Scholars@Duke
Gayani Tillekeratne

Gayani Tillekeratne

Associate Professor of Medicine
Medicine, Infectious Diseases
gayani.tillekeratne@duke.edu
310 Trent Drive #213, Durham, NC 27705

Selected Publications

Academic global health collaboration: the Ruhuna-Duke partnership.

Journal Article Glob Health Action · December 2025 The role of institutional partnerships is increasingly recognized as a means of advancing our collective efficacy in improving public health. Shared challenges related to infectious and chronic diseases, as well as social determinants of health including e ... Full text Link to item Cite

Diverse respiratory viruses detected among hospitalized patients with pneumonia in Sri Lanka and Vietnam.

Journal Article IJID Reg · December 2025 OBJECTIVES: We conducted surveillance for novel respiratory viruses among patients hospitalized with pneumonia in Sri Lanka and Vietnam. METHODS: We enrolled patients from January 2020 to July 2022 at one major hospital each in Sri Lanka and Vietnam. The p ... Full text Link to item Cite

Use of the BIOFIRE® FILMARRAY® Pneumonia plus Panel to characterize the etiology of lower respiratory tract infections among hospitalized patients in Southern Province, Sri Lanka.

Journal Article BMC Infect Dis · September 29, 2025 BACKGROUND: Lower respiratory tract infections (LRTIs) account for a heavy burden of illness in low- and middle-income country settings, but the etiology of these infections is often unknown. In this study, we applied the BIOFIRE® FILMARRAY® Pneumonia plus ... Full text Link to item Cite

Electronic Clinical Decision Support Tools to Manage Patients with Lower Respiratory Tract Infection: Clinicians' Perspectives in Sri Lanka.

Journal Article Am J Trop Med Hyg · May 7, 2025 In low-resource settings, providers often manage lower respiratory tract infections (LRTIs) without diagnostic tests, which may cause antibacterial overuse. Electronic clinical decision support tools (eCDSTs) can support evidence-based decision-making and ... Full text Link to item Cite

A Rapid Host Response Blood Test for Bacterial/Viral Infection Discrimination Using a Portable Molecular Diagnostic Platform.

Journal Article Open Forum Infect Dis · January 2025 BACKGROUND: Difficulty discriminating bacterial versus viral etiologies of infection drives unwarranted antibacterial prescriptions and, therefore, antibacterial resistance. METHODS: Utilizing a rapid portable test that measures peripheral blood host gene ... Full text Link to item Cite

Exploring supportive roles for global north investigators in global health research.

Journal Article PLOS Glob Public Health · 2025 Many academics are increasingly pushing for solutions to address inequitable partnership dynamics in global health research and practice. Efforts to improve equity in collaborations have prompted academic institutions to grapple with promotion and tenure c ... Full text Link to item Cite

Association of race, ethnicity, and housing stability with COVID-19 testing method by investigators in underserved populations 2020-2023.

Journal Article Front Public Health · 2025 BACKGROUND: Expanding SARS-CoV-2 testing was a critical part of community-based health efforts during the COVID-19 pandemic. In the RADx-UP consortium, a large NIH-funded network of community-engaged researchers in the United States, investigators were abl ... Full text Link to item Cite

Host gene expression in the Nasopharynx can discriminate microbiologically confirmed viral and bacterial lower respiratory tract infection.

Journal Article J Clin Transl Sci · 2025 INTRODUCTION: Distinguishing viral versus bacterial lower respiratory tract infection (LRTI) is challenging. We previously developed a rapid, host response-based test (Biomeme HR-B/V assay) using peripheral blood samples to identify viral versus bacterial ... Full text Link to item Cite

Physician knowledge, attitudes, and perceptions of antibiograms: a pre-implementation study in southern Sri Lanka.

Journal Article Antimicrob Steward Healthc Epidemiol · 2025 OBJECTIVE: The purpose of this study is to explore physicians' knowledge, attitudes, and perceptions toward antibiograms and identify perceived barriers and facilitators to their implementation in a low-resource setting in Sri Lanka. DESIGN: A qualitative ... Full text Link to item Cite

Electronic Clinical Decision Support Tools: Strategies to Improve the Management of Lower Respiratory Tract Infections in Low-Resource Settings.

Journal Article Am J Trop Med Hyg · December 4, 2024 Lower respiratory tract infection (LRTI) is a common reason for hospitalization and antibacterial use globally. There is considerable overlap in the clinical presentation of bacterial and viral LRTIs. Low- or middle-income countries (LMICs) face the dual c ... Full text Link to item Cite

Prevalence and molecular epidemiology of methicillin-resistant Staphylococcus aureus in livestock farmers, livestock, and livestock products in southern Sri Lanka: A one health approach.

