Fazle Rabbi Chowdhury

Fazle

2nd Year Prize Winner 2018

I completed my Bachelor degree (MBBS) from Khulna Medical College, Bangladesh in 2004. As an undergraduate student, I noticed clinical research in Bangladesh is much neglected despite the abundance of data and sources. Research among clinicians still not a priority and rarely acknowledged. I was very lucky to get mentors like Prof. A.F.M. Saiful Islam (Pharmacology), Prof. H.A.M.Nazmul Ahasan (Medicine) and Prof. M. Mizanur Rahman (Surgery) who influenced me and ignited my interest in clinical research. After graduation, I did my MSc. in Tropical and Infectious diseases from the Liverpool School of Tropical Medicine, the UK in 2009, funded by a Commonwealth Scholarship. I was working with TB-beads and Light Emitting Diode (LED)-based fluorescence microscopy to optimize tuberculosis case detection in resource-poor settings.
After my masters, I joined the government service in Bangladesh and delivered clinical service in both primary and secondary level hospitals. I continued my research in different areas of tropical medicine along with clinical training. In January 2013, I completed my Fellowship in Internal Medicine (FCPS) from Bangladesh College of Physicians and Surgeon (BCPS), Dhaka and became a consultant in 2015. During my clinical training, I observed first-hand many fatal cases of sepsis, and the challenges of diagnosis and treatment of those cases, leading to my interest in melioidosis and other causes of Gram-negative sepsis. I discussed these challenges with Professor of Medicine Dr. M.A.Faiz and Prof. Nicholas Day of Mahidol Oxford Research Unit (MORU) who eventually referred me to my supervisor Prof. Susanna Dunachie with a view to pursuing research in this domain.

I started my DPhil at Oxford in January 2016 funded by a Commonwealth scholarship and fellowship plan. My primary research focus is melioidosis. Melioidosis is a sepsis illness caused by the Gram-negative bacterium Burkholderia pseudomallei, and has an in-hospital mortality of up to 40%. It is a common cause of death in Northern Thailand and Northern Australia, and hugely under-diagnosed in the wider Southeast Asian region. Bangladesh is an example of a highly populous rural country where melioidosis may be a significant undiagnosed cause of death, and a recent serological survey suggested up to 45% of the population had been exposed to the bacterium. Around two-thirds of patients with melioidosis have Type 2 Diabetes Mellitus. Very little is understood about the adaptive immune response.

I have investigated the role of mucosal-associated invariant T-cells (MAIT cells) in defence against this deadly bacterium. MAIT cells are an abundant human T cell subset, which provide host defence against pathogens. Their role in acute melioidosis was not known. I have tracked their phenotype and function during acute melioidosis with distinct clinical outcomes. My research demonstrated a substantial reduction in MAIT IFN-γ expression during acute sepsis from B. pseudomallei compared to healthy endemic controls, with higher MAIT IFN-γ and GrB expression in survivors compared to fatal cases, supporting a promising protective role for this cell type in defence against melioidosis.

I also successfully set up and completed a ‘fever aetiology and melioidosis’ study in Bangladesh in 2017 where I collected samples from 210 adult febrile patients. In this observational clinical study, I looked for the proportion of melioidosis cases among febrile patients with or without diabetes. The study also enabled identification of other aetiologies of febrile illness, detected the pattern of antimicrobial resistance in culture-positive cases and status of hepatitis B virus infection among fever cohort in Dhaka, Bangladesh. I interestingly found B. pseudomallei to be the joint commonest cause of acute bacteraemia in Dhaka along with E. coli.

My ongoing research involves focussing on the protective role of MAIT cell against other Gram-negative organisms including Klebsiella pneumoniae, Salmonella typhi, E. coli and Pseudomonas aeruginosa, which commonly causes sepsis in the tropics. I am also interested in gene sequencing the hepatitis B virus exposed patient cohort of Bangladesh to look for evidence of occult infection, genetic diversity and polymorphism.

My other area of research interests is conducting clinical trials, pesticide poisoning, anti-microbial resistance and metabolomics marker and profiles in infectious diseases. I have recently been appointed Assistant Professor of Internal Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, where I will build an international clinical research programme after completing my D.Phil studies, and aim to effectively contribute to the university in terms of research, teaching and specialist clinical service.

Recent publications:

Chowdhury FR, Dewan G, Verma VR, Knipe DW, Isha IT, Faiz MA, Gunnell DJ, Eddleston M. Bans of WHO Class I Pesticides in Bangladesh –Suicide Prevention without Hampering Agricultural Output. Int J Epidemiol. 2018 Feb 1; 47(1):175-184. doi: 10.1093/ije/dyx157.

Chowdhury FR, Jilani MSA, Barai L, Rahman T, Saha MR, Amin MR, Fatema K, Islam KMS, Faiz MA, Dunachie SJ, Dance DAB. Melioidosis in Bangladesh: A Clinical and Epidemiological Analysis of Culture-Confirmed Cases. Trop Med Infect Dis. 2018 Apr 9; 3(2). pii: E40. doi: 10.3390/tropicalmed3020040.

Chowdhury FR, Rahman MM, Ullah P, Ruhan AM, Bari MS, Alam MMJ, Uddin MM, Maruf S, Patwary MI, Eddleston M. Salbutamol in acute organophosphorus insecticide poisoning - a pilot dose-response phase II study. Clin Toxicol (Phila). 2018 Sep; 56(9):820-827.

Chowdhury FR, Ibrahim QSU, Bari MS, Alam MMJ, Dunachie SJ, Rodriguez-Morales AJ, Patwary MI. The association between temperature, rainfall and humidity with common climate-sensitive infectious diseases in Bangladesh. PLoS One. 2018 Jun 21; 13(6):e0199579.

Chowdhury FR, Nur J, Hassan N, Seidlein LV, Dunachie SJ. Pandemics, Pathogenicity and Changing Molecular Epidemiology of Cholera in the era of Global Warming. Ann Clin Microbiol Antimicrob 2017 Mar 7; 16(1):10. doi: 10.1186/s12941-017-0185-1.

Sumonwiriya M, Paris DH ,Sunyakumthorn P, Anantatat T, Jenjaroen K, Chumseng S, Im-erbsin R, Tanganuchitcharnchai A, Jintaworn S, Blacksell SD, Chowdhury FR, Kronsteiner-Dobramysl B, Teparrukkul P, Dunachie SJ. Strong interferon-gamma mediated cellular immunity to scrub typhus demonstrated using a novel whole cell antigen ELISpot assay in rhesus macaques and humans. PLoS Negl Trop Dis. 2017 Sep 11; 11(9):e0005846.

Eddleston M, Chowdhury FR.Pharmacological treatment of organophosphorus insecticide poisoning: the old and the (possible) new. Br J Clin Pharmacol 2016 Mar; 81(3):462-70.doi: 10.1111/bcp.12784.
Chowdhury T, Ali MM, Hossain MM, Singh J, Yousuf ANM, Yasmin F, Chowdhury FR. Efficacy of Probiotics versus Placebo in the prevention of Necrotizing Enterocolitis in Preterm very low birth weight infants: A Double- blind Randomized Controlled Trial. J Coll Physicians Surg Pak 2016; 26(9):770-4.