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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  [49 journals]
  • A thirty one year old man with co-infection of malaria and dengue

    • Abstract: Malaria and dengue are two important mosquito borne diseases.
      Only imported malaria cases are currently seen in Sri Lanka, mostly from India and Africa. Co-infections with malaria and dengue have not been reported previously in Sri Lanka. A 31-year-old male who had returned from Mozambique 4 weeks before was admitted with a low grade fever for 4 days and diagnosed as dengue fever. After 5 days the fever became high grade and intermittent with chills and rigors. His blood film and antigen test were positive for P. falciparum. Antimalarial treatment was started with intravenous artesunate, followed by artemisinin based combination therapy. The patient’s fever improved with 24 hours of treatment and thereafter he recovered completely. Although co-infections are uncommon, malaria should be considered in any febrile patient with a travel history up to 1 year to a malaria endemic country, even if chemoprophylaxis is taken. Diagnosis of one infection should not exclude the possibility of a coexisting malarial infection in patients with an appropriate travel history, since missing the diagnosis can lead to severe consequences. Published on 2017-05-04 04:27:22
  • New onset of fever and lymphadenopathy in a patient on antitubercular
           treatment for tuberculous meningitis: Drug resistance or paradoxical
           response phenomenon'

    • Abstract: Central nervous system (CNS) involvement is one of the most devastating clinical manifestations of tuberculosis (TB) noted in 5 to 10% of patients with extra pulmonary TB and accounts for approximately 1% of all patients with TB. Clinical deterioration during treatment with anti-tuberculosis drugs (ATD) is not uncommon in immunocompetent persons. Possibilities include multi-drug resistant tuberculosis (MDR-TB), a paradoxical response or some other non-tubercularcauses of fever. Corticosteroids are considered tohave a beneficial effect in the management of paradoxical reactions. Immuno-modulatory drugs, including tumour necrosis factor-α antagonists, thalidomide and interferon-γ have beenused in isolated cases with more severe forms of paradoxical reactions.We report here a case of a 13 year old girl who while being treated for tubercular meningitis, developed high grade fever with lymphadenopathy. Her lymph node biopsy showed caseous necrosis with presence of AFB suggestive of a paradoxical reaction. Published on 2017-05-04 04:25:30
  • Bilateral lower limb gangrene due to HIV vasculitis – a rare case

    • Abstract: Human immunodeficiency virus (HIV) positive patients may develop vasculitis, either mediated by immunological factors or by direct vascular injury. It may also be caused by infectious agents or by some nonspecific causes. We describe a patient who developed manifestations suggestive of extremities vasculitis (occlusive variety) with no identifiable risk factors other than HIV. He responded to steroid and combination anti-retroviral therapy Published on 2017-05-04 04:24:32
  • Treatment of native valve endocarditis due to coagulase negative
           staphylococci, complicated by a drug reaction with eosinophilia and
           systemic symptoms (DRESS syndrome)

    • Abstract: Coagulase negative staphylococci (CoNS) are a rare cause of native valve endocarditis (NVE). However, they are emerging as important pathogens of NVE.  We  describe  a  61  year  old  male  who  developed  NVE  caused by CoNS and presented  with  cerebral  embolic  phenomena.  He was treated with vancomycin and subsequently with linezolid. He developed a drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) to linezolid which was managed successfully.  The patient’s recovery was good after six weeks of treatment with anti-staphylococcal antibiotics. Published on 2017-05-04 04:23:35
  • Preliminary survey on knowledge, attitudes and practices regarding rabies

    • Abstract: IntroductionThe Public Health Veterinary Services’ goal is to reduce the number of deaths from rabies to zero by 2020. Community awareness and responsible behaviour of pet owners are key to achieving this goal. Knowledge, attitude and practices (KAP) regarding rabies has been reported only from Kandy district. We describe a preliminary survey among outpatients in Colombo, to supplement existing knowledge.MethodsA convenience sample (n = 200) was selected during April to May 2016, from outpatients of the National Hospital of Sri Lanka. Data was collected using a self-administered questionnaire. ResultsMajority were female (66.5%), Buddhist (80.5%) and from Colombo (58.5%). More than 75% of the sample knew dogs were the main reservoir, that transmission was by biting, that washing the wound was important and that rabies could be prevented by vaccinating dogs and humans. However, only 22.5% were aware that rabies was fatal after development of disease. Knowledge was lacking regarding other animal reservoirs, other modes of transmission and clinical features of rabid animals. Pet owners were more likely to have been bitten by a dog than others (p
  • Awareness of occupational risks and practices among funeral industry
           workers in Sri Lanka

