S. enteritidis brain abscesses are very rare and are usually associated with immunocompromised conditions. Our patient appears to be the first reported case associated with SCD, the pathogenesis of which is unclear at present. Further clinical research is suggested in countries with a high prevalence of SCD to determine the association of SCD and the development of Salmonella brain abscesses.

BackgroundMelioidosis is an infection caused by the facultative intracellular gram-negative bacterium; Burkholderia pseudomallei. It gives rise to protean clinical manifestations and has a varied prognosis. Although it was rare in Sri Lanka increasing numbers of cases are being reported with high morbidity and mortality. Here we report a case of melioidosis presenting with lymphadenitis which was diagnosed early and treated promptly with a good outcome.Case presentationA 53-year-old Sinhalese woman with diabetes presented with fever and left sided painful inguinal lymphadenitis for one month. She had undergone incision and drainage of a thigh abscess three months previously and had been treated with a short course of antibiotics. There was no record that abscess material was tested microbiologically.She had neutrophil leukocytosis and elevated inflammatory markers. Initial pus culture revealed a scanty growth of “Pseudomonas sp.” and Escherichia coli which were sensitive to ceftazidime and resistant to gentamicin.Due to the history of diabetes, recurrent abscess formation and the suggestive sensitivity pattern of the bacterial isolates, we actively investigated for melioidosis. The bacterial isolate was subsequently identified as B. pseudomallei by polymerase chain reaction and antibodies to melioidin antigen were found to be raised at a titre of 1:160.The patient was treated with high dose intravenous ceftazidime for four weeks followed by eradication therapy with cotrimoxazole and doxycycline. As the patient was intolerant to cotrimoxazole, the antibiotics were changed to a combination of co-amoxyclav and doxycycline and continued for 12 weeks. The patient was well after 6 months without any relapse.ConclusionsMelioidosis is an emerging infection in South Asia. It may present with recurrent abscesses. Therefore it is very important to send pus for culture whenever an abscess is drained. However, it should be noted that the reporting laboratory may be unfamiliar with this bacterium and the isolate may be misidentified as Pseudomonas or even E. coli. Melioidosis should be suspected when an isolate with the typical antibiotic sensitivity pattern of ceftazidime sensitivity and gentamicin resistance is cultured, especially in a patient with diabetes. This will expedite diagnosis and prompt treatment leading to an excellent prognosis.

Background The first case of HIV infection in Sri Lanka was reported in 1987 and at the end of 2018 there were 3500 people living with HIV. There have been commendable efforts made towards the detection, treatment, and prevention of HIV in the country. Even though the genetic diversity of HIV has been shown to affect the parameters ranging from detection to vaccine development, there is no data available with respect to the molecular epidemiology of HIV-1 in Sri Lanka. Methods In this report we have performed the ancillary analysis of pol gene region sequences (n = 85) obtained primarily for the purpose of HIV-1 drug resistance genotyping. Briefly, dried blood spot specimens (DBS) collected from HIV-1 infected individuals between December 2015 and August 2018 were subjected to pol gene amplification and sequencing. These pol gene sequences were used to interpret the drug resistance mutation profiles. Further, sequences were subjected to HIV-1 subtyping using REGA 3.0, COMET, jPHMM and, RIP online subtyping tools. Moreover, Bayesian phylogenetic analysis was employed to estimate the evolutionary history of HIV-1 subtype C in Sri Lanka. Results Our analysis revealed that the majority (51.8%) of pol gene sequences were subtype C. Other than subtype C, there were sequences categorized as subtypes A1, B, D and G. In addition to pure subtypes there were sequences which were observed to be circulating recombinant forms (CRFs) and a few of the recombinants were identified as potential unique recombinants (URFs). We also observed the presence of drug resistance mutations in 56 (65.9%) out of 85 sequences. Estimates of the Bayesian evolutionary analysis suggested that the HIV-1 subtype C was introduced to Sri Lanka during the early 1970s (1972.8).

Background We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO’s recommendations. Methods HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0. Analyses were weighted to adjust for multistage sampling and genotypic failure rate. We used logistic regression to assess differences between groups. Results Overall, in 10% (15 of 150) of patients initiating ART, HIV drug resistance mutations were detected. The prevalence of resistance to NNRTI drugs efavirenz/nevirapine was 8.4% (95% CI 4.6–15.0) but differed among those reporting having prior antiretroviral (ARV) exposure (24.4%, 95% CI 13.8–39.5) compared with 4.6% (95% CI 1.6–12.8) for those reporting as being ARV naive (OR 4.6, 95% CI 1.3–16.6, P = 0.021). PDR to efavirenz/nevirapine was also nearly twice as high among women (14.1%, 95% CI 6.1–29.4) compared with men (7.0%, 95% CI 3.1–14.7) (P = 0.340) and three times high among heterosexuals (10.4%, 95% CI 2.4–35.4) compared with MSM (3.8%, 95% CI 1.1–12.7) (P = 0.028). NRTI PDR prevalence was 3.8% (95% CI 1.1–12.1) and no PI PDR was observed in the study. Conclusions A high prevalence of efavirenz/nevirapine PDR was reported, especially in patients with prior ARV exposure, in women and those reporting being heterosexual. These findings highlight the need to fast-track the transition to the WHO-recommended dolutegravir-based first-line ART.

Sri Lanka has been declared as a country that eliminated mother to child transmission of HIV and syphilis by the World Health Organisation (WHO), Geneva on 13 th November 2019. National STD AIDS Control Programme (NSACP) of Sri LankaIn 1954, commenced a programme for the prevention of congenital syphilis.In 2002, started the programme for the prevention of mother to child transmission of HIV.In 2013, these two programmes were combined for the "Elimination of mother to child transmission (EMTCT) of HIV and syphilis."Overall target was to achieve and maintain the impact indicators for one year and process indicators for two years and then maintain these achievements to be eligible for the application of the validation process. The programme was designed on a multi-disciplinary, multi-partnered, and multi-level approach with strong links between maternal and child health services and sexually transmitted infections and HIV services in both government and private sectors.By end 2018, the country had achieved the set targets to be eligible to apply for the WHO validation of EMTCT of HIV and syphilis.In July 2019, the ministry of health made a formal request to the WHO to validate the EMTCT of HIV and syphilis programme. After a thorough assessment of the country situation, the regional validation team recommended certification of Sri Lanka. This was further assessed by the Global validation team at WHO Geneva.