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Article ; Online: Dengue and post-infection fatigue: findings from a prospective cohort-the Colombo Dengue Study.

Sigera, Ponsuge C / Rajapakse, Senaka / Weeratunga, Praveen / De Silva, Nipun L / Gomes, Laksiri / Malavige, Gathsaurie N / Rodrigo, Chaturaka / Fernando, Sumadhya D

Transactions of the Royal Society of Tropical Medicine and Hygiene

2022 Volume 115, Issue 6, Page(s) 669–676

Abstract: Background: Previous studies on post-infection fatigue in dengue are few but suggest that up to 25% of dengue patients may suffer from fatigue. This study aimed to evaluate the prevalence and associations of post-infection fatigue in dengue patients ... ...

Abstract	Background: Previous studies on post-infection fatigue in dengue are few but suggest that up to 25% of dengue patients may suffer from fatigue. This study aimed to evaluate the prevalence and associations of post-infection fatigue in dengue patients compared with non-dengue fever patients. Methods: Post-infection fatigue and its demographic and clinical associations were assessed in adult dengue and non-dengue fever patients 2 months after the acute infection in a prospective cohort study in Sri Lanka. Fatigue at 2 months (primary endpoint) was assessed with the fatigue questionnaire as a dichotomous outcome based on a pre-recommended cut-off (score ≥4) and as the total score from the questionnaire (higher score indicates more fatigue). Results: Of 260 patients, 158 had dengue and, of these, 51 (32%) had fatigue at 2 months. Risk was higher in dengue patients (vs non-dengue; relative risk [RR] 4.93 [95% confidence interval {CI} 2.3 to 10.4]) and more so in female dengue patients (vs male dengue patients; RR 2.45 [95% CI 1.24 to 4.86]). Severe dengue patients had a higher mean fatigue score (p=0.024). Conclusions: Post-infection fatigue is an underappreciated burden of this widely prevalent infection. Our findings are useful to triage patients at risk of fatigue for follow-up.
MeSH term(s)	Adult ; Cohort Studies ; Dengue/complications ; Dengue/epidemiology ; Fatigue/epidemiology ; Fatigue/etiology ; Female ; Humans ; Male ; Prospective Studies ; Sri Lanka/epidemiology
Language	English
Publishing date	2022-05-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1093/trstmh/traa110
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Article ; Online: Success of malaria chemoprophylaxis for outbound civil and military travellers in prevention of reintroduction of malaria in Sri Lanka.

Fernando, Sumadhya D / Ranaweera, Dewanee / Weerasena, Methnie S / Booso, Rahuman / Wickramasekara, Thamara / Madurapperuma, Chirath P / Danansuriya, Manjula / Rodrigo, Chaturaka / Herath, Hemantha

International health

2020 Volume 12, Issue 4, Page(s) 332–338

Abstract: Background: Sri Lanka was certified as malaria-free in September 2016. However, the continuous presence of the malaria vector poses serious risks of reintroduction of the disease. Chemoprophylaxis and advice on malaria preventive behaviour for ... ...

