scholarly journals Histopathology of Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Harshima Wijesinghe ◽  
Nayana Gunathilaka ◽  
Saveen Semege ◽  
Nishantha Pathirana ◽  
Nuwani Manamperi ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Cutaneous Leishmaniasis ◽  
Leishmania Donovani ◽  
Clinical Presentation ◽  
Cross Sectional Study ◽  
Causative Organism ◽  
Variable Intensity ◽  
Cross Sectional ◽  
The North ◽  
Parasitic Load

Cutaneous leishmaniasis (CL) is a neglected tropical disease that is gaining importance in Sri Lanka and internationally. The clinical presentation, pathology, and method of parasite elimination in CL vary according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This collaborative cross-sectional study describes the clinicopathological features of cutaneous leishmaniasis among personnel of the tri-forces serving in the North and East of the country. The histology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression, and histology) was reviewed. The parasitic load was assessed semiquantitatively. The histological features were correlated with the clinical presentation and organism load. The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%). The lesion types included papule (34.7%), nodule (32.7%), and an ulcer (30.6%). The evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 of the biopsies and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17), and interface change (66%; n=33). Dermal changes were seen in all cases and were characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20% (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation, and type of lesion (P=0.034) were significantly associated with the organism load. Granuloma formation was associated with a reduction in organism load, indicating that the macrophage activation played an important role in the control of the organism.

scholarly journals Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from high endemic district of Sri Lanka.

2020 ◽  
Author(s):  
Chandana Hewawasam ◽  
Hema S Weerakoon ◽  
Vyshnavi Thilakan ◽  
Tishni Lelwala ◽  
Kalana Prasanka ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Leishmania Donovani ◽  
Parasitic Infection ◽  
Cross Sectional Study ◽  
Causative Organism ◽  
Cross Sectional ◽  
Public And Private ◽  
Notification System ◽  
Endemic District ◽  
Self Administered Questionnaire

Abstract Background: Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification of leishmaniasis. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis. Methods: A cross-sectional study was conducted in the Anuradhapura district which reported the highest prevalence of leishmaniasis. Medical officers from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators. Results: One hundred and eighty-eight (188) medical officers completed the questionnaire. Of them, 95.7% were aware of leishmaniasis as a parasitic infection and 84.7% correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 181 (96.8%) knew that the vector of leishmaniasis is sandfly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 176 (94.1%). Nearly half of the respondents (98, 54.1%) was aware of the fact that the Anuradhapura district has the highest prevalence of the disease. Many of them had the idea that leishmaniasis is an emerging disease (155, 84.3%,) and early diagnosis is important in controlling the disease (163, 89.1%). Although about three fourth (123, 73.7 %,) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 74 (42.5%) were aware that it is a legal requirement. Some medical officers (39, 22%) believed that the current notification system in the country is not effective. Unavailability of notification forms (60, 36.8%) heavy workload (85, 50.3%) and inadequate supportive staff (55, 35.1%) were reported as barriers for timely notification. Even though 105 (58.0%) of medical officers had suspected leishmaniasis during last eight years period only 35 (19.4%) had notified. Conclusions: Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka.

scholarly journals Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from an endemic district, Sri Lanka.

2020 ◽  
Author(s):  
Chandana Hewawasam ◽  
Hema S Weerakoon ◽  
Vyshnavi Thilakan ◽  
Tishni Lelwala ◽  
Kalana Prasanka ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Leishmania Donovani ◽  
Parasitic Infection ◽  
Cross Sectional Study ◽  
Sand Fly ◽  
Causative Organism ◽  
Cross Sectional ◽  
Public And Private ◽  
Notification System ◽  
Endemic District

Abstract Background: Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification of leishmaniasis. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis.Methods: A cross-sectional study was conducted in the Anuradhapura district which reported the highest case load of leishmaniasis. Medical officers from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators.Results: One hundred and eighty-eight (188) medical officers completed the questionnaire. Of them, 95.7% were aware of leishmaniasis as a parasitic infection and 84.7% correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 181 (96.8%) knew that the vector of leishmaniasis is sand fly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 176 (94.1%). Nearly half of the respondents (98, 54.1%) were aware of the fact that the Anuradhapura district has the highest disease burden. Many of them had the idea that leishmaniasis is an emerging disease (155, 84.3%,) and early diagnosis is important in controlling the disease (163, 89.1%). Although about three fourth (123, 73.7 %,) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 74 (42.5%) were aware that it is a legal requirement. Some medical officers (39, 22%) believed that the current notification system in the country is not effective. Unavailability of notification forms (60, 36.8%) heavy workload (85, 50.3%) and inadequate supportive staff (55, 35.1%) were reported as barriers for timely notification. Even though 105 (58.0%) of medical officers had suspected leishmaniasis during last eight years period only 35 (19.4%) had notified.Conclusions: Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka.

scholarly journals Genetic diversity of Leishmania donovani that causes cutaneous leishmaniasis in Sri Lanka: a cross sectional study with regional comparisons

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Udeshika Lakmini Kariyawasam ◽  
Angamuthu Selvapandiyan ◽  
Keshav Rai ◽  
Tasaduq Hussain Wani ◽  
Kavita Ahuja ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Sri Lanka ◽  
Cutaneous Leishmaniasis ◽  
Leishmania Donovani ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Regional Comparisons

scholarly journals Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from high endemic district of Sri Lanka.

