Search

Background: There are limited data on short- versus long-term changes in adaptive immune response across different COVID-19 disease severity groups. Methods: A multicenter prospective study of 140 adult patients with COVID-19 (a total of 325 samples) were analyzed for inflammatory markers and lymphocyte subsets at presentation, week 2, and week 24. Results: Inflammatory markers at presentation were higher in the critical/severe than in moderate and mild groups. A predominance of memory B cell response in the mild and moderate group was noted by week 2. In contrast, the immune system in the severe/critical group was dysfunctional, with expansion of exhausted CD8+ T cells and atypical memory B cells. By 24 weeks, there was a possible trend of normalization. Conclusion: There was substantial difference in the degree of inflammation and distribution of different B and T cell subsets in the different disease severity groups. Despite the initial dysfunctional immune response in the severe/critical group, a comparable memory B and CD8+ T cell responses to the mild group was achieved at 24 weeks.

Abstract Background The 30-year-old armed conflict in Sri Lanka resulted in a general breakdown of civil administration in the Northern and Eastern provinces, leading to mobilisation of many armed forces personnel to assist with reconstruction and resettlement. This occupational group has been identified as a priority risk group for leishmaniasis. Methods Individuals enlisted at all military establishments in Mullaitivu and Kilinochchi districts, Northern Province of Sri Lanka were included. Five thousand individuals were screened for skin lesions between September 2018 and August 2019. Persons with lesions suspected as cutaneous leishmaniasis (CL) were further investigated. Information on sociodemographic/other potential risk factors was obtained through an interviewer-administered structured questionnaire. The diagnosis was confirmed by microscopic visualization of parasitic stages from different samples obtained (skin scraping, lesion aspirate and tissue impression smears), histopathology and polymerase chain reaction DNA amplification. Results Among 5000 individuals screened, 74 individuals were suspected of having CL. Of these, 67.6% (n = 50) patients were confirmed for CL by microscopy. Around two third of both males (67.6%; n = 48) and females (66.6%; n = 2) were positive for Leishmania. The soldiers belonging to 26–35-year age group reported the highest susceptibility (83.3%; OR: 4.83, 95% CI: 3.49–6.20%). Of the sociodemographic factors, age, wearing short-sleeved upper body clothing as the uniform and non-use of insect repellents were identified as significant risk factors. Most of the CL patients had a single lesion (86.0%; n = 43) of an ulcerative type (34.0%; n = 17), mostly on their upper limb (67.9%; n = 34). Lesions were mostly 5–10 mm diameter (59.9%; n = 30) in size with poorly defined margins (72.0%; n = 36). Amongst the diagnostic techniques, microscopic examination of slit skin smear and tissue impression smear were able to discriminate the majority of patients (92.1%; n = 46) for CL. Conclusions In order to highlight the true burden of leishmaniasis in the military personnel, cases of leishmaniasis from military institutes should be recognized as a different entity per say and be included in the national figures so as to depict the real magnitude of the disease burden amongst this high-risk group.

After introduction of rotavirus vaccine, other pathogens might become leading causes of hospitalizations for severe diarrhea among children