Abstract	Background: Sri Lanka was certified as malaria-free in September 2016. However, the continuous presence of the malaria vector poses serious risks of reintroduction of the disease. Chemoprophylaxis and advice on malaria preventive behaviour for international travellers is a key strategy adopted to reduce the risk of imported malaria. Methods: We conducted an efficiency study of malaria chemoprophylaxis for civilian and military travellers who requested travel advice from the Anti Malaria Campaign (AMC) prior to departure. The AMC is the only agency that can issue malaria chemoprophylaxis to travellers and hence this sample is representative of all such individuals seeking travel advice in Sri Lanka. Results: A total of 544 (400 civilians and 144 military) travellers were interviewed prior to departure and after return. The majority travelled to African destinations (516/544 [94.8%]) and were prescribed mefloquine (517/544 [95%]). Chemoprophylaxis was well tolerated and discontinuation due to adverse events was minimal. Regular chemoprophylaxis was reported by 505 (92.8%) participants while overseas. The protective efficacy of chemoprophylaxis was 100% among those who complied with the full course. Conclusions: The compliance with chemoprophylaxis and its protective efficacy were satisfactory in this study. It is an effective tool in preventing imported malaria to post-elimination Sri Lanka.
MeSH term(s)	Adult ; Animals ; Antimalarials/therapeutic use ; Chemoprevention/statistics & numerical data ; Disease Transmission, Infectious/prevention & control ; Female ; Humans ; Malaria/prevention & control ; Malaria/transmission ; Male ; Middle Aged ; Military Personnel/statistics & numerical data ; Sri Lanka ; Travel/statistics & numerical data
Chemical Substances	Antimalarials
Language	English
Publishing date	2020-01-09
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2526175-7
ISSN	1876-3405 ; 1876-3413
ISSN (online)	1876-3405
ISSN	1876-3413
DOI	10.1093/inthealth/ihz094
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Article ; Online: The 'hidden' burden of malaria

Rodrigo Chaturaka / Fernando Sumadhya D / Rajapakse Senaka

Malaria Journal, Vol 9, Iss 1, p

cognitive impairment following infection

2010 Volume 366

Abstract: Abstract Background The burden of post-malaria cognitive impairment is often overlooked. Given the large number of infections occurring worldwide, the magnitude of the problem is likely to be substantial. The objectives of this paper are; (i) to assess ... ...

Abstract	Abstract Background The burden of post-malaria cognitive impairment is often overlooked. Given the large number of infections occurring worldwide, the magnitude of the problem is likely to be substantial. The objectives of this paper are; (i) to assess the evidence on post malarial cognitive impairment or impact on school education; (ii) to assess the possible positive impact of malaria drug prophylaxis on cognition; and (iii) to suggest recommendations on minimizing the burden of post-malarial cognitive impairment Methods PUBMED and SCOPUS were searched for all articles with the key word 'Malaria' in the title field and 'cognitive impairment' in any field. Google Scholar was searched for the same keywords anywhere in the article. The search was restricted to articles published in English within the last 15 years (1995-2010). After filtering of abstracts from the initial search, 44 papers had research evidence on this topic. Results & Discussion Cognitive abilities and school performance were shown to be impaired in sub-groups of patients (with either cerebral malaria or uncomplicated malaria) when compared with healthy controls. Studies comparing cognitive functions before and after treatment for acute malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups. The implications of these findings are discussed.
Keywords	Arctic medicine. Tropical medicine ; RC955-962 ; Infectious and parasitic diseases ; RC109-216
Subject code	616
Language	English
Publishing date	2010-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Malaria is an important differential diagnosis in visitors returning from Sri Lankan National Safari Parks.

Fernando, Sumadhya D / Paranavitane, Sarath / Galappaththy, Gawrie N L

Journal of travel medicine

2011 Volume 18, Issue 5, Page(s) 361–362

Abstract: Diagnostic confusion may occur between dengue and malaria when febrile patients with thrombocytopenia return from travel to previous malaria endemic areas. Laboratory tests should include blood smear examination for malaria parasites even though current ... ...

Abstract	Diagnostic confusion may occur between dengue and malaria when febrile patients with thrombocytopenia return from travel to previous malaria endemic areas. Laboratory tests should include blood smear examination for malaria parasites even though current malaria endemicity in Sri Lanka is low.
MeSH term(s)	Child ; Dengue/diagnosis ; Diagnosis, Differential ; Endemic Diseases ; Female ; Humans ; Malaria/diagnosis ; Malaria/epidemiology ; Male ; Sri Lanka/epidemiology ; Travel
Language	English
Publishing date	2011-09
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1212504-0
ISSN	1708-8305 ; 1195-1982
ISSN (online)	1708-8305
ISSN	1195-1982
DOI	10.1111/j.1708-8305.2011.00542.x
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Article ; Online: Severe Dengue Epidemic, Sri Lanka, 2017.

