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • Comparison of a rapid immunochromatography assay with an enzyme linked
           immunosorbent assay (ELISA) for anti-dengue virus IgM detection

    • Authors: T Senaratne, F Noordeen, N Dissanayake, KGRA Kumara
      Abstract: Objectives
      The current study was undertaken to compare the sensitivity, specificity, positive predictive value and negative predictive values of a dengue IgM rapid immunochromatography (ICT) assay with a dengue IgM capture ELISA for the detection of anti-dengue virus IgM in patients clinically suspected of having dengue fever (DF). Methods
      Blood samples (n=119) were collected from paediatric and adult patients suspected of having DF at Teaching Hospital, Peradeniya (THP) after 5 days of fever. The samples were analyzed for the presence of anti-dengue virus IgM using a commercial rapid dengue IgM ICT assay (Hexagon dengue, Human, Germany) and a commercial IgM capture ELISA (Panbio Diagnostics Inc, Australia) provided to THP by the Ministry of Health for the diagnosis of dengue fever. Results
      When tested using the rapid dengue IgM ICT assay, 80 blood samples were positive and 39 were negative for anti-dengue virus IgM. When tested using the dengue IgM ELISA, 100 sera were positive and 19 were negative for dengue IgM. Using the IgM capture ELISA as the comparator,  the sensitivity and the specificity of the rapid assay were 79% and 94.7% respectively with  a positive (PPV) and negative (NPV) predictive value  of 98.8% and 46.2%. Conclusion
      In comparison with the results of the IgM capture ELISA, the low sensitivity and NPV for anti-dengue virus IgM detection by the rapid dengue IgM ICT assay was noted. The low sensitivity and NPV means that patients with DF will be missed when using this test. In contrast, the high specificity and PPV indicate that this rapid assay is able to detect true positives. Since preliminary screening of DF is carried out widely using these rapid tests, the strengths and limitations of this and other similar tests require validation before use in diagnostic laboratories
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):77-82
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • A preliminary study on clinical profiles of dengue and dengue haemorrhagic
           fever suspected patients from two hospitals in the Western Province of Sri

    • Authors: PDNN Sirisena, F Noordeen, L Fernando
      Abstract: Objective: Dengue fever (DF) is one of the most common public health problems in Sri Lanka. A pilot study was undertaken to investigate the clinical profiles of DF and dengue haemorrhagic fever (DHF) in patients admitted to two hospitals from July 2011 to July 2012. The objective of the study was to evaluate clinical patterns to improve pattern recognition and to determine whether these profiles have changed in recent times. Study design: The clinical profile was collected using a CDC style questionnaire and analyzed (Minitab, V14). Blood samples were collected from 50 patients from Gampaha and 204 patients from Negombo hospitals with a clinical suspicion of DF/DHF, between fever days 2 to 7. Laboratory data included a complete blood count (CBC) with haemoglobin, haematocrit, total leukocyte and platelet countsand liver function. CBC was repeated daily during the acute phase of the illness. Chest x-ray or ultrasound scanning was done to assess pleural and abdominal fluid accumulation. Results: The sample consisted of 168 (66.1%) males and 86 (33.8%) females. The age of the patients ranged from 6 months to 66 years with a mean of 12 (SD = 13.4). Fever was the major presenting complaint (100%) with headache in 90.1%. Retro orbital pain was present in 27.6% of patients and 78 % and 79.1 % experienced arthralgia and myalgia respectively. Rash and pleural effusion were present in 20% and 10.6 % respectively. Ascites and hepatomegaly were noted in 6.2% and 1.1%. Of the 254 patients, 69% had DF and 31% had DHF. The lowest WBC was 0.98 x 103/mL. Platelet count of <100,000 was seen in 65.3% cases. Only 35 patients (21 DF and 14 DHF) were tested for IgM/IgG. Based on these results, 38% (8/21) of DF cases were primary and 62 % (13/21) were either secondary or with past flavivirus infections. Primary dengue infection resulted in 43% (6/14) of DHF cases with 57% (8/14) resulting from secondary or with past flavivirus infections. Conclusion: The majority of clinically diagnosed dengue patients were males. The most common clinical feature was fever with headache, myalgia and arthralgia. DHF seemed to have occurred in both primary and secondary dengue infections. Some symptoms included in the WHO guidelines such as  rash, hemorrhagic manifestations and retro orbital pain were less commonly seen in the study.
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):99-107
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • Increasing antibiotic resistance in a tertiary care hospital in Sri Lanka

    • Authors: K Jayatilleke
      Abstract: The current study was carried out to analyze blood culture isolates and their antibiotic susceptibility data in a tertiary care hospital using WHONET software. The isolates of blood cultures received from 1st January 2013 to 31st December 2013 were analyzed. Of the Staphylococcus aureus, 41.8% were methicillin resistant Staphylococcus aureus (MRSA). Only 40.7% of Escherichia coli were sensitive to cefotaxime and 92.5% were sensitive to meropenem. Of Klebsiella pneumoniae ss. pneumoniae only 34.7% were sensitive to cefotaxime and 60% were sensitive to meropenem. Only 14.2% of Acinetobacter species were sensitive to meropenem and 26.1% were sensitive to ciprofloxacin.  All 14 isolates from ICU patients were resistant to all the antibiotics tested (Pan resistant). There is an increased percentage of resistance to most antibiotics when this susceptibility data is compared with the previous year’s data of the same hospital and data of the Antibiotic Resistance Surveillance Project (ARSP) of Sri Lanka College of Microbiologists carried out in 2009-2010. Action needs to be taken to control antibiotic resistance with immediate effect. Continuous surveillance of antimicrobial resistance is of paramount importance to monitor trends in antibiotic resistance.
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):108-114
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • First case of vaccine derived poliovirus isolated from a patient with a
           primary immune deficiency in Sri Lanka

    • Authors: S Gunasena, R de Silva, D Ratnayake, C Kumarasiri, J Deshpande
      Abstract: Persons with primary immune deficiency disorders (PID) exposed to oral polio vaccine (OPV)) are at increased risk of vaccine-associated paralytic poliomyelitis (VAPP)  and prolonged excretion of vaccine-derived polioviruses (VDPVs) VDPVs are identified by a genetic divergence of at least 1%, or with Poliovirus 2, at least 0.6% in the VP1 region from the parent Sabin strain. A potential source of VDPV is a person with PID who excretes vaccine-derived polioviruses (iVDPVs).  These viruses may occasionally cause paralytic disease in the patient with PID, but has not been reported to have caused outbreaks of paralysis in immunologically normal people We report the first isolate of iVDPV in Sri Lanka from a child with severe combined immune deficiency (SCID).
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):115-118
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
  • Bilateral axillary lymphadenopathy: A rare manifestation of Plasmodium
           falciparum malaria

    • Authors: B Nisahan, T Kumanan, G Selvaratnam
      Abstract: Malaria can present with a variety of signs and symptoms. Periodic febrile paroxysms associated with rigors and sweating is classical of malaria. Malaria presenting with lymphadenopathy is an extremely rare manifestation. Lymphadenopathy is considered as one of the negative findings in diagnosing malaria. We describe a case of a 25year old male who presented with fever, confusion and bilateral axillary lymphadenopathy, diagnosed to have Plasmodium falciparum malaria. He was successfully treated with antimalarial drugs and the lymphadenopathy subsequently regressed.
      DOI : Sri Lankan Journal of Infectious Diseases 2014; Vol.4(2):119-121 
      PubDate: 2014-10-29
      Issue No: Vol. 4 (2014)
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