Journal Article Infect Genet Evol · December 2024 Methicillin-resistant Staphylococcus aureus (MRSA) colonization can lead to subsequent severe infections. Unlike community and hospital-associated types, Livestock-associated MRSA (LA-MRSA) transmits to humans through direct contact with livestock and cont ... Full text Link to item Cite

Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka.

Journal Article PLoS One · 2024 BACKGROUND: Antimicrobial overprescription is common for lower respiratory tract infections (LRTI), as viral and bacterial infections generally present with similar clinical features. Overprescription is associated with downstream antimicrobial resistance. ... Full text Link to item Cite

Host-response transcriptional biomarkers accurately discriminate bacterial and viral infections of global relevance.

Journal Article Sci Rep · December 18, 2023 Diagnostic limitations challenge management of clinically indistinguishable acute infectious illness globally. Gene expression classification models show great promise distinguishing causes of fever. We generated transcriptional data for a 294-participant ... Full text Link to item Cite

Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: a prospective cohort study.

Journal Article BMJ Public Health · November 2023 INTRODUCTION: Acute febrile illness (AFI) is a common cause of hospital admissions in tropical settings. Identifying AFI aetiology is essential for guiding clinicians' diagnoses and developing diagnostic and management guidelines. We used rigorous, gold-st ... Full text Link to item Cite

Priorities and Progress in Diagnostic Research by the Antibacterial Resistance Leadership Group.

Journal Article Clin Infect Dis · October 16, 2023 The advancement of infectious disease diagnostics, along with studies devoted to infections caused by gram-negative and gram-positive bacteria, is a top scientific priority of the Antibacterial Resistance Leadership Group (ARLG). Diagnostic tests for infec ... Full text Link to item Cite

RADx-UP Testing Core: Access to COVID-19 Diagnostics in Community-Engaged Research with Underserved Populations.

Journal Article J Clin Microbiol · August 23, 2023 Research on the COVID-19 pandemic revealed a disproportionate burden of COVID-19 infection and death among underserved populations and exposed low rates of SARS-CoV-2 testing in these communities. A landmark National Institutes of Health (NIH) funding init ... Full text Open Access Link to item Cite

Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania.

Journal Article Open Forum Infect Dis · August 2023 BACKGROUND: We describe antibacterial use in light of microbiology data and treatment guidelines for common febrile syndromes in Moshi, Tanzania. METHODS: We compared data from 2 hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 ... Full text Open Access Link to item Cite

Influenza Vaccination Implementation in Sri Lanka: A Cost-Effectiveness Analysis.

Journal Article Vaccines (Basel) · May 3, 2023 Influenza causes an estimated 3 to 5 million cases of severe illness annually, along with substantial morbidity and mortality, particularly in low- and middle-income countries (LMICs). Currently, Sri Lanka has no influenza vaccination policies and does not ... Full text Open Access Link to item Cite

Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review.

Journal Article Front Public Health · 2023 INTRODUCTION: The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pande ... Full text Open Access Link to item Cite

Mass drug administration of antibacterials: weighing the evidence regarding benefits and risks.

Journal Article Infect Dis Poverty · June 30, 2022 BACKGROUND: Mass drug administration (MDA) is a strategy to improve health at the population level through widespread delivery of medicine in a community. We surveyed the literature to summarize the benefits and potential risks associated with MDA of antib ... Full text Link to item Cite

Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka.

Journal Article BMC Health Serv Res · May 16, 2022 BACKGROUND: The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and i ... Full text Link to item Cite

Prospective Validation of a Rapid Host Gene Expression Test to Discriminate Bacterial From Viral Respiratory Infection.

Journal Article JAMA Netw Open · April 1, 2022 IMPORTANCE: Bacterial and viral causes of acute respiratory illness (ARI) are difficult to clinically distinguish, resulting in the inappropriate use of antibacterial therapy. The use of a host gene expression-based test that is able to discriminate bacter ... Full text Open Access Link to item Cite

Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries.

Journal Article Front Public Health · 2022 BACKGROUND: To develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and patter ... Full text Link to item Cite

Elevated Procalcitonin Levels Are Associated with Severity of Acute Lower Respiratory Tract Infections in Sri Lanka

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2022 Cite

Outcomes among children and adults at risk of severe dengue in Sri Lanka: Opportunity for outpatient case management in countries with high disease burden.

