Malaria in Sri Lanka: Investigating causes of the recent elimination and making plans to prevent reintroduction.

Sri Lanka is a country that has long suffered from epidemics of malaria. In this historical context, it is remarkable that in 2016 the Indian Ocean island nation was able to officially celebrate the elimination of this parasitic disease of major public health importance. The most devastating outbreak recorded in Sri Lanka was during 1934-35, when close to 80,000 human deaths were reported. Indoor residual spraying with the insecticides, DDT and malathion commenced in 1947 and was successful in causing a rapid decline in malaria incidence. However, poor vector control measures, resistance of mosquitoes to these insecticides and resistance of blood-stage Plasmodium parasites to the prevailing drugs used are considered the principal reasons for the occurrence of subsequent outbreaks. Despite this, Sri Lanka achieved the significant milestone of zero locally transmitted malaria cases in October 2012 and zero recorded deaths since 2007. Vector surveillance, parasitological examination, and clinical case management were collective effective activities that most likely led to elimination of malaria. Yet, there remains a high risk of reintroduction due to imported cases and an enduring vulnerability to vector transmission. In order to prevent re-establishment of malaria, continued financial support, sustained surveillance for vector species present in Sri Lanka and effective control of imported cases through rapid detection and early diagnosis are all required. In addition to these immediate practical priorities, further studies on vector biology and genetic variations that affect vectorial capacity would help to shed light on how to avoid reintroduction. This review affords an insight into the determinants of past malaria epidemics, strategies deployed to achieve and maintain the current status of elimination, lessons learnt from this success and plans to avoid resurgence of infection.

An outbreak of paederus dermatitis in a suburban hospital in Sri Lanka.

BACKGROUND: In a modern hospital built recently in Sri Lanka the staff members on night shifts and some patients in the open wards were known to be affected by an acute vesicating dermatitis. The study was carried out to identify the cause of the dermatitis and recommend preventive measures. METHODS: Members of the hospital staff and patients who developed an acute vesicating dermatitis over a period of 2 years were studied using a questionnaire. The clinical features, relationship to night shifts and the month of occurrence were noted. Insects were caught at night on several occasions and identified. Lesions were reproduced in volunteers. RESULTS: Out of a total of 124 patients studied, 108 were members of the hospital staff and it was noted that they had all been on night shifts within 2 days prior to the onset of the lesions. The insect caught belongs to class Coleoptera, family Staphylinidae, genus Paederus, and species fuscipes. The incidence was seasonal with clustering of cases seen to occur twice a year. CONCLUSIONS: This is an outbreak of dermatitis due to Paederus fuscipes. Awareness of the condition and its clinical features will prevent misdiagnosis and the simple preventive measures suggested are based on the behavioral pattern of this nocturnal beetle.

Vitamin A status of children in Sri Lanka.

A representative country-wide rural nutrition status survey determined the extent and distribution of vitamin A deficiency in Sri Lanka in children 6 through 71 months of age. Trained paramedical personnel recorded the presence or absence of selected ophthalmological signs and symptoms associated with vitamin A deficiency in 13,450 children. The results of the country-wide clinical survey indicate that a vitamin A deficiency problem of public health importance may exist in two of 15 health areas. Serum vitamin A levels were determined on 346 survey children from two of 15 health areas and compared with clinical findings for these areas. The lowest mean serum vitamin A, 26.3 microgram/100 ml, occurred in children with clinical eye findings. A high prevalence of clinical eye findings, 34%, and the low mean serum vitamin A value, 28.2 microgram/100 ml, were found in the group of chronically undernourished children--children who are less than 90% of their expected height for age. The survey results enabled planned redirection of the distribution of vitamin A capsules to preschool children in Sri Lanka to areas shown to have the highest prevalences of ophthalmological signs and symptoms and/or the highest prevalence of chronic undernutrition.

Immunofluorescence of the skin in gold rashes - with particular reference to IgE.

Immunofluorescence studies have been carried out on rashes from 36 patients with rheumatoid arthritis receiving gold therapy. 24 of the rashes were clinically attributed to gold and 12 were diagnosed as coincidental rashes. IgE was found in 6 of the gold rashes and in 4 of the coincidental rashes. Immunofluorescence changes of immune complex vasculitis, lichen planus, or pemphigoid were found in 9 gold rashes while 2 coincidental rashes showed vascular fluorescence for immunoglobulins but nor for complement. Two definite gold rashes showing no changes on immunofluorescence showed perivascular infiltration with lymphocytes on light microscopy. Thus, while immunofluorescence is only marginally helpful in the diagnoses of gold rashes, evidence of an immunological reaction tends to favour a diagnosis of a gold-induced rash.

Plasma and urinary amino acids and selected sulfur metabolites in young men fed a diet devoid of methionine and cystine.

A preliminary investigation was conducted to explore the use of plasma methionine and cystine for determining human sulfur amino acid requirements. Measurements of urinary methionine, cystine, taurine, and inorganic sulfate were included. After a 3-day control period, three young men were fed for 8 days a diet containing a purified -l-amino acid mixture, patterned after egg protein but devoid of methionine and cystine. Fasting plasma methionine and cystine levels showed little decrease during the 8-day period. Urinary cystine and taurine responses were inconsistent among the subjects. Urinary methionine and inorganic sulfate levels decreased markedly within a few days after feeding of the experimental diet, and may be useful criteria for determining human sulfur amino acid requirements.

Pilo-sebaceous duct physiology. III. Observations on the number and size of pilo-sebaceous ducts in acne vulgaris.

We have used surface microscopy to measure the pil-sebaceous duct orifices at different sites in 150 subjects. Our data have shown that there are more pilo-sebaceous units on the face compared to the back and that these exists are smaller on the face. Despite the small exit the sebum excretion rate per gland on the forehead was not significantly different from that on the back. Thus the number of pilo-sebaceous duct units and the pilo-sebaceous canal exit size are possible factors in the localization of acne.

Protein requirements of man: obligatory urinary and fecal nitrogen losses in elderly women.

Eleven health elderly women, ranging in age from 67 to 91 years, were given an essentially protein-free diet for 8 to 10 days, to determine obligatory urinary and fecal nitrogen losses. Body cell mass (BCM) was calculated from whole body 40K, and basal metabolic rate was determined by indirect calorimetry. Urine was analyzed daily for nitrogen and creatinine, and fecal N was measured in pooled samples. Urinary N output reached a relatively stable-state level by day 6; the average of the last four daily measurements was taken as an estimate of obligatory urinary N loss. The obligatory urinary N was: 24.4 +/- 5.2 mg N/kg body weight; 89.5 +/- 17.1 mg N/kg BCM; 1.44 +/- 0.14 mg N/basal kcal; and 2.11 g N/g creatinine. Obligatory fecal N was 9.8 mg N/kg body weight. Comparison of these results with published data for young adults indicates that obligatory urinary N losses in elderly women are similar to those for young women when expressed per unit body weight but higher than young women and men when expressed per unit creatinine excretion and per unit BCM.

Pilo-sebaceous duct physiology. 2. The effect of keratin hydration on sebum excretion rate.

Sebum excretion rate was measured before and after occlusions of the skin in eleven subjects. The sebum excretion rate rose significantly following occlusion, confirming the view that there is an obstruction to the outflow of sebum with keratin hydration.