Cutaneous leishmaniasis (CL) lesions are chronic and result in disfiguring scars. The microbiolog... more Cutaneous leishmaniasis (CL) lesions are chronic and result in disfiguring scars. The microbiological aspects of these wounds have not been systematically investigated. We have recently reported that 61.5% of CL wounds in a Sri Lankan cohort harboured bacterial biofilms, mainly composed of bacilli, Enterobacteriaceae, and Pseudomonas, which could delay wound healing. We have additionally reported that biofilms were significantly associated patients over 40 years of age, discharge, pain and/or itching of the wound, and high pus cell counts. Using this as background knowledge and other relevant literature, we highlight the importance of investigating the role of biofilms in CL wound healing, clinical indicators, cost-effective laboratory tests involving less invasive sampling techniques for diagnosing biofilms and potential therapeutic options for biofilm-containing CL wounds, such as adjunctive application of wound debridement and antimicrobial treatment along with anti-parasitic drugs.
Objectives: This study was initiated to determine the sensitivity and specificity of a commercial... more Objectives: This study was initiated to determine the sensitivity and specificity of a commercially available rapid diagnostic test (RDT) to detect leishmania antigen in cutaneous leishmaniasis(CL) skin lesions among Sri Lankan patients compared to PCR and Slit skin smear(SSS). Methods: Patients clinically suggestive of CL lesions were subjected to parasitological investigations. The clinical history was collected by the researcher. Samples were collected by a qualified trained medical officer from the suspected CL lesions at the dermatology clinic in the Hambantota hospital and from the patients coming to the Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura. RDT was done at the Hambantota hospital and samples were brought to the Department of Parasitology, to perform SSS, PCR and cultures. Results: Fifty samples have been collected thus far and PCR was performed only in 48 samples. Out of the 50 samples only 9 were positive by RDT and 32 by...
Objectives: To isolate PCR quality DNA from punch biopsy samples of 35 suspected cutaneous leishm... more Objectives: To isolate PCR quality DNA from punch biopsy samples of 35 suspected cutaneous leishmaniasis (CL) lesions, carry out Internal Transcribed Spacer 1 (ITS1) PCR, analyse Restriction Fragment Length Polymorphism (RFLP), sequence of ITS1 region of 10 randomly selected patient samples and to determine the genetic variation among the causative parasites.Methods: Punch biopsies (3mm) from CL lesions (n=35) were taken and stored in NET buffer at -20C. DNA was extracted using a commercially available kit. ITS1 PCR was carried out using previously described primers. PCR products were digested with Haelll, run in a 1.7 % ethidium bromide gel and visualized under UV light. Same ITS1 PCR products of 10 randomly selected samples were sequenced commercially. Analysis of sequences was carried out with CLUSTALW2 multiple sequence analyzing software.Results: All 35 CL samples showed the same Leishmania donovani ITS1 RFLP pattern. The BLAST search confirmed that the 10 sequenced Sri Lankan ...
The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather... more The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather than more common visceral form. We have visualized biofilms and profiled the microbiome of lesions and unaffected skin in thirty-nine CL patients. Twenty-four lesions (61.5%) were biofilm-positive according to fluorescence in situ hybridization. Biopsies of biofilm-positive lesions were dominated by Pseudomonas, class Bacilli and Enterobacteriaceae and distinguished by significantly lower community evenness. Higher relative abundance of a class Bacilli OTU was detected in wound swabs versus contralateral skin. Wound swabs and biopsies had significantly distinct microbiome profiles and lower diversity compared to unaffected skin. Greater abundances of potentially pathogenic organisms were observed in wet ulcers, lesions with high parasite loads and large wounds. In summary, more than half of L. donovani associated CL wounds harboured biofilms and the wounds exhibited a distinct, less div...
The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern i... more The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required...