Abstract Background Successful reduction of malaria transmission to very low levels has made Isabel Province, Solomon Islands, a target for early elimination by 2014. High malaria transmission in neighbouring provinces and the potential for local asymptomatic infections to cause malaria resurgence highlights the need for sub-national tailoring of surveillance interventions. This study contributes to a situational analysis of malaria in Isabel Province to inform an appropriate surveillance intervention. Methods A mixed method study was carried out in Isabel Province in late 2009 and early 2010. The quantitative component was a population-based prevalence survey of 8,554 people from 129 villages, which were selected using a spatially stratified sampling approach to achieve uniform geographical coverage of populated areas. Diagnosis was initially based on Giemsa-stained blood slides followed by molecular analysis using polymerase chain reaction (PCR). Local perceptions and practices related to management of fever and treatment-seeking that would impact a surveillance intervention were also explored using qualitative research methods. Results Approximately 33% (8,554/26,221) of the population of Isabel Province participated in the survey. Only one subject was found to be infected with Plasmodium falciparum (Pf) (96 parasites/μL) using Giemsa-stained blood films, giving a prevalence of 0.01%. PCR analysis detected a further 13 cases, giving an estimated malaria prevalence of 0.51%. There was a wide geographical distribution of infected subjects. None reported having travelled outside Isabel Province in the previous three months suggesting low-level indigenous malaria transmission. The qualitative findings provide warning signs that the current community vigilance approach to surveillance will not be sufficient to achieve elimination. In addition, fever severity is being used by individuals as an indicator for malaria and a trigger for timely treatment-seeking and case reporting. In light of the finding of a low prevalence of parasitaemia, the current surveillance system may not be able to detect and prevent malaria resurgence. Conclusion An adaption to the malERA surveillance framework is proposed and recommendations made for a tailored provincial-level surveillance intervention, which will be essential to achieve elimination, and to maintain this status while the rest of the country catches up.

Abstract Background The Solomon Islands National Malaria Programme is currently focused on intensified control and progressive elimination. Recent control efforts in Isabel Province have reduced their malaria incidence to 2.6/1,000 population in 2009 1 whereas most neighbouring provinces have much higher incidences. A malaria surveillance-response system that involves testing all travellers entering Isabel Province using rapid diagnostic tests (RDT) to prevent cases being imported had been proposed by local health authorities. This study provides information on the feasibility and acceptability of implementing a new approach of surveillance and response in the context of low levels of indigenous malaria transmission in Isabel Province. Methods A total of 13 focus group discussions (FGD) and 22 key informant interviews (KII) were conducted in Isabel Province, Solomon Islands. Key topics included: the travel patterns of people to, from and within Isabel Province; the acceptability, community perceptions, attitudes and suggestions towards the proposed surveillance programme; and management of suspected malaria cases. This information was triangulated with data obtained from port authorities, airlines and passenger ships travelling to and from Isabel Province in the preceding two years. Results Travel within Isabel Province and to and from other provinces is common with marked seasonality. The majority of inter-provincial travel is done on scheduled public transport; namely passenger ships and aircrafts. In Isabel Province there is a healthy community spirit as well as high concern regarding malaria and its importation and there is currently effective malaria passive case detection and management. Conducting malaria screening at ports and airports would be acceptable to the community. Conclusion A robust surveillance-response system is essential when moving towards malaria elimination. Many factors contribute positively towards the feasibility of an RDT based malaria surveillance system in Isabel Province. Due to financial and logistical restraints local health authorities have concluded that a system of community-based vigilance to identify new arrivals in villages and direct them to have malaria testing is more feasible than formal screening at ports and airports. A surveillance response system to prevent introduction of malaria into Isabel Province can be integrated into the National Malaria Control Programme provided the operational steps are carefully planned with regards to human and financial resources.

Abstract Background Improvements in availability and accessibility of artemisinin-based combination therapy (ACT) for malaria treatment and the emergence of multi-drug-resistant parasites have prompted many countries to adopt ACT as the first-line drug. In 2009, Solomon Islands (SI) likewise implemented new national treatment guidelines for malaria. The ACT, Coartem® (artemether-lumefantrine) is now the primary pharmacotherapy in SI for Plasmodium falciparum malaria, Plasmodium vivax malaria or mixed infections. Targeted treatment is also recommended in the new treatment regime through maintenance of quality microscopy services and the introduction of Rapid Diagnostic Tests (RDTs). Ascertaining the factors that influence community and provider acceptance of and adherence to the new treatment regime will be vital to improving the effectiveness of this intervention and reducing the risk of development of drug resistance. Methods In order to understand community and prescriber perceptions and acceptability of the new diagnostic and treatment interventions, 12 focus group discussions (FGDs) and 12 key informant interviews (KII) were carried out in rural and urban villages of Malaita Province, Solomon Islands four months subsequent to roll out of these interventions. Results Lack of access to microscopy or distrust in the accuracy of diagnostic tools were reported by some participants as reasons for the ongoing practice of presumptive treatment of malaria. Lack of confidence in RDT accuracy has negatively impacted its acceptability. Coartem® had good acceptability among most participants, however, some rural participants questioned its effectiveness due to lack of side effects and the larger quantity of tablets required to be taken. Storing of left over medication for subsequent fever episodes was reported as common. Conclusion To address these issues, further training and supportive supervision of healthcare workers will be essential, as will the engagement of influential community members in health promotion activities to improve acceptability of RDTs and adherence to the new treatment regime. Exploring the extent of these issues beyond the study population must be a priority for malaria programme managers. Practices such as presumptive treatment and the taking of sub-curative doses are of considerable concern for both the health of individuals and the increased risk it poses to the development of parasite resistance to this important first-line treatment against malaria.