Journal Article PLoS Negl Trop Dis · December 2021 BACKGROUND: Healthcare systems in dengue-endemic countries are often overburdened due to the high number of patients hospitalized according to dengue management guidelines. We systematically evaluated clinical outcomes in a large cohort of patients hospita ... Full text Link to item Cite

Knowledge, Perceptions, and Attitudes Regarding Antibiotic Use for Lower Respiratory Tract Infections: Insights from Patients in Sri Lanka.

Journal Article Am J Trop Med Hyg · September 27, 2021 Antibiotic resistance is an emerging global public health threat. One of the main drivers of this threat is the inappropriate use of antibiotics. In Sri Lanka, antibiotic consumption is increasing, but little is known locally about how patients perceive an ... Full text Link to item Cite

Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka.

Journal Article Antimicrob Resist Infect Control · April 30, 2021 BACKGROUND: The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with M ... Full text Link to item Cite

Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study.

Journal Article Antimicrob Resist Infect Control · March 25, 2021 BACKGROUND: Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine p ... Full text Link to item Cite

Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses.

Journal Article BMC Infect Dis · January 21, 2021 BACKGROUND: Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevale ... Full text Link to item Cite

Staphylococcus pettenkoferi Bacteremia in an American Intensive Care Unit.

Journal Article Case reports in infectious diseases · January 2021 Coagulase-negative staphylococci (CoNS) are considered the most common cause of nosocomial bloodstream infections; yet, these species are frequently designated as contaminants in the absence of systemic signs and symptoms of infection. Immunocompromised pa ... Full text Cite

The Host Response to Viral Infections Reveals Common and Virus-Specific Signatures in the Peripheral Blood.

Journal Article Front Immunol · 2021 Viruses cause a wide spectrum of clinical disease, the majority being acute respiratory infections (ARI). In most cases, ARI symptoms are similar for different viruses although severity can be variable. The objective of this study was to understand the sha ... Full text Open Access Link to item Cite

COVID-19 SURVEILLANCE IN THE SOUTHERN PROVINCE OF SRI LANKA

Conference AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE · 2021 Cite

SEROPREVALENCE OF SARS-COV-2 AMONG MEDICAL UNDERGRADUATES IN A STATE UNIVERSITY OF SRI LANKA

Conference AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE · 2021 Cite

Outbreak of severe acute respiratory infection in Southern Province, Sri Lanka in 2018: a cross-sectional study.

Journal Article BMJ Open · November 6, 2020 OBJECTIVES: To determine aetiology of illness among children and adults presenting during outbreak of severe respiratory illness in Southern Province, Sri Lanka, in 2018. DESIGN: Prospective, cross-sectional study. SETTING: 1600-bed, public, tertiary care ... Full text Link to item Cite

Geospatial analysis of dengue emergence in rural areas in the Southern Province of Sri Lanka.

Conference Trans R Soc Trop Med Hyg · June 1, 2020 BACKGROUND: Dengue is a major cause of acute febrile illness in Sri Lanka. Dengue has historically been considered an urban disease. In 2012-2013, we documented that acute dengue was surprisingly associated with self-reported rural residence in the Souther ... Full text Link to item Cite

Previously Derived Host Gene Expression Classifiers Identify Bacterial and Viral Etiologies of Acute Febrile Respiratory Illness in a South Asian Population.

Journal Article Open Forum Infect Dis · June 2020 BACKGROUND: Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI i ... Full text Open Access Link to item Cite

Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis.

Journal Article Lancet Glob Health · August 2019 BACKGROUND: Influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus are the most common viruses associated with acute lower respiratory infections in young children (<5 years) and older people (≥65 years). A global report of ... Full text Link to item Cite

Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka.

Journal Article Am J Trop Med Hyg · March 2019 The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ... Full text Link to item Cite

Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices.

Journal Article Infect Control Hosp Epidemiol · February 2019 A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% in medical wards, 68.0% in surgical wards, and 97.6% in intensive care wards. Amoxicillin-clavulanate ... Full text Link to item Cite

Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka.

Journal Article BMJ Glob Health · 2019 BACKGROUND: Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The econo ... Full text Link to item Cite

HOST GENES ARE DIFFERENTIALLY EXPRESSED IN DENGUE COMPARED TO INFLUENZA INFECTIONS

Conference AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE · January 1, 2019 Link to item Cite

AN OUTBREAK OF ADENOVIRUS CAUSING SEVERE RESPIRATORY ILLNESS IN SOUTHERN SRI LANKA, 2018

Conference AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE · January 1, 2019 Link to item Cite

Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic.