Annals of Tropical Medicine and Public Health, 2016
Background: Trichomoniasis is a sexually transmitted parasitic infection. The World Health Organi... more Background: Trichomoniasis is a sexually transmitted parasitic infection. The World Health Organization (WHO) advocated flow charts for curable sexually transmitted infections (STIs) to improve the care. In this study, an attempt was made to evaluate the validity and reliability of WHO syndromic algorithm for vaginal discharge against trichomonas immunochromatographic test (ICT). Trichomonas ICT is a test with high validity, reliability, and feasibility. Objectives: The objective was to evaluate the validity and reliability of "WHO syndromic algorithm for vaginal discharge" against "trichomonas ICT" as a screening tool for trichomonas infection among women of reproductive age in the Western Province, Sri Lanka. Materials and Methods: This cross-sectional study was conducted in sexually transmitted disease clinics, well woman clinics, gynecology clinics, and institutional health clinics in the Western Province, Sri Lanka. We enrolled 100 women in the age group of 15-45 years using the stratified random sampling method. They were interviewed and examined and the specimens were collected to identify trichomoniasis by culture and ICT. Two-stage analyses were done to evaluate the performance of the WHO algorithm against Trichomonas ICT. Results: In a two-stage analysis, the specificity of syndromic algorithm improved from 80.9% to 94.4% while false positive rate reduced from 19.1% to 5.6%. The net effect of specificity was 98.7% while the false positive rate was 1.3%. Conclusion: The validity and reliability of WHO syndromic algorithm as a diagnostic tool for trichomoniasis can be improved by adding trichomonas ICT.
Introduction: Out of the global incidence of 174 million cases of trichomoniasis per year, 44% (7... more Introduction: Out of the global incidence of 174 million cases of trichomoniasis per year, 44% (76.5 million) of cases occur in the South and South East Asia (WHO). Vaginal trichomoniasis has been linked with complications such as pre term birth, pre mature rupture of membranes, low birth weight, post-abortion or post-hysterectomy infection and acquisition and transmission of HIV(Madico et al.,1998; Wendel, 2003; Schwebke and Burgess, 2004; Schwebke, 2004). Trichomonas vaginalis is a predictor for cervical neoplasia (Viikki et al., 2000) and can reduce the chances of conception for both female and males(Soper, 2004). Not many studies have been done on the prevalence of Trichomonas vaginalis in Sri Lanka. Lack of research in this field had led to the difficulty in identifying the magnitude of the problem and its impact on Sri Lanka. Objectives: The objectives of this study were to compare the syndromic approach, clinical findings and laboratory diagnosis for the determination of the ...
The primary tools for prevention are long-lasting insecticidal nets that reduce contact between v... more The primary tools for prevention are long-lasting insecticidal nets that reduce contact between vector mosquitoes and humans; indoor residual spraying in which residual insecticides (including DDT) are sprayed on the walls of homes; and intermittent ...
Plasmodim vivax malaria accounts for more than 90% of malaria cases in Sri Lanka. There is limite... more Plasmodim vivax malaria accounts for more than 90% of malaria cases in Sri Lanka. There is limited information on the genetic heterogeneity of P. vivax in endemic areas of the country. Here we have assessed the potential of two P. vivax genes as genetic markers for their use in genotyping parasites collected from the field. DNA extracted from Geimsa-stained P. vivax positive slides were genotyped at two polymorphic loci: the P. vivax merozoite surface protein 3- alpha (Pvmsp-3alpha) and circumsporozoite protein (Pvcs). Analysis of these two genetic markers revealed 11 distinguishable variant types from the two genetic markers: 4 for Pvcs and 7 for Pvmsp-3alpha. The results indicate that the P. vivax parasite population is highly diverse in Sri Lanka, despite the low level of transmission.
Resurgence is a major concern after malaria elimination. After the initiation of the elimination ... more Resurgence is a major concern after malaria elimination. After the initiation of the elimination program on Aneityum Island in 1991, microscopy showed that Plasmodium falciparum disappeared immediately, whereas P. vivax disappeared from 1996 onward, until P. vivax cases were reported in January 2002. By conducting malariometric surveys of the entire population of Aneityum, we investigated the age distribution of individuals with parasites during this epidemic in the context of antimalarial antibody levels and parasite antigen diversity. In July 2002, P. vivax infections were detected by microscopy in 22/759 individuals: 20/298 born after the beginning of the elimination program in 1991, 2/126 born between 1982 and 1991, and none of 335 born before 1982. PCR increased the number of infections detected to 77, distributed among all age groups. Prevalences were 12.1%, 16.7%, and 6.0%, respectively ( P < 0.001). In November, a similar age pattern was found, but with fewer infections: ...
