BackgroundClinically diagnosed amoebic liver abscess (ALA) caused by Entamoeba histolytica has been an important public health problem in Jaffna district, northern Sri Lanka for last three decades. In order to draw up a control strategy for elimination of this condition, knowledge of its epidemiology and factors associated with this condition in the local context is vital.MethodsAll clinically diagnosed ALA patients admitted to the Teaching Hospital, Jaffna during the study period were included in the study and the data were collected using an interviewer administered questionnaire. One hundred blood samples from randomly selected toddy (a local alcoholic drink consisting of the fermented sap of the Palmyrah palm) consumers and 200 toddy samples were collected. Toddy samples were cultured in Robinson’s medium to establish the presence of Entamoeba histolytica in the sample. Climatic data and the total toddy sales in the district were obtained from the Meteorological and Excise Departments respectively. A sub group of randomly selected 100 patients were compared with 100 toddy consumers who were negative for E. histolytica antibody to explore the potential risk factors.ResultsBetween July 2012 and July 2015, 346 of 367 ALA patients were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy consumption of alcohol (100%). Almost all (94.2%) were within the age group 31–50 years. None of the cultured toddy samples grew E. histolytica. The monthly incidence of disease peaked in the dry season, matching the total toddy sales in the district. Age, type of alcohol and frequency of drinking were identified as potential risk factors whereas frequency of alcohol consumption and type of alcohol (consuming toddy and arrack) were identified as the independent risk factors. Moreover, the knowledge, attitude and practices towards ALA were poor among participants and the control group.ConclusionsThough the number of cases has declined in recent years, ALA still remains as an important public health problem in Jaffna district. The transmission route of E. histolytica leading to ALA has to be further explored. Moreover, greater awareness among the public who are at risk would be beneficial in order to eliminate the disease.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5036-2) contains supplementary material, which is available to authorized users.

BackgroundDengue, chikungunya, malaria, filariasis and Japanese encephalitis are common mosquito-borne diseases endemic to Sri Lanka. Aedes aegypti and Aedes albopictus, the major vectors of dengue, were recently shown to undergo pre-imaginal development in brackish water bodies in the island. A limited survey of selected coastal localities of the Jaffna district in northern Sri Lanka was carried out to identify mosquito species undergoing pre-imaginal development in brackish and saline waters. The effect of salinity on the toxicity of Bacillus thuringiensis israelensis larvicide to Ae. aegypti larvae at salinity levels naturally tolerated by Ae. aegypti was examined.MethodsLarvae collected at the selected sites along the Jaffna coast were identified and salinity of habitat water determined in the laboratory. The LC50 and LC90 of B. thuringiensis toxin, the active ingredient of a commercial formulation of the larvicide BACTIVEC®, were determined with Ae. aegypti larvae. Bioassays were also carried out at salinities varying from 0 to18 ppt to determine the toxicity of Bacillus thuringiensis to fresh and brackish water-derived larvae of Ae. aegypti.ResultsLarvae of four Anopheles, two Aedes, one Culex and one Lutzia species were collected from brackish and saline sites with salinity in the range 2 to 68 ppt. The LC50 and LC90 of B. thuringiensis toxin for the second instar larvae of Ae. aegypti in fresh water were 0.006 ppm and 0.013 ppm respectively, with corresponding values for brackish water populations of 0.008 and 0.012 ppm respectively. One hundred percent survival of second instar fresh water and brackish water-derived Ae. aegypti larvae was recorded at salinity up to 10 and 12 ppt and 100% mortality at 16 and 18 ppt, yielding an LC 50 for salinity of 13.9 ppt and 15.4 ppt at 24 h post-treatment respectively for the two populations. Statistical analysis showed significantly reduced toxicity of B. thuringiensis to fresh and brackish water-derived Ae. aegypti larvae at high salinities.ConclusionA variety of mosquito vectors of human diseases undergo pre-imaginal development in brackish or saline waters in coastal areas of the Jaffna district in northern Sri Lanka. Salinity has a small but significant negative impact on the toxicity of B. thuringiensis toxin to Ae. aegypti larvae at salinity levels where Ae. aegypti larvae are found in the environment. This has implications for the use of B. thuringiensis toxin as a larvicide in brackish waters.

BackgroundSince 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial.MethodsAll clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson’s medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced.ResultsFrom July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results.ConclusionTo our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.

BackgroundMany cases of Cutaneous Larva Migrans (CLM) have been observed among devotees, during and immediately after the annual festival at the Nallur Hindu temple in Jaffna.ObjectiveTo ascertain the risk factors associated with infestation and devotees' knowledge and practices regarding the condition.Methodology/Principal FindingsA cross-sectional study using an interviewer-administered questionnaire and observation was conducted in August 2010. Out of 200 selected devotees 194(97%) responded. Soil and dog faecal samples were collected from the temple premises and examined for the presence of nematode larva and egg respectively. Among 194 male respondents, 58.2%(95% CI: 51.2%–65.0%) had lesions of CLM. One hundred and thirty (67%) respondents performed the ritual everyday; whereas 33% did so on special days. One hundred and twelve (57.7%) participants performed the ritual before 5.00am and remaining 42.3% performed after 5.00am. Among the participants, 77(36.7%) had the similar condition in previous years. One hundred and fifty seven (80.9%) were aware about this disease and 52(27%) devotees adopted some kind of precautionary measures. Bivariate analysis showed significant association between occurrence of CLM lesions and frequency of performing the ritual (p<0.001, OR-15.1; 95% CI:7.2-32.0), the timing of ritual performance (p = 0.022, OR-1.96; 95% CI:1.10–3.52), similar condition in previous year (p<0.001, OR-6.83; 95% CI: 3.39–13.76) and previous awareness of the condition (p = 0.005; OR-0.59;95% CI:0.43–0.82). Multivariate analysis showed that the frequency of ritual performance (OR-11.75; 95% CI 5.37–25.74) and similar conditions in previous years (OR-4.71; 95% CI: 2.14–10.39) were the independent risk factors. Two of the 20 soil samples were positive for the nematode larvae and three out of five dog faeces were positive for hookworm eggs.Conclusions/SignificanceDeworming the stray dogs around the temple premises combined with the awareness programs among the public may be the effective and feasible precautionary measures to control similar epidemics in future.

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