Abstract Background Glucose-6-phosphate dehydrogenase deficiency poses a significant impediment to primaquine use for the elimination of liver stage infection with Plasmodium vivax and for gametocyte clearance, because of the risk of life-threatening haemolytic anaemia that can occur in G6PD deficient patients. Although a range of methods for screening G6PD deficiency have been described, almost all require skilled personnel, expensive laboratory equipment, freshly collected blood, and are time consuming; factors that render them unsuitable for mass-screening purposes. Methods A published WST8/1-methoxy PMS method was adapted to assay G6PD activity in a 96-well format using dried blood spots, and used it to undertake population screening within a malaria survey undertaken in Isabel Province, Solomon Islands. The assay results were compared to a biochemical test and a recently marketed rapid diagnostic test. Results Comparative testing with biochemical and rapid diagnostic test indicated that results obtained by filter paper assay were accurate providing that blood spots were assayed within 5 days when stored at ambient temperature and 10 days when stored at 4 degrees. Screening of 8541 people from 41 villages in Isabel Province, Solomon Islands revealed the prevalence of G6PD deficiency as defined by enzyme activity < 30% of normal control was 20.3% and a prevalence of severe deficiency that would predispose to primaquine-induced hemolysis (WHO Class I-II) of 6.9%. Conclusions The assay enabled simple and quick semi-quantitative population screening in a malaria-endemic region. The study indicated a high prevalence of G6PD deficiency in Isabel Province and highlights the critical need to consider G6PD deficiency in the context of P. vivax malaria elimination strategies in Solomon Islands, particularly in light of the potential role of primaquine mass drug administration.

As there are sparse data on the impact of growth media on the phenomenon of biofilm development for Candida we evaluated the efficacy of three culture media on growth, adhesion and biofilm formation of two pathogenic yeasts, Candida albicans and Candida tropicalis. The planktonic phase yeast growth, either as monocultures or mixed cultures, in sabouraud dextrose broth (SDB), yeast nitrogen base (YNB), and RPMI 1640 was compared, and adhesion as well as biofilm formation were monitored using MTT and crystal violet (CV) assays and scanning electron microscopy. Planktonic cells of C. albicans, C. tropicalis and their 1:1 co-culture showed maximal growth in SDB. C. albicans/C. tropicalis adhesion was significantly facilitated in RPMI 1640 although the YNB elicited the maximum growth for C. tropicalis. Similarly, the biofilm growth was uniformly higher for both species in RPMI 1640, and C. tropicalis was the slower biofilm former in all three media. Scanning electron microscopy images tended to confirm the results of MTT and CV assay. Taken together, our data indicate that researchers should pay heed to the choice of laboratory culture media when comparing relative planktonic/biofilm growth of Candida. There is also a need for standardisation of biofilm development media so as to facilitate cross comparisons between laboratories.