Tissera, Hasitha A / Jayamanne, Bernard D W / Raut, Rajendra / Janaki, Sakunthala M D / Tozan, Yesim / Samaraweera, Preshila C / Liyanage, Prasad / Ghouse, Azhar / Rodrigo, Chaturaka / de Silva, Aravinda M / Fernando, Sumadhya D

Emerging infectious diseases

2020 Volume 26, Issue 4, Page(s) 682–691

Abstract: In 2017, a dengue epidemic of unexpected magnitude occurred in Sri Lanka. A total of 186,101 suspected cases and 440 dengue-related deaths occurred. We conducted a comprehensive analysis of this epidemic by comparing national surveillance data for 2017 ... ...

Abstract	In 2017, a dengue epidemic of unexpected magnitude occurred in Sri Lanka. A total of 186,101 suspected cases and 440 dengue-related deaths occurred. We conducted a comprehensive analysis of this epidemic by comparing national surveillance data for 2017 with data from the preceding 5 years. In all Sri Lanka districts, dengue incidence in 2017 increased significantly over incidence during the previous 5 years. Older schoolchildren and young adults were more clinically symptomatic than those at extremes of age. Limited virologic surveillance showed the dominant circulating variant was dengue virus type 2 cosmopolitan genotype in the most affected district. One quarter of total annual cases were reported 5 weeks after the southwest monsoon started. Changes in vector abundance were not predictive of the increased incidence. Direct government expenditures on dengue control activities in 2017 were US $12.7 million. The lessons learned from this outbreak are useful for other tropical nations facing increasing dengue incidence.
MeSH term(s)	Child ; Dengue/epidemiology ; Dengue Virus/genetics ; Epidemics ; Humans ; Severe Dengue/diagnosis ; Severe Dengue/epidemiology ; Sri Lanka/epidemiology ; Young Adult
Language	English
Publishing date	2020-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2604.190435
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Article ; Online: The 'hidden' burden of malaria: cognitive impairment following infection.

Fernando, Sumadhya D / Rodrigo, Chaturaka / Rajapakse, Senaka

Malaria journal

2010 Volume 9, Page(s) 366

Abstract: Background: The burden of post-malaria cognitive impairment is often overlooked. Given the large number of infections occurring worldwide, the magnitude of the problem is likely to be substantial. The objectives of this paper are; (i) to assess the ... ...

Abstract	Background: The burden of post-malaria cognitive impairment is often overlooked. Given the large number of infections occurring worldwide, the magnitude of the problem is likely to be substantial. The objectives of this paper are; (i) to assess the evidence on post malarial cognitive impairment or impact on school education; (ii) to assess the possible positive impact of malaria drug prophylaxis on cognition; and (iii) to suggest recommendations on minimizing the burden of post-malarial cognitive impairment. Methods: PUBMED and SCOPUS were searched for all articles with the key word 'Malaria' in the title field and 'cognitive impairment' in any field. Google Scholar was searched for the same keywords anywhere in the article. The search was restricted to articles published in English within the last 15 years (1995-2010). After filtering of abstracts from the initial search, 44 papers had research evidence on this topic. Results & discussion: Cognitive abilities and school performance were shown to be impaired in sub-groups of patients (with either cerebral malaria or uncomplicated malaria) when compared with healthy controls. Studies comparing cognitive functions before and after treatment for acute malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups. The implications of these findings are discussed.
MeSH term(s)	Cognition Disorders/epidemiology ; Cognition Disorders/prevention & control ; Humans ; Malaria/complications ; Malaria/drug therapy ; Malaria/prevention & control
Language	English
Publishing date	2010-12-20
Publishing country	England
Document type	Journal Article ; Review
ISSN	1475-2875
ISSN (online)	1475-2875
DOI	10.1186/1475-2875-9-366
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Article ; Online: Improving diagnosis of trichomonas vaginalis infection in resource limited health care settings in sri lanka.