Background. Malaria was an endemic problem in Trincomalee District, Eastern Province of Sri Lanka... more Background. Malaria was an endemic problem in Trincomalee District, Eastern Province of Sri Lanka. Very few recent data concerning Anopheles are available which transmit malaria. Therefore, the aim of this study is to identify various Anopheles species and the dynamics of anophelines including malaria vectors in Trincomalee District for effective vector control under the current malaria elimination program embarked in the country. Method. Entomological surveys were conducted on a monthly basis, using five entomological techniques, namely, indoor hand collection (HC), window trap collection (WTC), cattle-baited net collection (CBNC), and cattle-baited hut collection (CBHC) from June 2010 to June 2012 in 32 study areas under five entomological sentinel sites. Results. Seventeen anopheline species were encountered, of which Anopheles subpictus was the predominant species in all sampling methods. It is noted that A. culicifacies and A. subpictus have adapted to breed in polluted water i...
The Southeast Asian journal of tropical medicine and public health, 1998
To assess the possibility of developing a protocol for the clinical diagnosis of malaria, a study... more To assess the possibility of developing a protocol for the clinical diagnosis of malaria, a study was done at the regional laboratory of the Anti-Malaria Campaign in Puttalam, Sri Lanka. Of a group of 502 patients, who suspected they were suffering from malaria, 97 had a positive blood film for malaria parasites (71 Plasmodium vivax and 26 P. falciparum). There were no important differences in signs and symptoms between those with positive and those with negative blood films. It is argued that it is unlikely that health workers can improve on the diagnosis of malaria made by the patients themselves, if laboratory facilities are not available. For Sri Lanka the best option is to expand the number of facilities where microscopic examination for malaria parasites can take place.
Cutaneous leishmaniasis (CL) lesions are chronic and result in disfiguring scars. The microbiolog... more Cutaneous leishmaniasis (CL) lesions are chronic and result in disfiguring scars. The microbiological aspects of these wounds have not been systematically investigated. We have recently reported that 61.5% of CL wounds in a Sri Lankan cohort harboured bacterial biofilms, mainly composed of bacilli, Enterobacteriaceae, and Pseudomonas, which could delay wound healing. We have additionally reported that biofilms were significantly associated patients over 40 years of age, discharge, pain and/or itching of the wound, and high pus cell counts. Using this as background knowledge and other relevant literature, we highlight the importance of investigating the role of biofilms in CL wound healing, clinical indicators, cost-effective laboratory tests involving less invasive sampling techniques for diagnosing biofilms and potential therapeutic options for biofilm-containing CL wounds, such as adjunctive application of wound debridement and antimicrobial treatment along with anti-parasitic drugs.
Objectives: This study was initiated to determine the sensitivity and specificity of a commercial... more Objectives: This study was initiated to determine the sensitivity and specificity of a commercially available rapid diagnostic test (RDT) to detect leishmania antigen in cutaneous leishmaniasis(CL) skin lesions among Sri Lankan patients compared to PCR and Slit skin smear(SSS). Methods: Patients clinically suggestive of CL lesions were subjected to parasitological investigations. The clinical history was collected by the researcher. Samples were collected by a qualified trained medical officer from the suspected CL lesions at the dermatology clinic in the Hambantota hospital and from the patients coming to the Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura. RDT was done at the Hambantota hospital and samples were brought to the Department of Parasitology, to perform SSS, PCR and cultures. Results: Fifty samples have been collected thus far and PCR was performed only in 48 samples. Out of the 50 samples only 9 were positive by RDT and 32 by...
