Browsing by Author "Manamperi, A."

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Aedes albopictus the “underrated” Asian Tiger
(University of Kelaniya, 2010) Jayasooriya, D.H.S.W.; Gunawardene, Y.I.N.S.; Manamperi, A.; de Silva, H.J.; Abeyewickreme, W.
Introduction The mosquito Aedes aegypti was thought to be the main vector responsible for virtually all dengue epidemics; while Aedes albopictus was considered a vector in which the virus is maintained but does not cause epidemics. Objective The study was conducted covering three endemic districts in Sri Lanka to determine the role of genus Aedes during dengue transmission. Methods and Material Mosquitoes were collected within a 350m radius from the location of the positive patients. Heads and abdomens of 63 pools were tested for DENV RNA with and RT-PCR-LH-(P32) assays Results Discussion Ae. albopictus was present in majority of the locations in all districts surveyed. Ae. albopictus was found in 13/17 (76.47%), 24/25 (96%)and 19/22 (86.36%) sites in Colombo, Gampaha and Kurunegala respectively. The RT-PCR-LH-(P32) assays indicated that 5/25 (20%) sites in Gampaha, 2/17 (11.76%) in Colombo and 6/22 (27.27%) in Kurunegala were positive for DENV. In Gampaha and Colombo there were 3 and 1 of DEN-2 positive pools respectively, while there were 2 and 1 of DEN-3 positive pools respectively. A higher number of positive pools (4/1or 21.05%) for DEN-1 and 1/1(5.26 %) for DEN-4 were found in Kurunegala. In Kurunegala one pool was positive for both DEN-2 and DEN-4 indicating the circulation of multiple serotypes within close proximity. Moreover one of the three DEN-2 positive pools in Gampaha consisting of only male Ae. albopictus mosquitoes is supportive of the belief of vertical transmission of DENV. In a DEN-4 positive location in Kurunegala HI was found to be10%, BI= 1and CI= 5.88 %while anotherDEN-2 positive site in Wattala showed HI of 5.55%and a BI of 5.55 suggesting active transmission. The abundance of Ae. albopictus in all districts and the findings indicating that100% of the positive pools were made of Ae. albopictus in this study highlights the importance of Ae. albopictus in the transmission dynamics dengue. The ability of Ae. albopictus to be infected with low viremia and the degree to which it permits replication within the mosquito itself could have an impact on the transmission and these verity of the disease. Co-circulation of two or more serotypes in a single pool or in different pools of mosquitoes within the same district is suggestive of hyper endemic transmission dengue in the three districts. The greater susceptibility of Ae. albopictus to infection by DENV is said to lead to greater virus adaptation. Sri Lanka as a whole would be at serious risks for multiple outbreaks in future. Our results indicate that Ae. albopictus is more efficient in dengue transmission than previously thought. The results shed light on the efficiency of Ae. albopictus as a vector in transmitting DENV in the absence or low abundance of Ae. aegypti in Sri Lanka. The present study suggests that Ae. albopictus sp is underrated in terms of transmission potential during peak transmission periods of dengue in Sri Lanka. Key words: RT-PCR-LH-(P32) RT-PCR-Liquid Hybridization with P32 radio isotope, HI-House hold Index, BI- Breteau Index, CI-Container Index,DENV-Dengue Virus Authors wish to acknowledge the financial assistance rendered by the NSF Sri Lanka (GrantNo:SIDA/2006/BT/02)and the IAEA (Grant NoTC SRL 6/028).
Analysis of genetic polymorphism of Plasmodium vivax duffy binding protein ligand domain of Sri Lankan isolates
(Sri Lanka Association for the Advancement of Science, 2008) Premaratne, P.H.; Aravinda, R.; Manamperi, A.; Randeniya, P.V.
Interaction of Plasmodium vivax Duffy Binding Protein region II (PvDBPII) critical binding motif (CBM) with its erythrocyte receptor is critical for maintaining blood stage infections, rendering PvDBP a leading vaccine candidate. Since the efficacy of a vaccine based on a polymorphic antigen, such PvDBP, is influenced by the local host immune response, characterization of the GD among local parasite strains is important in specific geographic settings. GD of the PvDBPII-CBM was assessed for the first time among field isolates from Sri Lanka. Forty single clonal P. vivax infections identified from two malaria endemic areas (Anuradhapura and Kataragama) and from a non-endemic area (Colombo), were used to generate nucleotide sequence data of CBM of PvDBPII (aa 285 to 521) by nested PCR amplification followed by direct sequencing. Twenty dimorphic sites, 20 nucleotide polymorphisms and 15 haplotypes (haplotype diversity = 0.890) were identified at the CBM of PvDBPII compared to Sal-1 sequence. Genetic polymorphism in terms of pair wise diversity (p) and Tamura's three parameter model (d) were calculated to be 0.00950 (S.D.=0.00072) and 0.00959 (S.D.= 0.00052), respectively, consistent with published data from world wide isolates. Eighteen non-synonymous(NS) and 02 synonymous(S) mutations were identified, and the ratio of NS (0.01086) to S (0.00458) mutation rates was significantly >1, suggesting that positive selection acts on the CBS of PvDBPII. Residues essential for erythrocyte binding on PvDBPII-CBR were conserved in these 40 isolates. Six polymorphic residues recorded in high frequencies in worldwide isolates were also present among Sri Lankan isolates. Polymorphisms occurring at higher frequencies than Papua New Guinea isolates, of three amino acid residues involved in resistance to binding inhibitory antibodies were also detected. Thus, even under low and unstable transmission conditions prevalent in the island, relatively high allelic diversity and positive selection acting on CBM of PvDBPII, possibly due to immune pressure were detected in Sri Lankan P. vivax field isolates. Financial support by the National Science Foundation (Grant numbers NSF/SCH/2004/07 and NSF/RG/2005/HS/06) and the National Research Council (Grant numbers 05-34) is acknowledged.
