Legionella pneumonia as a cause of atypical pneumonia in a tertiary care hospital in Sri Lanka

Atypical pneumonia which contributes to an important proportion of community acquired pneumonia and Legionella pneumophila is a noteworthy pathogen worldwide. Legionnaires’ disease, the severe form of pneumonia is predominantly caused by Legionella pneumophila serogroup 1. This study was conducted to determine the presence of Legionella pneumophila as a pathogen and the associated risk factors among the patients admitted with atypical pneumonia to a tertiary care hospital in Sri Lanka. Seventy-five adult patients diagnosed with atypical pneumonia attending professorial medical unit of Colombo South Teaching Hospital, Sri Lanka were enrolled. Risk factors related to the disease was assessed by an interviewer administered questionnaire. Expectorated sputum was processed on supplemented buffered charcoal yeast extract medium and urine specimens were tested for Legionella pneumophila serogroup 1 antigen. Fifty-six percent of the patients were males and 91% were residing in urban areas. Smoking was admitted by 32% and that of alcohol consumption was in 25%. Composting and potting, distant travelling and frequent use of air conditioning was reported in 28%, 37% and 4% respectively. Majority of participants were not exposed to cooling towers, humidifiers or plumbing and not visited high risk areas. Among the study group, 21% had diabetes, 24% had ischaemic heart disease and 36% had chronic lung diseases. None of the sputum samples grew Legionella pneumophila, and all urine samples were negative for the antigen of Legionella pneumophila serogroup 1. It is concluded that, in this population of community acquired atypical pneumonia, Legionella pneumophila was not identified as a causative agent. KEYWORDS: Atypical pneumonia, community acquired pneumonia, Legionella pneumophil

Evaluation of bactericidal activity of antiseptics and disinfectants commonly used in healthcare settings in Colombo District

Background: Increasing risk of healthcare associated infections especially polymicrobial wound infections is a major problem in healthcare settings in Sri Lanka. Proper use of antiseptics and disinfectants may be useful in reducing the magnitude of such infections.Objectives: To determine the efficacy of bactericidal activity in recommended concentrations and lower concentrations of selected antiseptics and disinfectants.Methods: Bactericidal activity of 40%, 50% and 60% isopropyl alcohol, 1%, 5% and 10% povidone iodine, 1%, 2% and 4% chlorhexidine gluconate, 1.22%, 1.42% and 1.62% peracetic acid, 1.9% and 2.9% hypertonic saline and 1.5%, 2% and 2.5% of the mixture of 2-aminoethanol, didecyldimethylammonium chloride, potassium carbonate and bis (3-Aminopropyl) dodecylamine was evaluated with 9 standard strains of American Type Culture Collection (ATCC) and 13 clinical isolates of bacteria. Reduction of growth of methicillin sensitive Staphylococcus aureus (MSSA), methicillin resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, Enterococcus faecalis, Acinetobacter baumannii, Escherichia coli, Klebsiellapneumoniae (ESBL and carbapenem resistant), Pseudomonas aeruginosa was assessed with contact times of 1 minute, 15 minutes and 24 hours by counting colonies comparing with test control which contains same volume of distilled water instead of antiseptic or disinfectant solution.Results: All chemicals except hypertonic saline showed 100% bactericidal activity in all concentrations against all tested bacteria in stated contact times. Hypertonic saline in 1.9% and 2.9% showed significant reduction of Gram positive bacteria and Acinetobacter baumannii only after 24 hours. Acinetobacter baumannii was inhibited by1.9% and 2.9% of hypertonic saline in 67.48% and 68.20% of respectively; however, other Gram negative bacteria were not inhibited.Conclusion: Recommended concentrations of antiseptics and disinfectants have an accepted bactericidal activity against tested standard strains and clinical isolates. Hypertonic saline is only effective to inhibit Gram positive bacteria after 24 hours of contact time.Acknowledgement: Staff of Department of Microbiology, the University of Sri Jayewardenepura, Sri Jayewardenepura General Hospital and Colombo South Teaching Hospital

