Visceral leishmaniasis is a vector-borne protozoan disease targeted for elimination from the Indian subcontinent by year 2020. Sri Lanka is a new focus of human leishmaniasis caused by a genetically distinct variant of Leishmania donovani, which is the species more widely known to cause visceral leishmaniasis (VL). The clinical entity that is most frequent in Sri Lanka is cutaneous leishmaniasis (CL), though a few cases of muco-cutaneous (MCL) and VL have also been reported in the recent past. In CL, papules, nodules, ulcerating nodules and ulcers occur mainly as single lesions on exposed body areas of affected individuals. A wide age range is affected including both sexes. The potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka is not known. There is no evidence for a serological response in CL patients who have demonstrated negative for rK 39 antibodies in sera, (rk39 test being the recommended test for VL detection), while MCL and VL cases have been rK39 positive.Phlebotomus argentipes, the vector of L. donovani in other parts of the world is a widely prevalent insect in almost all parts of Sri Lanka. Studies are underway for vector identification. L.donovani is transmitted between this vector and the human host, the only known host for this species. However, domestic dogs have shown the presence of Leishmania parasites and also the presence of anti -L. donovani antibodies in their sera, providing primary evidence for the likely presence of an animal reservoir in Sri Lanka. Field-based risk factor studies have shown that there is peri-domestic as well as zoonotic/outdoor transmission cycles in different parts of the country.At present patients are detected mainly passively based on self referrals. Only a proportion of these patients proceed for pre-treatment laboratory confirmation due to the lack of freely available investigation facilities. Leishmaniasis was made a notifiable disease in Sri Lanka in 2008. Action plan for its control was drawn up with primary involvement of the Ministry of Health and other stake holders in 2008. Preventive and control activities are required to be put in place sooner rather than later. Enhanced case detection and active treatment are of prime value in controlling L.donovani infections. Availability of cost effective and field friendly diagnostic services in a decentralized manner, timely case management and vector control using appropriate protocols are necessary. To achieve this, a considerable amount of information is already available, and further research is needed to fill in the essential gaps.

Abstract. Clinical immunity to malaria was studied by quantifying the intensity of symptoms as well as by measurement of several hematologic indicators of pathology (the erythrocyte sedimentation rate [ESR], serum bilirubin, reticulocyte count, plasma tumor necrosis factor-␣ [TNF-␣], and blood glucose levels) in 39 Plasmodium vivax malaria patients exposed to endemic malaria in southern Sri Lanka, and for comparison in 43 nonimmune patients who were residents of nonmalarious regions of the country. The intensity of 11 symptoms was scored numerically in all patients using a questionnaire. This clinical score was validated by introducing internal controls to the questionnaire, and by correlating it with the underlying pathology. Both the intensity of clinical disease as well as the degree of underlying pathology were found to be significantly lower in endemic area patients (mean clinical score ϭ 8.8, median ESR ϭ 8 mm) compared with the nonendemic area patients (mean clinical score ϭ 19.0, median ESR 31.5 mm). Endemic area patients also had lower parasite densities (mean ϭ 0.06%) than those from the nonendemic area (0.12%) (P Ͻ 0.05). However, at any parasite density, both clinical disease and pathology were significantly less in the endemic area patients (P Ͻ 0.001, for both clinical score and ESR), indicating that the clinical immunity seen in the endemic area patients was a true tolerance of parasites. Although plasma TNF-␣ levels were elevated in both groups of patients, they were significantly higher in the nonendemic area patients than in patients from the endemic area (P Ͻ 0.01). Furthermore, at comparable levels of plasma TNF-␣, nonendemic area patients had both a higher intensity of clinical disease and an underlying pathology than those from the endemic area, suggesting that if TNF-

Introduction Human dirofilariasis is a zoonotic infection caused by the filarial worm, Dirofilaria (Nochtiella) repens, whose primary host is the dog. This infection is on the increase over the past decade in Sri Lanka and the prevalence of canine dirofilariasis in the country is also believed to be high. We present here a study on public awareness of dirofilariasis and the prevalence of this infection in dogs in Negombo, an urban area that has a high domestic canine population.Objective To assess the awareness of dirofilariasis infection among residents and study the prevalence of this infection in domestic dogs in Negombo. Methods A descriptive cross-sectional study within the city of Negombo during September and November 2003 using a pre-tested, interviewer-administered questionnaire with cluster sampling was done. Two hundred seventy adults, including 132 dog owners, were included in the study. Data analysis was done using the EpiInfo programme.The prevalence of canine dirofilariasis was studied in a group of 65 dogs over the age of 1 year. They were selected

Toxoplasma gondii is an intracellular parasite able to cross the placental barrier and known to infect foetal tissues leading to abortions and congenital deformities. A case control study comparing the seroprevalence of T. gondii in 100 healthy pregnant women within 28 weeks of pregnancy and 100 women having undergone a spontaneous miscarriage in the past 6 months attending the Antenatal and Gynaecology clinics of the Professorial Obstetrics & Gynaecology Unit of the De Soyza Maternity Hospital for Women in Colombo was conducted between April 2009 and 2010. Serum was tested for antibodies against T. gondii using OnSite Toxo IgG/IgM Rapid Test-Dip Strip®. Personal details and data regarding the known risk factors for the infection were obtained using an interviewer administered questionnaire. The participants were aged between 15 and 46 years (median 29); 38% of women in each group were primigravidae. All participants were sero-negative for anti-T. gondii IgM antibodies. However, 22.5% (n=45) of all study subjects were sero-positive for anti-T. gondii IgG antibodies, which included 62.2% (n=28) from the healthy group and 37.8% (n=17) from those with a recent past history of a spontaneous miscarriage. The difference in seropositivity for Toxoplasma gondii between the two selected groups was not statistically significant (X 2 =3.47; p=0.063). There were no significant associations between sero-positivity and known risk factors either (p>0.05). Although the study did not reveal any evidence for association between exposure to Toxoplasma gondii infection and spontaneous miscarriage, the presence of more than 75% non-immune women of child bearing age is a cause for concern considering the potential risks posed by this parasite, emphasizing the importance of an organized educational programme targeting this high risk group to prevent infection during pregnancy.

Objective Microscopic examination of blood smears is the 'gold standard' for malaria diagnosis, but is labour intensive and requires skilled operators. Plasmodium vivax malaria accounts for up to 70% of infections in Sri Lanka. The objective of this study was to determine the effectiveness of an immunochromatographic test which can detect both the species of Plasmodium, P. vivax and P. falciparum, present in Sri Lanka.