Application of nucleic acid technology (NAT) in the diagnosis of active viral replication in HBV and HCV infections and evidence for HBV surface antigen mutants
(Sri Lanka Association for the Advancement of Science, 2008) Manamperi, A.; Gunawardene, Y.I.N.S.; Hapuarachchi, C.; Bandara, A.; Wellawaththage, C.; Abeyewickreme, W.; de Silva, J.
Introduction: The community prevalence of Hepatitis B (HBV) and hepatitis C (HCV) infections, although considered low (< 1%) in Sri Lanka based on serological markers, pose a significant health threat to patients in high risk groups. The early diagnosis of active viral infection is crucial in such situations to prevent further transmission and to enable the clinicians to initiate successful therapeutic interventions. Objective: This study was carried out to investigate the usefulness of polymerase chain reaction (PCR) in the diagnosis of active viral replication in HBV and HCV infections. Methodology: All specimens from patients with serological evidence of hepatitis B (HBV surface antigen and/or antibodies for HBV core protein) or hepatitis C (antibodies for hepatitis C core protein-Anti-HCV) and referred to the Molecular Medicine Unit from May 2005 to May 2008 were analyzed by PCR and reverse-transcription PCR (RT-PCR) for HBV DNA (n=130) and HCV RNA (n=95) respectively. Results: Of the 130 patients tested, 57 (44%) were positive for HBV DNA. The positive group of patients included 10 renal transplant patients, 4 multiply transfused patients, 4 paediatric patients with lymphoma, and 1 patient with cirrhosis. Six HBV DNA positive patients had negative HBsAg serology profiles indicating the possibility of surface antigen mutant strains. The HBV DNA negative patients with positive serology profiles indicate sero-converted/ patients with resolved infections or false positive serology results. Of the 95 patients tested, 14 (15%) were positive for HCV RNA and included 3 paediatric patients with thalassaemia. HCV RNA negative, anti-HCV positive profiles reflect either false positive serology results (due to less specific antibody assays) or donors who have been exposed to HCV previously and subsequently resolved their infections. Conclusions: A major proportion of patients with serological markers for HBV have active viral infection whereas only relatively a minor proportion of patients with serological markers for HCV have active viral replication. We have also found the first possible evidence of hepatitis B surface antigen mutant strains. This underlines the importance of the nucleic acid based technology in the diagnosis and assessment of infection with or suspected to have hepatitis B or C infections. We also emphasize the importance of introducing NAT for screening donors for HBV DNA and HCV RNA to substantially lower the risk of acquiring HBV/HCV infection from a transfusion.
Asia-Pacific Health 2020 and Genomics without Borders: Co-Production of Knowledge by Science and Society Partnership for Global Personalized Medicine
(Bentham Science, 2011) Ozdemir, V.; David, H.; Muljono, D. H.; Pang, T.; Ferguson, L.; Manamperi, A.; Samper, S.; Someya, T.; Tasse, A. M.; Tsai, S-J.; Zhou, H-H.; Lee, E. J. D.
No Abstract Available
Assessment of Real Time Polymerase Chain Reaction (PCR) Assay for the Early Diagnosis of Leptospirosis in Humans
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Uduwawala, U.M.H.U.; Manamperi, A.; Gunaratna, G.P.S.; Karunanayake, L.; Chandani, W.L.; Hapugoda, M.
