Human Tuberculosis Caused by Mycobacterium bovis, Taiwan

results for Japanese encephalitis virus–specifi c IgM. Of the 11 patients, 10 had no history of travel to India or other dengue-endemic countries. DF or DHF was initially diagnosed for 7 patients, and viral encephalitis, typhoid fever, or viral fever was diagnosed for others without serologic tests. Reverse transcription–PCR and virus isolation were performed at Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, but the dengue virus genome was not detected, and no virus was isolated, likely because sample collection was delayed and the sample was transported to Japan in a deteriorated condition. DF/DHF have been considered to be a possible public health threat to Nepal because DF/DHF epidemics have occurred recently in India and Pakistan, which reported several thousand cases and >100 deaths (6). The fi rst DF case in Nepal was reported in 2004 (7). Further, the fi rst DENV2 strain of Nepal origin was isolated from a Japanese traveler who visited Nepal and in which DF developed after the patient returned to Japan. The isolated DENV-2 (GenBank accession no. AB194882) was 98% homologous with DENV-2 isolated in India (8). The prevalence of dengue virus antibody was reported to be 10.4% in the southwestern region of Nepal (9). These reports suggest that dengue virus has been circulating in Nepal for several years. Thus, DF/DHF has likely been misdiagnosed and illness caused by dengue virus underestimated in Nepal. In contrast, Japanese encephalitis has been a public health problem in southwestern region of Nepal, and large epidemics have occurred almost every year since 1978 (10). Nepal has no dengue surveillance programs, and health professionals do not usually consider dengue as a differential diagnosis. The emergence occurred in the lowland Terai belt region, which borders the state of Bihar, India. The Aedes mosquito is known to persist in this region. The emerging DENV-2 is likely to have been introduced into Nepal from India.