    • Abstract: Background:
      Funeral industry workers are at occupational risk of exposure to numerous infections. The study aimed to assess the knowledge, attitudes and practices on infection control and investigate the presence of HIV antibodies among funeral industry workers in Western Province of Sri Lanka.
      Seventy funeral industry workers who had dealt with at least a single cadaver were included in the study. An interviewer administered questionnaire was used to collect data on aspects of infection control relevant to cadaver handling. The knowledge was assessed using 44 questions while attitudes and practices were assessed using 13 and 25 questions respectively. An average correct score of ≥75% was considered as good, 74%-50% as moderate and <50% as poor. HIV antibodies were investigated using a rapid immunochromatographic assay.
      The participants had an overall moderate knowledge (52%), poor attitudes (42%) and moderate practices (53%) regarding infection control. Only 53% and 23% knew that HIV and HBV infection can be transmitted through cadavers. Further 51% had the attitude that cadavers carry a risk of infection. None had good attitudes on compulsory use of all protective equipment. However 84% claimed to use gloves during embalming. Vaccination for hepatitis B and tetanus was reported in 10%. None had received formal training in cadaver handling. No participants were positive for antibody against HIV.
      The funeral industry workers had moderate knowledge (52%), moderate practices (53%) and poor attitudes (42%). Implementation of formal training programs and guidelines on embalming practices is needed. Published on 2017-05-04 04:21:32
  • Selecting patients who can be re-challenged with Nevirapine in case of
           skin rash with Efavirenz – A Study

    • Abstract: Introduction and Objectives: A common adverse effect of Efavirenz (EFV) – a first line drug used in treatment of patients with HIV infections is skin rash. In case of EFV-induced skin rash, the usual practice is to switch to a Protease Inhibitor (PI), as another non-nucleoside reverse transcriptase inhibitor (NNRTI) might have cross-­reactivity with a higher incidence of skin rash which is often severe. The aim of the study was therefore to determine whether with careful evaluation and stratification, using pre­defined criteria of patients who developed rash with EFV, it might be possible to find a subset of patients among whom Nevirapine (NVP) may be safely used, sparing PIs for second-­line treatment. Methods: Of 7000 ART naive patients initiated on EFV in an 18 month period from November 2014 to April 2016, 97(1.9%) developed a rash. Patients developing rash with EFV were carefully selected using pre­defined criteria: grade of rash (only Grade I/II rash were selected), hepatic function, age, gender and CD4 levels (males > 400 cells/cmm and females >250 cells/cmm were excluded if hepatic function was deranged), co­-infection status (Hepatitis B/C were excluded), opportunistic infections, concomitant use of other drugs. Based on these stratification criteria, 23 of the 97 patients were selected for challenge with NVP. Results: Of the 23 selected patients, only 3 (13%) patients developed recurrence of rash, all being mild in nature. Conclusions: In carefully selected patients, challenge with NVP can be done in case of rash with EFV as the theory of cross­-reactivity does not always hold true. This might help spare PIs in the initial phase, which could then be used as second line therapy - a particularly helpful strategy in developing countries, where newer drugs are still not available under public health programmes. Published on 2017-05-04 04:20:37
  • Teicoplanin non-susceptible coagulase-negative staphylococci in a large

    • Abstract: Introduction and Objectives: Coagulase-negative staphylococci (CoNS) are relatively low in virulence but some are increasingly recognized as agents of clinically important infections. Glycopeptides are the drugs of choice for treatment of methicillin-resistant CoNS infections. Our aim was to analyse the susceptibility profile of CoNS in our healthcare network from 2010-2012. Methods: All CoNS with susceptibility results were analysed as two groups; teicoplanin-susceptible (Teico-S) and non–susceptible (Teico-NS). Analysis included results of other antistaphylococcal antibiotic susceptibilities, sample type (sterile, non-sterile), species and patient location (intensive care unit (ICU) vs non-ICU). Results: Of the 1510 CoNS isolates with susceptibility results, 109 (7.2%) were non-susceptible to teicoplanin. Teicoplanin non-susceptibility was associated with non-susceptibility to ≥ 3 antistaphylococcal-antibiotics, detected more frequently from sterile samples compared to non-sterile samples and from ICU compared to ward patients. Staphylococcus epidermidis was the most common species recovered and was more likely to be Teico-NS. Conclusions: Teicoplanin non-susceptibility is associated with multi-resistance to ≥3 antistaphylococcal antibiotics. Clinicians should be aware that vancomycin resistance may be selected from Teico-NS strains. Published on 2017-05-04 04:19:31
  • Editorial

    • Abstract: No abstract Published on 2017-05-04 04:18:55
  • Infection prevention and control in Sri Lankan hospitals in relation to
           WHO Guidelines

    • Abstract: Healthcare associated Infections (HAI or HCAI) are a major problem in healthcare settings. Healthcare associated infections are defined as infections which occur in a patient during the process of care in a hospital or any other healthcare facility which was not present or incubating at the time of admission. Properly conducted Infection Prevention and Control (IPC) programmes are essential to reduce the burden of HCAIs as well as antimicrobial resistance (AMR). Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level according to World Health Organisation (WHO) recommends 8 core components. In this article IPC practices in Sri Lanka are examined in comparison to the WHO guidelines Published on 2017-05-04 04:18:02
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