Leptospirosis is the most widespread zoonotic disease worldwide having a great impact on health issues in developing countries. It is caused by a pathogenic spirochete of the genus Leptospira where humans become infected through contact with the urine of infected animals. It is often exceptionally under-recognized as the clinical manifestation mimics variety of similar disease conditions that occur in the same environmental and climatologic conditions which accentuate the importance of laboratory diagnosis of leptospirosis. At present, no hospital based facilities are available for acute confirmation of the disease. The existing practice is retrospective confirmation with serological diagnosis. Therefore, the establishment of acute phase diagnosis will help in monitoring the disease, determining when hospital admission is required and reduce case fatalities. The objective of this study was to establish and evaluate a molecular-based assay to provide laboratory confirmation of leptospirosis at the acute phase of the infection (1-5 days of fever). Patients fulfilling clinical criteria stipulated by the accepted case definition were selected for the study and patients who failed to show evidence of sero conversion were considered as true negatives. A real time Polymerase Chain Reaction (PCR) assay with targeting a 203 bp fragment in the secY gene which is conserved among pathogenic serovars of Leptospira was established using a reference DNA sample (L.interrogans serovar Icterohaemorrhagiae strain RGA). Analytical sensitivity and the analytical specificity of the assay were calculated. The accuracy of the real time PCR was determined by a panel of acute blood samples collected from laboratory confirmed leptospirosis patients (n=35) and non-leptospirosis (n=44) patients based on Microscopic Agglutination Test (MAT) and/or IgM immunochromatography. Patients who failed to give positive test results either with MAT or IgM immunochromatography were considered as true negatives. Analytical sensitivity was approximately 314 genome equivalents per reaction and analytical specificity showed no amplification of Leptospira saprophytic sp. and other micro-organisms. The assay could effectively detect Leptospira DNA from clinically diagnosed leptospirosis suspected patients with 60.0% (21/35) diagnostic sensitivity and 77.27% (34/44) diagnostic specificity. This may be attributed to some samples failing laboratory confirmation despite their collection based on clinical suspicion. Therefore, real time PCR established can be used for rapid and definitive diagnosis of leptospirosis during the acute phase of infection
Assessment of the distribution of Aedes breeding sites at the households of district of Gampaha
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Perera, E. H. L.; Hapugoda, M. D.; Viswakula, S.; Gunawardene, Y. I. N. S.; Subasinghe, U.; Fernando, L.; Manamperi, A.
Dengue is the most important mosquito-borne viral infection in Sri Lanka at present. Integrated Vector Management (IVM) targeting dengue vector mosquitoes has become the main disease control measure. The objective of this study was to assess the distribution of the Aedes breeding habitats in dengue high and low risk areas in the District of Gampaha where the second highest incidence of dengue reported during last 10 years. Negombo Medical Officer of Health (MOH) area was selected based high incidence of dengue cases reported in the District of Gampaha during last 10 years. A dengue high risk (Kurana East) and low risk (Udayarthoppuwa) Grama Niladhari (GN) divisions with similar geographical situation in the same MOH area were selected as study and control areas respectively. Standard larval surveillance was conducted randomly selected 150 houses in each site for 18 months (April, 2018-October, 2019). In the dengue high risk and low risk areas, the proportions of the larvae of Aedes species to the total larval collection were 34.19% (185/541) and 21.68% (147/678) respectively. High densities of Ae. albopictus larvae were reported in both high [171/185=92.4%)] and low [141/147=95.92%) risk areas. Ae. aegypti was present in low abundance in both areas [High risk-7.56% (14/185) and Low risk- 2.72% (4/147)]. In the high-risk site, breeding sites of the Ae. albopictus larvae were reported as plastic buckets/barrels (55.19 %-154/279), waste plastics (35.15%-98/279), metal tins (3.94%-11/279) and tube wells (2.86%-8/279). In low-risk area, the majority of breeding sites for Ae. albopictus larvae was found in coconut shells (76.14%- 201/264) and plastic waste (21.96%-51/264). In both areas, Ae. aegypti larvae was found in plastic buckets/barrels only. There is a significance difference between the Ae. albopictus breeding places in the dengue high and low risk areas (P=0.024). Although Ae. aegypti is considered as the major vector of dengue, Ae. albopictus was reported as the prominent dengue vector species in the high dengue risk area in the District of Gampaha. Even though, municipal council removes solid waste weekly, a large number of breeding sites are available at both areas. As there is a significant difference between Ae. albopictus breeding sites at the dengue high and low risk areas, it is essential to specifically focus on removal of breeding sites for successful vector control measure.
Capacity building in genomic medicine and molecular diagnostics: the case of Sri Lanka
(Bentham Science, 2012) Manamperi, A.; Huzair, F.
In this paper, we advance the extant health technology innovation frames on global personalized medicine by highlighting the need to rethink genomics medicine in real-life settings – including situations where populations are frequently faced with natural disasters or man-made conflicts. We identify the steps towards building sufficient capacity to effectively harness and integrate genomic medicine and molecular diagnostics in order to benefit global society including those in resource-limited settings and post-war capacity building contexts. Surprisingly, despite a great number of populations currently living in developing countries, including in a state of post-war or conflict resolution context, the public health pharmacogenomics community has largely neglected this crucial dimension in biomedical literature. By exploring the particular case of Sri-Lanka in this paper, we are able to investigate the obstacles commonly faced by low and middle income countries similarly afflicted by crises, natural disasters, conflict and the need for improved, more cost effective health care. Sri Lanka has a relatively strong platform for launching molecular diagnostic technology, including a well networked set of primary, secondary and tertiary care institutions, a small but burgeoning private health and research sector and a strong science base in its universities. Despite this, there has been slow uptake and exploitation of novel molecular diagnostics due to various factors such as a weak regulatory framework and high costs associated with the import of molecular reagents and import and maintenance of equipment. In summary, as a way forward for health technology assessment in resource-limited countries, this paper brings to the fore an integrated discourse on real-life experiences and putative solutions on genomics and molecular diagnostic medicine. For a comprehensive discussion in the nascent field of public health pharmacogenomics, post-war and post-conflict capacity building on biotechnologies such as genomics is essential.