Objectives: To isolate PCR quality DNA from punch biopsy samples of 35 suspected cutaneous leishm... more Objectives: To isolate PCR quality DNA from punch biopsy samples of 35 suspected cutaneous leishmaniasis (CL) lesions, carry out Internal Transcribed Spacer 1 (ITS1) PCR, analyse Restriction Fragment Length Polymorphism (RFLP), sequence of ITS1 region of 10 randomly selected patient samples and to determine the genetic variation among the causative parasites.Methods: Punch biopsies (3mm) from CL lesions (n=35) were taken and stored in NET buffer at -20C. DNA was extracted using a commercially available kit. ITS1 PCR was carried out using previously described primers. PCR products were digested with Haelll, run in a 1.7 % ethidium bromide gel and visualized under UV light. Same ITS1 PCR products of 10 randomly selected samples were sequenced commercially. Analysis of sequences was carried out with CLUSTALW2 multiple sequence analyzing software.Results: All 35 CL samples showed the same Leishmania donovani ITS1 RFLP pattern. The BLAST search confirmed that the 10 sequenced Sri Lankan ...
The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather... more The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather than more common visceral form. We have visualized biofilms and profiled the microbiome of lesions and unaffected skin in thirty-nine CL patients. Twenty-four lesions (61.5%) were biofilm-positive according to fluorescence in situ hybridization. Biopsies of biofilm-positive lesions were dominated by Pseudomonas, class Bacilli and Enterobacteriaceae and distinguished by significantly lower community evenness. Higher relative abundance of a class Bacilli OTU was detected in wound swabs versus contralateral skin. Wound swabs and biopsies had significantly distinct microbiome profiles and lower diversity compared to unaffected skin. Greater abundances of potentially pathogenic organisms were observed in wet ulcers, lesions with high parasite loads and large wounds. In summary, more than half of L. donovani associated CL wounds harboured biofilms and the wounds exhibited a distinct, less div...
The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern i... more The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required...
Annals of Tropical Medicine and Public Health, 2016
Background: Trichomoniasis is a sexually transmitted parasitic infection. The World Health Organi... more Background: Trichomoniasis is a sexually transmitted parasitic infection. The World Health Organization (WHO) advocated flow charts for curable sexually transmitted infections (STIs) to improve the care. In this study, an attempt was made to evaluate the validity and reliability of WHO syndromic algorithm for vaginal discharge against trichomonas immunochromatographic test (ICT). Trichomonas ICT is a test with high validity, reliability, and feasibility. Objectives: The objective was to evaluate the validity and reliability of "WHO syndromic algorithm for vaginal discharge" against "trichomonas ICT" as a screening tool for trichomonas infection among women of reproductive age in the Western Province, Sri Lanka. Materials and Methods: This cross-sectional study was conducted in sexually transmitted disease clinics, well woman clinics, gynecology clinics, and institutional health clinics in the Western Province, Sri Lanka. We enrolled 100 women in the age group of 15-45 years using the stratified random sampling method. They were interviewed and examined and the specimens were collected to identify trichomoniasis by culture and ICT. Two-stage analyses were done to evaluate the performance of the WHO algorithm against Trichomonas ICT. Results: In a two-stage analysis, the specificity of syndromic algorithm improved from 80.9% to 94.4% while false positive rate reduced from 19.1% to 5.6%. The net effect of specificity was 98.7% while the false positive rate was 1.3%. Conclusion: The validity and reliability of WHO syndromic algorithm as a diagnostic tool for trichomoniasis can be improved by adding trichomonas ICT.
Introduction: Out of the global incidence of 174 million cases of trichomoniasis per year, 44% (7... more Introduction: Out of the global incidence of 174 million cases of trichomoniasis per year, 44% (76.5 million) of cases occur in the South and South East Asia (WHO). Vaginal trichomoniasis has been linked with complications such as pre term birth, pre mature rupture of membranes, low birth weight, post-abortion or post-hysterectomy infection and acquisition and transmission of HIV(Madico et al.,1998; Wendel, 2003; Schwebke and Burgess, 2004; Schwebke, 2004). Trichomonas vaginalis is a predictor for cervical neoplasia (Viikki et al., 2000) and can reduce the chances of conception for both female and males(Soper, 2004). Not many studies have been done on the prevalence of Trichomonas vaginalis in Sri Lanka. Lack of research in this field had led to the difficulty in identifying the magnitude of the problem and its impact on Sri Lanka. Objectives: The objectives of this study were to compare the syndromic approach, clinical findings and laboratory diagnosis for the determination of the ...
