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Das P, Rahman MZ, Banu S, Rahman M, Chisti MJ, Chowdhury F, Akhtar Z, Palit A, Martin DW, Anwar MU, Namwase AS, Angra P, Kato CY, Ramos CJ, Singleton J, Stewart-Juba J, Patel N, Condit M, Chung IH, Galloway R, Friedman M, Cohen AL. Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic. PLoS One 2022; 17:e0273902. [PMID: 36048788 PMCID: PMC9436081 DOI: 10.1371/journal.pone.0273902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
Understanding the distribution of pathogens causing acute febrile illness (AFI) is important for clinical management of patients in resource-poor settings. We evaluated the proportion of AFI caused by specific pathogens among outpatients in Bangladesh. During May 2019-March 2020, physicians screened patients aged ≥2 years in outpatient departments of four tertiary level public hospitals. We randomly enrolled patients having measured fever (≥100.4°F) during assessment with onset within the past 14 days. Blood and urine samples were tested at icddr,b through rapid diagnostic tests, bacterial culture, and polymerase chain reaction (PCR). Acute and convalescent samples were sent to the Centers for Disease Control and Prevention (USA) for Rickettsia and Orientia (R/O) and Leptospira tests. Among 690 patients, 69 (10%) had enteric fever (Salmonella enterica serotype Typhi orSalmonella enterica serotype Paratyphi), 51 (7.4%) Escherichia coli, and 28 (4.1%) dengue detected. Of the 441 patients tested for R/O, 39 (8.8%) had rickettsioses. We found 7 (2%) Leptospira cases among the 403 AFI patients tested. Nine patients (1%) were hospitalized, and none died. The highest proportion of enteric fever (15%, 36/231) and rickettsioses (14%, 25/182) was in Rajshahi. Dhaka had the most dengue cases (68%, 19/28). R/O affected older children and young adults (IQR 8-23 years) and was detected more frequently in the 21-25 years age-group (17%, 12/70). R/O was more likely to be found in patients in Rajshahi region than in Sylhet (aOR 2.49, 95% CI 0.85-7.32) between July and December (aOR 2.01, 1.01-5.23), and who had a history of recent animal entry inside their house than not (aOR 2.0, 0.93-4.3). Gram-negative Enterobacteriaceae were the most common bacterial infections, and dengue was the most common viral infection among AFI patients in Bangladeshi hospitals, though there was geographic variability. These results can help guide empiric outpatient AFI management.
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Affiliation(s)
- Pritimoy Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M. Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anik Palit
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel W. Martin
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Mahabub Ul Anwar
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Angella Sandra Namwase
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Pawan Angra
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Cecilia Y. Kato
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Carmen J. Ramos
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Joseph Singleton
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Jeri Stewart-Juba
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Nikita Patel
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Marah Condit
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Ida H. Chung
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Renee Galloway
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Michael Friedman
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Adam L. Cohen
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Chowdhury S, Aleem MA, Khan MSI, Hossain ME, Ghosh S, Rahman MZ. Major zoonotic diseases of public health importance in Bangladesh. Vet Med Sci 2021; 7:1199-1210. [PMID: 33650812 PMCID: PMC8013274 DOI: 10.1002/vms3.465] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/01/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022] Open
Abstract
Zoonotic diseases cause repeated outbreaks in humans globally. The majority of emerging infections in humans are zoonotic. COVID‐19 is an ideal example of a recently identified emerging zoonotic disease, causing a global pandemic. Anthropogenic factors such as modernisation of agriculture and livestock farming, wildlife hunting, the destruction of wild animal habitats, mixing wild and domestic animals, wildlife trading, changing food habits and urbanisation could drive the emergence of zoonotic diseases in humans. Since 2001, Bangladesh has been reporting many emerging zoonotic disease outbreaks such as nipah, highly pathogenic avian influenza, pandemic H1N1, and COVID‐19. There are many other potential zoonotic pathogens such as Ebola, Middle East respiratory syndrome coronavirus, Kyasanur forest disease virus and Crimean–Congo haemorrhagic fever that may emerge in the future. However, we have a limited understanding of zoonotic diseases’ overall risk in humans and associated factors that drive the emergence of zoonotic pathogens. This narrative review summarised the major emerging, re‐emerging, neglected and other potential zoonotic diseases in Bangladesh and their associated risk factors. Nipah virus and Bacillus anthracis caused repeated outbreaks in humans. More than 300 human cases with Nipah virus infection were reported since the first outbreak in 2001. The highly pathogenic avian influenza virus (H5N1) caused more than 550 outbreaks in poultry, and eight human cases were reported so far since 2007. People of Bangladesh are frequently exposed to zoonotic pathogens due to close interaction with domestic and peri‐domestic animals. The rapidly changing intensified animal–human–ecosystem interfaces and risky practices increase the risk of zoonotic disease transmission. The narrative review's findings are useful to draw attention to the risk and emergence of zoonotic diseases to public health policymakers in Bangladesh and the application of one‐health approach to address this public health threat.
