Making a breakthrough in the study of leptospirosis, a bacterial infection transmitted from animals, a team of Sri Lankan researchers in a collaborative endeavour has discovered six new genotypes of this largely undermined tropical disease. In an exclusive interview with the Sunday Island, they throw light on the findings of their research which are now in international literature enabling new knowledge on the world’s commonest zoonotic disease.
by Randima Attygalle
No longer considered the ‘rural farmer’s disease’, leptospirosis, commonly called rat fever or mee una in Sinhala, is changing its dynamics, urging clinicians, health policy-makers and the public to revisit this common tropical disease of both humans and animals. The bacterium that causes leptospirosis is spread through the urine of infected animals, which can get into water or soil and can survive there for weeks or months. Many different kinds of wild and domestic animals carry the bacterium including cattle, pigs, rodents, dogs, horses and wild animals.
Humans can become infected with the bacterium either through contact with urine of an infected animal or with water or soil contaminated with the urine of infected animals. The bacteria can enter the body through skin, eyes, nose or mouth. Outbreaks of leptospirosis are usually caused by exposure to contaminated water, such as floodwaters. It is a serious occupational hazard for those working outdoors such as farmers, miners etc. and professionals such as veterinarians in close contact with animals. According to global research findings, around one million cases of leptospirosis and 58,900 deaths are estimated to occur worldwide each year. More than 70% of the deaths are reported from the tropical, poorest regions of the world.
A re-merging disease here at home, leptospirosis has gained much attention since the large outbreak in 2008. “The annual incidence of leptospirosis that had required hospitalization from 2008 to 2015 was 52.1 per 100,000 people, with an estimated case fatality rate of 7.0% according to National Health Bulletin data. In 2018 there was another resurgence in numbers. The disease is no more a ‘seasonal’ one as it was conventionally known to be, resulting in multiple outbreaks per year, notably during rainy seasons. Manifestations of the disease have also changed, with a wide array of new clinical entities such as pulmonary haemorrhage (bleeding into the lungs), pancreatitis, and myocarditis coupled with high case fatality. These shifts in the disease call for new strategies, new interventions and the need to reorganize ourselves as the health care sector,” says Dr. Panduka Karunanayake, Senior Lecturer from the Department of Clinical Medicine, University of Colombo.
The purpose of this research project between researchers from several local institutions (Medical Research Institute and Base Hospital Elpitiya under the Ministry of Health, and University of Peradeniya and University of Colombo) and Japan (National Institute of Infectious Diseases in Tokyo, and Graduate School of Infectious Diseases and Institute of Genetic Medicine of Hokkaido University) had been to identify the serogroups and genetic groups of Leptospira organisms that are found here at home. “This knowledge is important to better understand the new clinical manifestations for their early diagnosis and treatment, and to know the carrier animal for specific control measures, as this disease is carried by animals,” explains Dr. Karunanayake.
A laborious process, first, the organisms need to be ‘isolated’ (grown) in artificial culture, and thereafter artificially ‘maintained’ (kept alive) in culture media. This needs specialized laboratories with biosafety measures. The National Reference Laboratory (NRL) for Leptospirosis at the MRI offers this service to hospitals routinely. “Organisms were isolated from blood of patients affected by the 2015-2017 leptospirosis outbreak from the Base Hospital in Elpitiya and animal kidney tissue from Kandy. Once they were successfully grown and maintained in culture, they were sent to Japan for the genetic characterization which was done for us by the Japanese collaborator (Dr. Nobuo Koizumi, National Institute of Infectious Diseases (NIID), Japan),” says Dr Karunanayake.
The genetic characterization and serogroup analyses were done in NIID, Japan which demonstrated that these strains belonged to three genetically-defined species. “When their genotypic strains were analyzed, it was found that the isolates belong to 15 different strains, of which six were not described before in the world literature, hence treated as ‘novel genotypes’. Of these, three were from patients treated at the Base Hospital in Elpitiya. They were causing multiple complications such as kidney, liver, heart and lung involvement and septic shock. However, all of these patients survived,” says Dr. Karunanayake.