2019 ◽  
Author(s):  
Chandana Hewawasam ◽  
Hema S Weerakoon ◽  
Vyshnavi Thilakan ◽  
Tishni Lelwala ◽  
Kalana Prasanka ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Leishmania Donovani ◽  
Parasitic Infection ◽  
Cross Sectional Study ◽  
Causative Organism ◽  
Cross Sectional ◽  
Public And Private ◽  
Notification System ◽  
Endemic District ◽  
Self Administered Questionnaire

Abstract Background : Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis. Methods : A cross-sectional study was conducted in Anuradhapura district which reported the highest prevalence of leishmaniasis. Participants from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators. Results : One hundred and eighty-eight (188) medical officers (involved in treating 75,326 population) completed the questionnaire. Of them, 95.7% (n=177) were aware of leishmaniasis as a parasitic infection and 84.7% (n=155) correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 96.8% (n=181) knew that the vector of leishmaniasis is sandfly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 94.1% (n=176). Nearly half of the population (54.1%, n=98) was aware of the fact that Anuradhapura district has the highest prevalence of the disease. Many of them had the idea that leishmaniasis is an emerging disease (84.3%, n=155) and early diagnosis is important in controlling the disease (89.1%, n=163). Although about three fourth (73.7 %, n=123) of the population mentioned that leishmaniasis should be notified at first clinical suspicion, only 42.5% (n=74) were aware that it is a legal requirement. Some medical officers (22%, n=39) believed the current notification system in the country is not effective. Unavailability of notification forms (36.8%, n=60), heavy workload (50.3%, n=85) and inadequate supportive staff (35.1%, n=55) were reported as barriers for timely notification. Even though 58.0% (n=105) of medical officers had suspected leishmaniasis during last eight years period only 19.4% (n=35) had notified. Conclusions : Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka. Keywords : Leishmaniasis, Notification, Physicians, Knowledge, attitude, practice, Sri Lanka

scholarly journals Is Leishmaniasis adequately notified in Sri Lanka? A survey among doctors from an endemic district, Sri Lanka.

2020 ◽  
Author(s):  
Chandana Hewawasam ◽  
Hema S Weerakoon ◽  
Kalana Prasanka ◽  
Vyshnavi Thilakan ◽  
Tishni Lelwala ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Leishmania Donovani ◽  
Parasitic Infection ◽  
Cross Sectional Study ◽  
Sand Fly ◽  
Causative Organism ◽  
Cross Sectional ◽  
Public And Private ◽  
Notification System ◽  
Endemic District

Abstract Background: Leishmaniasis is a notifiable disease in Sri Lanka since 2008. Previous studies show a gap in the notification of leishmaniasis. Purpose of the present study was to determine the Knowledge, attitudes and practice of medical officers regarding leishmaniasis.Methods: A cross-sectional study was conducted in the Anuradhapura district which reported the highest case load of leishmaniasis. Medical officers from public and private health care institutes in the area filled a self-administered questionnaire in the presence of the investigators.Results: One hundred and eighty-eight (188) medical officers completed the questionnaire. Of them, 95.7% were aware of leishmaniasis as a parasitic infection and 84.7% correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 181 (96.8%) knew that the vector of leishmaniasis is sand fly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 176 (94.1%). Nearly half of the respondents (98, 54.1%) were aware of the fact that the Anuradhapura district has the highest disease burden. Many of them had the idea that leishmaniasis is an emerging disease (155, 84.3%,) and early diagnosis is important in controlling the disease (163, 89.1%). Although about three fourth (123, 73.7 %,) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 74 (42.5%) were aware that it is a legal requirement. Some medical officers (39, 22%) believed that the current notification system in the country is not effective. Unavailability of notification forms (60, 36.8%) heavy workload (85, 50.3%) and inadequate supportive staff (55, 35.1%) were reported as barriers for timely notification. Even though 105 (58.0%) of medical officers had suspected leishmaniasis during last eight years period only 35 (19.4%) had notified.Conclusions: Even though more than 90% of the participants had good theoretical knowledge about leishmaniasis; notification of leishmaniasis is considerably inadequate. This study emphasizes the need for greater efforts to improve the notification of leishmaniasis in Sri Lanka.

scholarly journals GIS-Based Risk Mapping of Cutaneous Leishmaniasis: A Survey in an Endemic Area of Central Iran

