Is leishmaniasis in Sri Lanka benign and be ignored?

Cutaneous leishmaniasis is now an endemic disease in Sri Lanka. Many studies have focussed on various aspects of this disease but the knowledge, particularly on epidemiological and vector aspects is still poor and the awareness among the general public and even medical/paramedical personnel regarding this disease remains grossly inadequate. The steady increase in the numbers and spread of cutaneous leishmaniasis cases in Sri Lanka and the very close similarity (genotypic and phenotypic) between the local parasite Leishmania donovani MON-37 and the parasite causing visceral leishmaniasis in India (L. donovani MON-2), considered together with the more recent case reports of autochthonous cases of visceral disease in this country, calls for urgent action for setting up of a surveillance programme to estimate the true disease burden and to implement an organized control strategy, combined with operational and epidemiological research to aid control efforts to avert a potentially major catastrophe of more virulent form of leishmaniasis, particularly the visceral type becoming endemic in Sri Lanka.

Studies on prevalence of anopheline species and community perception of malaria in Jaffna district, Sri Lanka.

BACKGROUND & OBJECTIVES: Over two decades of civil unrest and the conflict situation have had detrimental effects on vector control activities and management of malaria in Jaffna district which is an endemic region for malaria in Sri Lanka. With the background that only a few small-scale studies on malaria and its vectors have been reported from this district, a study was designed to explore the current status of malaria in the Jaffna district in relation to vector and community aspects. METHODS: Adults and larvae of anopheline mosquitoes were collected monthly from selected endemic localities. Species prevalence of the collected mosquitoes was studied while the collected adults of Anopheles subpictus, a potential vector in the district, was screened for sibling species composition based on morphological characteristics and exposed to common insecticides using WHO bioassay kits. Knowledge, attitude and practices (KAP) of the community were tested using a pre-tested structured questionnaire in high-risk and low-risk localities in the district. RESULTS: The anopheline mosquito species distribution in the district was--An. culicifacies (0.5%), An. subpictus (46%), An. varuna (4%), An. nigerrimus (44%) and An. pallidus (5.5%). Among the collected larvae the percent prevalence of An. culicifacies was 13% and other species follows as: An. subpictus (71%), An. varuna (4%), An. nigerrimus (10%) and An. pallidus (2%). Sibling species B, C and D of An. subpictus were present in the district with the predominance of B in both coastal and inland areas, while all members showed both indoor and outdoor resting characteristics, they were highly resistant to DDT (4%) and highly susceptible to malathion (5%). KAP study in the district showed a reasonable level of knowledge, positive attitude and practices towards malaria. CONCLUSION: An. subpictus, the reported major vector of Jaffna and a well-established secondary vector of malaria in the country, continues to be the predominant anopheline species. The distribution of sibling species of An. subpictus complex in the Jaffna district, revealed for the first time, has implications for future studies on its bionomics and malaria transmission pattern in this area and the planning of control strategies for this region. The community perception of disease, which revealed a satisfactory knowledge indicates the potential for better community participation in future malaria control activities in this region. As potential vectors are still present, health authorities need to be vigilant to prevent any future epidemics of malaria.

Study of dirofilariasis in a selected area in the Western Province.

INTRODUCTION: Human dirofilariasis is a zoonotic infection caused by the filarial worm, Dirofilaria (Nochtiella) repens, whose primary host is the dog. This infection is on the increase over the past decade in Sri Lanka and the prevalence of canine dirofilariasis in the country is also believed to be high. We present here a study on public awareness of dirofilariasis and the prevalence of this infection in dogs in Negombo, an urban area that has a high domestic canine population. OBJECTIVE: To assess the awareness of dirofilariasis infection among residents and study the prevalence of this infection in domestic dogs in Negombo. DESIGN: Prospective study. SETTING: Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka. METHODS: A descriptive cross-sectional study within the city of Negombo during September and November 2003 using a pre-tested, interviewer-administered questionnaire with cluster sampling was done. Two hundred seventy adults, including 132 dog owners, were included in the study. Data analysis was done using the Epilnfo programme. The prevalence of canine dirofilariasis was studied in a group of 65 dogs over the age of 1 year. They were selected by cluster sampling with random choice of the streets within the study area. Stained thick blood films, made following an earlobe-prick at any time during the day, were microscopically examined for the presence of microfilariae. RESULTS: Forty nine of the respondents (18%) were aware of the existence of canine dirofilariasis while human dirofilariasis was known only to 6%. Awareness was related to the level of education. Knowledge of canine filariasis was better among pet owners (32/132) when compared to others (18/138; p < 0.05). Veterinary surgeons were acknowledged as the source of information by 38% of those who were aware of the disease. Forty five per cent (n = 29) of the dogs screened were positive for microfilariae. Out of these 18 and two dogs were infected with D repens. and B. ceylonensis, respectively, while nine others were co-infected with the two parasites. CONCLUSIONS: The knowledge of dirofilariasis is extremely poor in the study area. The high prevalence of filarial infections in dogs highlights the importance of improving the public awareness of this disease, especially among the dog owners. Proper management of this condition in dogs-the reservoirs of infection for human dirofilariasis, is important for the control of this zoonotic infection.