Clinical utility of PCR and real time PCR assays for Cytomegalovirus, hepatitis B and hepatitis C infections.
(Sri Lanka Association for the Advancement of Science, 2008) Dassanayake, R.S.; de Silva, P.; Weerasena, J.; Gunawardene, Y.I.N.S.; Manamperi, A.
Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Reactivation of cytomegalovirus (CMV), Hepatitis B (HBV) and C (HCV) viruses from the status of latency is seen in immunocompromised individuals and such reactivation is often associated with morbidity and mortality in such individuals. The prevalence of these viral infections in a selected population of patients referred to the Molecular Diagnostic Laboratory at the Durdan's Hospital, Colombo, during the period from August 2007 to May 2008 were studied using qualitative PCR assays. All specimens from patients with suspected clinical diagnoses of either CMV or HBV or HCV infections were analyzed. Of 176 samples analyzed for CMV 78 were positive (37 males, 29 females) and majority of them are patients from a nephrology unit. Out of 40 and 10 samples analyzed from males and females, respectively, 22 and 4 were positive for HBV. Twenty six samples were analyzed for HCV and only 6 were fond to be infected with viruses and all of them were from males. Although PCR detection of these viral DNA/RNA is a sensitive method to detect infection, it lacks specificity for the detection of active viral disease and for monitoring the efficacy of antiviral therapy. Therefore, Real-time PCR (RT-PCR) assays for the detection and quantification of CMV-DNA, HBV-DNA and HCV-RNA were developed using SYBRgreen1 chemistry. The assays developed are capable of detecting viral particles in blood samples and quantifying viral DNA accurately over a broad range of input target copies (102 - 108copies/ml) and therefore, can be used to predict the reactivation of viruses by comparing with published kinetic criteria in clinical guidelines. Post PCR analyses of Real-time PCR products by agarose gel electrophoresis revealed bands having the same intensity for a wide range of target copies (103 -108copies/ml). In contrast, RT-PCR elicited higher cycle threshold for the descending order of concentration of target copies. Therefore, based on these results, it is evident that the intensity of conventional PCR bands should not be used for the assessment of viral reactivation or for monitoring therapeutic intervention and for this purpose RT-PCR is the method of choice
Co-existence of double serotypes of dengue in patients of Gampaha District
(Sri Lanka Association for the Advancement of Science, 2007) Jayasooriya, D.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.; Premaratna, R.; Manamperi, A.; de Silva, H.J.; Abeyewickreme, W.
Dengue virus (DENV) known to cause a productive cytolytic infection in humans exists in four different serotypes Dengue 1 (D1), Dengue 2 (D2), Dengue 3 (D3) and Dengue 4 (D4). Among 4 serotypes of DENV, D 3 thought to be associated with explosive DHF epidemics and severe disease in many countries. Our objective was to determine the prevalence of dengue serotypes in Gampaha District and to correlate them with disease severity. Serum samples were collected from patients who were within 4 days of onset of fever and clinically suspected of dengue according to WHO criteria. Total viral RNA extracted from each serum sample was subjected to RT-PCR followed by a semi-nested PCR using specific primers. Out of 91 samples collected between Nov 2005 and Dec 2006, 16 samples were confirmed positive for DENV RNA by RT-PCR. Our results of multiplex semi-nested PCR indicated that 9/16 (56.25 %) of the positive cases were co-infected with serotype 2 and 3 (D2 & D3), while 4/16 (25%) were infected with D 3 and 3/16 (18.75 %) with D 2. 3/4 of D 3 cases had DHF , 1/3 of D2 cases were DHF while there were no DHF cases among the D2 and D3 co-infected patients. The mean Packed cell Volume (PCV) values of D3, D2 and D2 & D3 co-infected were 53.8 %, 48 % and 39.6% respectively while the mean platelet values of those were 66,000 mm3, 123,000 mm3 and 174.000 mm3 , respectively. Dengue infection by a single serotype is common among patients. Although few cases of co-infection by more than one serotype had been previously reported in a few other countries, this is the first description of simultaneous co-infection by D2 and D3 in Gampaha district. In this limited study we have observed a reduction of disease severity in D2 and D3 simultaneously co-infected patients. Could simultaneous co-infection by more than one serotype or a combination of two particular serotypes have lead to a decrease in disease severity among dengue patients is a matter yet to be studied. Further studies are needed to support these conjectures and to establish the clinical implications of simultaneous co-infection on the prevalence of DHF and disease severity. Acknowledgement: NSF (grant SIDA/2006/BT/02) & IAEA (SRL TC 6/028)
Comparison of five DNA extraction methods from human blood for the detection of Wuchereria bancrofti by polymerase chain reaction assays
(Sri Lanka Association for the Advancement of Science, 2008) Wijegunawardana, N.D.A.D.; Gunawardene, Y.I.N.S.; Manamperi, A.; Hapuarachchi, H.A.C.; Gunawardena, N.K.; Abeysundara, S.; Abeyewickreme, W.
