Browsing by Author "Perera, K.V.H.K.K."

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Central nervous system infections in a tertiary care hospital: disease patterns and difficulties in diagnosis
(Sri Lanka Medical Association, 2011) Ranawaka, U.K.; Harshani, M.L.; Fonseka, V.N.R.M.; Hathagoda, K.L.W.; Nawaratne, A.N.H.M.U.K.G.D.B.; Weerasooriya, W.A.L.K.; Samarakoon, S.M.S.B.; Thirumawalawan, K.; Premawansa, G.; Fernando, M.A.M.; de Silva, L.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Wijesooriya, T.; Rajindrajith, E.G.D.S.
INTRODUCTION AND OBJECTIVES: Central nervous system (CNS) infections produce high morbidity and mortality, and effective treatment and outcome depend on precise microbiological diagnosis. We aimed to describe the pattern of CNS infections and accuracy of diagnosis in patients presenting to a tertiary care hospital. METHODS: We prospectively studied patients with suspected CNS infection admitted to medical and paediatric units of Colombo North Teaching Hospital over three years. Data related to demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorised as definite, probable, possible, and uncertain. RESULTS: 426 patients (293 adults, 133 children) were studied [57.2% males, mean age (SD) years-adults 44(20), children 4(3.15)]. Of them, 27.5% had received antibiotics before admission. Blood cultures were done in 149 (35%) and only 14 were positive. Lumbar puncture was done in 347 (81.4%). CSF culture was positive only in two patients. CSF Gram stains and TB-PCR were all negative. The likely diagnosis was meningitis in 35.4%, encephalitis in 10.6% and a non-specific 'meningo-encephalitis' in 16.7%. A 'definite' microbiological diagnosis was made only in five patients. Diagnosis was considered 'probable' in, 53.7%, 'possible' in 8.7%, and 'uncertain' in 14.8%. An alternative diagnosis was found in 22% (13.6% adults, 40.6% children). Intravenous antibiotics (86.8%) and acyclovir (42.5%) were widely used on empiric grounds. CONCLUSIONS: Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting. Better facilities are needed to improve aetiological diagnosis, and are likely to improve care and minimise treatment costs.
A Clinical guide for early detection of dengue fever and timing of investigations to detect patients likely to develop complications
(Oxford University Press, 2009) Premaratna, R.; Pathmeswaran, A.; Amarasekera, N.D.D.M.; Motha, M.B.C.; Perera, K.V.H.K.K.; de Silva, H.J.
We aimed to identify clinical features that would be useful for case detection and the appropriate timing of investigations and hospital admissions in patients with short-duration fever, suspected to be dengue fever (DF). Of 928 adult patients with short-duration fever admitted to Colombo North Teaching Hospital, Sri Lanka during February-June 2004, one in four were randomly selected for assessment of the severity of six clinical features: headache, body aches, vomiting, retro-orbital pain, generalised weakness (scale 0-9) and skin erythema (grade 1-5). There were 148 DF patients (95 males, mean age+/-SD: 28+/-12 years) and 54 non-DF patients as controls (44 males, mean age+/-SD: 25+/-11 years). All symptoms assessed (cut-off >or=5) and skin erythema (>or=grade 2) had a good positive predictive value for DF. However, erythema had the best negative predictive value, helping to differentiate DF from other short-duration fevers. More than 95% of patients with dengue had a platelet count above 50000/microl until the third day of illness. The platelet counts were significantly reduced when erythema, fever, vomiting and generalised weakness were persistent. In conclusion, erythema elicited by hand impression may help in the prediction of DF, and follow-up blood counts are indicated when symptoms persist.
Clinical profile and difficulties in diagnosis of central nervous system infections in adult patients in a tertiary care hospital
(Sri Lanka Medical Association, 2013) Ranawaka, U.K.; Rajindrajith, E.G.D.S.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Premaratna, B.A.H.R.; de Silva, H.J.
Influenza virus infections among a sample of hospital attendees in Ragama, Sri Lanka
(Sri Lanka Medical Association, 2010) Perera, K.V.H.K.K.; Chan, K.H.; Ma, E.; Peiris, J.S.M.
OBJECTIVES: This study was carried out to define the types of influenza viruses circulating among humans and to understand the seasonality of influenza virus activity. Such information is essential for deciding on influenza vaccination strategy and on the appropriate time for delivering influenza vaccination, if such a vaccination policy was decided to be a priority. METHOD: During the period July 2003 - August 2004, 300 nasopharyngeal aspirates (NPA) were obtained from a systematic sample of patients reported to Out-patient Department, Colombo North Teaching Hospital, Ragama with ≤4 days history of acute respiratory tract infection (ARTI). The clinical signs and symptoms of the patients were prospectively recorded. Isolation of the influenza virus was carried out by inoculating in Madin Darby Canine Kidney cell line (MDCK). The isolates were identified by immunofluorescence assay and characterised by haemagglutination inhibition test. RT-PCR was carried out on all NPA samples. Genetic sequencing and phylogenetic analysis of the haemagglutinin gene of representative viruses were carried out. RESULTS: Twenty three influenza A and nine influenza B viruses were isolated by cell culture methods. Influenza A H3N2 Panama/2000/99-like viruses were isolated in 8% of patients with ARTI and influenza B/Sichuan/ 379/99-like viruses were isolated in 3%. Twenty eight influenza A virus infections were identified by the RT-PCR method. Phylogenetic analysis was carried out with data from other H3-subtype viruses isolated worldwide. The Sri Lanka viruses are antigenically and genetically similar to those in the northern and southern hemispheres. CONCLUSIONS: Influenza viruses circulate at different times of the year and is the aetiological agent causing 11% of all ARTI. Influenza activity corresponded to a peak in rainfall; however the correlation of influenza virus activity with rainfall is not invariable. The Sri Lankan isolates of 2003-4 were genetically related to the influenza A viruses circulating around the globe
The story of swine influenza in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Perera, K.V.H.K.K.
Influenza A virus infections in pigs is a disease of concern in terms of both animal and human health. Systematic virological and serological surveillance was carried in the Government Slaughter House Dematagoda, Sri Lanka during 2009-2013, with paired nasal and tracheal swabs from 4683 animals and serum from 3351 animals. We isolated 26 H1N1pdm like virus from swine swabs from MDCK monolayers and serological data was obtained by haemagglutination inhibition test using panel of swine and human viral antigens. We comprehensively analyzed full genomes of viral isolates from 26 swine and 35 human samples. To understand the molecular epidemiology and spatial and temporal dynamics of spillover events, we compared our data with full-genome sequences of H1N1pdm available in public databases as of August 2013. Full genome phylogenetic and epidemiologic analysis of the human and swine influenza viruses demonstrated natural independent spillover events of H1N1pdm influenza viruses from human to pigs, with self-limited transmission and extinction within pig herds. H1N1pdm viruses appear assembled as multiple discrete introductions into swine, followed by clonal expansion within swine. The spread of such virus lineages across multiple farms appears to be mediated by breaches of external bio-security measures including the manner of swine transportation.