Evaluation of a rapid whole blood immunochromatographic assay for the diagnosis of Plasmodium falciparum and Plasmodium vivax malaria.

OBJECTIVE: Microscopic examination of blood smears is the 'gold standard' for malaria diagnosis, but is labour intensive and requires skilled operators. Plasmodium vivax malaria accounts for up to 70% of infections in Sri Lanka. The objective of this study was to determine the effectiveness of an immunochromatographic test which can detect both the species of Plasmodium, P. vivax and P. falciparum, present in Sri Lanka. DESIGN: Prospective study from May 2001 to March 2002. SETTING AND METHODS: All persons above 5 years of age who presented to the Malaria Research Station, Kataragama or the Anti-malaria Clinic, Kurunegala, with a history of fever were recruited to the study. Thick and thin blood smears were examined for malarial parasites. The rapid diagnostic test (RDT), ICT Malaria P.f/P.v (AMRAD ICT, Australia) was performed simultaneously by an independent investigator. The severity of clinical disease of all patients was evaluated. RESULTS: The study sample comprised 328 individuals of whom 126 (38%) were infected, 102 with P. vivax (31.1%) and 24 with P. falciparum (7.3%). The RDT was found to be highly sensitive (100%) and specific (100%) for the diagnosis of P. falciparum when compared with field microscopy. The sensitivity for the diagnosis of P. vivax malaria was only 70%. When P. vivax parasitaemia was greater than 5000 parasites/microL the RDT was 96.2% sensitive. A significant association was noted between the band intensity on the dipstick and both peripheral blood parasitaemia (p < 0.001) and clinical severity of disease with P. vivax (p = 0.011). CONCLUSIONS: The ICT Malaria P.f/P.v test can be used in Sri Lanka in the absence of microscopists.

Clinical features, risk factors and efficacy of cryotherapy in cutaneous leishmaniasis in Sri Lanka.

INTRODUCTION: The first autochthonus case of cutaneous leishmaniasis in Sri Lanka was reported in 1992. Several case reports from different parts of the island have been documented. The case incidence has increased in the recent past. OBJECTIVES: To determine the clinical patterns, risk factors and efficacy of cryotherapy for cutaneous leishmaniasis in Sri Lanka. PATIENTS: Sixty-five patients with cutaneous leishmaniasis. DESIGN: Prospective study. SETTING: Department of Parasitology, Faculty of Medicine, Colombo. METHODS: Direct smears prepared from lesion aspirates or punch biopsies were stained and examined for Leishmania sp. All patients with positive smears were included in the study. A pre-designed questionnaire was completed based on clinical evaluation, and the patients were treated and followed up regularly. Investigations were repeated on day 14 and day 90 depending on the response to treatment. RESULTS: Lesions were non-tender, non-itchy papules (early lesions), scaling single nodules or dry crust forming single or multiple ulcers. Young adult males with outdoor behavioural characteristics were mostly affected. Other risk factors were close proximity to jungles, potential reservoir hosts in the environment, lack of awareness and inadequate knowledge and use of preventive measures. Compliance rate for cryotherapy was 40%. The need for frequent hospital visits, the long course of treatment, limited availability and undesirable side effects were identified as reasons for poor compliance. Smear positive rate on day 14 after treatment was 89%. CONCLUSIONS: Cutaneous leishmaniasis is now an established disease in Sri Lanka. Raising public awareness, early diagnosis, definite species identification, availability of proper treatment methods and vector studies are important for its effective control.

First successful in vitro culture of autochthonous Leishmania sp. in Sri Lanka.

Since the first autochthonous case of cutaneous leishmaniasis in Sri Lanka was reported in 1992 (1) attempts to culture the causative organisms have been unsuccessful. We report the first successful isolation of the local Leishmania sp. by in vitro culture, which would pave the way for species and strain indentification.

Megaselia scalaris (Diptera: Phoridae) can live on ripe bananas--a potential health hazard?

OBJECTIVE: Identification of larvae that inest bananas and investigating its habits. DESIGN: Laboratory based study. SETTING: Department of Parasitology, Faculty of Medicine, University of Colombo. METHODS: Bananas brought to the department with a query of maggot infestation were examined and the presence of maggots was confirmed. Maggots were allowed to develop into adults. The larvae and the flies were identified using standard keys. RESULTS: Megaselia scalaris was identified, the larvae of which infest ripe bananas. Three generations of M scalaris were reared using ripe bananas as the only source of food. Two other banana specimens yielded larvae that eventually grew into adult flies of Bactrocera species. CONCLUSIONS: In addition to Bactrocera spp. larvae of which are known pests in bananas, M scalaris larvae were detected as pests for the first time. We demonstrated that M scalaris can complete its life-cycle depending on ripe bananas as the only source of food. The vast consumption of bananas and the potential of M scalaris to cause intestinal and wound myiasis in humans make these findings medically important.