Introduction: Arbovirus diseases remain a public health threat in Sri Lanka. Dengue is endemic and two outbreaks of chikungunya infections have been reported. There is limited data on Zika virus (ZIKV) infections in Sri Lanka, and this could be due to a lack of comprehensive ZIKV surveillance. Our aim was to determine the presence of antibodies to dengue, chikungunya, and Zika infections in adults from a suburban population in Sri Lanka. Methods: A total of 149 healthy adult volunteers over 18 years of age (mean age: 43±14 years, males – 43%), with no prior diagnosed arboviral infections and no history of overseas travel, participated in the study. ELISA and neutralization assays were carried out to detect past dengue, chikungunya, or Zika infections. Results: A total of 94.6% (141/149) of the participants demonstrated dengue IgG antibodies, 37.5% (56/149) were positive for chikungunya IgG, and 5.3% (8/149) were positive for anti-ZIKV IgG antibodies. Neutralization assays confirmed ZIKV-specific antibodies in 6.7% (10/149), when 40/149 of the participating population were tested. Conclusion: This clearly demonstrated past ZIKV infections in this population. In addition, this study indicates that >90% of individuals had asymptomatic dengue but no serious symptoms. These results provide a cross-sectional view on the DENV, ZIKV, and CHIKV epidemic status and demonstrate a need for the implementation of enhanced surveillance and more effective measures against the spread of these arbovirus diseases.

Fusarium species are plant pathogens which exist ubiquitously in the environment. While they can cause superficial and subcutaneous infections in healthy individuals, they can give rise to deep and disseminated infections in immunocompromised patients, particularly in patients with haematological malignancies with a high risk of mortality. This case describes a young male diagnosed with B cell Acute Lymphoblastic Leukaemia (B-ALL) who developed disseminated Fusarium infection with febrile neutropenia following induction chemotherapy. Necrotic skin lesions led to the diagnosis in this patient. Though the patient had a clinical recurrence of infection due to inadequate treatment initially, he was finally completely cured with combined antifungal therapy using amphotericin B and voriconazole.

Abstract Background Spatial and temporal changes in the dengue incidence are associated with multiple factors, such as climate, immunity among a population against dengue viruses (DENV), circulating DENV serotypes and vertical transmission (VT) of DENV in an area at a given time. The level of VT in a specific location has epidemiological implications in terms of viral maintenance in vectors. Identification of the circulating DENV serotypes in both patients and Aedes mosquito larvae in an area may be useful for the early detection of outbreaks. We report here the results of a prospective descriptive study that was conducted to detect the levels of VT in Aedes mosquito larvae and circulating DENV serotypes in patients and Aedes mosquito larvae from December 2015 to March 2017 in an area of Sri Lanka at high risk for dengue. Methods A total of 200 patients with clinically suspected dengue who had been admitted to a tertiary care hospital during a dengue outbreak (3 study periods: December 2015–January 2016, June–August 2016, December 2016–January 2017) and in the inter-outbreak periods (February–May 2016 and September–November 2016) were investigated. Blood samples were drawn from the study participants to test for DENV. The houses of the study participants were visited within 7 days of admission to the hospital, and Aedes larvae were also collected within a radius of 400 m from the houses. The larvae were separately identified to species and then pooled according to each patient’s identification number. Patients’ sera and the Aedes larvae were tested to identify the infecting DENV serotypes using a reverse transcription PCR (RT-PCR) method. Levels of VT in Aedes mosquito larvae were also identified. Results All four DENV serotypes (DENV-1 to -4) were identified in the study area. In the early part of the study (December 2015–February 2016), DENV-3 was predominant and from April 2016 to March 2017, DENV-2 became the most predominant type. Four cases of DENV co-infections were noted during the study period in patients. Interestingly, all four DENV serotypes were detected in Aedes albopictus larvae, which was the prominent immature vectorial form identified throughout the study period in the area, showing 9.8% VT of DENV. With the exception of DENV-4, the other three DENV serotypes were identified in Aedes aegypti larvae with a VT of 8.1%. Conclusion Comparatively high rates of VT of DENV was detected in Ae. albopictus and Ae. aegypti larvae. A shift in the predominant DENV serotype with simultaneous circulation of all four DENV serotypes was identified in the study area from December 2015 to March 2017. Graphical Abstract

