RESUMO
Objective: To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka, during outbreaks reported between 2013 and 2017. Methods: The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka. Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka, WHO. Leptospirosis was confirmed by either single microscopic agglutination test titre 1: 400 or by positive polymerase chain reaction (PCR) test result. Results: Out of 372 clinically suspected cases, 29.00% were confirmed as leptospirosis cases by either microscopic agglutination test (50.00%) or positive polymerase chain reaction (52.77%) and 12.90% were presumptively identified as leptospirosis. Clinical symptoms (headache, vomiting, jaundice and dyspnoea) and variations in haematological parameters (haemoglobin, platelet count) and biochemical parameters (serum creatinine, serum urea, serum bilirubin and C-reactive protein) were associated with confirmed leptospirosis (P<0.05). Acute kidney injury, meningitis, myocarditis, pulmonary haemorrhage and acute liver failure was seen among 21.30%, 12.04%, 6.48%, 6.48%, 5.56%, respectively with 4.63% fatality among the leptospirosis confirmed patients. The sensitivity, specificity, positive predictive value and negative predictive value of the case definition of Ministry of Health, Sri Lanka were 96.29%, 9.09%, 31.13%and 85.71%, respectively, when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard. Conclusions: Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients. However, pulmonary haemorrhage is predominantly associated with mortality. The case definition of Ministry of Health, Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.
RESUMO
Objective: To determine the effect of glucose, sucrose, and saccharin on growth, adhesion, and biofilm formation of Candida albicans and Candida tropicalis
Materials and Methods: The growth rates of mono-cultures of planktonic C. albicans and C. tropicalis and 1:1 mixed co-cultures were determined in yeast nitrogen broth supplemented with 5% [30 mM] and 10% [60 ITIM] glucose, sucrose, and saccharin, using optical density measurements at 2-h intervals over a 14-h period. Adhesion and biofilm growth were performed and the growth quantified using a standard 3-[4,5-dimethyl-thiazol-2-yl]-2,5-diphenyltetrazolium bromide [MTT] assay. The biofilm architecture was visualized using scanning electron microscopy. One- and two-way analysis of variance [ANOVA] was performed to analyse the differences among multiple means
Results:The highest planktonic growth was noted in 5% glucose after 14 h [p < 0.05]. No significant planktonic growth was observed in either concentration of saccharin. Both the concentrations of glucose and sucrose elicited significantly increased adhesion from MTT activity of 0.017 to >0.019 in mono- as well as co-cultures [p < 0.05], whilst the lower concentration of saccharin significantly dampened the adhesion. Maximal biofilm growth was ob-served in both species with the lower concentration of sucrose [5%], although a similar concentration of saccharin abrogated biofilm development: the highest MTT value [>0.35] was obtained for glucose and the lowest [>0.15] for saccharin
Conclusion: In this study, glucose and sucrose accelerated the growth, adhesion, and biofilm formation of Candida species. However, the non-nutritive sweetener saccharin appeared to dampen, and in some instances suppress, these virulent attributes of Candida