Demographic, exposure, clinical, biochemical and diagnostic data of febrile patients recruited for the largest field study on leptospirosis in Sri Lanka.
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ABSTRACT:
SUBMITTER: Agampodi S
PROVIDER: S-EPMC9234077 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Leptospirosis is a re-emerging zoonotic disease all over the world, important in tropical and subtropical areas. A majority of leptospirosis infected patients present as subclinical or mild disease while 5-10% may develop severe infection requiring hospitalisation and critical care. It is possible that several factors, such as the infecting serovar, level of leptospiraemia, host genetic factors and host immune response, may be important in predisposition towards severe disease. Different Leptospira strains circulate in different geographical regions contributing to variable disease severity. Therefore, it is important to investigate the circulating strains at geographical locations during each outbreak for epidemiological studies and to support the clinical management of the patients. In this study immunochromatography, microscopic agglutination test and polymerase chain reaction were used to diagnose leptospirosis. Further restriction fragment length polymorphism and DNA sequencing methods were used to identify the circulating strains in two selected geographical regions of Sri Lanka. Leptospira interrogans, Leptospira borgpetersenii and Leptospira kirschneri strains were identified to be circulating in western and southern provinces. L. interrogans was the predominant species circulating in western and southern provinces in 2013 and its presence was mainly associated with renal failure.
| S-EPMC4501411 | biostudies-literature
Project description:BACKGROUND:Although the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka. METHOD:A systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability. RESULTS:The estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7-52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542-980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2-9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively. CONCLUSION:Our systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54-604·23) per 100,000 people published previously.
| S-EPMC6364467 | biostudies-literature
Project description:BackgroundChikungunya virus (CHIKV) re-emerged in Sri Lanka in late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK) in patients presenting with acute undifferentiated febrile illness in unstudied rural and semi-urban southern Sri Lanka in 2007.Methodology/principal findingsWe enrolled febrile patients ? 2 years of age, collected uniform epidemiologic and clinical data, and obtained serum samples for serology, virus isolation, and real-time reverse-transcriptase PCR (RT-PCR). Serology on paired acute and convalescent samples identified acute chikungunya infection in 3.5% (28/797) patients without acute dengue virus (DENV) infection, 64.3% (18/28) of which were confirmed by viral isolation and/or real-time RT-PCR. No CHIKV/DENV co-infections were detected among 54 patients with confirmed acute DENV. Sequencing of the E1 coding region of six temporally distinct CHIKV isolates (April through October 2007) showed that all isolates posessed the E1-226A residue and were most closely related to Sri Lankan and Indian isolates from the same time period. Except for more frequent and persistent musculoskeletal symptoms, acute chikungunya infections mimicked DENV and other acute febrile illnesses. Only 12/797 (1.5%) patients had serological evidence of past chikungunya infection.Conclusions/significanceOur findings suggest CHIKV is a prominent cause of non-specific acute febrile illness in southern Sri Lanka.
| S-EPMC3846738 | biostudies-literature
Project description:BackgroundTrichomonas vaginalis infection is underreported due to nonspecific clinical presentation and the nonavailability of sensitive laboratory diagnostic tests at the clinical setup. Hence, this study was designed to compare the sensitivity and specificity of microscopy and culture methods with polymerase chain reaction (PCR). The socio-demographic factors associated with the infection were explored.MethodsThe study was carried out at the National Sexually Transmitted Diseases and Acquired Immuno Deficiency Syndrome Control Programme in Colombo and Sexually Transmitted Diseases and Acquired Immuno Deficiency Syndrome Control Programme in Kandy. Samples were collected from a total of 385 patients including, 272 females (70.7%) and 113 males (29.3%), and tested using microscopy (wet mount and Giemsa staining), culture, and PCR. Genus-specific primer set (TFR1/TFR2) that amplifies 5.8S rRNA and species-specific primer sets (TV16Sf-2/TV16Sr-2 and TVK3/7) that amplifies 18S rRNA and repetitive DNA, respectively, were used. Patient's socio-demographic and sexual behaviour data were obtained using a standard interviewer-administered questionnaire. Data were analyzed with R statistical software Version 3.6.3.ResultsThe overall prevalence of trichomoniasis was 4.4% (17/385). Of these, six (1.6%) were positive for microscopic examination, 7 (1.8%) were positive for culture, and 13 (3.4%) for TVK3/7, 15 (3.9%) for TV16Sf/r, and TFR1/2 17 (4.4%) were positive for PCR. Sensitivities of PCR using TFR1/2, TV16Sf/r, and TVK3/7 primer sets were 100%, 88.20%, and 76.50%, respectively, against the expanded gold standard. Trichomoniasis was associated with age above 36 (p = 0.033), not using condoms in last three months (p = 0.016), multiple sex partners (p = 0.001), reason for attendance (p = 0.027), symptomatic nature (p = 0.015), and the presence of other sexually transmitted diseases (p = 0.001).ConclusionsThe study highlighted that age over 36 years, multiple sex partners, not using condoms, reason for attendance, symptomatic nature, and having other sexually transmitted diseases can increase the risk of acquiring trichomoniasis. Furthermore, this study confirmed PCR as highly sensitive and specific diagnostic test for the diagnosis of trichomoniasis in comparison to microscopy and culture methods.