Dengue is a major viral disease affecting the tropics. Although previous research has focused on the relationship between the infecting dengue virus (DENV) serotypes and disease severity, less work has been done on the relationship between the clinical and laboratory features and the infecting DENV serotypes in Sri Lanka. We evaluated the relationship between the clinical and laboratory features and the infecting DENV serotypes in adult patients with clinically suspected dengue admitted to the Base Hospital, Mawanella, Sri Lanka from December 2015 to March 2017.Blood samples of 200 dengue suspected patients were tested for the infecting DENV serotypes using a reverse transcription polymerase chain reaction with primers targeting the envelope region of the virus. Relationship between the infecting DENV serotypes with clinical and laboratory features was assessed using Z score and paired t tests.Of the 200 patients tested, 39 (19.5%) were positive for DENV, any of the four DENV serotypes alone or in combination. The highest number of infections was noted with DENV-2 (n=18, 46.1%). Fever (P=0.000) and rash (P=0.017) were frequently noted in DENV negative patients while bleeding (P=0.012) was more frequently noted in DENV serotype positive patients. Platelet count of 13mgdl−1 (P=0.016) were noted in 15 of the 18 DENV-2 positive patients.Clinical and laboratory features of severe dengue with bleeding manifestations, low platelet counts and high Hb were noted in DENV-2 infections.

Iliopsoas abscess (IPA) is a collection of pus in the iliopsoas muscle. It is rare and usually presents with vague symptoms. IPA can be either primary or secondary. An IPA was diagnosed by computed tomography (CT) in a 64-year-old male with diabetes mellitus and chronic kidney disease (CKD) who presented with a limp. Pus specimen from IPA yielded non-lactose fermenting Escherichia coli which is rarely isolated from IPA. The isolate was sensitive to meropenem and treated with intravenous meropenem for 4 weeks. Source control was achieved by ultrasound scan-guided aspiration of the abscess.

Introduction: The most important and frequently occurring eye infections are conjunctivitis and corneal ulcers. Though the significance of Streptococcus pneumoniae in eye infections is well-known, identification of causative serotypes is important for comparison with serotypes causing invasive diseases. Objectives: To describe the spectrum and characteristics of bacterial pathogens associated with conjunctivitis and corneal ulcers with special reference to S. pneumoniae.Methods: A descriptive cross-sectional study was carried out from January to April 2008 in which samples were collected from patients above one month old with suspected conjunctivitis or corneal ulcers seen in the out-patients department and wards of the National Eye Hospital, Colombo, Sri Lanka. Both eye swabs (n=322) and corneal buttons (n=31) were cultured. Isolated bacteriawere identified as far as possible and antibiotic sensitivity testing done. S. pneumoniae isolates were stored in sheep blood agar slants at -70 ºC and serotyped. Results: There were 296 conjunctival swabs and 26 corneal swabs. From 296 conjunctival swabs 118 (39.8%) samples yielded no bacterial growth. There were 185 bacterial isolates from 159 significant positive samples. The most frequently isolated bacteria were coagulase negative Staphylococcus sp. (n=58: 31.4%), and second commonest was S. pneumoniae (n=33: 17.84%). From 57 samples from patients with corneal ulcers, 47 (82%) did not yield any bacterial growth. Sensitivity to chloramphenicol was high among Staphylococcus sp., S. pneumoniae, Haemophilus influenzae, Moraxella sp and coliforms. Among pneumococcal isolates serotyped, 19F was predominant. Conclusion: Coagulase negative staphylococci were predominantly isolated from eye swabs and corneal buttons, but the most significant frequent isolate was S. pneumoniae. Except Pseudomonas, >90% isolates were sensitive to chloramphenicol. The predominant pneumococcal serotype was 19F.

