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Browsing by Author "Weerasekera, C.J."

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    Chemoprophylaxis for malaria: A costly approach to prevent re-establishment of malaria in Sri Lanka
    (Sri Lanka Medical Association, 2021) Muzrif, M.M.; Mendis, K.N.; Weerasekera, C.J.; Karunaratna, S.; Wickremasinghe, R.; Ranaweera, K.D.N.P.; Fernando, S.D.
    Introduction and Objectives As a measure to prevent the re-establishment of malaria in the country, the Anti Malaria Campaign (AMC) provides antimalarial chemoprophylactic medicines for up to six months free-of-charge to anyone travelling to malaria endemic countries. The objective of this study was to identify the trends of chemoprophylaxis prescription by the AMC and the costs involved. Methods Data were extracted from the national malaria database regarding the number of travellers issued with antimalarial chemoprophylactic medicines during the years 2017-2019. The amount spent for purchase of antimalarial chemoprophylactic medicines was determined. Results Over the three year period the overall number of individuals issued with antimalarial chemoprophylaxis increased (1714 in 2017, 2600 in 2018 and 3053 in 2019). The number of travellers obtaining chemoprophylaxis for malaria when travelling to African countries reduced, while the number travelling to India increased. The cost incurred to the Government of Sri Lanka to purchase mefloquine and doxycycline for prophylaxis was USD 45,755, while the cost to purchase CQ over the three year period for prophylaxis alone was USD 310,714. The total cost incurred to purchase the prophylactic antimalarials have also increased significantly over the three year period, the cost being eleven times higher in 2019 than in 2017. Conclusion Chemoprophylaxis against malaria remains an important strategy to sustain the malaria elimination status in Sri Lanka, and the cost of this intervention is considerable and increasing over time. The local production of anti malarials might be warranted if it will reduce the cost of chemoprophylaxis.
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    Detection of human strongyloidiasis among patients with a high risk of complications attending selected tertiary care hospitals in Colombo, Sri Lanka using molecular and serological diagnostic tools
    (BioMed Central, 2024-10) Weerasekera, C.J.; Gunathilaka, N.; Menike, C.; Anpahalan, P.; Perera, N.; De Silva, N.R.; Wickremasinghe, R.
    BACKGROUND Strongyloidiasis a neglected tropical disease is known to cause severe disease among immunosuppressed and has not been studied extensively in Sri Lanka. Parasitological diagnostic approaches based on faecal microscopy and culture often fail to detect low-intensity infections. This study investigates the presence of strongyloidiasis among selected immunocompromised individuals using parasitological, molecular and serological techniques.METHODS Adult patients with immunocompromising conditions admitted to three tertiary care hospitals in Sri Lanka were recruited. A faecal sample and 2 ml of venous blood were collected. The faecal samples were subjected to direct faecal smear and cultures (agar plate, charcoal and Harada-Mori) and polymerase chain reaction (PCR) using species specific primers designed for Strongyloides stercoralis. The presence of Strongyloides IgG antibodies was tested in the collected serum samples using DRG Strongyloides IgG enzyme-linked immunosorbent assay (ELISA) kits. The PCR products of the positive samples were sequenced using Sanger sequencing method.RESULTS A total of 260 patients were recruited to this study, out of which 160 provided faecal samples and 122 provided blood samples. Out of the 160 faecal samples, none were positive for strongyloidiasis by direct smear, charcoal and Harada-Mori cultures. Only one sample (0.6%) was positive by agar plate culture. Out of the 123 samples subjected to PCR, 14 (11.4%), including the culture positive patient, were positive for S. stercoralis. Sequencing results of the PCR products indicated 100% similarity to S. stercoralis. Out of the 122 serum samples subjected to ELISA, 20 (16.4%), including the culture positive patient, were positive for Strongyloides IgG antibodies. However, sociodemographic, exposure factors, clinical features were not significantly associated with the presence of strongyloidiasis infection.CONCLUSIONS Strongyloidiasis is present among the immunocompromised population in Sri Lanka, even in the absence of a significant relationship with associated factors. It is advisable to screen such patients with highly sensitive tests such as PCR for early diagnosis and treatment.
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    Incidental diagnosis of strongyloidiasis in a patient with hepatic metastasis
    (Sri Lankan Society for Microbiology, 2023) Weerasekera, C.J.; Menike, C.W.; Anpahalan, J.P.; Senevirathne, S.A.A.; Perera, N.; de Silva, N.R.; Wickremasinghe, D.R.
    Strongyloides stercoralis is a soil-transmitted helminth infecting humans that can cause hyperinfection and disseminated disease in the immunocompromised host. This case report describes a 56-year-old patient, diagnosed with hepatic metastasis, who was screened for strongyloidiasis by faecal culture. The agar plate culture became positive on the third day of incubation, demonstrating characteristic tracks and yielding rhabditiform larvae. The charcoal and Harada-Mori cultures were negative. The patient was treated with albendazole for 7 days but declined further follow up.
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    The presence of strongyloidiasis and associated risk factors in patients undergoing treatment at the National Cancer Institute, Maharagama, Sri Lanka
    (Sri Lanka Medical Association, 2023) Weerasekera, C.J.; Menike, C.W.; Wimalasiri, U.; Wijerathna, T.; Jayathilake, D.C.C.; Somawardane, U.A.B.P.; Saravanamuttu, U.; Yoganathan, N.; Perera, N.; Gunathilaka, N.; de Silva, N.R.; Wickremasinghe, D.R.
    INTRODUCTION: Strongyloides stercoralis can cause severe disease in the immunocompromised. Without a proper gold-standard diagnostic technique, strongyloidiasis is scarcely studied both globally and locally. OBJECTIVES: We aimed to estimate the prevalence of strongyloidiasis among immunocompromised adult patients and to identify risk factors. METHODS: This study was carried out between February to October 2022. A faecal sample and 2 ml of venous blood were collected from consented patients. Direct faecal smear, agar plate, Harada-Mori and Charcoal cultures were performed on the faecal samples. Qualitative Polymerase Chain Reaction (PCR) was performed on selected faecal samples using S. stercoralis targeting ITS1 region. Strongyloides IgG ELISA was carried out on the serum samples using DRG Strongyloides IgG ELISA kit. RESULTS: Collectively, 144 patients (males = 68, females = 76) provided blood/faecal sample or both. Relevant to strongyloidiasis-associated symptoms, some patients had diarrhoea (n=12) and eosinophilia (n=11). Some of them (n=74) had occupational or recreational exposure to soil as potential risk factors. Overall, 24 patients were positive for strongyloidiasis from one or more diagnostic method (5 PCR and 19 ELISA). There were zero culture or direct smear positives. There was no significant association between disease positivity with either of the clinical features or risk factors. CONCLUSION: The prevalence of strongyloidiasis in patients with malignancies was 16.66%. Strongyloidiasis is existent in the immunocompromised in Sri Lanka even in the absence of suggestive clinical features or regular exposure to risk factors. Screening immunocompromised patients with sensitive techniques such as PCR for timely diagnosis and treatment is recommended.

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