Introduction: Lymphatic filariasis (Lf) is the second most common vector-borne disease globally. Approximately 90% of global burden of Lf is caused by Wuchereria bancrofti. W. bancrofti is routinely diagnosed by morphological identification of microfilariae (Mf) by microscopy which is a labour intense, low sensitive and time consuming method. Detection of W. bancrofti Deoxyribonucleic acid (DNA) using polymerase chain reaction (PCR) technique has become popular today, because of its high sensitivity and specificity. The overall success of the PCR strategy in detecting a filarial parasite in human blood varies between sample preparation methods. The objective of this study was to compare five DNA extraction methods (Lysis + centrifugation, Chelex method, Mf pellet method, Q1Aamp DNA Mini Kit commercial system, and Phenol-chloroform) with regard to duration of completion, labor involvement and PCR analytical sensitivity in-relation to DNA quality and quantity for the detection of W. bancrofti in human blood. Five blood samples positive for mf of W. bancrofti were tested for each DNA extraction method and were compared with respect to the sensitivity, time and quality/quantity of DNA and also by PCR analysis. Of the 5 methods tested, Mf pellet method was found to be the most simple and effective technique for the isolation of W. bancrofti Mf in human blood. This method was quick (15 min to complete), simple (5 min of manual labor), and very economical. It does not require any organic solvents, and the entire extraction procedure uses only two steps requiring supernatant transfer between tubes, hence minimizing the possibility of cross-contamination. Moreover, the PCR analytical sensitivity of the Mf pellet method was comparable to that of the commercial kit used. No PCR inhibitors were detected, independently of Mf count in the blood. Same method (optimal DNA extraction method) can be also used for the detection of parasite DNA from the field collected Mf positive mosquitoes using a PCR. Therefore, we recommend the Mf pellet method for processing large numbers of blood samples in community surveys aimed at determining the prevalence of W. bancrofti infection.
Current developments in genomics and personalized health care: impact on public health
(SAGE Publishing, 2008) Manamperi, A.
The knowledge gained from the characterization of genomes, especially the human genome, holds considerable potential for the development of new health care innovations for prevention, diagnosis, and management of many diseases in the coming decade. However, owing to the presence of highly complex scientific, economic, social, and ethical issues associated with this field, societies will need to be better prepared for the era of postgenomics and its consequences. It is important to ensure that the benefits of genomics are distributed fairly among all the countries of the world and that the well-tried and more conventional approaches to medical research and practice are not neglected while the medical potential of genomicsis being explored. In this report, the author focuses mainly on human genomics, its applications, development of related technologies and issues related to the dissemination of knowledge derived from genome information, and finally, their impact on global health care.
Dengue as-a public health problem in Sri Lanka
(La Fondation pour l’Université de Lyon, 2009) Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.; Premaratna, R.; Manamperi, A.; Gunasena, S.; Abeyewickreme, W.
Dengue infection is an important global public health problem and an increasing number of persons from the South Asian region have been directly or indirectly affected by the disease. In Sri Lanka, dengue has become a major threat to public health in many urban and sub-urban' areas during past three decades. Rapid unplanned urbanization and increasing human population has increase the rate of infection and the frequency. The study area, Gampaha District is the second most populous district in the country having a population density of 1 539 persons per km2 and was the district reporting the second highest incidence of dengue in 2008. Therefore, current research efforts are focused on dengue transmission, examining the presence of sub-clinical infections, role of vector mosquitoes and Knowledge, Attitude and Practices (KAP) of the community on dengue infection in an effort to contain the disease. In the present study, dengue antibodies were detected in samples collected from clinically suspected patients and as well as in samples collected from volunteers. Volunteer sera collected around the confirmed cases had a 23.6% sero-positive rate for dengue IgM antibodies. The rate of asymptomatic recent infections was calculated to be 16.9%. In present study we have serologically confirmed the presence of subclinical infections and according to the published data this is the first confirmation of asymptomatic dengue infections in Sri Lanka. According to the entomological investigations carried out, the common breeding places for Aedes vectors were found to be discarded small containers. Even though Ae. Aegypti has been considered as the principal vector transmitting dengue fever, current studies highlighted the predominant ro!e of Ae. albopictus in the disease transmission. A previous study in Sri Lanka also suggested that prevalence and .presence of high-density of Ae. albopictus should be considered as a risk factor for endemic/epidemic dengue. In view of the above, the spread of dengue by Ae. albopictus should be a matter of great concern. Findings of KAP survey revealed that the community possessed substantially higher knowledge on the spread of dengue, vectors, vector breeding and also seriousness of the infection. However it was observed that good knowledge does not necessarily lead to good practices. Since the attitudes of the respondents were found to be good and most of them were supportive of control measures; next effort of the present study is to see how a novel community mobilized solid waste management system will be effective in dengue vector control.
Detection of pathogenic Leptospira with rapid extraction followed by recombinase polymerase amplification (RPA) and quantitative polymerase chain reaction (qPCR) assay-A comprehensive study from Sri Lanka
(Public Library of Science, 2024) Uduwawala, H.; Manamperi, A.; Gunaratna, G.P.S.; Karunanayake, L.; Ceruti, A.; Wahed, A.A.E.; Fernando, L.; Premaratna, R.; Hapugoda, M.