Introduction: The decision to support the implementation of safety cannulae in a health care institution requires analysis of its cost-effectiveness. The aim of our study was to evaluate the effectiveness of safety cannulae over conventional cannulae in reducing needle stick injury (NSI) incidence in Sri Jayewardenepura General Hospital (SJGH), Sri Lanka.Methods: Hospital device utilization data, NSI data, and total expenditure data including the cost of management of NSIs for conventional and safety cannulae were collected from the period 01/01/2016 to 30/06/2019. The NSI incidence (annual rates per 100,000 devices) for conventional and safety cannulae were calculated and compared to determine the existence of a statistical difference between them. The cost per device inclusive of the management of associated NSIs was also calculated.Results: The total number of conventional and safety cannulae utilized during the study period was 86,412 and 284,686 respectively. In total, there were 12 NSIs associated with conventional cannula insertion and 5 NSIs associated with safety cannula insertion. The annual NSI incidence per 100,000 devices for conventional and safety cannulae was 13.89 (95% CI 7.18-24.26) and 1.76 (95% CI 0.57-4.099) respectively. There was a significant reduction of NSI incidence with the use of safety cannulae (p< 0.0001). The cost per device inclusive of management of associated NSIs for conventional and safety cannulae was Lankan Rupee (LKR) 73.18 and LKR 83.17 respectively.Conclusion: There was a substantial reduction of NSI incidence with safety cannulae and we recommend its use in the prevention of occupational risk to health care workers..

Purpose: Surveillance of different SARS-CoV-2 variants of concern (VOCs) is a crucial aspect in control of the pandemic. Although sequencing is the gold-standard to detect VOCs, it is labor intensive and is costly. We compared a cost-effective real-time PCR assay that detects single nucleotide polymorphisms (SNPs) of VOCs, with next generation sequencing (NGS) in surveillance of VOCs. Methods & Materials: A total of 782 SARS CoV-2 PCR positive samples From May – August 2021 were screened using two variant RT-qPCR assays (Seegene Allplex™ SARS-CoV-2 Variant Assay I and II), which detects 7 SNPs in the spike protein assigning them to one of the VOCs. We compared the results of the variant RT-qPCR with Illumina (n=97) and Oxford Nanopore (n=53) platforms in a subset of samples (n=150). Sequences with > 25x coverage were used and assigned to a Pangolin lineage. Results: 516 samples amplified for N501Y and HV69/70 deletion of the spike protein were assigned as alpha (B.1.1.7). Two samples with spike K417N mutation along with N501Y and E484K were considered to be beta (B.1.351) and 175 samples which are only positive for spike L452R mutation were considered to be delta (B.1.617). 120/156 samples designated as alpha, 22/175 designated as delta and 2 samples designated as beta by RT-qPCR were sequenced either by Illumina or Oxford nanopore platforms. The sequencing results showed a 100% accuracy with the variant RT-qPCR for identification of VOCs. Conclusion: RT-qPCR that detected SNPs specific for VOCs, appear to be highly sensitive and specific in detection of VOCs and had a similar specificity of genomic sequencing. Therefore, this could be a rapid and less expensive method for surveillance of VOCs, in lower income countries. However, as it only detects specific SNPs, any emerging mutations of concern in these VOCs or newly emerging variants, will not be detected.

Abstract. The vaginal microbiome likely influences host signaling compounds within the reproductive tract, including pro-inflammatory signals, which may play an important role during pregnancy. Vaginal lactobacilli are associated with positive pregnancy outcome, whereas bacterial vaginosis, a dysbiosis of the vaginal microbiome, is associated with an increased risk of adverse pregnancy outcomes including preterm birth. If the host response could be predicted based on the taxonomic composition of the vaginal microbiome, particularly early in pregnancy, then those predictions could potentially be used to personalize intervention methods to reduce preterm birth and other adverse events. In this proof of principle study, we apply multivariate strategies to analyze 16S rRNA-based taxonomic surveys in conjunction with targeted immuno-proteomic and lipidomic data from vaginal samples from 58 women enrolled in the Multi-Omic Microbiome Study-Pregnancy Initiative during early pregnancy. Relationships between the vaginal microbiome and the vaginal lipidome have not been previously reported. Results from this study reveal significant multiple pairwise associations between microbial taxa, specific eicosanoids and sphingomyelins, and cytokines. While the biologic significance of these associations is not yet known, these results support the utility of such multi-omic approaches as a means to predict the impact of the microbiome on the host.