Although leptospirosis had been prevalent in our country since the 1950s, it has been changing its nature in the last decade. “While the number of cases are increasing alarmingly, the clinical picture too is changing, with the identification of new and troublesome complications including pulmonary haemorrhage, pancreatic involvement, heart involvement, community-acquired sepsis, etc.” he said. The disease is also affecting a wider group of people, such as those living in urban areas and people exposed only briefly to stagnant waters or floods.
“After 40 years since Dr. K. Nityananda’s work in the 1960s and 1970s at the NRL, we have been able to introduce new strains for the first time to the world literature on leptospirosis, again from the NRL,” observes Dr. Lilani Karunanayake, Consultant Clinical Microbiologist and Head/National Reference Laboratory for Leptospirosis at the Medical Research Institute. The emergence of new genotypes, as she points out, imply the importance of strict quarantine of imported cattle as well as other imported domestic animals that are potential reservoirs of leptospirosis. “Unintentional introduction of rodent reservoirs through improper garbage disposal and the existence of unidentified reservoir animals in the country also call for attention,” says the senior microbiologist who further says that new knowledge from this study will be valuable in future research for patient management and specifically-targeted control approaches for reservoir hosts in the prevention and control of leptospirosis in Sri Lanka. She extended her thanks to the clinicians from various hospitals who sent in samples, which enabled these discoveries in the best interest of people.
The National Reference Laboratory (NRL) for Leptospirosis at the MRI which serves as the central referral laboratory in the country performs certain specific leptospirosis tests, samples for which are sent from hospitals island-wide. “Although certain tests could be performed at peripheral levels, some of the advanced cases need to be referred to the central lab,” notes Dr. Karunanayake, adding that the Teaching Hospitals at regional level should be strengthened with testing facilities for early detection.
Non-specific features of the patients such as fever, headaches, body aches, diarrhea which could mimic other conditions such as dengue has rendered early detection of leptospirosis very challenging, says Dr. Sajiv De Silva, Consultant Physician, Base Hospital, Balapitiya. “Hence kidney complications and the lung involvement are two specific features we give attention to in our investigations which often require intensive care. We also take serious account of the patient’s exposure to paddy fields and muddy water. In the Elpitiya patient cluster which we took as our research sample, the kidney complications and pulmonary haemorrhage were very severe which enabled us to add the new genotypes from this cluster to the world literature on leptospirosis.” He further remarks that these genotypes are more virulent than those found in the Western Province. Similar to the cluster in Elpitiya, more recent samples from patients in Galle, Balapitiya and Udugama in the Southern Province have reflected more severe complications, particularly lung and kidney complications which trigger rapid deterioration of the patient.
Patient demographic changes are also significant as the research reveals, points out Dr. De Silva. “Apart from farmers and miners who were traditionally identified as the most vulnerable to the disease, today we find a considerable percentage of young patients who had contacted it by merely visiting a paddy field or bathing in a river.” Diagnosing leptospirosis has become a “dilemma” for the physicians at the peripheral level, observes the Consultant who adds that, blurring lines between dengue and leptospirosis makes it more challenging. “In both situations platelets will drop. However in the treatment of dengue, while fluids need to be administered proportionate to the urine output, in the case of leptospirosis, fluids cannot be administered to mitigate pulmonary hemorrhage.”
Reiterating on the urgency of seeking early hospital care, the physician notes, “the earlier they come, faster the laboratory diagnosis would be.” Although clinical diagnosis of leptospirosis was not possible in the first few days of symptoms, today the availability of the PCR test (free in the state health sector) makes this possible, he adds. The toll the disease takes on families and the national health budget cannot be undermined. In a bid to create awareness on prevention of it by promoting safety footwear and early detection among the communities at rural level, a programme is now in place facilitated by the MOHs and PHIs says Dr. De Silva.
The breakthrough research is also a reflection of the validity of the ‘One Health’ concept where collaborative health efforts of multiple disciplines working nationally and globally can attain optimal health for people, animals and the environment, observes Dr. Chandika Gamage, Veterinarian and Senior Lecturer from the Department of Microbiology, Faculty of Medicine, University of Peradeniya. “Pathogens isolated from rats and humans in a molecular study during the research had revealed same genetic strain types which have enabled us to enlarge our knowledge on leptospirosis,” explains Dr. Gamage.