Leptospirosis is the most widespread zoonosis in the world. The disease is more prevalent in tropical regions where the majority of developing countries are located. Leptospirosis is considered a protean manifestation zoonosis with severity of the disease ranging from a mild febrile illness to a severe and life-threatening illness. Clinical symptoms of leptospirosis overlap with other tropical febrile illnesses. Early, rapid, and definitive diagnosis is important for effective patient management. Since Polymerase Chain Reaction (PCR)-based assays are not readily available in most clinical settings, there is a need for an affordable, simple, and rapid diagnostic test. Quantitative PCR (qPCR) and Recombinase Polymerase Amplification (RPA) were implemented at the Faculty of Medicine, University of Kelaniya, and a prospective study to evaluate RPA for diagnosis of acute phase of leptospirosis was conducted. Results indicate that RPA and qPCR were positive in 81% (98/121) of the total positive and acute clinical samples. Of the 81 positive MAT confirmed patients 60 (74%) and 53 (65%) were positive with qPCR and RPA respectively. Retrospective evaluation revealed a high diagnostic accuracy (sensitivity-70% and specificity-87%) of RPA compared to MAT as the reference gold standard. Results further suggest that there is no significant difference between the two assays, qPCR and RPA-SwiftX (P = 0.40). Laboratory procedures for the extraction and detection by qPCR in the laboratory have been optimized to obtain results within 6 hours. However, the RPA-SwiftX method under field conditions took 35 minutes. The RPA-SwiftX method could replace the qPCR which shows similar sensitivity and specificity. Therefore, RPA established under the current study presents a powerful tool for the early and rapid diagnosis of leptospirosis at point-of-care.
DNA profiling technology in identity testing and their applications
(Authour, 2009) Manamperi, A.
No abstract available
Efficacy and potential use of VectoBac WGr for the control of Culex quinquifaciatus mosquitoes in three different localities of Gampaha district, Sri Lanka
(Sri Lanka Association for the Advancement of Science, 2009) Wijegunawardana, N.D.A.D.; Hapangama, H.A.D.C.; Gunawardene, Y.I.N.S.; Manamperi, A.; Abeyewickreme, W.
Some methods of mosquito population control, especially the application of pesticides for adult mosquitoes, can have an impact on the environment and individuals with a heightened sensitivity to pesticides. Of the available control tools, biological controls are considered to be generally host-specific and environmental friendly. Although biological controls are not feasible on a large scale, they are often very effective in localized areas. Therefore, efficacy and potential use of water dispersible granular (WDG) formulations of bacterial larvicide, Vectobac- WGr (Bacillus thuringiensis israelensis [Bti]) (Valent BioSciences Cooperation in USA) was tested against Culex quinquefasciatus in three selected localities in the district of Gampaha. Pre-treatment, treatment and post-treatment adult C. quinquefasciatus mosquito densities were recorded for 20 consecutive days within the study period between May to December 2008. The study period covered both rainy and dry seasons. The larvicide was applied to three selected treatment sites and three control sites with a backpack sprayer to test the efficacy of Bti treatment. The six Pre-treatment surveillances in the three treatment and three control sites were done once a week in the first month and once in two weeks for the second month. Adult mosquitoes collected were identified in the laboratory to the species level and the numbers were recorded. For each site, 30 households were selected, with a total of 180 households. During the first month, treatment and surveillance cycles were carried out at weekly intervals, and once in two weeks during the next two months. Six posttreatment surveillances were carried out in the same way as the pre-treatment surveillances. According to the results obtained in this study, out of three treatment sites, two sites were shown to have Culex mosquito density reduction of 19% and 4%, while an increase in mosquito density was observed in the third site. Further, the three control sites, showed an average of 17% mosquito density reduction even without the application of Vectobac-WGr treatment. These results suggest that the product Vectobac-WGr is not effective on Culex quinquefasciatus as a larvicide to control filariasis in Sri Lanka.
Efficacy and Safety of Oral Hydroxyurea in Patients with Transfusion Dependent β Thalassaemia: a Randomized Double-Blind Placebo-Controlled Clinical Trial
(Sri Lanka Medical Association, 2020) Yasara, N.; Wickramarathne, N.; Silva, I.; Hameed, N.; Attanayaka, A.M.K.R.; Jayasinghe, V.L.; Wickramasinghe, N.; Rodrigo, R.; Perera, L.; Mettananda, K.C.D.; Manamperi, A.; Premawardhena, A.; Mettananda, S.