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Affiliation(s)
- Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad A Aleem
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Md Shafiqul I Khan
- Department of Food Microbiology, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Mohammad Enayet Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Z Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Domestic dogs are mammalian reservoirs for the emerging zoonosis flea-borne spotted fever, caused by Rickettsia felis. Sci Rep 2020; 10:4151. [PMID: 32139802 PMCID: PMC7058065 DOI: 10.1038/s41598-020-61122-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/17/2020] [Indexed: 11/08/2022] Open
Abstract
Rickettsia felis is an obligate intracellular bacterium that is being increasingly recognized as an etiological agent of human rickettsial disease globally. The agent is transmitted through the bite of an infected vector, the cat flea, Ctenocephalides felis, however there is to date, no consensus on the pathogen's vertebrate reservoir, required for the maintenance of this agent in nature. This study for the first time, demonstrates the role of the domestic dog (Canis familiaris) as a vertebrate reservoir of R. felis. The ability of dogs to sustain prolonged periods of rickettsemia, ability to remain asymptomatically infected with normal haematological parameters and ability to act as biological vehicles for the horizontal transmission of R. felis between infected and uninfected fleas provides indication of their status as a mammalian reservoir of this emerging zoonosis.
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Kingston HW, Hossain M, Leopold S, Anantatat T, Tanganuchitcharnchai A, Sinha I, Plewes K, Maude RJ, Chowdhury MAH, Paul S, Uddin RAME, Siddiqui MAN, Zahed AS, Abu Sayeed A, Rahman MH, Barua A, Uddin MJ, Sattar MA, Dondorp AM, Blacksell SD, Day NPJ, Ghose A, Hossain A, Paris DH. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerg Infect Dis 2019; 24. [PMID: 29553921 PMCID: PMC5875266 DOI: 10.3201/eid2404.170190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Scrub and murine typhus are common, treatable causes of undifferentiated febrile illnesses in hospitalized patients. We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence–confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.
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Chowdhury NF, Paul SK, Aung MS, Hossain MA, Ahamed F, Ahmed S, Haque N, Nasreen SA, Khan SI, Rahman SMM, Rahman ASMM, Ferdouse F, Ahmed R, Sultan SM, Ahmed MU, Urushibara N, Kobayashi N. Nationwide prevalence of Rickettsia felis infections in patients with febrile illness in Bangladesh. New Microbes New Infect 2017; 19:123-125. [PMID: 28831298 PMCID: PMC5552056 DOI: 10.1016/j.nmni.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022] Open
Abstract
From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections.
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Affiliation(s)
| | - S K Paul
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M S Aung
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M A Hossain
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - F Ahamed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S Ahmed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - N Haque
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S A Nasreen
- Jamalpur Medical College, Jamalpur, Bangladesh
| | - S I Khan
- Patuakhali Medical College, Patuakhali, Bangladesh
| | | | | | - F Ferdouse
- Shaheed Monsur Ali Medical College, Dhaka, Bangladesh
| | - R Ahmed
- Manikganj Medical College, Manikganj, Bangladesh
| | - S M Sultan
- Uttara Adhunik Medical College, Dhaka, Bangladesh
| | - M U Ahmed
- Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - N Urushibara
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - N Kobayashi
- Sapporo Medical University School of Medicine, Sapporo, Japan
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Teoh YT, Hii SF, Graves S, Rees R, Stenos J, Traub RJ. Evidence of exposure to Rickettsia felis in Australian patients. One Health 2016; 2:95-98. [PMID: 28616481 PMCID: PMC5441329 DOI: 10.1016/j.onehlt.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 11/22/2022] Open
Abstract
Rickettsia felis is an emerging zoonosis, causing flea-borne spotted fever (FBSF). Serological diagnosis is typically confounded by cross-reactivity with typhus group rickettsiae and prior to the development of specific serological methods, cases of FBSF in Australia were misdiagnosed. Patient sera tested between August 2010 and December 2013 and known to be seropositive to R. typhi by immunofluorescence antibody testing (IFAT) were subsequently retested against R. felis using an R. felis-specific IFAT. Sera of 49 patients were of a sufficient quality to be included in re-analysis. A classification of FBSF and murine typhus (MT) was attributed to fourteen and seven patients respectively, based on a minimum four-fold higher antibody titre to R. felis than to R. typhi and vice versa. Twenty-eight patients were classified as indeterminate for either R. felis or R. typhi (antibody titres within two-fold of one another). Historically, it is likely that Australian patients clinically ill with FBSF were misdiagnosed. It is important that medical practitioners consider FBSF as part of their differential diagnoses, and obtain relevant history with regard to patient's exposure to domestic pets and their fleas. Australian microbiology diagnostic laboratories should include serological testing for R. felis as part of the diagnostic panel for febrile diseases. Veterinarians are encouraged to increase their awareness of this emerging zoonosis and advocate flea control in pets.
