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Kularatne D, Chulasiri P, Dharmapala A, Kularatne S. Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report. J Med Case Rep 2023; 17:509. [PMID: 38082342 PMCID: PMC10714539 DOI: 10.1186/s13256-023-04226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Plasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been several imported cases of malaria, including P. ovale, which have been detected sporadically. The reporting case of P. ovale was imported and detected incidentally in 2021, with several atypical presentations. CASE PRESENTATION A 40-year-old Sri Lankan medical doctor developed continuous fever with chills, rigors, and dysuria a day following removal of a large lipoma at the root of the neck under general anaesthesia. When the fever has been responding to antibiotics, on the 4th postoperative day a mild thrombocytopenia on complete blood count was detected. A blood smear which was done on the 5th postoperative day incidentally found a malaria parasite and confirmed as Plasmodium ovale with a density of 6535 parasites/microliter on the same day. He never had malaria in the past, but he had worked in South Sudan 1 year ago and visited India six months ago. On the 6th postoperative day, he was treated with chloroquine, and hyperparasitemia reduced rapidly by the next day. As the fever recurred with clinical deterioration, he was treated with different antibiotics. During the course of the illness, he did not develop pallor, or icterus except for a palpable soft spleen. The parasite count was zero on the 9th postoperative day and his fever subsided on the next day. Further, he was treated with primaquine to prevent future relapse and transmission. CONCLUSION A long incubation period, incidental detection of P ovale in a blood smear, and hyperparasitaemia are the atypical presentations of this case. Postoperative bacterial infection and stress may have reactivated the dormant malaria (hyponozoites) in this patient with an unusual picture. Coinfection of malaria with bacterial sepsis is a challenge in the management of the patient. As the Anopheles mosquito vector exists in Sri Lanka, the risk of indigenous transmission is high from such imported cases of P. ovale.
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Affiliation(s)
- Damsara Kularatne
- Center for Research in Tropical Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - Arinda Dharmapala
- Department of Surgery, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Senanayake Kularatne
- Department of Medicine, Faculty of Medicine, University of Sri Lanka, Colombo, Sri Lanka
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Seneviratne S, Fernando D, Chulasiri P, Gunasekera K, Thenuwara N, Aluthweera C, Wijesundara A, Fernandopulle R, Mendis K, Wickremasinghe R. A malaria death due to an imported Plasmodium falciparum infection in Sri Lanka during the prevention of re-establishment phase of malaria. Malar J 2023; 22:243. [PMID: 37620890 PMCID: PMC10463374 DOI: 10.1186/s12936-023-04681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Sri Lanka has maintained a rigorous programme to prevent the re-establishment of malaria ever since the disease was eliminated in October 2012. It includes efforts to sustain case surveillance to ensure early diagnosis and management of malaria. Yet, in April of 2023 the death occurred of an individual with imported malaria. CASE PRESENTATION The deceased was a 37-year-old Sri Lankan male who returned to Sri Lanka on the 10th of April after a business trip to several countries including Tanzania. He was febrile on arrival and consulted three Allopathic Medical Practitioners in succession in his home town in the Western Province of Sri Lanka, over a period of 5 days starting from the very day that he arrived in the country. Malaria was not tested for at any of these consultations and his clinical condition deteriorated. On the evening of 14th of April he was admitted to the medical intensive care unit of a major private hospital in the capital city of Colombo with multiple organ failure. There, on a request by the treating physician blood was tested for malaria and reported early the next morning as Plasmodium falciparum malaria with a high parasitaemia (> 10%). The patient died shortly after on the 15th of April before any anti-malarial medication was administered. The deceased had been a frequent business traveller to Africa, but with no past history of malaria. He had not taken chemoprophylaxis for malaria on this or previous travels to Africa. DISCUSSION The patient's P. falciparum infection progressed rapidly over 5 days of arriving in Sri Lanka leading to severe malaria without being diagnosed, despite him seeking healthcare from three different Medical Practitioners. Finally, a diagnosis of malaria was made on admission to an intensive care unit; the patient died before anti-malarial medicines were administered. CONCLUSIONS This first death due to severe P. falciparum malaria reported in Sri Lanka after elimination of the disease was due to the delay in diagnosing malaria.
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Affiliation(s)
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | | | | | | | | | | | - Rohini Fernandopulle
- Faculty of Medicine, General Sir John Kotelawala Defense University, Ratmalana, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Nanayakkara D, Batuwitage C, Chulasiri P, Abeywardhana D, Samaraweera S. Association between mammographic breast density and breast carcinoma. Ceylon Med J 2022; 67:108-112. [PMID: 37933880 DOI: 10.4038/cmj.v67i3.9698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Introduction Breast cancer has a high incidence and is showing a rising trend in Sri Lanka. Mammographic breast density is a radiologically measurable risk factor which has been found to be significantly associated with breast cancer risk in women with minor variations between ethnicities. However, the Asian populations studied in previous international studies were of Japanese, Chinese and Filipino ethnicities and not Sri Lankan or other South Asian ethnicities. Also, a previous Sri Lankan study found no significant association between breast density and breast cancer. Therefore it is of interest to study whether there is actually an association between breast density and breast cancer in Sri Lankan women. Objectives This study aimed to assess whether there is a significant association between mammographic breast density and breast cancer in a Sri Lankan women and also to assess factors affecting breast density. Methodology We conducted a retrospective unmatched case control study of 110 women (22 cases of breast cancer and 88 controls) aged between 40 and 75 years who came for mammography to Sri Jayewardenepura General Hospital. Breast density was categorized in to two, as lower density (BIRADS type a and b compositions) and higher density (type c and d compositions) for the analysis. Results Contrary to most international research findings and similar to the previous Sri Lankan study, no significant association was found between breast density and breast cancer. Additionally, out of multiple factors, only age, menopausal state and BMI were found to be significantly associated with breast density. Conclusion :These findings may indicate that there is a true difference in the Sri Lankan population form the previously studied international populations suggesting that there is no association between breast density and breast cancer in Sri Lankan women. A further multicenter research is necessary to prove or disprove this theory.