INTRODUCTION AND OBJECTIVES: Patients with β- thalassaemia require blood transfusions and iron chelation for life. Hydroxyurea is a licenced medication for sickle cell disease but its usefulness in transfusion dependent β-thalassaemia is unclear. Here, we aim to assess the efficacy and safety of oral hydroxyurea in patients with transfusion dependent β-thalassaemia. METHODS: A phase III randomized double-blind placebo-controlled clinical trial was conducted at Thalassaemia Unit of Colombo North Teaching Hospital in 2019. Forty-one patients with transfusion dependent β-thalassaemia were randomized into hydroxyurea (10-20mg/kg/day) or placebo (pharmaceutically inert capsule identical to hydroxyurea) groups. Transfused blood volume, pre-transfusion haemoglobin, haemoglobin F level and side effects were monitored monthly during 6- month treatment and 6-month follow-up periods. Adverse events were assessed by trained medical officers. The study was approved by ethics committee of University of Kelaniya and registered in Sri Lanka Clinical Trials Registry (SLCTR/ 2018/024). RESULTS: Of the 41 (hydroxyurea-20; placebo-21) patients, three discontinued treatment due to thrombocytopenia (hydroxyurea-2) and rash (placebo-1). Baseline characteristics of two groups were similar. Mean pre-transfusion haemoglobin (8.52+0.57 vs 8.38+0.55, p=0.45) and haemoglobin F levels (4.3+7.1% vs 3.1+1.9%, p=0.48) were higher in hydroxyurea group compared to placebo. Also, transfused blood volume was lower in hydroxyurea group (102+24ml/kg vs 111+27ml/kg, p=0.3). However, none were statistically significant. Based on elevation of haemoglobin F (>1.5% from baseline), we identified 6/18 patients as hydroxyurea responders. Hydroxyurea responders required significantly lower blood volume (87+13ml/kg) compared to non-responders (110+25ml/kg, p=0.05) and placebo group (111+27ml/kg, p<0.05) while maintaining higher pre-transfusion haemoglobin level (8.6+0.5 vs 8.4+0.5 and 8.3+0.5). No serious side effects were reported. CONCLUSIONS: One-third of patients with transfusion dependent β-thalassaemia responded to hydroxyurea treatment requiring 20% less blood compared to controls. No serious side effects were reported following hydroxyurea treatment.
Efficacy and safety of oral hydroxyurea in transfusion-dependent β-thalassaemia: a protocol for randomised double-blind controlled clinical trial
(BMJ Publishing Group Ltd., 2020) Yasara, N.; Wickramarathne, N.; Mettananda, C.; Manamperi, A.; Premawardhena, A.; Mettananda, S.
INTRODUCTION: Despite being one of the first diseases to be genetically characterised, β-thalassaemia remains a disorder without a cure in a majority of patients. Most patients with β-thalassaemia receive only supportive treatment and therefore have a poor quality of life and shorter life spans. Hydroxyurea, which has shown to induce fetal haemoglobin synthesis in human erythroid cells, is currently recommended for the treatment of sickle cell disease. However, its clinical usefulness in transfusion-dependent β-thalassaemia is unclear. Here, we present a protocol for a randomised double-blind controlled clinical trial to evaluate the efficacy and safety of oral hydroxyurea in transfusion-dependent β-thalassaemia. METHODS AND ANALYSIS: This single-centre randomised double-blind placebo-controlled clinical trial is conducted at the Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Adult and adolescent patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomised into the intervention or control group. The intervention group receives oral hydroxyurea 10-20 mg/kg daily for 6 months, while the control group receives a placebo which is identical in size, shape and colour to hydroxyurea without its active ingredient. Transfused blood volume, pretransfusion haemoglobin level, fetal haemoglobin percentage and adverse effects of treatment are monitored during treatment and 6 months post-treatment. Cessation or reduction of blood transfusions during the treatment period will be the primary outcome measure. The statistical analysis will be based on intention to treat. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Ethics Committee of Faculty of Medicine, University of Kelaniya (P/116/05/2018) and the trial is approved by the National Medicinal Regulatory Authority of Sri Lanka. Results of the trial will be disseminated in scientific publications in reputed journals.
Efficacy of hydroxyurea in reducing the erythropoietic stress of ineffective erythropoiesis in transfusion dependent beta thalassaemia: A randomised, double-blind placebo-controlled clinical trial
(Sri Lanka Association for the Advancement of Science, 2021) Yasara, N.; Premawardhena, A.; Perera, P.; Manamperi, A.; Mettananda, S.
The unbalanced synthesis and accumulation of a-globin chains due to impaired synthesis of 0- globin results in the destruction of red blood cells (RBC) and erythroid precursors of patients with P-thalassaemia. This leads to an increased erythropoietic activity and ineffective erythropoiesis in the bone marrow of these patients. Hydroxyurea is a licenced medication that decreases the RBC destruction of patients with p-thalassaemia. However, its effect on erythropoietic stress is unclear. In this study, our objective was to evaluate the effect of hydroxyurea on erythropoietic stress of ineffective erythropoiesis in transfusion-dependent (TD) p-thalassaemia. This experimental study was carried out at the Thalassaemia Unit of Colombo North Teaching Hospital as part of a randomised, double-blind placebo-controlled clinical trial that evaluates the efficacy of hydroxyurea. We recruited 24 patients with TD p-thalassaemia who were taking hydroxyurea IQ- 20 mg/kg/day and 16 patients who were receiving a placebo. The erythropoietic stress of ineffective erythropoiesis was assessed by measuring serum soluble transferrin receptor (sTfR) levels before and six months after taking either hydroxyurea or placebo. Levels of sTfR were measured using a validated enzyme-linked immunosorbent assay. Paired t-test was used in the statistical analysis. Nineteen (79%) out of 24 patients who received hydroxyurea showed a reduction in sTfR level, of which 8 (33%) and 6 (25%) showed >25% and 10-25% reductions, respectively. A significant reduction in mean sTfR level was observed after hydroxyurea treatment (72.3±SD25.9) compared to pre-treatment levels (89.6士SD22.9), (pv0.01). Conversely, no difference in sTfR levels was seen in patients who received the placebo pre・(91.9土SD24.7) and post-treatment (96.4±SD19.4), (p=0.17). In conclusion, oral hydroxyurea significantly reduced the erythropoietic stress of ineffective erythropoiesis in patients with TD p-thalassaemia showing a promise as a treatment modality.