| S-EPMC8513885 | biostudies-literature
Project description: Not available
| S-BSST1368 | biostudies-other
Project description:Leptospirosis is known to be an important cause of weather disaster-related infectious disease epidemics. In 2011, an outbreak of leptospirosis occurred in the relatively dry district of Anuradhapura, Sri Lanka where diagnosis was resisted by local practitioners because leptospirosis was not known in the area and the clinical presentation was considered atypical. To identify the causative Leptospira associated with this outbreak, we carried out a cross-sectional study. Consecutive clinically suspected cases in this district were studied during a two-and-a-half-month period. Of 96 clinically suspected cases, 32 (33.3%) were confirmed by qPCR, of which the etiological cause in 26 cases was identified using 16S rDNA sequencing to the species level. Median bacterial load was 4.1 × 10(2)/mL (inter-quartile range 3.1-6.1 × 10(2)/mL). In contrast to a 2008 Sri Lankan leptospirosis outbreak in the districts of Kegalle, Kandy, and Matale, in which a predominance of Leptospira interrogans serovars Lai and Geyaweera was found, most cases in the 2011 outbreak were caused by Leptospira kirschneri. Seven (21.9%) confirmed cases had acute renal failure; five (15.6%) had myocarditis; severe thrombocytopenia (<20,000/uL) was seen in five (15.6%) cases. This outbreak of leptospirosis in the relatively dry zone of Sri Lanka due primarily to L. kirschneri was characterized by markedly different clinical presentations and low leptospiremia. These observations and data demonstrate the public health relevance of molecular diagnostics in such settings, possibly related to the microgeographic variations of different Leptospira species, but of particular value to public health intervention in what appears to have been a regionally neglected tropical disease.
| S-EPMC3894175 | biostudies-literature
Project description:BackgroundLeptospirosis is a bacterial zoonosis. Leptospirosis incidence (LI) in Sri Lanka is high. Infected animals excrete leptospires into the environment via their urine. Survival of leptospires in the environment until they enter into a person and several other factors that influence leptospirosis transmission are dependent upon local weather. Past studies show that rainfall and other weather parameters are correlated with the LI in the Kandy district, Sri Lanka. El Niño Southern Oscillation (ENSO), ENSO Modoki, and the Indian Ocean Dipole (IOD) are teleconnections known to be modulating rainfall in Sri Lanka. There is a severe dearth of published studies on the correlations between indices of these teleconnections and LI.MethodsWe acquired the counts of leptospirosis cases notified and midyear estimated population data of the Kandy district from 2004 to 2019, respectively, from weekly epidemiology reports of the Ministry of Health and Department of Census and Statistics of Sri Lanka. We estimated weekly and monthly LI of Kandy. We obtained weekly and monthly teleconnection indices data for the same period from the National Oceanic and Atmospheric Administration (NOAA) of the USA and Japan Agency for Marine-Earth Science and Technology (JAMSTEC). We performed wavelet time series analysis to determine correlations with lag periods between teleconnection indices and LI time series. Then, we did time-lagged detrended cross-correlation analysis (DCCA) to verify wavelet analysis results and to find the magnitudes of the correlations detected.ResultsWavelet analysis displayed indices of ENSO, IOD, and ENSO Modoki were correlated with the LI of Kandy with 1.9-11.5-month lags. Indices of ENSO showed two correlation patterns with Kandy LI. Time-lagged DCCA results show all indices of the three teleconnections studied were significantly correlated with the LI of Kandy with 2-5-month lag periods.ConclusionsResults of the two analysis methods generally agree indicating that ENSO and IOD modulate LI in Kandy by modulating local rainfall and probably other weather parameters. We recommend further studies about the ENSO Modoki and LI correlation in Sri Lanka. Monitoring for extreme teleconnection events and enhancing preventive measures during lag periods can blunt LI peaks that may follow.