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Affiliation(s)
- Yen Thon Teoh
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Stephen Graves
- The Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC 3220, Australia
| | - Robert Rees
- Bayer Animal Health, Tingalpa, QLD 4173, Australia
| | - John Stenos
- The Australian Rickettsial Reference Laboratory, University Hospital, Geelong, VIC 3220, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC 3052, Australia
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Inpankaew T, Hii SF, Chimnoi W, Traub RJ. Canine vector-borne pathogens in semi-domesticated dogs residing in northern Cambodia. Parasit Vectors 2016; 9:253. [PMID: 27161452 PMCID: PMC4862146 DOI: 10.1186/s13071-016-1552-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/28/2016] [Indexed: 11/18/2022] Open
Abstract
Background In Southeast Asia, the canine vector-borne pathogens Babesia spp., Ehrlichia canis, Anaplasma platys, Hepatozoon canis, haemotropic mycoplasmas and Dirofilaria immitis cause significant morbidity and mortality in dogs. Moreover, dogs have also been implicated as natural reservoirs for Rickettsia felis, the agent of flea-borne spotted fever, increasingly implicated as a cause of undifferentiated fever in humans in Southeast Asia. The objective of this study was to determine the prevalence and diversity of canine vector-borne pathogens in 101 semi-domesticated dogs from rural Cambodia using molecular diagnostic techniques. Results The most common canine vector-borne pathogens found infecting dogs in this study were Babesia vogeli (32.7 %) followed by Ehrlichia canis (21.8 %), Dirofilaria immitis (15.8 %), Hepatozoon canis (10.9 %), Mycoplasma haemocanis (9.9 %) and “Candidatus Mycoplasma haematoparvum” (2.9 %). A high level of co-infection with CVBD agents (23.8 %) was present, most commonly B. vogeli and E. canis. Naturally occurring R. felis infection was also detected in 10.9 % of dogs in support of their role as a natural mammalian reservoir for flea-borne spotted fever in humans. Conclusions This study reports for the first time, the prevalence and diversity of CVBD pathogens in dogs in Cambodia. In total, five species of CVBD pathogens were found infecting semi-domesticated dogs and many were co-infected with two or more pathogens. This study supports the role of dogs as natural mammalian reservoirs for R. felis, the agent of flea-borne spotted fever in humans.
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Affiliation(s)
- Tawin Inpankaew
- Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Wissanuwat Chimnoi
- Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, 10900, Thailand
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, 3052, Australia.
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Angelakis E, Mediannikov O, Parola P, Raoult D. Rickettsia felis: The Complex Journey of an Emergent Human Pathogen. Trends Parasitol 2016; 32:554-564. [PMID: 27155905 DOI: 10.1016/j.pt.2016.04.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
Rickettsia felis is an obligate intracellular bacterium that is different from other officially recognized rickettsial species. It has multiple genes of different origins, an incubation temperature of less than 32°C, and a conjugative plasmid. This Rickettsia is commonly detected in febrile patients in sub-Saharan Africa. R. felis is frequently detected in cat fleas, but recently mosquitoes have been suspected to be able to transmit the bacterium. However, many aspects of the ecology and epidemiology of R. felis are not completely understood and remain to be uncovered. We aim here to give an update of the current knowledge about this fascinating organism.
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Affiliation(s)
- Emmanouil Angelakis
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France.
| | - Oleg Mediannikov
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Philippe Parola
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
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Ahmed R, Paul SK, Hossain MA, Ahmed S, Mahmud MC, Nasreen SA, Ferdouse F, Sharmi RH, Ahamed F, Ghosh S, Urushibara N, Aung MS, Kobayashi N. Molecular Detection ofRickettsia felisin Humans, Cats, and Cat Fleas in Bangladesh, 2013–2014. Vector Borne Zoonotic Dis 2016; 16:356-8. [DOI: 10.1089/vbz.2015.1886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rajib Ahmed
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
- Department of Biochemistry, Manikganj Medical College, Manikganj, Bangladesh
| | - Shyamal Kumar Paul
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
| | | | - Salma Ahmed
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
| | | | | | - Faria Ferdouse
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Rumana Hasan Sharmi
- Department of Biochemistry, Manikganj Medical College, Manikganj, Bangladesh
| | - Farid Ahamed
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Souvik Ghosh
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, St. Kitts, West Indies
| | - Noriko Urushibara
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Meiji Soe Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobumichi Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
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