Fernando, Sumadhya D / Herath, Sathya / Rodrigo, Chaturaka / Rajapakse, Senaka

Journal of global infectious diseases

2012 Volume 3, Issue 4, Page(s) 324–328

Abstract: Objective: This study was designed to compare diagnosis of trichomoniasis by culture, wet smear examination, and Giemsa stain. A modified technique was used to transport and prepare the specimen to ensure parasite viability prior to Giemsa staining.: ... ...

Abstract	Objective: This study was designed to compare diagnosis of trichomoniasis by culture, wet smear examination, and Giemsa stain. A modified technique was used to transport and prepare the specimen to ensure parasite viability prior to Giemsa staining. Materials and methods: A clinic-based prospective study was carried out in association with the National STD/AIDS Control Programme over a period of 18 months. Three swabs were collected from the posterior fornix of 346 newly registered female patients for diagnosis of trichomoniasis. A wet smear was prepared using the first swab. The second swab was placed in 5 mL of 0.9% saline with three drops of 5% glucose at room temperature and centrifuged twice at a low speed prior to preparation of a Giemsa stained smear. The third swab was for culture. The three tests were performed independently. The specificity and sensitivity of the wet smear and Giemsa stain were compared to culture. Results: With culture, the prevalence of trichomoniasis was 6.9% (95% CI: 4.1-9.3%). The Giemsa-stained smear was found to be highly sensitive (100%, 95% CI: 86.2-100%) and specific (99.69%, 95% CI: 98.26-99.95%) compared to culture. The wet smear was less sensitive (95.83%, 95% CI: 79.76-99.26%) but equally specific (100%, 95% CI: 98.82-100%). Conclusion: In developing countries, facilities for using culture are limited and wet smear examination in the field is also difficult due to the immediate need for laboratory facilities. Our study demonstrated that, in this setting, using a transport medium prior to Giemsa staining is a feasible alternative, with a high-diagnostic yield.
Language	English
Publishing date	2012-01-05
Publishing country	India
Document type	Journal Article
ZDB-ID	2545454-7
ISSN	0974-8245 ; 0974-777X
ISSN (online)	0974-8245
ISSN	0974-777X
DOI	10.4103/0974-777X.91051
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Article ; Online: Clinical features and sociodemographic factors affecting Trichomonas vaginalis infection in women attending a central sexually transmitted diseases clinic in Sri Lanka.

Fernando, Sumadhya D / Herath, Sathya / Rodrigo, Chaturaka / Rajapakse, Lalani

Indian journal of sexually transmitted diseases and AIDS

2012 Volume 33, Issue 1, Page(s) 25–31

Abstract: Introduction: Trichomoniasis is a relatively neglected area of research in Sri Lanka. Given the number of infections observed, an analysis of sociodemographic characteristics of patients would be valuable in prevention.: Materials and methods: Data ... ...

Abstract	Introduction: Trichomoniasis is a relatively neglected area of research in Sri Lanka. Given the number of infections observed, an analysis of sociodemographic characteristics of patients would be valuable in prevention. Materials and methods: Data were collected from 359 newly registered women at a tertiary level sexually transmitted diseases clinic over a period of 18 months. Trichomoniasis was diagnosed by culture of vaginal swabs collected from the posterior fornix. Results: The prevalence of trichomoniasis in the sample was 7.2%. Of those who tested positive for trichomoniasis, 76% were in the age group of 21-45 years, 68% were married and living with a spouse and 60% were unemployed. A diagnosis of Trichomoniasis was associated with being married (OR, 1.6; CI, 0.56-4.41), age over 33 years (OR=1.3, CI, 0.55-2.9), being employed (OR, 1.3; CI, 0.56 - 2.94), having an education of less than ten years at school (OR, 3.0; CI 1.28-7.26) and not using condoms during the last sexual act (OR 2.0, CI 0.84-4.86). The risk was less among commercial sex workers (OR, 0.3, CI: 0.14-0.85), those with multiple sexual partners (OR, 0.2; CI; 0.073-0.408) and women reporting extramarital sexual relationships (OR, 0.3; CI, 0.128-0.733). Conclusions: Education on safe sex and recognition of symptoms is currently targeted at high risk groups such as commercial sex workers. Extending these programmes to the rest of the community will further reduce the risk of transmission of trichomonas.
Language	English
Publishing date	2012-04-23
Publishing country	India
Document type	Journal Article
ISSN	2589-0565
ISSN (online)	2589-0565
DOI	10.4103/0253-7184.93813
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Article ; Online: Association of HLA class I and II genes with cutaneous leishmaniasis: a case control study from Sri Lanka and a systematic review.

