ferent case-fatality rates may be related, however, to the intensive training in dengue case management that occurred during this epidemic period, or to the lack of spe- cific antimicrobial therapy for unrecognized cases of lep- tospirosis. Our findings underscore the need for greater awareness of leptospirosis in the Indian subcontinent, more data on its incidence in Bangladesh, and optimal treatment regimens for leptospirosis that can be applied in resource-poor settings. Acknowledgments We thank Adam Cohen for assistance with preparing speci- mens for shipment. This study was funded by the International Center for Tropical Disease Research of the National Institutes of Health (U01-AI58935 and GR-00100), by a cooperative agreement from the US Agency for International Development (HRN-A-00-96- 90005-00), and by core donors to the ICDDR,B: Centre for Health and Population Research. Dr. LaRocque was supported by the Burroughs-Wellcome Fund Postdoctoral Fellowship in Tropical Infectious Diseases of the American Society of Tropical Medicine and Hygiene. The funding sources had no involvement in the study design, interpretation, or decision to submit this paper. Dr. LaRocque is a clinical assistant in infectious diseases at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School. She is involved in collaborative research on cholera with the ICDDR,B. References 1. Levett PN. Leptospirosis. Clin Microbiol Rev. 2001;14:296–326. 2. Chaudhry R, Premlatha MM, Mohanty S, Dhawan B, Singh KK, Dey AB. Emerging leptospirosis, north India. Emerg Infect Dis. 2002;8:1526–7. 3. Karande S, Bhatt M, Kelkar A, Kulkarni M, De A, Varaiya A. An observational study to detect leptospirosis in Mumbai, India, 2000. Arch Dis Child. 2003;88:1070–5. Leptospirosis during Dengue Outbreak, Bangladesh 4. Rahman M, Rahman K, Siddque AK, Shoma S, Kamal AH, Ali KS, et al. First outbreak of dengue hemorrhagic fever, Bangladesh. Emerg Infect Dis. 2002;8:738–40. 5. Vaughn DW, Nisalak A, Solomon T, Kalayanarooj S, Nguyen MD, Kneen R, et al. Rapid serologic diagnosis of dengue virus infection using a commercial capture ELISA that distinguishes primary and secondary infections. Am J Trop Med Hyg. 1999;60:693–8. 6. Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol. 1992;30:545–51. 7. Levett PN, Morey RE, Galloway RL, Turner DE, Steigerwalt AG, Mayer LW. Detection of pathogenic leptospires by real-time quanti- tative PCR. J Med Microbiol. 2005;54:45–9. 8. Haake DA, Chao G, Zuerner RL, Barnett JK, Barnett D, Mazel M, et al. The leptospiral major outer membrane protein LipL32 is a lipopro- tein expressed during mammalian infection. Infect Immun. 2000;68:2276–85. 9. Bajani MD, Ashford DA, Bragg SL, Woods CW, Aye T, Spiegel RA, et al. Evaluation of four commercially available rapid serologic tests for diagnosis of leptospirosis. J Clin Microbiol. 2003;41:803–9. 10. Levett PN, Branch SL, Edwards CN. Detection of dengue infection in patients investigated for leptospirosis in Barbados. Am J Trop Med Hyg. 2000;62:112–4. 11. Sanders EJ, Rigau-Perez JG, Smits HL, Deseda CC, Vorndam VA, Aye T, et al. Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1996 [correction of 1966]. Am J Trop Med Hyg. 1999;61:399–404. 12. Flannery B, Pereira MM, Velloso L de F, Carvalho C de C, de Codes LG, Orrico G de S, et al. Referral pattern of leptospirosis cases dur- ing a large urban epidemic of dengue. Am J Trop Med Hyg. 2001;65:657–63. 13. Suputtamongkol Y, Niwattayakul K, Suttinont C, Losuwanaluk K, Limpaiboon R, Chierakul W, et al. An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis. Clin Infect Dis. 2004;39:1417–24. 14. Hossain MA, Khatun M, Arjumand F, Nisaluk A, Breiman RF. Serologic evidence of dengue infection before onset of epidemic, Bangladesh. Emerg Infect Dis 2003;9:1411–4. 15. Laras K, Cao BV, Bounlu K, Nguyen TK, Olson JG, Thongchanh S, et al. The importance of leptospirosis in southeast Asia. Am J Trop Med Hyg 2002;67:278–86. Address for correspondence: Regina C. LaRocque, Division of Infectious Diseases, Gray-Jackson 504, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; fax: 617-726-7416; email: rclarocque@ partners.org Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 11, No. 5, May 2005 769