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Chulasiri P, Ranaweera P, Sudarshan P, Jayasinghe M, Harishchandra J, Gunasekera K, Vitharana H, Silva P, Ringwald P, Fernandopulle R, Mendis K, Fernando D. Transfusion-induced Plasmodium falciparum malaria in a beta thalassaemia patient during the prevention of re-establishment phase in Sri Lanka. Malar J 2021; 20:352. [PMID: 34445999 PMCID: PMC8390059 DOI: 10.1186/s12936-021-03881-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria was eliminated from Sri Lanka in 2012, and since then 50-60 imported malaria cases have been reported yearly. The country has remained malaria-free since, except for a single case of indigenous malaria in 2018. Blood donors are routinely screened for malaria, and transfusion malaria has not been reported in the country since 1966. CASE PRESENTATION A 17-year-old splenectomized beta thalassaemia patient developed a transfusion-induced Plasmodium falciparum malaria infection following a blood transfusion 18 days earlier. The blood donor was an armed forces personnel who returned from South Sudan following a United Nations peace-keeping mission. The blood recipient's malaria infection took a complicated clinical course with elevated liver enzymes, lowered blood pressure and a prolonged parasite clearance time of 7 days but he recovered fully after two courses of artemether-lumefantrine interrupted by a course of intravenous artesunate. The prolonged parasite clearance is likely due to lack of splenic clearance of dead or damaged intra-erythrocytic parasites (due to a splenectomy) rather than to the parasite strain being resistant to artemisinin or the partner drug. This is corroborated by the fact that the blood donor's infection responded to artemether-lumefantrine with parasites being cleared on day 3. The blood donor who had not displayed signs or symptoms of malaria, had been screened for malaria on arrival in Sri Lanka and was negative on both microscopy and RDT. At the point of blood donation a blood smear examined microscopically was also reported negative for malaria, but retrospectively, the preserved smear of the donor's blood was found to contain P. falciparum parasites at a very low density. The donor when tested after the transfusion-induced case was diagnosed, also tested positive for malaria and was treated. CONCLUSIONS After malaria elimination, transfusion-induced malaria from blood donors returning from malaria endemic countries poses a threat to preventing the re-establishment of the disease. Improved surveillance of arrivals in Sri Lanka from malaria endemic countries using more sensitive methods for screening than microscopy may be required to reduce this risk. More stringent criteria for selecting blood donors, and more effective methods of screening donors for malaria than microscopy may also be necessary.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Rohini Fernandopulle
- Faculty of Medicine, General Sir John Kotelawala Defense University, Ratmalana, Sri Lanka
| | - Kamini Mendis
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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Karunaratne B, Munasinghe F, Nadeekantha P, Kumarasiri S, Mallawarachchi K, Chulasiri P, Hewage S, Joseph N. The Impact of 'Lockdown' on Medical Oncology Services in Sri Lanka. Clin Oncol (R Coll Radiol) 2021; 33:e615. [PMID: 34426043 DOI: 10.1016/j.clon.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- B Karunaratne
- District General Hospital, Nuwara-Eliya, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Maharagama, Sri Lanka
| | | | | | - S Kumarasiri
- District General Hospital, Nuwara-Eliya, Sri Lanka
| | | | - P Chulasiri
- Anti-malaria Campaign, Ministry of Health, Colombo, Sri Lanka
| | - S Hewage
- National Programme for Tuberculosis Control and Chest Diseases, Sri Lanka
| | - N Joseph
- Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Maharagama, Sri Lanka; District General Hospital, Chilaw, Sri Lanka; Teaching Hospital, Batticaloa, Sri Lanka
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Ruwanpathirana T, Senanayake S, Gunawardana N, Munasinghe A, Ginige S, Gamage D, Amarasekara J, Lokuketagoda B, Chulasiri P, Amunugama S, Palihawadana P, Caplin B, Pearce N. Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology. BMC Public Health 2019. [PMID: 31200694 DOI: 10.1186/s12889‐019‐7117‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. METHODS We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. RESULTS A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2-6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2-13.1) were triple than the females (3.7%; 95% CI 2.9-4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. CONCLUSIONS These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function.
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Affiliation(s)
| | - Sameera Senanayake
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka.
| | | | | | - Samitha Ginige
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Jagath Amarasekara
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | | | | | | | - Paba Palihawadana
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Ruwanpathirana T, Senanayake S, Gunawardana N, Munasinghe A, Ginige S, Gamage D, Amarasekara J, Lokuketagoda B, Chulasiri P, Amunugama S, Palihawadana P, Caplin B, Pearce N. Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology. BMC Public Health 2019; 19:763. [PMID: 31200694 PMCID: PMC6570843 DOI: 10.1186/s12889-019-7117-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. Methods We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. Results A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2–6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2–13.1) were triple than the females (3.7%; 95% CI 2.9–4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. Conclusions These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function. Electronic supplementary material The online version of this article (10.1186/s12889-019-7117-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sameera Senanayake
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka.
| | | | | | - Samitha Ginige
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Jagath Amarasekara
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | | | | | | | - Paba Palihawadana
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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