Microbiological analysis of skin and soft tissue infections in cancer patients at Apeksha Hospital, Sri Lanka

Background: Skin and soft tissue infections (SSTIs) in patients with malignancies are common and frequently have serious consequences. These infections are caused by a wide range of microorganisms with variable anti-microbial susceptibilities.Objectives: To analyse skin and soft tissue infections in cancer patients at Apeksha Hospital with regard to causative agents, antibiotic susceptibility and associated factors.Methods: A descriptive cross sectional study was carried out for 18-month period. Specimens from adult cancer patients admitted to Apeksha Hospital, Maharagama with SSTIs were analysed. Aerobic and anaerobic bacterial culture, fungal culture, species identification and antibiotic susceptibility testing were performed. Clinical data were obtained from patient records.Results: A total of 85 patients were included with a male: female ratio of 1:1.1.Majority (75%) were >50 years old. Out of the 80 aerobic bacterial isolates most (69%) were Gram negatives, majority being Enterobateriaceae (42/80) followed by Pseudomonas (11/80). Escherichia coli was the commonest bacterial species. Staphylococcus aureus was the commonestGram positive organism (22/80). No strict anaerobic bacteria were yielded however, 3 fungi (two Candida albicans, one Fusarium species) were isolated. Enterobacteria showed lowest resistance to amikacin (7%) and meropenem (10%). Pseudomonas species had highest resistance to ticarcillin-clavulanate (64%). Methicillin resistant Staphylococcus aureus (MRSA) rate was 61%. None had resistance to anti-MRSA agents. Gram-negative bacteria caused 74% of wound infections while 54% of the abscesses were caused by Gram positives. Gram negatives were prevalent (73%) in patients with solid organ cancers and Gram positives in haematological malignancies (83%). Gram-negative infections (69%) predominate in patients on radiotherapy while chemoptherapy had similar rates of infections by the two types of organisms.Conclusion: SSTIs in the cancer patients at Apeksha Hospital, Maharagama are mainly caused by Gram negative bacteria however, Gram positives predominate in haematological malignancies. Multi-drug resistance is prevalent in all commonly isolated pathogens.Acknowledgements: University of Sri Jayewardenepura research grant ASP/01/R/MED/2016/61 (Centre for Cancer Research

Are the health care workers geared to prevent H1N1 in the future?

Objective: Our aim was to assess the knowledge on transmission and prevention of H1N1 influenza among health care workers who play a fundamental role in the community. Methods: We selected Colombo South Teaching Hospital as the study setting to conduct a descriptive cross sectional study. The expected proportion of adequate knowledge was taken as 50% and at 0.05 precision with a non-respondent rate of 10% a study sample of 406 nurses was obtained. A self-administered questionnaire aided in seeking information on socio-demographic details, knowledge and attitude regarding H1N1. Significance level was set at p < 0.05 and tested using Chi-square. Results: Majority knew nasal secretions 338(83.3%) and infective saliva 308(75.9%) as modes of transmission of H1N1 and their mean score was 8.37(S.D±1.53) out of 10. Higher percentages of the study sample knew about hand hygiene 375(92.4%), facial masks 391(96.3%), and patient isolation 344(84.5%) as effective means of prevention. A proportion of 80.5% (n=327) also knew that vaccine is a preventive method and their knowledge on its efficacy had a significant association with vaccination (p= 0.001). However 55.9% (n=227) have not been vaccinated due to side effects of the vaccine. The practices on both transmission of H1N1 (p=0.171) and prevention of H1N1 had no significant association with their actual knowledge (p=0.268). Conclusion: Despite the knowledge their practice of prevention as health care workers was inadequate. Therefore the necessity arises to identify areas in which improvement can be made with the purpose of getting them efficiently and confidently involved in disease prevention