The primary tools for prevention are long-lasting insecticidal nets that reduce contact between v... more The primary tools for prevention are long-lasting insecticidal nets that reduce contact between vector mosquitoes and humans; indoor residual spraying in which residual insecticides (including DDT) are sprayed on the walls of homes; and intermittent ...
Plasmodim vivax malaria accounts for more than 90% of malaria cases in Sri Lanka. There is limite... more Plasmodim vivax malaria accounts for more than 90% of malaria cases in Sri Lanka. There is limited information on the genetic heterogeneity of P. vivax in endemic areas of the country. Here we have assessed the potential of two P. vivax genes as genetic markers for their use in genotyping parasites collected from the field. DNA extracted from Geimsa-stained P. vivax positive slides were genotyped at two polymorphic loci: the P. vivax merozoite surface protein 3- alpha (Pvmsp-3alpha) and circumsporozoite protein (Pvcs). Analysis of these two genetic markers revealed 11 distinguishable variant types from the two genetic markers: 4 for Pvcs and 7 for Pvmsp-3alpha. The results indicate that the P. vivax parasite population is highly diverse in Sri Lanka, despite the low level of transmission.
Resurgence is a major concern after malaria elimination. After the initiation of the elimination ... more Resurgence is a major concern after malaria elimination. After the initiation of the elimination program on Aneityum Island in 1991, microscopy showed that Plasmodium falciparum disappeared immediately, whereas P. vivax disappeared from 1996 onward, until P. vivax cases were reported in January 2002. By conducting malariometric surveys of the entire population of Aneityum, we investigated the age distribution of individuals with parasites during this epidemic in the context of antimalarial antibody levels and parasite antigen diversity. In July 2002, P. vivax infections were detected by microscopy in 22/759 individuals: 20/298 born after the beginning of the elimination program in 1991, 2/126 born between 1982 and 1991, and none of 335 born before 1982. PCR increased the number of infections detected to 77, distributed among all age groups. Prevalences were 12.1%, 16.7%, and 6.0%, respectively ( P < 0.001). In November, a similar age pattern was found, but with fewer infections: ...
Background. Malaria was an endemic problem in Trincomalee District, Eastern Province of Sri Lanka... more Background. Malaria was an endemic problem in Trincomalee District, Eastern Province of Sri Lanka. Very few recent data concerning Anopheles are available which transmit malaria. Therefore, the aim of this study is to identify various Anopheles species and the dynamics of anophelines including malaria vectors in Trincomalee District for effective vector control under the current malaria elimination program embarked in the country. Method. Entomological surveys were conducted on a monthly basis, using five entomological techniques, namely, indoor hand collection (HC), window trap collection (WTC), cattle-baited net collection (CBNC), and cattle-baited hut collection (CBHC) from June 2010 to June 2012 in 32 study areas under five entomological sentinel sites. Results. Seventeen anopheline species were encountered, of which Anopheles subpictus was the predominant species in all sampling methods. It is noted that A. culicifacies and A. subpictus have adapted to breed in polluted water i...
The Southeast Asian journal of tropical medicine and public health, 1998
To assess the possibility of developing a protocol for the clinical diagnosis of malaria, a study... more To assess the possibility of developing a protocol for the clinical diagnosis of malaria, a study was done at the regional laboratory of the Anti-Malaria Campaign in Puttalam, Sri Lanka. Of a group of 502 patients, who suspected they were suffering from malaria, 97 had a positive blood film for malaria parasites (71 Plasmodium vivax and 26 P. falciparum). There were no important differences in signs and symptoms between those with positive and those with negative blood films. It is argued that it is unlikely that health workers can improve on the diagnosis of malaria made by the patients themselves, if laboratory facilities are not available. For Sri Lanka the best option is to expand the number of facilities where microscopic examination for malaria parasites can take place.
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Papers by Renu Wickremasinghe