Although traditionally leptospirosis had been considered a disease spread by rats (‘natural reservoirs’), it is now becoming clear that there are other animals, such as cattle, that harbour the bacteria and spread it, points out Dr. Gamage. The research had further thrown light on dairy cattle as a potent reservoir of the disease. They are often grazed on grassland infected with rat urine and can can set off a vicious cycle, says the Veterinarian. “One excretion of cattle urine can be an amplifier pathogen of leptospirosis.”
Concurrent studies in humans, animals and environmental sampling can determine how these interact to bring about disease in humans which validates the One Health approach, says the Veterinarian. Furthermore, diverse sero groups were found in this study to cause both human disease and that present in animals like cattle and buffalo, pointing towards the need for new preventive strategies to control human leptospirosis in Sri Lanka, he says. Research will also be extended to the study of domestic animals such as dogs and cats as potential carriers of the disease.
“It is imperative that we contribute to the control of leptospirosis through One Health perspective through preventive measures such as safe garbage disposal which would otherwise become breeding grounds for rats, vaccination of cats and dogs, use of preventive footwear in agrarian and other outdoor pursuits. While a patient infected with the disease may be treated, unless we adopt a holistic approach towards prevention, the environment around us could still be a catalyst of the disease hindering the control or even elimination of the disease.”
An air of discontent prevails
We have had a series of “Avurudhu parties” here in Aotearoa. No shortage of Kavum, Kokis, Athiraha, and even Wali Thalapa. Buffalo curd available locally and of course imported treacle in abundance. Yours truly has assumed the role of a fly on the wall during these festivities and gleaned much information, worth talking about.
First to get on to the Pearl, the talk of the botched-up vaccination plan and running out of the second dose of vaccine. Bizarre permutations as to what would happen if the second dose was not available on time and to who would be press-ganged into getting the “dodgier” types of vaccine from China and Russia, etc. The possible repercussions of getting a second dose of another type of vaccine to the original, the speculations of which left me rather glad that the general populace of Aotearoa has not been vaccinated to date. The talk moved on to the Easter bombings and the recent comments by leaders of the Roman Catholic church as to the possible perpetrators of the attack. Some increasingly obvious conclusions as to those responsible for the planning and funding of same are being reached by those other than some of us who dared to voice our opinions over a year ago! This combined with the increasing and very rapid unpopularity of the person they elected to high office hoping he was genie of the magic lamp type, and the possible reverse of Hong Kong that could take shape on the reclaimed land near the Colombo port, does not bode well for an already dubious future. By reverse of Hong Kong, I mean Hong Kong is trying to hold out as a bastion for democracy, whilst the proposed port city seems to be modeled on the opposite!
Moving on to Aotearoa, the rest of the world seems to be praying for a leader such as our own Jacinda Ardern, but the fat cats of Aotearoa are getting rather sick of her. Those who own multiple houses and have been setting off their interest payments against their taxes due to a loophole in the law that has now been plugged are grumbling. The fact that most young people can’t afford to buy their first houses due to rich people and property developers snapping up all available property, happily funded by banks who are only interested in the bottom line, is of no consequence to them. The fact that this could lead to so much discontent that it could even lead to armed insurrection doesn’t bother them. They seem to have forgotten that we have had almost no deaths and hardly any Covid 19 cases in our community when they say that the lockdowns, we underwent were too excessive and how the economy and business sector has suffered. These very people throng the stadia during the rugby and cricket games and enjoy music concerts with gay abandon. Megacorporations are not happy about the restrictions that are coming on with regard to the use of Liquid Petroleum Gas (LPG) due to environmental concerns. To top it all off I had a lecture from my 13-year-old daughter about how I am being “led by the nose” by Jacinda Ardern and her propaganda! Where she got that from could only be from her elder brothers whose get rich quick schemes have seen a setback due to certain leftist policies coming in from the Labour government that is in power with an absolute majority.