Knowledge, attitudes and practices of hand hygiene among final year medical and nursing students at the University of Sri Jayewardenepura

Effective hand hygiene is essential for reducing healthcare associated infections. However, compliance of healthcare workers to hand hygiene guidelines are reportedly poor. It is important therefore to instill adequate knowledge and good attitudes and practices at the time of primary training of the healthcare workers. This study was done to identify gaps in knowledge, attitudes and practices to improve existing training programs and enhance good practices and working ethics in the future. A self-administered questionnaire based cross sectional study was done to compare the knowledge, attitudes, practices and satisfaction of facilities between final year medical and nursing students of the Faculty of Medical Sciences, University of Sri Jayewardenepura. Participants had moderate knowledge (77%) but attitudes, practices and satisfaction of facilities of all the participants was overall poor (&lt;50%). However the nursing students had better knowledge (p=0.023), attitudes (p&lt;0.001), practices (p&lt;0.001) and satisfaction of facilities (p&lt;0.001) compared with the medical students. The knowledge, attitudes, practices and satisfaction of facilities of medical and nursing students are unsatisfactory. The study shows the need for further improvement of the existing hand hygiene training programs to address the gaps in knowledge, attitudes and practices. Further, there is a need to improve the facilities available for hand hygiene and make them readily accessible for students at their training centers to enable them to engage in good practices which will be beneficial for them as doctors and nurses in the future. DOI: http://dx.doi.org/10.4038/sljid.v3i1.4761 </p

Etiology of superficial fungal infections among cleaning staff at University of Sri Jayewardenapura

Objective: Superficial fungal infections (SFIs) are the infections of the keratinous tissue caused by dermatophytes, yeasts and non-dermatophyte fungi. Cleaners are identified as a risk category for the SFI as they are frequently exposed to moist environment.To determine the etiological agent causing SFIs among cleaning staff at Sri Jayewardenepura University. Methods: Eighty cleaners were included in the study. Fifty six were clinically suspected for SFIs. Laboratory identification  was done using direct microscopy with 10% KOH or Gram stain followed by culture on Sabouraud's Dextrose Agar with or  without 0.05 mg/ml Chloramphenicol at 25ºC- 30 ºC aerobically for three weeks. Speciation was done using   morpho physiological methods. Results: Forty one (51.2%) had SFIs. Out of the 56 clinically suspected cases 76 specimens were collected from different infected sites. Out of 65 scrapings and nail clippings, 45 (69.2%) were KOH positive while 4 (6.1%) were identified as Pityriasis versicolor by KOH. Sixteen  (24.6%) were negative for KOH. Out of KOH positive specimens only 28 were culture positive while 17 were culture negative.Aspergillus niger was the comments organism isolated from these specimens (20) followed by the non albicans Candida spp. (7), Candida albicans (2), dematiaceous fungi (7), Pityriasis versicolor (4), Fusarium spp. (3) and dermatophyte species. Multiple fungal species were isolated in 4 specimens. Conclusion: Aspergillus niger was the commonest pathogen causing SFIs among the study group followed by non albicans Candida spp. Regular examination of this population is recommended because they are at high risk for fungal diseases

Proportion of Superficial fungal infections among the cleaning staff members at University of Sri Jayewardenepura

