Neglected infections like Leptospira and Rickettsia demand attention in acute febrile illness management - Study shows

Dhaka, Bangladesh, 23 May 2023: Scientists from icddr,b in collaboration with the Directorate General of Health Services (DGHS) and Centers for Disease Control and Prevention (US-CDC), USA organised a dissemination seminar titled "Causative Pathogens of Acute Febrile Illness (AFI) and Antimicrobial Resistance in Bangladesh" at icddr,b's Sasakawa Auditorium in Mohakhali. AFI is characterized by an acute onset of fever which is often associated with other symptoms such as headache, chills, diarrhoea, and cough and can be caused by viruses, bacteria, parasites, and fungi. The seminar presented preliminary findings from three studies, which investigated the circulating pathogens responsible for acute febrile illness in Bangladesh, explored antimicrobial resistance in selected communities and hospitals in Dhaka city (ARCH); and Candida Auris infection among hospitalized patients in intensive care units.
Dr Daniel Martin, from the Division of Global Health Protection at the US CDC, provided an overview of acute febrile illness surveillance for global health security. Dr Tanzir Ahmed Shuvo, Senior Research Investigator at icddr,b, presented the findings from the Bangladesh chapter of the AFI study involving five medical college hospitals across five divisions. The study, initiated in September 2021 and expected to continue until September 2024, aims to identify circulating pathogens causing acute febrile illness including potential epidemic or pandemic-causing pathogens and explore antibiotic usage and resistance patterns among AFI patients.
Preliminary findings indicated that influenza A was the most frequently detected pathogen (5.2%), followed by Leptospira (4.6%), Dengue (4.4%), and others. The study also identified Rickettsia infections caused by Orientia tsutsugamushi and Coxiella burnetii. Dr Shuvo emphasized the importance of recognizing and diagnosing neglected infections such as Leptospira and Rickettsia. The study further highlighted the significant burden of antibiotic resistance and the importance of adhering to World Health Organization AWaRe (Access, Watch, Reserve) classifications for antibiotic use.
Dr Fahmida Chowdhury, Associate Scientist at icddr,b and principal investigator of all three studies, presented on antimicrobial resistance in selected communities and hospitals in Dhaka city. Syeda Mah-E-Muneer, Assistant Scientist at icddr,b presented Candida Auris, an emerging fungus infection among hospitalized patients in intensive care units. Mah-E-Muneer recommended the use of 70% alcohol or 10% sodium hypochlorite-based disinfectants for eliminating this type of fungus effectively.
Renowned child specialist Prof. Dr Md. Abid Hossain Mollah praised the research team for their diligent efforts in investigating the causative agents of AFI. He also emphasized the crucial need for close collaboration between researchers and clinicians to ensure the study's robustness and effectiveness. Brigadier General Dr MD Nazmul Islam, Director of Dhaka Medical College, urged the researchers to suggest easier and more accessible disinfectants for Candida fungus elimination as the study progresses. Dr Martin in his address acknowledged the significance of the presented data for public health. 
Dr Tahmeed Ahmed, Executive Director at icddr,b and Chairperson of the seminar stressed the importance of antibiotic stewardship, urging professional bodies such as pediatric and surgical associations to adopt guidelines for antibiotic use to combat the growing epidemic of antimicrobial resistance.
Dr Sheikh Daud Adnan, Director, Hospital & Clinics, Directorate General of Health Services emphasized on the importance of continuing the acute febrile illness study for a longer period of time in order to have more clear picture of the geographical distribution and seasonal patterns of the infections. Dr Md. Shafiqul Islam, Deputy Director (Communicable Disease Control), DGHS; Brig Gen Dr Md Rashid Un Nabi Director, Sir Salimullah Medical College Mitford Hospital also spoke on the occasion.
The seminar was attended by clinicians, representatives from the Directorate General of Health Services (DGHS), study hospitals, and icddr,b.