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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2025-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Double-trouble: A rare case of co-infection with melioidosis and leptospirosis from Sri Lanka(Sage, 2023) Gunasena, J.B.; de Silva, S.T.Melioidosis and leptospirosis are two emerging tropical infections that share somewhat similar clinical manifestations but require different methods of management. A 59-year-old farmer presented to a tertiary care hospital with an acute febrile illness associated with arthralgia, myalgia and jaundice, complicated by oliguric acute kidney injury and pulmonary haemorrhage. Treatment was initiated for complicated leptospirosis but with poor response. Blood culture was positive for Burkholderia pseudomallei and microscopic agglutination test (MAT) for leptospirosis was positive at the highest titres of 1:2560, confirming a co-infection of leptospirosis and melioidosis. The patient made a complete recovery with therapeutic plasma exchange (TPE), intermittent haemodialysis and intravenous (IV) antibiotics. Similar environmental conditions harbour melioidosis and leptospirosis, making co-infection a very real possibility. Co-infection should be suspected in patients from endemic areas with water and soil exposure. Using two antibiotics to cover both pathogens effectively is prudent. IV penicillin with IV ceftazidime is one such effective combination.Item Hypokalaemic quadriparesis in a patient with leptospirosis in the absence of renal potassium wasting(Postgraduate Institute of Medicine University of Colombo, 2022) Senevirathne, S.A.A.; Luke, D.; Perera, H.M.M.No abstract availableItem Awareness of zoonotic infections and preventive measures and the practice of those measures among farm workers in a livestock farm, Galle(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Gunawardhana, T.; Gunwardhane, B.Introduction: Livestock farm workers are at higher risk of emerging and re-emerging zoonotic infections. To mitigate the risk, awareness of diseases and practice of preventive measures is important. Objective of the study was to assess the awareness of zoonotic infections and preventive measures and practice of those measures among farm workers in a livestock farm, Galle. Methods: A cross sectional study was conducted among 108 farm workers of a selected farm, Galle. Awareness of existence of zoonotic infections, disease specific knowledge on ‘leptospirosis’, ‘rabies’, ‘brucellosis’, ‘swine & avian influenza’ and practice of preventive measures at their work setting (i.e., hand washing, personal protective equipment usage, disinfectant usage) were assessed using an interviewer administered questionnaire. Using Chi-square test, associations with knowledge and practices were assessed. Results: Response rate was 100%. Leptospirosis, rabies and swine and avian influenza were known diseases to majority (99.1%, 97.2% and 86.1% respectively) of participants. Most of them had good knowledge on disease specific questions: leptospirosis 98.2%, rabies 88.9% and swine & avian influenza 70.4%. But brucellosis was known by 4.6% while only 0.9% were having good knowledge about brucellosis. With regards to the practices of preventive measures, majority (92.6%) displayed good practices. Statistically significant associations between socio demographic factors (i.e., level of education, time spent with animals in a day, monthly income) and awareness of zoonotic infections or practices of preventive methods could not be found (p =0.05). Conclusion: Awareness of farm workers on zoonotic infections were satisfactory. Further encouragement is preferred to continue better practices.Item Association of Hantavirus infections and Leptospirosis with the occurrence of Chronic Kidney Disease of Uncertain Etiology in the North Central Province of Sri Lanka: A prospective study with patients and healthy persons(Frontiers Media SA, 2020) Sunil-Chandra, N.P.; Jayaweera, J.A.A.S.; Kumbukgolla, W.; Jayasundara, M.V.M.L.ABSTRACT: Chronic Kidney disease of uncertain etiology (CKDu) has become a significant disease burden, affecting farming community of Sri Lanka and the exact etiology, which could be multifactorial, is not hitherto established. This study is aimed to determine the association of past hantavirus infection and leptospirosis with the occurrence of CKDu. A cohort (n = 179) of known CKDu patients living in high-CKDu prevalent areas of Anuradhapura district of Sri Lanka was compared with a group of 49 healthy, sex-matched younger blood relatives of CKDu patients (control-1) and another 48 healthy, age, and sex-matched individuals living in low-CKDu prevalent area (control-2) of the same district where same life style and climate conditions prevail. Fifty out of 179 (27.9%) CKDu patients, 16/49 (32.7%) of control-1 and 7/48 (14.6%) of control-2 were found positive for IgG antibodies to Puumala, Hantaan or both strains of hantaviruses. Hantaan strain specificity was found to be predominant in all study groups. Hantavirus IgG sero-prevalence of healthy individuals living in low-CKDu prevalent area was significantly lower compared to CKDu patients and healthy younger blood relatives living in high-CKDu prevalent areas (p = 0.03). Past hantavirus infection possesses a significant risk for the occurrence of CKDu (OR = 4.5; 95% CI-3.1-5.4, p = 0.02). In contrast, IgG seroprevalence to hantaviruses was not significantly different in CKDu patients and healthy younger blood relatives living in high-CKDu prevalent areas indicating past hantavirus infection has no association with the occurrence of CKDu or possibly, younger relatives may develop CKDu in subsequent years. Seroprevalence to leptospirosis showed no significant difference between CKDu patients and healthy controls. KEYWORDS: CKDu; chronic kidney disease; hantaviruses; leptospira; sero-prevalence. Erratum in: Front Cell Infect Microbiol. 