BackgroundAlthough the physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date. Therefore, the objective of the present study was to determine the prevalence of depressive, anxiety and stress symptoms among past dengue patients.MethodsA community-based, case–control study in a multi-ethnic urban setting was conducted in Sri Lanka involving adults who were diagnosed to have dengue fever by a positive dengue IgM antibody response between 6 and 24 months ago. Self-administered Depression, Anxiety and Stress Scale (DASS-21), Centre for Epidemiological Studies Depression Scale (CESD-20) and a structured clinical interview by a psychiatrist were done in the patients and in an age and gender-matched control group.ResultsFifty-three participants each in the patient (mean age 42.9 years, SD 15.5) and control (mean age 41.6 years, SD 15.3) groups were surveyed. The ages ranged from 18 to 70 years and 64.2% were females. The majority (90.6%; n = 48) of the individuals had been diagnosed with dengue fever followed by dengue haemorrhagic fever (9.4% n = 5). Dengue patients had higher DASS-21 mean depressive scores (means 11.7/9.4, SD 6.4/4.0, t = 2.2, p = .028), anxiety scores (means 10.7/7.2, SD 6.8/1.8, t = 3.6, p = .0005), stress scores (means 12.0/8.8, SD 5.3/3.5, t = 3.6, p = .0004) and CESD-20 scores (means 16.1/11.7, SD 9.4/7.3, t = 2.6, p = .008) than controls. The DSM-5 depressive disorder was clinically detected by the psychiatrist among 15.1 and 7.5% in patient and control groups (OR 2.1; CI .5–7.7; p = .22). Limitations: a limitation is the small sample size.ConclusionPatients with past dengue had significantly higher depressive, anxiety and stress symptoms than the control group according to the DASS-21 and CESD-20 tools. To our knowledge, this is the first report on delayed psychological morbidity related to dengue. This may warrant healthcare professionals to incorporate mental counselling for dengue patients.
Rapidly progressing antibiotic resistance is a great challenge in therapy. In particular, the infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are exceedingly difficult to treat. Carbapenemase production is the predominant mechanism of resistance in CRE. Early and accurate identification of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is extremely important for the treatment and prevention of such infections. In the present study, four phenotypic carbapenemase detection tests were compared and an algorithm was developed for rapid and cost-effective identification of CP-CRE. A total of 117 Enterobacteriaceae (54 CP-CRE, 3 non-CP-CRE, and 60 non-CRE) isolates were tested for carbapenemase production using modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test (CNPt), and CNPt-direct test. The overall sensitivity/specificity values were 90.7%/92.1% for MHT, 100%/100% for mCIM, 75.9%/100% for CNPt, and 83.3%/100% for CNPt-direct. OXA-48-like enzymes were detected with 93.2% sensitivity by MHT and >77.3% sensitivity by two Carba NP tests. MHT could only detect half of the NDM carbapenemase producers. CNPt-direct exhibited enhanced sensitivity compared to CNPt (100% vs 25%) for detection of NDM producers. Considering these findings we propose CNPt-direct as the first test followed by mCIM for rapid detection of CP-CRE. With this algorithm >80% of the CP-CRE could be detected within 24 hours from the time the sample is received and 100% CP-CRE could be detected in day two. In conclusion, mCIM was the most sensitive assay for the identification of CP-CRE. CNPt-direct performed better than CNPt. An algorithm consisting CNPt-direct and mCIM allows rapid and reliable detection of carbapenemase production in resource-limited settings.
Objective:Dirofilariasis is a parasitic infection caused by filarial nematodes belonging to the genus Dirofilaria. Human dirofilariasis due to Dirofilaria repens has been widely reported from European countries. Sri Lanka is the most affected country in Asia with an infection rate of almost 60% in dog population. However, human infection of D. repens remains undiagnosed and many of the cases are not scientifically documented. Therefore, the objective of the present investigation is to document the presence of dirofilariasis infections in humans.Method:A 1 year and 10 months old boy from Ragama, Gampaha District, Western Province of Sri Lanka, was presented to a private hospital with a painless, non-pruritic and ill-defined subcutaneous nodule on his right hypochondrial region of the anterior abdominal wall for 1 week. On examination, there was a non-tender swelling measuring 2 cm × 2 cm in the anterior abdominal wall, with surrounding mild redness. The patient was referred for ultrasound confirmation.Results:The ultrasound scan revealed a hypoechoic nodular lesion measuring 11 mm × 6 mm in the anterior abdominal wall. Parasitological examination on the excised nodule confirmed the presence of D. repens measuring 10.5 cm in length having characteristic cuticle with longitudinal ridges.Conclusion:It is essential to record the human infections and increase the awareness about this infection, diagnostic tests and vector controlling measures, in order to reduce the disease prevalence through suppressing vector densities, proper diagnosis and patient care.
Wounds present serious health problems in humans and animals. Importantly, if left untreated, wounds invariably lead to long-term morbidity. The inappropriate use and costs of antibiotics place significant challenges globally and affect the health budgets of many countries. Though some antibiotics are administered systemically, treatment of localized infections, in particular, chronic wound infections, does not need such therapy—this would minimize development of antibiotic resistance. Of these measures, nanoparticles of silver, ZnO, and gold seem to give promising results against common wound pathogens while having few limitations. Chemical components of essential oils, which are extracted from different plants, have been shown to act against common wound pathogens. Plant extracts have shown different mechanisms in biofilm elimination. Chlorhexidine and chlorine derivatives act as wound antiseptics. Attempts with biological agents such as maggots have also been shown to provide anti-infective as well as mechanical removal of wound debris. Honey, including those obtained from bees, has a wide coverage against wound pathogens. Glycerin and hypertonic saline are anti-infective through the concentration-dependent killing of pathogens. Hyperbaric oxygen acts against many wound pathogens, in particular anaerobes. This review is focused on nonantibiotic attempts for the cure of localized infections, in particular, chronic wounds with common wound pathogens.
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