| S-EPMC8152333 | biostudies-literature
Project description:IntroductionAnalyzing dengue disease patterns from different parts of the world should help us formulate more evidence based treatment guidelines and appropriately allocate limited healthcare resources. Therefore, we described the disease characteristics of hospitalised pediatric patients with dengue infections from Sri Lanka during the 2017 dengue epidemic.MethodsClinical and biochemical characteristics of pediatric dengue patients treated at a secondary care hospital in Sri Lanka from 1 June 2017 to 31 August 2017 were analyzed. Our findings were compared with previous pediatric dengue studies in Asia.Results a total of 305patients (number of males = 184(60%); mean age = 8.6 years) were analyzed. DF (Dengue Fever)-245 (80.3%), DHF (Dengue Hemorrhagic fever)-I:52 (17%), DHF-II:7 (2.3%), and DHF-III:1 (0.3%). Significant associations were found between DHF and abdominal symptoms/signs and overt bleeding manifestations (P < .001). Time of onset of the critical phase was variable (Day 3: 12%, Day 4-5: 78%, Day 6: 5%, and Day 7: 5%). Platelet and white-cell counts (WBC) were significantly lower in DHF than DF; liver enzyme derangement was mild and was similar in the DHF and DF subgroups. None had cardiac, renal, or neurological manifestations and all recovered uneventfully.ConclusionIn Sri Lankan pediatric dengue patients, we found abdominal symptoms and signs, decreased WBC and platelet counts and bleeding manifestations were to be significantly associated with DHF. Liver enzyme derangement did not predict DHF. The time of onset of the critical phase was difficult to predict due to the considerable variations noted.
| S-EPMC7686613 | biostudies-literature
Project description:BackgroundLeishmaniasis is a neglected tropical disease that affects countries in the developing world. In Sri Lanka, cutaneous leishmaniasis is the most common form of the disease. It is prevalent in dry and intermediate zones, mostly associated with rural settings. Understanding basic risk factors is critical in the management of the disease with effective interventions. This study is focused on assessing the demographic, socioeconomic and landscape factors associated with leishmaniasis in Kurunegala District, Sri Lanka.MethodsA descriptive cross-sectional study was conducted. Households of the past patients and randomly selected households, which had no history of leishmaniasis cases were interviewed. The clinical, socioeconomic, demographic, landscape and awareness-related data were obtained using a pre-tested, interviewer-administered questionnaire.ResultsA total of 101 patients and a similar number of controls were included in the study. All the patients had the cutaneous form of the disease. Housewives and personnel with monthly incomes less than Rs. 10,000 (56.76 USD) were 3.9- and 9.5-times more prone to the disease, respectively, according to multivariate analysis. Presence of decaying garbage, termite hills, unclear areas, wet soil and gardening areas were always associated with the increased odds of acquiring the disease.ConclusionsDemographic factors do not play a pivotal role in the prevalence of leishmaniasis in the area. Housewives, inhabitants with low incomes and individuals who live in areas with conditions suitable for sand fly breeding and resting are major groups with a higher risk of infection. Special attention must be given in raising awareness and environmental management in control activities.
| S-EPMC7216469 | biostudies-literature
Project description:BACKGROUND: Despite a relatively good national case reporting system in Sri Lanka, detailed maps of malaria distribution have not been publicly available. METHODS: In this study, monthly records over the period 1995 - 2000 of microscopically confirmed malaria parasite positive blood film readings, at sub-district spatial resolution, were used to produce maps of malaria distribution across the island. Also, annual malaria trends at district resolution were displayed for the period 1995 - 2002. RESULTS: The maps show that Plasmodium vivax malaria incidence has a marked variation in distribution over the island. The incidence of Plasmodium falciparum malaria follows a similar spatial pattern but is generally much lower than that of P. vivax. In the north, malaria shows one seasonal peak in the beginning of the year, whereas towards the south a second peak around June is more pronounced. CONCLUSION: This paper provides the first publicly available maps of both P. vivax and P. falciparum malaria incidence distribution on the island of Sri Lanka at sub-district resolution, which may be useful to health professionals, travellers and travel medicine professionals in their assessment of malaria risk in Sri Lanka. As incidence of malaria changes over time, regular updates of these maps are necessary.
| S-EPMC183859 | biostudies-literature