The Quest for Understanding Cutaneous Leishmaniasis in Northern Province,Sri Lanka:An Analysis of Clinical Data From the District General Hospital,Vavuniya

The study aimed to examine the clinical and epidemiological patterns of cutaneous leishmaniasis(CL)in patients attending the Dermatology Unit,District General Hospital in Vavuniya,Sri Lanka.A total of 77 patients clinically suspected for CL were interviewed through a structured questionnaire,and skin-lesion samples were obtained between January 2016 and January 2017.The definitive diagnosis of CL was made through microscopic identification of smears,histopathological examination of biopsies and kDNA PCR.Treatment modalities were chosen based on the location of the lesions on the body and complexity of the lesions.Of 77 suspected patients,68 were confirmed for CL,with a mean age of 34.6(±12.7)years,and included 54 males(79.4%)and 14 females(20.6%).Being a male was a significant risk factor(P=0.032,OR=4.82)associated with CL.Lesions were observed mainly on the exposed areas of the body,of which the forearm(22.1%)was the most commonly affected site.Single lesions(75.0%)and ulcerated nodules with central crust(39.7%)were the prominent features among the infected group.The age group of 21–40 years was significantly associated with healing lesions(P=0.028,marginal effect=0.55).However,a significant negative relationship was detected between ulcerated nodular lesions and lesion healing(P=0.0436,marginal effect=−0.375).Males are at higher risk of CL.Early diagnosis and specific treatment,along with preventive measures such as protective clothing and sand fly repellents,can limit the spread of the disease.There is a need for a comprehensive approach to prevent and control the transmission of CL.

Comparative Evaluation of RT-PCR Kits Available in Sri Lanka for Diagnosis of COVID-19

Identification of gene targets by real-time reverse transcriptase PCR(rRT-PCR)is considered as the gold standard for diagnosis of se-vere acute respiratory syndrome coronavirus 2(SARS-CoV-2)infections.Although many commercial rRT-PCR kits are currently used in Sri Lanka,analytical performance of these kits have not been investigated adequately.Therefore,the objective of the present study was to evaluate the analytical performance of rRT-PCR kits used in the laboratory of the Faculty of Medicine,University of Jaffna(five kits).Performance of the five rRT-PCR kits selected for this study was compared with the CDC 2019-Novel Coronavirus(2019-nCoV)RT-PCR Diagnostic Panel as reference standard.The sensitivity,specificity,positive predictive value,negative predictive value and Cohen’sκcoefficient of the five different commercial kits were analyzed.SARS-CoV-2 positive(62)and negative(32)respiratory sam-ples collected respectively from symptomatic individuals and asymptomatic healthy individuals were used in this study.Comparison of the cycle threshold(Ct)values of the five commercial kits revealed heterogeneity.Among them,the TaqPathTM kit showed the highest sensitivity(98.4%)and interrater reliability(0.976).The HBRT-COVID-19 kit showed the lowest sensitivity(91.9%),specificity(93.7%)and interrater reliability(0.838).Although the five RT-PCR kits exhibited varying sensitivity,specificity and Ct values,all of them are suitable for the routine diagnosis of SARS-CoV-2 infections as all values were higher than 90%.

Cytomorphological Variations of Leishman-Donovan Bodies Found in Cutaneous Leishmaniasis Patients in Sri Lanka

Leishmania parasites undergo a dimorphic life cycle.Diagnosis of cutaneous leishmaniasis(CL)is primarily made by the microscopic identification of the amastigote form of the parasite in a smear.Therefore,correct identification of Leishman-Donovan(LD)bodies in smears is crucial for CL confirmation.The aim of this study was to provide a broad overview of different cytomorphologies of LD bodies to improve the sensitivity of microscopic detection of Leishmania donovani,which causes CL in Sri Lanka.A total of 125 smears,prepared from patients who met the positive diagnostic criteria of CL,were Giemsa stained and examined microscopically.The density,cellular location and all possible cytomorphological forms of the parasite were documented.A total of 10 different cytomorphological forms of LD bodies were identified.Among them,the round form was observed only intracellularly.The other morphological forms,namely the pear shape,cigarette shape,candle flame form,embryo shape,flagellate form,binary form and rosette form,were found only extracellularly.The spindle form and lens shape were observed in both intracellular and extracellular locations.L.donovani amastigotes have a wide range of morphologies besides their classical forms.Although Leishmania are considered as obligatory intracellular parasites,theymanage to survive successfully within the extracellular hostile conditions as well.Therefore,having a broader view of different morphological forms for Leishmania parasites may help to improve diagnosis of CL.