Evaluation of an IS 6110 - based PCR assay for laboratory detection of M. tuberculosis complex DNA in clinical samples
(Sri Lanka Association for the Advancement of Science, 2008) Palliyaguruge, R.H.; Gunawardene, Y.I.N.S.; Manamperi, A.; Wijekoon, C.N.; Wellawaththage, L.C.; Abeyewickreme, W.
Due to the slow growth rate of the causative agent, the diagnosis of Tuberculosis (TB) takes considerable time period leading to the complication and spread of the disease. Towards this end, use of Polymerase Chain Reaction (PCR) technology, has revolutionized diagnosis of TB by reducing the diagnostic time. The aim of the present study was to compare two primer pairs and DNA extraction methods for the PCR based detection of M. tuberculosis complex (MTB) DNA in clinical samples for the routine laboratory diagnosis of TB. Two DNA extraction methods (Modified Boom's method and Roche commercial kit) and two IS 6110-based primer pairs were compared with respect to the sensitivity, time and quality/quantity of DNA. Extra pulmonary and pulmonary specimens from 45 TB suspected patients referred to the Molecular Medicine Unit, University of Kelaniya from February 2007 to April 2008 were analyzed. Results indicated 50 % and 70 % of the samples extracted from modified Boom's method and commercial kit, respectively, had high quality DNA, while 17 % and 67 % of the specimens extracted by the Boom's method and commercial kit, respectively, had over 200 µg/ml DNA. Both primer pairs exhibited similar level of sensitivity (200 fg of MTB DNA). In comparison to the time consuming culture, which takes 4 to 6 weeks, the modified Boom's method and commercial kit combined with PCR takes only 48 and 24 hrs, respectively. Of the 19 positives (42.22%) 11 were males while 17 and 02 were extra-pulmonary and pulmonary TB, respectively. The commonest clinical indication for sending samples was suspected disseminated TB. Presence or absence of fever or presence or absence of very high ESR (>100 mm) did not have a significant positive or negative predictive value for PCR. Moderately high ESR (>50 mm) had a negative predictive value of 0.8 and Mantaux test had a positive predictive value of 0.8. According to the time required for completion, labour, quality/quantity of DNA (statically significant at p=0.05) and reproducibility the commercial kit proved to be an efficient DNA extraction procedure. Both sets of primers elicited similar discriminating power. There was not a single clinical indicator with satisfactory predictive values, which is useful in clinical decision making regarding the need for PCR diagnosis in individual patients. We report a simple, rapid and reproducible PCR assay for routine laboratory diagnosis of MTB DNA from both pulmonary and extra-pulmonary specimens.
Evaluation of PCR-ELISA as a tool for monitoring transmission of Wuchereria bancrofti in District of Gampaha, Sri Lanka
(Asian Pacific Organization for Cancer Prevention, 2013) Wijegunawardana, A.D.; Gunawardene, N.S.; Hapuarachchi, C.; Manamperi, A.; Gunawardena, K.; Abeyewickreme, W.; Latif, B.
OBJECTIVE: To compare Wuchereria bancrofti (W. bancrofti) infection rates of Culex quinquefasciatus, using dissection and PCR-ELISA in two consecutive time periods (from 2007 to 2008 and from 2008 to 2009). METHODS: Mosquitoes were collected in 30 sentinel and 15 non-sentinel sites in 15 Medical Officer of Health areas of Gampaha Districtknown for the presence of W. bancrofti transmission in two consecutive time period of 2007 to 2008 and 2008 to 2009. Captured mosquitoes were dissected to determine the W. bancrofti larvae (L1, L2, L3). PCR was carried out using DNA extracted from mosquito pools (15 body parts/pool) utilizing the primers specific for Wb-SspI repeat. PCR products were analyzed by hybridization ELISA using fluorescein-labeled wild type specific probes. The prevalence of infected/infective mosquitoes in PCR pools (3 pools/site) was estimated using the PoolScreen™ algorithm and a novel probability-based method. RESULTS: Of 45 batches of mosquitoes dissected, W. bancrofti infected mosquitoes were found in 19 and 13 batches, with an infection rate of 13.29% and 3.10% with mean larval density of 8.7 and 1.0 larvae per mosquito for two study periods in the Gampaha District. Total of 405 pools of head, thorax and abdomen were processed by PCR-ELISA for each year. Of these, 51 and 31 pools were positive for W. bancrofti in the two study periods respectively. The association of dissection based prevalence rates with PCR based rates as determined by the Pearson correlation coefficient were 0.176 and 0.890 respectively for the two periods. CONCLUSIONS: Data indicate that PCR-ELISA is more sensitive than the traditional dissection techniques for monitoring transmission intensity