Histopathological diagnosis of myocarditis in a dengue outbreak in Sri Lanka, 2009

<p>Abstract</p> <p>Background</p> <p>In 2009, an outbreak of dengue caused high fatality in Sri Lanka. We conducted 5 autopsies of clinically suspected myocarditis cases at the General Hospital, Peradeniya to describe the histopathology of the heart and other organs.</p> <p>Methods</p> <p>The diagnosis of dengue was confirmed with specific IgM and IgG ELISA, HAI and RT-PCR techniques. The histology was done in tissue sections stained with hematoxylin and eosin.</p> <p>Results</p> <p>Of the 319 cases of dengue fever, 166(52%) had severe infection. Of them, 149 patients (90%) had secondary dengue infection and in 5 patients, DEN-1 was identified as the causative serotype. The clinical diagnosis of myocarditis was considered in 45(27%) patients. The autopsies were done in 5 patients who succumbed to shock (3 females and 2 males) aged 13- 31 years. All had pleural effusions, ascites, bleeding patches in tissue planes and histological evidence of myocarditis. The main histological findings of the heart were interstitial oedema with inflammatory cell infiltration and necrosis of myocardial fibers. One patient had pericarditis. The concurrent pulmonary abnormalities were septal congestion, pulmonary haemorrhage and diffuse alveolar damage; one case showed massive necrosis of liver.</p> <p>Conclusions</p> <p>The histology supports occurrence of myocarditis in dengue infection.</p

The Importance of Poisoning vs. Road Traffic Injuries as a Cause of Death in Rural Sri Lanka

Road traffic crashes are considered by the WHO to be the most important global cause of death from injury. However, this may not be true for large areas of rural Asia where road vehicles are uncommon. The issue is important, since emphasising the importance of road traffic crashes risks switching resources to urban areas, away from already underfunded rural regions. In this study, we compared the importance of road traffic crashes with other forms of injury in a poor rural region of South Asia.We collected data on all deaths from injury in the North Central Province of Sri Lanka (NCP; population 1,105,198 at 2001 census) over 18 months using coronial, hospital, and police data. We calculated the incidence of death from all forms of intentional and unintentional injury in the province. The annual incidence of death from injury in the province was high: 84.2 per 100,000 population. Half of the deaths were from self-harm (41.3/100,000). Poisoning (35.7/100,000)-in particular, pesticide self-poisoning (23.7/100,000)-was the most common cause of death, being 3.9-fold more common than road traffic crashes (9.1/100,000).In poor rural regions of South Asia, fatal self-harm and pesticide self-poisoning in particular are significantly more important than road traffic injuries as a cause of death. It is possible that the data used by the WHO to calculate global injury estimates are biased towards urban areas with better data collection but little pesticide poisoning. More studies are required to inform a debate about the importance of different forms of injury and how avoidable deaths from any cause can be prevented. In the meantime, marked improvements in the effectiveness of therapy for pesticide poisoning, safer storage, reduced pesticide use, or reductions in pesticide toxicity are required urgently to reduce the number of deaths from self-poisoning in rural Asia

Contrasting Spatial Distribution and Risk Factors for Past Infection with Scrub Typhus and Murine Typhus in Vientiane City, Lao PDR

Scrub typhus and murine typhus are neglected but important treatable causes of fever, morbidity and mortality in South-East Asia. Epidemiological data suggests that scrub typhus would be more common in rural areas and murine typhus in urban areas but there are very few comparative data from places where both diseases occur, as is the case in Vientiane, the capital of the Lao PDR. We therefore determined the frequency of IgG antibody seropositivity against scrub typhus and murine typhus, as indices of prior exposure to these pathogens, in a randomly selected population of 2,002 adults living in different neighbourhoods in Vientiane. The overall prevalence of IgG against these two pathogens was ∼20%. However, within the city, the spatial distribution of IgG against these two diseases was radically different - past exposure to murine typhus being more frequent in urbanized areas while past exposure to scrub typhus more frequent in outlying areas. This study underscores the importance of ecological characteristics in improving the understanding of both scrub typhus and murine typhus transmission and epidemiology

Delayed diagnosis of Plasmodium vivax malaria in an elderly Sri Lankan pilgrim in India

Malaria was rampant in Sri Lanka two decades ago but we have since been declared free of malaria transmission by the WHO in 2016. However, neighboring India still has a high incidence of malaria, and visitors to India carry a high risk of contracting this disease.  Despite the elimination of indigenous cases of malaria in Sri Lanka, a fair number of cases are detected from travelers coming from endemic regions of the globe.  Delay in diagnosis occurs due to a lack of awareness among the medical community and a missed travel history as observed in this case scenario.We report a 71-year-old previously healthy Sri Lankan male who developed a febrile illness after sixteen days of traveling in India on pilgrimage. He presented with a six day history of of illness and it took a further seven days to consider malaria as a possible diagnosis. Malaria antigen was positive on day thirteen of the illness with Plasmodium vivax trophozoites and gametocytes seen on the thick and thin films. He was treated with chloroquine and recovered slowly with clearing of parasitaemia. A correct diagnosis and close liaison with the anti-malaria campaign helped in the successful management of our patient.This report is an eye opener to consider malaria as a diagnostic possibility and a clinical dilemma and to take a detailed travel history in patients presenting fever. Raising awareness of travelers about prevention against malaria and the need for malaria prophylaxis is also necessary.</p

Atypical manifestations of dengue infection due to co-infection with either hepatitis A or leptospirosis: two case reports

Febrile illnesses of infective aetiology are common causes of hospital admission in tropical countries. In Sri Lanka, the incidence of dengue infection has markedly increased during the last 15 years whilst infections such as leptospirosis and viral hepatitis A remain endemic. Most of the common infections share a common and non-specific symptomatology, making diagnosis at initial presentation difficult. Similarly co-infections can complicate the clinical course but may remain undetected unless a high index of suspicion is maintained especially during epidemics of one infection. We report two cases of co-infections, highlighting the importance of this possibility. Co-existence of dengue infection with hepatitis A in one patient and with leptospirosis in another patient resulted in an atypical and protracted course of illness with confusing clinical features in either case. </p

Influenza B infection, an underestimated killer – an experience at a Tertiary care Hospital – Sri Lanka

Influenza B virus causes outbreaks that are generally less extensive and are associated with less severe disease than those caused by influenza A virus. Influenza B outbreaks are generally seen in schools, military camps and elderly homes. Even though influenza B causes mild disease, severe outbreaks have also been reported and can be associated with significant morbidity and mortality. We report here an outbreak of a rare severe influenza B virus infection which started at a home causing death of one patient due to severe pneumonia and another needing ventilation due to severe myocarditis which then spread to involve the health care workers who were looking after the patient diagnosed as having influenza B. Eventually the outbreak was successfully contained preventing further spread. This illustrates the importance of having a high index of suspicion for the presence of influenza B virus infection as early initiation of treatment can prevent complications and death. It is also a reminder of the importance of taking good hygienic measures including hand washing and isolation of highly infectious patients. DOI: http://dx.doi.org/10.4038/sljid.v3i1.4473 </p