Browsing by Author "Gunasena, J.B."

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Double-trouble: A rare case of co-infection with melioidosis and leptospirosis from Sri Lanka
(Sage, 2023) Gunasena, J.B.; de Silva, S.T.
Melioidosis and leptospirosis are two emerging tropical infections that share somewhat similar clinical manifestations but require different methods of management. A 59-year-old farmer presented to a tertiary care hospital with an acute febrile illness associated with arthralgia, myalgia and jaundice, complicated by oliguric acute kidney injury and pulmonary haemorrhage. Treatment was initiated for complicated leptospirosis but with poor response. Blood culture was positive for Burkholderia pseudomallei and microscopic agglutination test (MAT) for leptospirosis was positive at the highest titres of 1:2560, confirming a co-infection of leptospirosis and melioidosis. The patient made a complete recovery with therapeutic plasma exchange (TPE), intermittent haemodialysis and intravenous (IV) antibiotics. Similar environmental conditions harbour melioidosis and leptospirosis, making co-infection a very real possibility. Co-infection should be suspected in patients from endemic areas with water and soil exposure. Using two antibiotics to cover both pathogens effectively is prudent. IV penicillin with IV ceftazidime is one such effective combination.
Organophosphate poisoning complicated by rhabdomyolysis-induced acute kidney injury: A Case report and review of literature
(Longdom Publishing SL, 2020) Gunasena, J.B.; de Silva, S.T.
BACKGROUND: Rhabdomyolysis induced acute kidney injury (AKI) following organophosphate poisoning is a rare complication. The mechanism responsible is uncertain. CASE REPORT: A 42 years old male was admitted to a tertiary care hospital in Sri Lanka after deliberate self-ingestion of Calcron® (Profenophos, an organophosphorus pesticide). He developed rhabdomyolysis induced AKI requiring regular haemodialysis. During the hospital stay he also developed bronchopneumonia with acute respiratory distress syndrome, requiring intubation and ventilation. The patient improved with intravenous antibiotics and repeated renal replacement with haemodialysis. At discharge he had made a full recovery. CONCLUSION: Organophosphate poisoning can rarely lead to rhabdomyolysis induced AKI. It is an adverse predictor of outcome. Clinicians should be vigilant about this complication since, with early diagnosis and aggressive treatment, a favourable outcome is possible.
Retrospective analysis of Pyrexia of Unknown Origin (PUO) among adult patients in a Tertiary Care Hospital in Sri Lanka
(Sri Lanka Medical Association, 2021) Premathilaka, L.H.R.A.; Darshana, L.G.T.; Liyanage, I.K.; Nishshanka, N.A.S.; Gamage, M.P.; Gunasena, J.B.; Sajeethan, P.; Mendis, B.M.I.U.; Shashiprabha, W.M.M.; Tilakaratna, P.M.Y.I.; Premawardhena, A.P.
Introduction and Objectives Pyrexia of “unknown origin” remains a clinical entity universally despite advances in diagnostic technologies. There are few if any systematic studies on PUO conducted in Sri Lanka. We retrospectively analysed data of patients with PUO from a tertiary care hospital. Methods Records of PUO patients admitted to Colombo North (Teaching) Hospital during the period of January 2015 – January 2020 were extracted from the archives. Details of etiology, diagnosis and usage of medication of each patient was recorded. Results A total of 100 PUO patients were recruited. Majority were males (n=55;54.5%). Median ages of male and female patients were 53.0 and 50.0 years respectively. A final diagnosis had been reached in the majority (n=65;65%). Mean number of days of hospital stay was 15.16 (SD; 7.81). Median of the total number of fever days among PUO patients was 30.5. Out of 65 patients whose etiology were identified, the majority were diagnosed with an infection (n = 47; 72.31%) followed by noninfectious inflammatory conditions (n=13; 20.0%) and malignancies (n=5; 7.7%). Tuberculosis was the commonest infection detected (n=15; 31.9%). Mean number of days taken to reach the final diagnosis was 11.57 (SD: 11.42). Contrast enhanced CT scan (CECT) pelvis/abdomen (n = 15; 23.1%) was the commonest investigation leading to the final diagnosis. Antibiotics had been prescribed for the majority of the PUO patients (n=90; 90%). Conclusion Infections, mainly tuberculous, was the commonest cause for PUO while a third of patients remained undiagnosed despite a prolonged hospital stay.
An unusual case of sepsis due to Salmonella enterica serovar Weltevreden, an emerging pathogen of non-typhoidal salmonellosis
(Sage Publishing, 2021) Gunasena, J.B.; de Silva, S.T.
ABSTRACT: Salmonella enterica serovar Weltevreden is identified as an emerging pathogen, especially in the South and Southeast Asian regions. A 45-year-old male presented with an acute febrile illness, disoriented and confused. Blood culture became positive for Salmonellae enterica serovar Weltevreden. The patient was started on intravenous Ceftriaxone. Despite aggressive management, he developed acute respiratory distress syndrome with septic shock, which required intubation and mechanical ventilation. On the 11th day of admission, he succumbed due to sepsis from peritonitis with bowel infarction. Severe sepsis due to S. Weltevreden is rare. Diabetes, malignancy, therapeutic immune suppression may predispose to invasive disease. Biochemical similarities to other Salmonella species may lead to S. Weltevreden being overlooked by clinicians. Isolates from around the world remain sensitive to most freely available antibiotics. Emergence of resistance to common antimicrobial agents could pose an obvious public health threat. KEYWORDS: Non typhoidal salmonella; Southeast Asia; antibiotic sensitivity; salmonella weltevreden; sepsis.