I laugh to myself and think about other examples I have seen of self-proclaimed pundits never being content with their lot. My education was in a very large Government school. As a perfect and a member of some sports teams we handled the administration and some of the governance of this school. Later in life when my children were attending a private school I got involved in the Executive committee of the PTA of that school. The “problems” faced by the private school and the vast dramas that were involved in trying to solve those problems were laughable when compared to those faced by even us, senior students (a much lower level in the administration) of the Government school.
It led me to believe that people always grumble. They are never content with their lot and there is always someone plugging their case and trying to sow the seeds of discontent among the populace. If those living in Aotearoa, in the present situation and well aware of the chaos and mayhem that is prevailing in the rest of the world are dissatisfied, when will anyone be satisfied? Everything is relative and one should try to step outside the confines of one’s own situation and look at the broad picture. In the words of learned barristers, I rest my case!
This week’s missive will not be complete without a tribute to the memory of Prince Phillip, the Duke of Edinburgh. He lived through some of the best and worst times of human existence on this planet and conducted himself impeccably. He showed his humanity and his failings, with a few bloopers down the line but most of those had an undercurrent of humor and couldn’t really be construed as offensive, despite the best efforts of the media and others to make them so. He served as consort to her Majesty the Queen with loyalty and aplomb and he leaves behind an enviable legacy in the world of conservation and youth affairs. It is hoped that his heirs will be up to the task for they face a task which in cricketing terms could be classed as coming into bat after the great Sir Vivian Richards had just scored a century, in his prime. Something very difficult to surpass in skill and entertainment value. Unfortunately, the Duke made just 99. May he rest in peace!
We have much to learn; and emulation is no disgrace
“Imitation is the sincerest form of flattery that mediocrity can pay to greatness.” said Oscar Wilde who, through sharply ironic wit, often proclaimed the absolute truth.
Cassandra quotes him today as she wants to point out how much we in Sri Lanka can benefit by reaping some ideas from the recent royal funeral in Windsor. And she does not excuse herself for placing stress on our mediocrity as juxtaposed with greatness. Nationalists may shout themselves hoarse and bring down a few more majestic trees by decrying the comparison. They can justifiably claim we have a cultural heritage of two and a half millennia but have we remained cultured, following faithfully and correctly the four great religions of the world? A loud NO from Cass, echoed by millions of others. Though Britain’s development of the English language, culture, arts and science was later than our civilization, they outstripped all countries at one time and are again elevated, while we are poised on bankruptcy, with the begging bowl in hand and thugs and thieves as legislators. We in Sri Lanka are mediocre if not degraded against the greatness shown by the Brits in many spheres. This is no Anglophile speaking but a dame who was born when the Brits were leaving us to govern ourselves and grew up with our statesmen doing a jolly good job of it; Sinhalese, Tamil, Burgher, and a few Muslims taking the lead graciously and effectively with complete honesty, to serve the people. They maintained and improved our country so it was admired by others and even some desiring to imitate Ceylon as Singapore’s Lee Kwan Yew admitted. And where are we now? Except the Rajapaksa family from Medamulana, wearing rose tinted glasses or with eyes shut by arrogance, and their followers and throngs of sycophants, others see our country and our people for what it, and the people, really are. No need to elaborate.
The funeral of Prince Philip juxtaposed against customs here
The low-key funeral observing all Covid-19 restrictions was noteworthy for being utterly devoid of bombast and vainglory. It was dignified and moving. Cass wonders how many of her readers watched the funeral on Saturday 17, late evening here. Prince Philip had detailed all arrangements from the Navy being prominent and other Forces joining in plus the substitution of the gun carriage with a jeep he had helped design. The horse carriage he was adept at racing was stationed close by the entrance to the chapel. He has bequeathed it to the daughter of his youngest son and Sophie; the Wessexes having been very close to him and the Queen.
The entire proceedings proved first and foremost that the royal family observed strict pandemic restrictions like mask wearing and physical distancing. There was no one rule for them and another rule for us, thus proving beyond doubt that England (usually), and more so the Royal Family (definitely) are a country and an institution despising double standards. The monarch decreed and abided by the same regulations that have restricted everyone else in the UK, sharing their fate. An anecdote is relevant here. The Queen learned that lesson long ago. She was 14 when her mother said, after Buckingham Palace was bombed in September 1940, that she “could look the East End in the face now.”