Samaranayake, Nilakshi / Fernando, Sumadhya D / Neththikumara, Nilaksha F / Rodrigo, Chaturaka / Karunaweera, Nadira D / Dissanayake, Vajira H W

BMC infectious diseases

2016 Volume 16, Page(s) 292

Abstract: Background: The outcome of leishmaniasis is an interplay between Leishamania and the host. Identifying contributory host genetic factors is complicated by the variability in phenotype, ethnicity and parasite species. Leishmaniasis is caused exclusively ... ...

Abstract	Background: The outcome of leishmaniasis is an interplay between Leishamania and the host. Identifying contributory host genetic factors is complicated by the variability in phenotype, ethnicity and parasite species. Leishmaniasis is caused exclusively by L. donovani in Sri Lanka with localized cutaneous leishmaniasis (LCL) being the predominant form. We report here an association study of human leucocyte antigen (HLA) class I and II genes with LCL in Sri Lanka, the first on HLA associations in cutaneous leishmaniasis in a South Asian population. Methods: An existing DNA repository of 200 each of patients and controls was typed for HLA-DQ by PCR-SSP. Next generation sequencing-based typing for HLA-A, HLA-B and HLA-DRB1 alleles was done in a subset of 280 samples. Association tests were performed on 28,489 genotyped and imputed SNPs spanning a region of 1.4 Mb across the HLA genes. To compare our results with similar studies, we carried out a systematic review to document all HLA associations reported to-date for cutaneous and muco-cutaneous leishmaniasis. Results: DRB104 DQB102 (P = 0.03; Pc = 0.09), DRB107 DQB102 (P = 0.03; Pc = 0.09) haplotypes were absent in patients. B07 (P = 0.007; Pc = 0.13; OR = 0.36; 95 % CI = 0.17-0.77) allele and DRB115 DQB106 (P = 0.00; Pc < 0.01; OR = 0.3; 95 % CI = 0.2-.0.6) haplotype were over represented in controls and DRB115 (P = 0.002; Pc = 0.01) allele was over represented in patients. Two SNPs (rs281864595/rs1050517) in the antigen recognition region of HLA-B, comprised a haplotype more frequent in controls (P = 0.04). The alleles identified by the systematic review to predispose or to protect from cutaneous/mucocutaneous leishmaniasis remained highly heterogeneous in different populations studied. Conclusions: Our preliminary findings suggest a role for some class I and class II HLA genes in determining predisposition to LCL in this population which should be corroborated with further studies. The systematic review reiterates this need, as the purported susceptibility or protection gained by certain HLA alleles or haplotypes has rarely been independently verified.
MeSH term(s)	Adolescent ; Adult ; Alleles ; Asian Continental Ancestry Group/genetics ; Case-Control Studies ; Child ; Child, Preschool ; Ethnic Groups ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; HLA-A Antigens/genetics ; HLA-B Antigens/genetics ; HLA-DQ beta-Chains/genetics ; HLA-DRB1 Chains/genetics ; Haplotypes ; High-Throughput Nucleotide Sequencing ; Humans ; Infant ; Infant, Newborn ; Leishmaniasis, Cutaneous/genetics ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Sri Lanka ; Young Adult
Chemical Substances	HLA-A Antigens ; HLA-B Antigens ; HLA-DQ beta-Chains ; HLA-DQB1 antigen ; HLA-DRB1 Chains
Language	English
Publishing date	2016-06-14
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-016-1626-8
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Article ; Online: Risk prediction for severe disease and better diagnostic accuracy in early dengue infection; the Colombo dengue study.