2021 ◽  
Author(s):  
Mohammad Maracy ◽  
Fariba Jaffary ◽  
Afshin Ebrahimi ◽  
Fatemeh Sokhanvari ◽  
Asieh Heidari ◽  
...  
Keyword(s):  
High Risk ◽  
Cutaneous Leishmaniasis ◽  
Hot Spot ◽  
Health Centre ◽  
Cross Sectional Study ◽  
Geographical Information ◽  
P Value ◽  
Cross Sectional ◽  
Isfahan Province ◽  
The North

Abstract Introduction: [Cutaneous Leishmaniasis (CL)] is Vector-borne infectious disease that is affected by various environmental agents. The main objective of this study was to determine the spatial distribution of CL incidence by using [Geographical Information System (GIS)].Materials and Methods: This is a cross-sectional study that was conducted during 5 years from 2014 to 2018 in Isfahan, Iran. We used the required data on each leishmaniasis patient that were recorded from 44 counties of Isfahan in databases and archive of provincial Health Centre. We used GIS for determining the incidence of CL in the high-risk foci. Moran index was used to identify high risk points (clustering in similar values) compared to the values of neighborhood points. Hot spot analysis was conducted by Getis-Ord-Gi. Results: The highest incidence of the disease occurred in the age group of 18-64 years and 61.6% of patients were male. According to seasonal distribution, autumn (58.6%) had the highest frequency. Time-trend of incidence showed that it had both decreasing and increasing, and there was a sudden upward trend of disease in 2018 except only two counties. The hot spots were involved the central areas of the Isfahan province slightly toward to the north and southeast of the province. Moran index showed that the differences for all points were not significant (p-value>0.05).Conclusions: Varzaneh (placed in southeast of Isfahan) was the hottest spot and had the worst position for leishmaniasis compared to all years and all cities.

scholarly journals Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B L O Luizeti ◽  
E M M Massuda ◽  
L F G Garcia
Keyword(s):  
Public Health ◽  
Health System ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Extreme Poverty ◽  
The Public ◽  
The North ◽  
Unified Health System ◽  
Shortage Of Doctors ◽  
Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

scholarly journals Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chandrani Nirmala Wijekoon ◽  
Indika Wettasinghe ◽  
Dinithi Fernando ◽  
Arosha Sampath Dissanayake ◽  
Malinda Gunawardana ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Early Recognition ◽  
Correct Diagnosis ◽  
Cross Sectional Study ◽  
Intravenous Route ◽  
Cross Sectional ◽  
Diagnosis And Management ◽  
Medical Graduates ◽  
Self Confidence ◽  
Case Diagnosis

Abstract Background Early recognition and the optimal management of anaphylaxis saves lives but studies from different countries have demonstrated gaps in knowledge and practices between healthcare workers. There is a paucity of such data from Sri Lanka. We assessed knowledge, perception and self-confidence in the diagnosis and management of anaphylaxis amongst pre-intern medical graduates who would soon become first-contact doctors attending emergencies. Methods This cross-sectional study included pre-interns who graduated with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees in 2019 from three Sri Lankan universities with differing undergraduate curricula. Using consecutive sampling data were collected within four months of the final-MBBS examinations with a self-administered questionnaire and the answers on case diagnosis and management were used as the basis of outcome scores. Results 385 participants responded (response rate: 91.5%). 16.4% correctly identified all anaphylaxis triggers. Only 7.3% correctly diagnosed all ten case scenarios and 34.5% all seven cases of anaphylaxis. 98.2 and 97.9% correctly identified 1:1000 adrenaline as the first-line treatment and the intramuscular route. 9.9% would preferentially but incorrectly use the intravenous route if access was available. Only 79.2 and 55.6% knew the correct adult and paediatric doses of adrenaline and 50% agreed that follow-up care was needed. The mean scores for case diagnosis and management of anaphylaxis were 7.7/10 ± 1.4 and 16.9/20 ± 1.9, respectively. Multiple linear regression indicated that the final MBBS results classification (class of degree or no class indicated) was a positive predictor of case diagnosis score [class vs no class: B = 0.662 (95% CI 0.347–0.978), p < 0.001] and being a graduate of University 2 [B = 1.568 (95% CI 1.182–1.953), p < 0.001] and passing with a class at final MBBS [B = 0.716 (95% CI 0.319–1.113), p < 0.001] were positive predictors of management score. Self confidence in diagnosing and managing anaphylaxis were rated as 79.7 and 62.1% and there was a positive correlation between knowledge and perception scores and self-confidence (case-diagnosis: rpb = 0.111, p = 0.03; management: rpb = 0.164, p = 0.001). Conclusions Knowledge, perception and self confidence in the diagnosis and management of anaphylaxis was sub optimal amongst pre-interns and we identified areas that need improvement. A higher MBBS qualification classification was a predictor for correct diagnosis and management and confidence in diagnosis and management positively correlated with knowledge and perception scores. Further and enhanced educational and training strategies are needed for this life threatening emergency condition.

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