Do all our people follow rules common to everyone? Oh! My heavens NO! There are differentiations according to layers in society. Shangri La would host a party for a hundred when only 30 are allowed to gather. During the height of the first wave when restrictions were strict, SLPP electioneering saw hordes thrust together and baby carrying, patting heads and hand clasping mostly by Mahinda Rajapaksha sans a mask. He has a charismatic bond with the masses but that needed to be curbed. Sajith Premadasa’s meetings were strict on physical distancing and mask wearing.
Only 30 were invited to the extremely solemn and yes, beautiful funeral service at Windsor Chapel. This meant eliminating even close relatives of the Family; but it was done. The Queen sat distanced from her daughter and sons and their spouses. Her now diminutive figure seated alone emphasized the loneliness she must be feeling after a close and successful marriage of 73 years.
This brings to mind our First Ladies. Cass steps out bravely to say that Elina Jayewardene was a gracious lady of restraint and dignity, the only perfect consort so far. Cass remembers Hema Premadasa beating her breast (true) and crying over the coffin of her late husband’s remains – in the true sense of the word – at the Prez’s funeral at Independence Square. There is dignity in restraint of even tears over a death in public. Among the women Heads of the country, the mother completely beat the daughter in dignity and ability.
We Sri Lankan women are now much more restrained in our mourning at funerals. Time was when widows even hoarsely wailed their sorrow, coiled and roiled with grief, and begged the dear departed “To look once more; say one word.” Cass in all the expressed grief of such funerals suppressed her laughter with difficulty. How would it be if the corpse obliged?
The choir at the funeral of Prince Philip was just four – one woman and three men. But their singing resounded in the high vaulted, completely majestic, centuries old church. The lone kilted piper within the Chapel evoked much. The service itself was short, just a Reading, prayers and listing of the multitude of honours bestowed on the Duke of Edinburgh, whose medals and decorations were on display beside the alter. The Archbishop of Canterbury, Justin Welby, and the Dean of Windsor, David Conner conducted the service.
To conclude, the Duke of Edinburgh had advised and laid stipulations on a simple funeral with the necessary pomp and pageantry but low key and very unostentatious. The actual funeral was even more low-key with mourners requested not to be on the streets or place flowers. The latter they did in all the residencies of the Royal Family in appreciation of a man who faithfully stood by the Queen and in his own way gave service to the nation.
Coming back to Free Sri Lanka, we seem to stress on that first word Cass inserted to the country name, even in these dire times of no crowds. And the worst is milling crowds are apparently encouraged to boost popularity of certain VVIPs by sycophants and by the preference/orders of the VVIP himself.
Consider the funeral of Minister Thondaman: crowds in Colombo and all VIPs wishing to register their presence before the body, and then the commotion at the actual cremation Up Country. Consider this year’s Sinhala New Year celebrations which were very dignified at the President’s residence but were inclusive of all traditions and a large gathering in the PM’s home, even raban playing by the Second Lady, and milling crowds outside.
Roller coaster ride of the country continues
Cass is relieved she had a topic to write on; namely that we should emulate the manner in which the much admired Duke of Edinburgh’s funeral was conducted, abiding by his stricture of it being low key and the country’s Covid restrictions. Our leaders especially must accept the saying I quoted at the beginning.
The country continues its roller coaster bumpy ride with some crying out the country is being sold to the Chinese, we will be a colony of theirs after they occupy the Port City; and others in remote areas sitting down for days on end, some near 100 days, drawing attention to the human elephant conflict. Much is touted about the Bill relating to the rules to govern the Port City.
Cassandra listens to all, and is somewhat warned and frightened, but cannot comment. However, one matter she speaks about loud and clear. The people must be told the status quo of the pandemic – daily numbers catching the infection and numbers dying. This is not for interest sake or ghoulish appetites; but to know how things are so we relax a wee bit or shut in more stringently. The Covid-19 Task Force, or the Health High Ups (not Pavithra please) should tell the country of the true situ of the pandemic as it holds the country in its grip. We want to know whether the grip is tightening or weakening. Please give us daily statistics. This newspaper announces total numbers. No help. Are we expected to jot down figures, subtract, and give ourselves daily infection and death statistics? No! It goes to prove that other matters – political slanted, ego boosting and economics – are more important than warning, containing the pandemic, and saving lives.