IntroductionSuperficial fungal infections (SFIs) are infections of the keratinous tissue caused by dermatophytes, yeasts and non-dermatophyte fungi.  Cleaning staff are identified as a risk category for the SFI as they are frequently exposed to moist environment.ObjectiveTo determine the proportion of infection, knowledge, attitudes, practices and risk factors of superficial fungal infections among the cleaning staff members at University of Sri JayewardenepuraMethodsEighty two cleaning staff members were included in the study. Clinical examination for SFIs was done by a medical officer and sample processing was carried out at the Department of Microbiology at University of Sri Jayewardenepura between May to October 2012. Laboratory identification of the fungal organisms was done using direct microscopy (10% KOH) followed by culture on Sabouraud's Dextrose Agar. Morphological and physiological methods were used to specieate the isolated fungi. An interviewer administrated questionnaire was carried out to assess the knowledge, attitudes and practices (KAPs) on SFIs. Data were categorized and scored based on variables that were to be analyzed. Results Forty one of 82 participants (51.2%) had SFIs. Out of the 56 clinically suspected cases 76 specimens were collected from different infected sites. Four skin scrapings were identified as Pityriasis versicolor by direct smear. Out of 57 scrapings and nail clippings, 45 (79%) were KOH positive, twelve (21%) were negative for direct smear.  Out of direct smear positive specimens only 28 were culture positive while 17 were culture negative. Aspergillus niger was the commonest organism isolated from these specimens (20) followed by the non albicans Candida spp. (7), Candida albicans (2), dematiaceous fungi (7), Pityriasis versicolor (4), Fusarium spp. (3) and dermatophyte species. Multiple fungal species were isolated in 4 specimens.Regarding total marks presentation of KAPs, our study population had an unsatisfactory level of knowledge 35(42.2%) while majority 40 (48.8%) had good attitudes, and 48 (58.5%) were shown to have a satisfactory level of safety practices.Describing the risk factors for SFIs among cleaning staff was one objective of our study. However our study showed that there was no statistically significant relationship between the risk factors with SFIs. ConclusionAspergillus niger was the commonest pathogen causing SFIs in the study group. Although participants have a satisfactory level of knowledge, attitudes and practices towards the SFIs regular examination of this population is recommended because they are at high risk for SFIs.DOI: http://dx.doi.org/10.4038/sljid.v4i1.6061</p

Group B Streptococcus colonisation and their antimicrobial susceptibility among pregnant women attending antenatal clinics in tertiary care hospitals in the Western Province of Sri Lanka

The proportion of Group B Streptococcus (GBS) colonisation in pregnant women >35 weeks of gestation was 18% and 49% by culture and real-time PCR respectively in selected hospitals from the Western Province of Sri Lanka. A Descriptive cross-sectional study was conducted from January to April 2019. Two low vaginal and rectal swabs were collected from 100 pregnant women. Identification of GBS was done by culture and real-time PCR. GBS isolates were found to be sensitive to penicillin, ampicillin, cefotaxime, vancomycin, while 5 and 4 isolates out of 18 were resistant to erythromycin and clindamycin, respectively. Further, there was a significant association between GBS colonisation and a history of vaginal discharge and unemployment.IMPACT STATEMENT What is already known on this subject? Prevalence of GBS colonisation in the vagina and rectum of pregnant women in developing countries ranges from 8.5% to 22%. The Conventional method of culture has been considered the gold standard for diagnosis, however, the culture method does not give positive results for all cases of GBS. Polymerase chain reaction (PCR) has been found to be more sensitive for the detection of GBS than culture. In Sri Lanka, ante-natal screening for GBS is not practiced as the prevalence of GBS is still unlcear due to non-availably of data. Only a few scattered studies have been conducted using culture in Sri Lanka. Thus there is an urgent need to determine the magnitude of the GBS colonisers of ante-natal women in order to set up guidelines for screening and management of GBS. What do the results of this study add? In this study, the overall GBS colonisation rate which was detected using both culture and PCR was 50% in Western Province of Sri Lanka. That was a high figure when compared to the figures which were detected previously in Sri Lanka using only conventional culture methods. The risk factors for GBS colonisation were found to have a significant relationship with the history of abnormal vaginal discharge. Further, it was found that when Candida species coexisted with GBS, the existence of GBS was enhanced. Penicillin remains the antibiotic of choice for GBS. What are the implications of these findings for clinical practice and/or further research? This study emphasises the importance of establishing national policies for screening of pregnant women of >35 weeks of gestation to reduce the risk of neonatal infection. Further, it gives an insight into the options of antibiotics that can be used for treatment of these GBS colonisers from Sri Lanka