2020;10:631515Item Effect of antimicrobial agents on inflammatory cytokines in acute Leptospirosis(American Society for Microbiology, 2018) Fernando, N.; de Silva, R.; Hadunnetti, S.M.; Karunanayake, L.; de Silva, N.L.; de Silva, H.J.; Rajapakse, S.; Premawansa, S.The aim of this study was to assess the inflammatory cytokine response and possible association with antimicrobial treatment with penicillin, ceftriaxone, and doxycycline in acute leptospirosis. In the early acute stage, interleukin-10 (IL-10) levels were higher in mild cases than in severe cases (P = 0.01). IL-6 and IL-8 levels were low in patients who received >5 antimicrobial doses (P < 0.01). IL-8 levels were negatively correlated with the number of ceftriaxone doses administered (r = -0.315; P = 0.031). Further studies are needed to evaluate the possible downregulation of proinflammatory cytokines by ceftriaxone in leptospirosis.Item Leptospirosis: challenges in diagnosis, and predictors of severity(Ceylon College of Physicians, 2016) Rajapakse, S.; Fernando, N.; Niloofa, M.J.R.; de Silva, H.J.; Karunanayake, L.; Premawansa, S.; Handunnetti, S.M.No Abstract availableItem Leptospirosis versus hantavirus infections in the Netherlands and in Belgium, 2000 to 2014 [Letter to the editor](European Centre for Disease Prevention and Control (ECDC), 2014) Clement, J.; Van Esbroeck, M.; Lagrou, K.; Verschueren, J.; Sunil-Chandra, N.P.; Van Ranst, M.No Abstract Available. Comment on: The hanta hunting study: underdiagnosis of Puumala hantavirus infections in symptomatic non-travelling leptospirosis-suspected patients in the Netherlands, in 2010 and April to November 2011.Goeijenbierm M et al. Euro surveillance.2014;19(38):20878Item Spatial and seasonal analysis of human leptospirosis in the District of Gampaha, Sri Lanka(Sri Lankan Society for Microbiology, 2016) Denipitiya, D.T.H.; Chandrasekharan, V.; Abeyewickreme, W.; Viswakula, S.; Hapugoda, M.Leptospirosis is a zoonostic infectious disease, caused by a pathogenic species of the Genus Leptospira. In recent years, a markedly increased number of leptospirosis cases have been reported in the District of Gampaha, in the Western Province of Sri Lanka. Typically, the risk of the disease in the district is seasonal with a small spike occurs in March to May and a large spike occurs during October to December. Objectives of this study were to analyze spatial and seasonal patterns of human leptospirosis and to predict the leptospirosis epidemic trend in the District of Gampaha, Sri Lanka. All Divisional Secretariats (DS) of the district of Gampaha were selected for the study. Epidemiological data were obtained from the Regional Epidemiological Unit, Gampaha. The leptospirosis cases were georeferenced according to DS in where these cases were reported. The cumulative incidence and the fatality were calculated for each DS. Of the georeferenced data, highest mean (±S.E.) of number of leptospirosis cases (72.60 ±15.54) were observed from DS of Mirigama. The highest mean cumulative incidence (4.97±1.10) and case fatality rate (3.88±2.42) were observed from DS of Divulapitiya and Katana respectively. According to past 10 years data on leptospirosis, highest mean numbers of leptospirosis cases were reported in March (51.00±12.99) and November (56.80±8.27). A predictive model for clinically confirmed human leptospirosis was designed for the district by using TSA package of the statistical software R. This study provides an evidence base for reducing disease burden by improving the understanding of the dynamic patterns of the disease in the District of Gampaha, Sri Lanka.Item Application of a real time Polymerase Chain Reaction (PCR) assay for the early diagnosis of human leptospirosis in Sri Lanka(Academic Press, Elsevier, 2016) Denipitiya, D.T.H.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hartskeerl, C.M.; Hartskeerl, R.A.; Jiffrey, A.M.; Hapugoda, M.D.Leptospirosis has a major impact on health in Sri Lanka but is probably grossly under-recognized due to difficulties in clinical diagnosis and lack of diagnostic laboratory services. The objective of this study was to establish and evaluate a SYBR Green-based real-time Polymerase Chain Reaction (rt-PCR) assay for early, rapid and definitive laboratory diagnosis of leptospirosis in Sri Lanka. The rt-PCR assay was established and analytical specificity and sensitivity were determined using reference DNA samples. Evaluation of the assay for diagnosis of clinical samples was performed using two panels of serum samples obtained from 111 clinically suspected adult patients. Patients were confirmed as leptospirosis (n = 65) and non-leptospirosis (n = 30) by the Patoc - MAT. Other 16 samples gave ambiguous results. The analytical sensitivity of the rt-PCR was approximately 60 genome copies and no cross-reactivity was observed with saprophytic Leptospira spp. and other pathogenic microorganisms. Based on confirmation with Patoc-MAT on paired samples this corresponds to a diagnostic sensitivity and specificity of 67.7% (44/65) and 90.0% (27/30), respectively. This study showed that rt-PCR has the potential to facilitate rapid and definitive diagnosis of leptospirosis during early phase of infection in Sri Lanka.
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