Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Chikungunya outbreak in 2008 in Ratnapura district, Sri Lanka - clinical and socio-economic analysis(Sri Lanka Association for the Advancement of Science, 2008) Sumanadasa, S.D.M.; Hapuarachchi, C.; Bandara, K.B.A.T.; Wellawaththage, L.C.; Abeyewickreme, W.Since 2006, Sri Lanka has experienced several outbreaks of chikungunya fever (CHIK) affecting several thousands of people. Today, CHIK has become one of the most important vector-borne diseases in the country. The objective of this study was to analyse the clinical manifestations and socio-economic status among CHIK patients reported from Pallebedda and Godakawela areas in Ratnapura district during the outbreak in February and March 2008. After obtaining the informed written consent, venous blood samples were collected from 80 suspected patients. A medical officer carried out clinical examination of each patient. Clinical information along with socio economic data of the patients was recorded in an interviewer-administered questionnaire. Serum samples were tested for CHIK by a Reverse-Transcription Polymerase Chain Reaction (RT-PCR) assay. Of eighty patients tested, 51% (n=42) were positive for CHIK. All positive patients had fever for less than 5 days duration. Majority of them (95%, n=40) had severe arthralgia with arthritis of small joints of hands and feet (81%, n=34). Moreover, a generalized, Itchy maculopapular rash was present in 78% (n=33) of them. The appearance of skin rash only after 4-5 days of fever was characteristic in the majority of patients. The mean age of positive patients was 38 years and consisted of 48% (n=20) of males. Many (43%, n=18) of them were farmers having a mean monthly family income of Rs. 4867.00. Analysis of educational status revealed that 60% (n=26) of family members had educated up to G.C.E. O/L whereas only 26% (n=12) had completed G.C.E. A/Ls. Twenty eight (67%) positive patients had at least one or more CHIK infected family members in addition. Moreover, 95% (n=40) of them were surrounded by infected neighbours indicating active, intense transmission in the area. According to the results, the most predominant clinical features of CHIK were fever either with severe arthralgia or arthritis of small joints of hands and feet. Skin rash, though characteristic, appeared to develop 4-5 days after the infection. CHIK has mainly affected the most productive labour force in these areas with majority belonging to the middle class farming community with a low monthly income. Hence, the sources of income of the affected families were severely hampered by the CHIK outbreak. Therefore, non-fatal, CHIK may have a negative impact on the socio-economic status of the affected communities. "The staff of the Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Dr Richard Perera and the staff of Godakawela Hospital and Dr. Susanth Kariyawasam and the staff of Pallebadda Hospital are acknowledged".Item Large-scale entomological assessment of Wuchereria bancrofti transmission by dissection and PCR-ELISA in Gampaha district, Sri Lanka(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.; Bandara, K.B.A.T.; Abeyewickreme, W.Entomological surveys are important tools for monitoring progress of lymphatic filariasis (Lf) eradication programs. In this study, dissection of Culex quinquefasciatus was compared with a Polymerase Chain Reaction - Enzyme Linked Immunosorbent Assay (PCR-ELISA) for pooled mosquitoes to assess filarial infection levels in the major vector of Wuchereria bancrofti in Gampaha district, following mass-treatment programme with diethylcarbamazine (DEC) and albendazole. Mosquitoes were collected in 30 sentinel and 15 non-sentinel sites in 15 Medical Officer of Health (MOH) areas of Gampaha district known for the presence of W. bancrofti transmission. Captured mosquitoes were dissected to determine the W. bancrofti larvae (L1, L2, L3). PCR was carried out using Deoxyribonucleic acid (DNA) extracted from mosquito pools (15 body parts/pool) utilizing primers specific for the 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 (3pools/site) was estimated using the PoolScreenTM algorithm and a novel probability-based method. The prevalence of infected mosquitoes with L1-L2 larvae of W. bancrofti ranged from 0%-8.54% by dissection and point estimates of infection prevalence as assayed by PCR-ELISA, ranged from 0% - 25.4%. Mosquitoes collected from all MOH areas (80%, N = 12), except for Minuwangoda, Dompe and Ragama, were positive for W. bancrofti larvae, with a prevalence rate ranging from 0.78% to 16.97% in both methods. Of 30 sentinel sites, 43.3% (N = 13) were positive for W. bancrofti transmission whereas it was evident in 40% (N = 6) of non-sentinel sites. The proportion of positive pools detected by the PCR-ELISA assay was higher than that obtained by the dissection indicating that PCR-ELISA assay is more sensitive than the dissection method in detecting infected/infective mosquitoes. Also results of this study showed that autochthonous transmission of W. bancrofti continues in the Gampaha district despite completion of the 5 year mass drug administration (MDA) programme. Therefore, we emphasize the use of more sensitive tools such as PCR-ELISA to monitor the impact of the MDA programme on disease transmission. This study also emphasizes that control measures should be further continued until the microfilareamic population is reduced to a level which could interrupt transmission in the area. Financial assistance received from WHO/SEARO/TDR (grant no. SN 1152) and University of Kelaniya (Grant no. RP/03/04/06/01/2006) is acknowledged