Sigera, Ponsuge Chathurani / Amarasekara, Ranmalee / Rodrigo, Chaturaka / Rajapakse, Senaka / Weeratunga, Praveen / De Silva, Nipun Lakshita / Huang, Chun Hong / Sahoo, Malaya K / Pinsky, Benjamin A / Pillai, Dylan R / Tissera, Hasitha A / Jayasinghe, Saroj / Handunnetti, Shiroma / Fernando, Sumadhya D

BMC infectious diseases

2019 Volume 19, Issue 1, Page(s) 680

Abstract: Background: A major challenge in dengue management in resource limited settings is the confirmation of diagnosis. Clinical features of dengue often overlap with other infections and molecular diagnostic tools are not readily accessible to clinicians at ... ...

Abstract	Background: A major challenge in dengue management in resource limited settings is the confirmation of diagnosis. Clinical features of dengue often overlap with other infections and molecular diagnostic tools are not readily accessible to clinicians at hospitals. In addition, the prediction of plasma leakage in dengue is also difficult. Hematocrit level and ultrasound scans (combined with clinical parameters) are helpful to detect plasma leakage once it has happened, not before. Methods: Colombo Dengue Study (CDS) is a prospective cohort study of clinically suspected adult dengue patients recruited from the National hospital of Sri Lanka (within the first 3 days of fever) that aimed to a) identify clinical and basic laboratory test parameters to differentiate dengue from non-dengue fever, b) evaluate the comparative efficacy of loop-mediated isothermal amplification (LAMP) for dengue diagnosis (vs. NS1 antigen test and RT-qPCR) and c) identify early associations that are predictive of plasma leakage or severe dengue. The basic laboratory tests considered here included hematological parameters, serum biochemistry and inflammatory markers. Results: Only 70% of clinically suspected patients were confirmed as having dengue by either the NS1 antigen test or RT-qPCR. On a Bayesian latent class model which assumes no "gold standard", LAMP performed equally or better than RT-qPCR and NS1 antigen test respectively. When confirmed dengue patients were compared with others, the earlier group had significantly lower lymphocyte counts and higher aspartate aminotransferase levels (AST) within the first 3 days of fever. Confirmed dengue patients with plasma leakage had a lower mean age and a higher median baseline AST level compared to those without plasma leakage (p < 0.05). Conclusion: Clinical suspicion overestimates the true number of dengue patients. RT-LAMP is a potentially useful low-cost diagnostic tool for dengue diagnosis. Confirmed dengue patients had significantly higher AST levels and lower lymphocyte counts in early disease compared to others. In confirmed dengue patients, younger age and a higher AST level in early infection were associated with subsequent plasma leakage.
MeSH term(s)	Adult ; Aspartate Aminotransferases/blood ; Bayes Theorem ; Biomarkers/blood ; Cohort Studies ; Dengue/diagnosis ; Dengue Virus/genetics ; Female ; Fever/virology ; Humans ; Immunologic Tests ; Lymphocyte Count ; Male ; Middle Aged ; Nucleic Acid Amplification Techniques/methods ; Prospective Studies ; Real-Time Polymerase Chain Reaction/methods ; Risk Assessment ; Sensitivity and Specificity ; Severe Dengue/blood ; Severe Dengue/diagnosis ; Severe Dengue/etiology ; Sri Lanka
Chemical Substances	Biomarkers ; Aspartate Aminotransferases (EC 2.6.1.1)
Language	English
Publishing date	2019-08-01
Publishing country	England
Document type	Journal Article ; Observational Study
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-019-4304-9
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