Browsing by Author "Wijesuriya, M.T.W."

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Antibiotic use and antimicrobial activity in urine of febrile patients
(Sri Lanka Medical Association, 2007) Wijesuriya, M.T.W.; Bailey, M.S.; Premaratna, R.; Wuthiekanun, V.; Peacock, S.J.; Lalloo, D.C.; de Silva, H.J.
OBJECTIVES: Prior antibiotic use may decrease sensitivity of bacterial cultures leading to diagnostic difficulties. Our objectives were to detect antimicrobial activity in urine of patients presenting with fever and to correlate urine antimicrobial activity to blood culture results and antibiotic history. DESIGN, SETTING AND METHODS: This is carried out as part of a fever study during a one-year period. A sample of urine is collected within 24 hours of admission before antibiotics from consenting, febrile (>38°C) patients. Antimicrobial activity in urine is detected by applying urine-soaked discs onto agar plates inoculated with standard bacterial cultures. All patients have extensive microbiological investigations including high-quality blood cultures (with leptospiral cultures), dengue and other viral serology. RESULTS: From 117 patients recruited in 4 months, 76(65%) reported taking medication for their fever, of which 40(53%) said this was an antibiotic. Standard E. coli and S. pyogenes cultures detected antimicrobial activity in 32(27%) and 25(21%) of urines respectively. Using both strains together increased detection to 39%. Only 19(47.5%) reporting prior antibiotic use had urine antimicrobial activity. From 41 denying prior medication, 8(20%) had urine antimicrobial activity. From 43 suspected of having bacterial infection, 46% had urine antimicrobial activity. No patients with positive bacterial cultures had detectable urine antimicrobial activity, whereas 53% of negative bacterial cultures had positive urine antimicrobial activity. CONCLUSIONS: Clinical history is unreliable in assessing prior antibiotic use. Detectable urine antimicrobial activity may lead to negative blood culture results. Therefore in suspected bacterial infections, an assessment of urine antimicrobial activity along with microbiological cultures will reduce the diagnostic dilemma.
The effect of nutrition on immune response in active pulmonary Tuberculosis
(Sri Lanka College of Microbiologists, 2006) Wijesuriya, M.T.W.; Weerasinghe, A.
INTRODUCTION: Studies identifying the active components of immune response against TB should consider the confounding effects of malnutrition and anaemia, which are known to impair cell-mediated immunity. OBJECTIVES: To compare nutritional status (malnutrition and anaemia) and immune status (lymphocyte subpopulations) of patients with Active Pulmonary Tuberculosis (ATB) with healthy controls 2.To describe the effect of nutritional status on immune response to ATB. METHODS: A cross-sectional, comparative study involving 49 smear-positive TB patients (41 males, median age 35 yrs) and 49 controls (25 males, median age 34yrs) was carried out. Persons with immunosuppress!on (HIV infection, diabetes mellitus, corticosteroid or immunosuppressive therapy) or on nutritional supplementation were excluded. Nutritional status was assessed using anthropometry, haemoglobin and red-cell indices. Labeled monoclonal antibodies against lymphocyte surface markers were used in dual parameter flow-cytometry to quantify (cells/mm3) total T(CD5), T-helper(CD4), T-cytotoxic(CDS), B(CD19), B1(CD19+CD5), Natural-killer(CD56), Natural-Killer-T(CD56+CD3)lymphocytes. Student t-test or Kruskal-wallis test for 2 groups was used where appropriate. p<0.05 was considered significant. RESULTS: Whilst nutritional status assessed by weight (43 vs 57 kg, p<0.001), mid-arm circumference (21.1 vs 27.6 cm, p<0.001) and body mass index (16 vs 20.7 kg/m2, p<0.001) was lower in ATB, anaemia was greater (61.2% vs 12.2%, p<0.001). Means of total lymphocytes (2,475 vs 3,211; p<0.0001) and most lymphocyte subsets (T, CD4, CDS, B and Bl cells) were significantly lower in patients with ATB (n-49) compared to controls (n=49). There was no statistically significant difference in the total lymphocytes, T, CD4, CDS, B, Bl, NK and NKT cells in undernourished TB patients (BMI< 18.5) and anaemic TB patients compared to well-nourished and non-anaemic TB patients. CONCLUSIONS: Malnutrition and anaemia observed in ATB does not have an impact on the peripheral depletion of lymphocyte subsets.
Locally advanced breast cancer as a possible portal of entry in a patient with tetanus
(Sri Lanka Medical Association, 2007) Wijesuriya, S.R.E.; Wijesuriya, M.T.W.; Perera, M.T.P.R.; de Zylva, S.T.U.; Deen, K.I.
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