A5014536460- Mosquito-borne diseases and control
- Antibiotic Use and Resistance
- Viral Infections and Vectors
- Respiratory viral infections research
- Influenza Virus Research Studies
- Malaria Research and Control
- Pneumonia and Respiratory Infections
- Patient Satisfaction in Healthcare
- Global Maternal and Child Health
- Bacterial Identification and Susceptibility Testing
- Vaccine Coverage and Hesitancy
- Antibiotic Resistance in Bacteria
- Antimicrobial Resistance in Staphylococcus
- Vector-borne infectious diseases
- Leptospirosis research and findings
- Enterobacteriaceae and Cronobacter Research
- Salmonella and Campylobacter epidemiology
- Innovations in Medical Education
- Renal cell carcinoma treatment
- Bladder and Urothelial Cancer Treatments
- Infective Endocarditis Diagnosis and Management
- Renal and related cancers
- Zoonotic diseases and public health
- Pharmaceutical Practices and Patient Outcomes
- Mobile Health and mHealth Applications
University of Ruhuna
2016-2025
Duke Institute for Health Innovation
2020-2025
Duke University
2015-2025
Engineering Associates (United States)
2019
Biology of Infection
2019
University of St. Gallen
2015-2018
Teaching Hospital Kandy
2018
Johns Hopkins University
2015
Genetech (Sri Lanka)
2015
Abstract Background Antimicrobial resistance has been named as one of the top ten threats to public health in world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce resistance. The purpose this study was determine perceived barriers development and implementation ASPs tertiary care centers three low- middle-income countries (LMICs). Methods Interviews were conducted with 45 physicians at hospitals Sri Lanka (n = 22), Kenya (12), Tanzania (11). assessed knowledge...
Background Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis dengue. Methodology/Principal findings The new WHO 2009 classification dengue divides suspected cases into three categories: without warning signs, with signs severe We evaluated vs physicians' subjective (gestalt impression) in large cohort patients presenting to tertiary care center southern Sri Lanka hospitalized...
Acute respiratory tract infections (ARTIs) are a common reason for unnecessary antibiotic prescriptions worldwide. Our objective was to determine if providing access rapid influenza test results could reduce ARTIs in resource-limited setting. We conducted prospective, pre-post study from March 2013 October 2014. Outpatients presenting hospital Sri Lanka were surveyed influenza-like illness-onset of fever ≥ 38.0°C and cough prior 7 days. Enrolled patients administered structured...
Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to tertiary care hospital in Sri Lanka with influenza-like illness received prescriptions, although almost half were later confirmed have influenza. The purpose this qualitative study was assess Lankan patients' and physicians' attitudes towards ARTI diagnosis treatment.Semi-structured interviews conducted 50 ARTIs five physicians the...
Viruses cause a wide spectrum of clinical disease, the majority being acute respiratory infections (ARI). In most cases, ARI symptoms are similar for different viruses although severity can be variable. The objective this study was to understand shared and unique elements host transcriptional response viral pathogens. We identified 162 subjects in US Sri Lanka with due influenza, enterovirus/rhinovirus, human metapneumovirus, dengue virus, cytomegalovirus, Epstein Barr Virus, or adenovirus....
In low-resource settings, providers often manage lower respiratory tract infections (LRTIs) without diagnostic tests, which may cause antibacterial overuse. Electronic clinical decision support tools (eCDSTs) can evidence-based decision-making and judicious use of antibacterials. This study aimed to explore the potential an eCDST help in Sri Lanka effectively LRTI. Semi-structured interviews were conducted with 15 clinicians, including 10 males five females, average 11.6 years (range: 4–25...
Abstract To determine the proportion of fevers caused by leptospirosis, we obtained serum specimens and epidemiologic clinical data from patients in Galle, Sri Lanka, March–October 2007. Immunoglobulin M ELISA was performed on paired to diagnose acute (seroconversion or 4-fold titer rise) past (titer without leptospirosis seroprevalence (acute). We compared (individually) diagnostic yield acute-phase impression with for leptospirosis. Of 889 specimens, 120 had leptosoirosis 241 The...
BackgroundChikungunya virus (CHIKV) re-emerged in Sri Lanka late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK) patients presenting with undifferentiated febrile illness unstudied rural semi-urban southern 2007. Methodology/Principal FindingsWe enrolled ≥ 2 years of age, collected uniform epidemiologic clinical data, obtained serum samples for serology, isolation, real-time reverse-transcriptase PCR (RT-PCR). Serology on paired...
Dengue is a frequent cause of acute febrile illness with an expanding global distribution. Since the 1960s, dengue in Sri Lanka has been documented primarily along heavily urbanized western coast periodic shifting serotypes. Outbreaks from 2005-2008 were attributed to new clade DENV-3 and more recently newly introduced genotype DENV-1. In 2007, we conducted etiologic surveillance Southern Province confirmed only 6.3% patients, no cases DENV-1 identified. To re-evaluate importance as etiology...
Abstract We studied rickettsioses in southern Sri Lanka. Of 883 febrile patients with paired serum samples, 156 (17.7%) had acute rickettsioses; were unsuspected at presentation. Additionally, 342 (38.7%) exposure to spotted fever and/or typhus group and 121 (13.7%) scrub typhus. Increased awareness of better tests are needed.
Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in the heavily urbanized western coast Sri Lanka since 1960s. New areas are now being affected, and reported number severity cases have increased. To study DENV southern Lanka, we obtained epidemiologic clinical data acute- convalescent-phase serum samples from patients >2 years old with febrile illness. We tested paired for IgG IgM serotyped by using isolation reverse transcription PCR. identified...
In tropical and subtropical settings, the epidemiology of viral acute respiratory tract infections varies widely between countries. We determined etiology, seasonality, clinical presentation among outpatients in southern Sri Lanka. From March 2013 to January 2015, we enrolled presenting with influenza-like illness (ILI). Nasal/nasopharyngeal samples were tested duplicate using antigen-based rapid influenza testing multiplex polymerase chain reaction (PCR) for viruses. Monthly proportion...
Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated UTIs has not been well described. We conducted prospective, laboratory-based surveillance from October to December 2013 at a tertiary care hospital southern Lanka enrolled patients ≥1 year age with clinically relevant due ESBL-PE. Isolate identity, antimicrobial drug...
Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according dengue management guidelines. We systematically evaluated clinical outcomes a large cohort with acute support triaging ambulatory versus inpatient future.From June 2017- December 2018, we conducted surveillance among children and adults fever within prior 7 days who were at largest tertiary-care (1,800 bed) hospital Southern Province, Sri Lanka. Patients developed...
The four serotypes of dengue virus (DENV-1, -2, -3, and -4) have had a rapidly expanding geographic range are now endemic in over 100 tropical subtropical countries. Sri Lanka has experienced periodic outbreaks since the 1960s, but 1989 epidemics become progressively larger associated with more severe disease. dominant 2012 epidemic was DENV-1, DENV-4 infections were also commonly observed. transmission first documented when it isolated from traveler 1978, been comparatively uncommon...
Abstract Background Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on utilization in low- and middle-income countries. The purpose this study was evaluate prevalence patterns prescription an ambulatory care setting Sri Lanka. Methods This cross-sectional survey conducted at Outpatient Department a public tertiary medical center Southern Province, Lanka from February April 2019. Among consecutive outpatients...
Abstract Background The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas high MDRE carriage. We determined the prevalence, timing, associated among infants southern Sri Lanka. Methods Women their newborn children were enrolled within 48 h after delivery Rectal swabs collected from women at enrollment 4–6 weeks later. isolated identified as (positive extended-spectrum β-lactamases or carbapenem...
Leptospirosis is a tropical disease associated with life threatening complications. Identifying clinical and investigation-based parameters that predict mortality morbidity vital to provide optimal supportive care.We conducted an observational study in endemic setting, the southern Sri Lanka. Consecutive patients having complicated leptospirosis were recruited over 18 months. Clinical, investigational treatment data collected predictors of analysed.Out 88 leptospirosis, 89% male. Mean age...
Abstract Diagnostic limitations challenge management of clinically indistinguishable acute infectious illness globally. Gene expression classification models show great promise distinguishing causes fever. We generated transcriptional data for a 294-participant (USA, Sri Lanka) discovery cohort with adjudicated viral or bacterial infections diverse etiology non-infectious disease mimics. then derived and cross-validated gene classifiers including: 1) single model to distinguish vs. (Global...
Abstract A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% medical wards, 68.0% surgical and 97.6% intensive care wards. Amoxicillin-clavulanate was most commonly used for major indications. Among patients antimicrobials, 31.0% received potentially inappropriate therapy.
Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack confirmatory testing. Consecutive outpatients presenting the largest tertiary care hospital southern Sri Lanka were surveyed influenza-like illness (ILI), defined as onset fever ≥ 38.0°C and cough. Patients administered questionnaire nasal/nasopharyngeal sampling rapid influenza A/B We enrolled 311 patients with ILI March November 2013:...
Abstract Background Dengue is a major cause of acute febrile illness in Sri Lanka. has historically been considered an urban disease. In 2012–2013, we documented that dengue was surprisingly associated with self-reported rural residence the Southern Province Methods Patients admitted were enrolled from June 2012–May 2013 cross-sectional surveillance study at largest tertiary care hospital Province. Acute diagnosed by serology and virology testing. Site visits performed to collect residential...
Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated reduction in prescriptions. The economic impact of diagnostic strategies is unknown.We estimated the incremental cost per prescription avoided three versus standard care when managing outpatients influenza-like illness (ILI): (1) clinical prediction tool, (2) targeted testing and (3) universal testing....
The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features viral infection among AFI admissions in Sri Lanka. enrolled patients ≥ 1 year age admitted a tertiary care hospital southern Lanka, June 2012-October 2014. collected epidemiologic/clinical data nasal or nasopharyngeal sample that was tested using polymerase chain reaction (Luminex NxTAG, Austin, TX). determined associations...
Background To develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets improving use. We sought systematically describe the prevalence patterns of use in three LMIC hospitals. Methods Consecutive patients admitted adult medical wards tertiary care hospitals Tanzania, Kenya, Sri Lanka were enrolled 2018–2019. The record was reviewed clinical information including type duration antimicrobials prescribed,...