Aspergillus species: An emerging pathogen in onychomycosis among diabetics

Introduction: Approximately, 33% patients with diabetes are afflicted with onychomycosis. In the past, nondermatophyte molds have been regarded as opportunistic pathogens; recently, Aspergillus species are considered as emerging pathogens of toenail infections. In Sri Lanka, the prevalence of Aspergillus species in onychomycosis among diabetics is not well documented. Objective: To determine the proportion of Aspergillus onychomycosis, risk factors and knowledge among diabetics. Materials and Methods: This was descriptive cross-sectional study. Three hundred diabetic patients were included. Clinical examinations of patients' toenails were performed by a clinical microbiologist. Laboratory identification was done, and pathogens were identified to the species level by morpho-physiological methods. All inferential statistics were tested at P < 0.05. Results: Among clinically suspected patients, 85% (255/300) were mycologically confirmed to have onychomycosis. Aspergillus species were most commonly isolated n = 180 (71%) followed by dermatophytes, yeasts, and other molds n = 75 (29%). Of the patients having Aspergillus onychomycosis, 149 (83%) were in the > age group. In men, Aspergillus onycomycosis was seen in 82%. Among patients who had Aspergillus nail infection, 114 (63%) had diabetes for a period of > years. Among patients who were engaged in agricultural activities, 77% were confirmed to have infected nails due to Aspergillus species. Conclusion: Aspergillus niger was the most common pathogen isolated from toenail infection. Aspergillus species should be considered as an important pathogen in toenail onychomycosis in diabetic patients. Risk factors associated with Aspergillus onychomycosis were age, gender, duration of diabetes, length of exposure to fungi, and occupation

Association of GDF15 levels with body mass index and endocrine status in β-thalassaemia.

Funder: Medical Research Council; Id: http://dx.doi.org/10.13039/501100000265Funder: Deutsche Forschungsgemeinschaft; Id: http://dx.doi.org/10.13039/501100001659Funder: European Association for the Study of Diabetes; Id: http://dx.doi.org/10.13039/501100007885Funder: Heinrich‐Heine‐Universität Düsseldorf; Id: http://dx.doi.org/10.13039/501100003484OBJECTIVE: GDF15 has emerged as a stress-induced hormone, acting on the brain to reduce food intake and body weight while affecting neuroendocrine function. Very high GDF15 levels are found in thalassaemia, where growth, energy balance and neuroendocrine function are impaired. We examined the relationships between GDF15 and anthropometric measures and endocrine status in β-thalassaemia. DESIGN: Cross sectional study. PATIENTS: All β-thalassaemia patients attending the thalassaemia unit of Colombo North Teaching Hospital for blood transfusions. MEASUREMENTS: Anthropometric data, appetite scores, circulating GDF15, IGF, thyroid and reproductive hormone levels in 103 β-thalassaemia patients were obtained. RESULTS: GDF15 levels were markedly elevated in thalassaemia patients (24.2-fold with β-thalassaemia major compared with healthy controls). Among patients with β-thalassaemia major, the relationship between GDF15 and body mass index (BMI) was curvilinear with all individuals with GDF15 levels above 24,000 pg/mL having a BMI below 20 kg/m2 . After adjustment for BMI, age and Tanner stage, serum IGF1 concentrations correlated negatively with GDF15 in all thalassaemia patients (β = -.027, p = .02). We found a significant positive relationship between GDF15 and gonadotropin (in both sexes) and testosterone (in males). CONCLUSIONS: GDF15 levels were markedly elevated in patients with β-thalassaemia and its association with BMI is consistent with the known effect of GDF15 to reduce body weight. The inverse association between GDF15 with IGF1 levels may reflect a neuroendocrine impact of GDF15 or an indirect effect via impaired nutritional state. The positive association with testosterone in males and gonadotropins in both sexes, was surprising and should prompt further GDF15 studies on the hypothalamic pituitary gonadal axis