Do you pump Octane 95 Petrol to your car to get better performance?
If your answer is YES, this article is for you
Dr. Saliya Jayasekara.
Senior Lecturer Department of Mechanical Engineering
University of Moratuwa
Many passenger vehicles, including three-wheelers and motorcycles are fueled by octane 95 gasoline when octane 92 gasoline (petrol) is available at a lower price.
Otto engine (petrol engine) is an internal combustion spark ignition engine invented by a German engineer Nicolaus Otto in 1876 and used in most of the light weight vehicles including cars, three wheelers and motor bicycles. Otto engines can burn most of the hydrocarbon fuels (including hydrogen and ethanol) that can mix with air by evaporation (low boiling point). But the combustion characteristics of different hydrocarbons are not the same when burned inside an engine. If an Otto engine is designed for a particular fuel, it would not perform similarly with a fuel that has a different chemical composition.
In a well-tuned Otto engine run on gasoline for which the engine is designed, the combustion of the gasoline (petrol) / air mixture will continue smoothly from the spark plug to the piston head by igniting successive layers of the mixture as shown in Figure 1 (a).
If low grade gasolines are used, the combustion of some of the air/ fuel mixture in the cylinder does not result from propagation of the flame front initiated by the spark plug, but one or more pockets of air/fuel mixture explode (Detonate) outside the envelope of the normal combustion front as shown in Figure 1 (b). This detonation can cause severe damage to the piston and the head of the engine while deteriorating thermal performance of the engine (low efficiency)
Gasoline is a petroleum-derived product comprising a mixture of different hydrocarbons ranging from 4 to 12 carbon atoms in a carbon chain with the boiling point ranging of 30–225°C. It is predominantly a mixture of paraffins, naphthenes, aromatics and olefins. Additives and blending agents are added to improve the performance and stability of gasoline. The engine designers learned that straight-chain paraffin have a much higher tendency to detonate than do branched-chain paraffin.
The tendency of a particular gasoline to detonate is expressed by its octane number (ON). Arbitrarily, tri-methyl-pentane, C8H18 (iso-octane) is assigned an ON of 100, while the straight-chain paraffin n-heptane, C7H16 is given an ON of zero. Hence, a fuel sample with the same anti-detonation quality as that of a mixture containing 90% iso-octane and 10% n-heptane is said to have an ON of 90. Gasoline is made up of a mixture of mostly branched-chain paraffin with suitable additives to give an ON in the range 90 –100. It was also learned through experiments that the ON of a gasoline blends (e.g. gasoline and ethanol) can be calculated by using weighted average ON of each compound. Most importantly, the octane number has nothing to do with the heating value (Calorific value) or the purity of the fuel.
Engine thermodynamics show that engines with a high compression ratio offer higher thermal performance than engines with a low compression ratio. These engines having high compression ratio require high octane gasoline (for example octane 95) to avoid detonation. However, using gasoline having higher octane ratings for the engines designed for a low octane rating (for example, 92 octane) would not provide an additional benefit or loss, other than increased fuel cost.
Therefore, it is important to know the designed octane number of the engine before fueling (refer owner’s manual of the vehicle). For example: the minimum ON requirement for two and three wheelers in south Asia is 87 (The World Bank). Most of the Toyota, Honda and Nissan models including hybrid engines recommend 92 octane gasoline.
Dr. Saliya Jayasekara received the B. Sc. degree in mechanical engineering from university of Moratuwa in 2001, and the M.Sc. and PhD degrees in decentralized power generation systems from Royal institute of technology Sweden and the Melbourne University Australia in 2004 and 2013 respectively. He has well over 13 years of national and international experience in design and installation of centralised/decentralised power plants, boilers (utility/package) and heat exchangers. Currently he is serving as a senior lecture at University of Moratuwa, a visiting lecturer and fellow at Deakin University Australia.
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