BACKGROUND Essential oils (EO) extracted from Cinnamomum verum has been used as an antimicrobial agents for centuries. The effects of C. verum leaf oil against virulence of microorganisms is not well studied yet. OBJECTIVES This study evaluates the effect of C. verum leaf oil against three virulence factors of Candida albicans, C. tropicalis and C. dubliniensis and its in-vivo toxicity. METHODS Chemical composition of EO was determined using gas chromatography-mass spectrometry (GC-MS). Minimum inhibitory concentration (MIC) was determined using clinical and laboratory standards institute (CLSI) M27-A3 broth microdilution. Effect of EO on initial adhesion was quantified using XTT assay after allowing Candida cells to adhere to the polystyrene surface for 2 h. Biofilm formation of Candida in the presence of EO was quantified using XTT viability assay. Efficacy on reduction of germ tube formation was evaluated using standard protocol. Visualisation of biofilm formation and progression under the EO treatment were done using scanning electron microscope (SEM) and Time lapses microscope respectively. In-vivo toxicity of EO was determined using Galleria mellonella larvae. Chlorhexidine digluconate: positive control. RESULTS Eugenol was the main compound of EO. MIC was 1.0 mg/mL. 50% reduction in initial adhesion was achieved by C. albicans, C. tropicalis and C. dubliniensis with 1.0, > 2.0 and 0.34 mg/mL respectively. 0.5 and 1.0 mg/mL significantly inhibit the germ tube formation. MBIC50 for forming biofilms were ≤ 0.35 mg/mL. 1.0 mg/mL prevent biofilm progression of Candida. SEM images exhibited cell wall damages, cellular shrinkages and decreased hyphal formation. No lethal effect was noted with in-vivo experiment model at any concentration tested. CONCLUSION C. verum leaf oil acts against virulence factors of Candida and does not show any toxicity.

Introduction and Objective: Chlorhexidine is used as an oral mouthwash to reduce oral colonization related to dental disease. Triphala (An ayurvedic preparation from the dried fruits of Emblica officinalis, Terminalia bellirica and Terminalia chebula) and Mimusops elengi(Munamal) are used as mouthwashes in Ayurvedic medicine and are known to have antimicrobial activity.This study was aimed to determine the effect of 0.2% Chlorhexidine gluconate, Triphala and Mimusops elengi (Munamal) on Candida species and three common bacterial pathogens.Methods: The effect of 0.2% chlorhexidine gluconate, Triphala and Mimusops elengi (Munamal) aqueous extracts against Candida spp., Staphylococcus aureus, and methicillin resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa were determined using an agar well diffusion method. Minimum inhibitory concentration (MIC) of Triphala and Munamal aqueous extracts for the microorganisms were determined using broth micro dilution method with alamar blue modification.Results: 0.2% Chlorhexidine gluconate showed a zone of inhibition for all test microbial strains. Triphala demonstrated activity against all tested microbial species except Candida glabrata, Candida dubliniensis and Escherichia coli. Munamal Pothu demonstrated activity against Staphylococcus aureus and MRSA only. Chlorhexidine gluconate inhibited the growth of Candida (C. albicans and C. tropicalis) at 1/512 dilution (MIC = 0.004 mg/ml for both organisms). The MIC of Triphala for C. albicans and C. tropicalis was 32.5 mg/ml. Anti-candida activity of Chlorhexidine gluconate was achieved at very low concentrations.Conclusions: Triphala as a potential oral mouthwash agent with activity against C. albicans and C. tropicalis requires further investigation.