Journal Article PLoS Negl Trop Dis · February 2018 BACKGROUND: Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. METHODOLOGY/PRINCIPAL FINDINGS: The new WHO 2009 classification o ... Full text Link to item Cite

Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka.

Journal Article Am J Trop Med Hyg · July 2017 In tropical and subtropical settings, the epidemiology of viral acute respiratory tract infections varies widely between countries. We determined the etiology, seasonality, and clinical presentation of viral acute respiratory tract infections among outpati ... Full text Link to item Cite

Analysis of Dengue Serotype 4 in Sri Lanka during the 2012-2013 Dengue Epidemic.

Journal Article Am J Trop Med Hyg · July 2017 The four serotypes of dengue virus (DENV-1, -2, -3, and -4) have had a rapidly expanding geographic range and are now endemic in over 100 tropical and subtropical countries. Sri Lanka has experienced periodic dengue outbreaks since the 1960s, but since 198 ... Full text Link to item Cite

Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians.

Journal Article BMC Fam Pract · March 16, 2017 BACKGROUND: Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiot ... Full text Open Access Link to item Cite

Prevalence and Correlates of Leprosy in a High-Risk Community Setting in Sri Lanka.

Journal Article Asia Pac J Public Health · October 2016 Leprosy is caused by the Mycobacterium leprae bacillus. Pockets of high endemicity remain in a number of countries including Sri Lanka, in spite of the fact that elimination has been achieved at the national level. In 2012, in a village in the Puttlam dist ... Full text Link to item Cite

Emergence of Epidemic Dengue-1 Virus in the Southern Province of Sri Lanka.

Journal Article PLoS Negl Trop Dis · October 2016 BACKGROUND: Dengue is a frequent cause of acute febrile illness with an expanding global distribution. Since the 1960s, dengue in Sri Lanka has been documented primarily along the heavily urbanized western coast with periodic shifting of serotypes. Outbrea ... Full text Open Access Link to item Cite

Extended-spectrum ß-Lactamase-producing Enterobacteriaceae as a Common Cause of Urinary Tract Infections in Sri Lanka.

Journal Article Infect Chemother · September 2016 BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, in Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated in UTIs has not ... Full text Link to item Cite

Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka.

Journal Article Am J Trop Med Hyg · November 2015 Acute respiratory tract infections (ARTIs) are a common reason for unnecessary antibiotic prescriptions worldwide. Our objective was to determine if providing access to rapid influenza test results could reduce antibiotic prescriptions for ARTIs in a resou ... Full text Link to item Cite

An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013.

Journal Article Am J Trop Med Hyg · May 2015 Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack of confirmatory testing. Consecutive outpatients presenting to the largest tertiary care hospital ... Full text Link to item Cite

A multifaceted intervention to reduce rates of catheter-associated urinary tract infections in a resource-limited setting.

Journal Article Am J Infect Control · January 2014 BACKGROUND: Health care-associated infections such as catheter-associated urinary tract infections (CAUTIs) are prevalent in resource-limited settings. This study was carried out to determine whether a multifaceted intervention targeting health care person ... Full text Link to item Cite

Identifying HIV-infected children who may benefit from early initiation of antiretrovirals

Journal Article Journal of Pediatric Infectious Diseases · November 11, 2009 In resource-limited settings lacking laboratory testing, clinical staging criteria may not identify all human immunodeficiency virus (HIV)-infected children who could benefit from antiretroviral therapy (ART). A retrospective analysis was conducted to iden ... Full text Cite

Total lymphocyte count and World Health Organization pediatric clinical stage as markers to assess need to initiate antiretroviral therapy among human immunodeficiency virus-infected children in Moshi, Northern Tanzania.

Journal Article Pediatr Infect Dis J · June 2009 BACKGROUND: The World Health Organization (WHO) has recommended the use of clinical staging alone and with total lymphocyte count to identify HIV infected children in need of antiretroviral therapy (ART) in resource-limited settings, when CD4 cell count is ... Full text Link to item Cite

Morbidity and mortality among a cohort of HIV-infected adults in a programme for community home-based care, in the Kilimanjaro Region of Tanzania (2003-2005).

Journal Article Ann Trop Med Parasitol · April 2009 Community home-based care (CHBC) plays an integral role in the care of HIV-infected patients living in resource-limited regions. A longitudinal cohort study has recently been conducted, in the Kilimanjaro Region of northern Tanzania, in order to identify t ... Full text Link to item Cite