The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: A case report.

Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira. Leptospirosis is transmitted mainly through contact with contaminated rivers, lakes, or animals carrying Leptospira. Human leptospirosis has a wide range of non-specific clinical manifestations ranging from fever, hypotension, and myalgia to multi-organ dysfunction, which severely hampers the timely clinical diagnosis and treatment of leptospirosis. Therefore, there is an urgent clinical need for an efficient strategy/method that can be used for the accurate diagnosis of leptospirosis, especially in critically ill patients. Here, we report a case of a 75-year-old male patient with clinical presentation of fever, cough, and diarrhea. Initial laboratory tests and a computed tomography (CT) scan of the chest suggested only tuberculosis. The patient was finally diagnosed with pulmonary tuberculosis (PTB) combined with leptospirosis by sputum Xpert MTB RIF, epidemiological investigations, and delayed serological testing. Furthermore, through metagenomic next-generation sequencing (mNGS) of clinical samples of cerebrospinal fluid (CSF), urine, plasma and sputum, the causative pathogens were identified as Mycobacterium tuberculosis complex and Leptospira spp. With specific treatment for both leptospirosis and tuberculosis, and associated supportive care (e.g., hemodialysis), the patient showed a good prognosis. This case report suggests that mNGS can generate a useful complement to conventional pathogenic diagnostic methods through more detailed etiological screening (i.e., at the level of species or species complex).

Travel-associated outbreak of COVID-19 in a departmental store, Wenzhou, China.

INTRODUCTION: A local outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic and the number of cases and deaths has increased exponentially. In this study, we report a COVID-19 outbreak that occurred in a departmental store, between January and February 2020, in Wenzhou, China and investigated the reasons for the outbreak. METHODOLOGY: An outbreak investigation was initiated after the index case was diagnosed as COVID-19. Cases (confirmed and suspected) and close contacts were defined. Their pharyngeal swabs were collected and examined with real-time polymerase chain reaction (RT-PCR) for nucleic acid. All investigations of the confirmed and suspected cases were carried out by epidemiologists and the source of infection was tracked by using big data. RESULTS: Thirty-nine COVID-19 cases and one asymptomatic individual were found in this outbreak, as determined by clinical manifestations, epidemiological investigation, and RT-PCR. Majority of COVID-19 cases occurred in a departmental store, three of whom traveled to participate in a meeting held in H city. After disease outbreak in the departmental store, intra-family transmission of COVID-19 occurred in five families. Two clusters of the COVID-19 outbreak were identified. One cluster was attributed to the family party, while another was attributed to a hotel party, which was responsible for transmission across three generations, infecting five family members. CONCLUSIONS: This was travel associated COVID-19 outbreak in a departmental store in Wenzhou, China. High infectivity of COVID-19 was observed. A departmental store, especially without recirculation of the air, was a high-risk site for the transmission of COVID-19. The use of big data and related information was very useful in epidemiological investigation of cases and contacts.

Epidemiological characteristics of coronavirus disease 2019 in Wenzhou / 预防医学

Objeetive @#The epidemiological characteristics of confirmed cases of the 2019 novel coronavirus diseases (COVID-19) which was reported in Wenzhou by February 28,2020 were described and analyzed to provide evidence for prevention and control measures in next stage. @*Methods@#The field investigation method was employed on all suspected and confirmed cases. The data of time,spatial and population distribution, source of infection and detective routes of all confirmed cases of COVID-19 in Wenzhou were collected and extracted from the reports of field investigation and the National Diseases Prevention and Control Information System.@*Results@#As of February 20,2020,504 confirmed cases of COVID-19 were diagnosed in Wenzhou, which included one death case. Among all 13 counties, the highest number of confirmed cases were distributed in Yueqing,Ruian and Lucheng. Among 504 cases, the male to female ratio was reported as 1.14:1. The youngest case was 2 years old while the oldest case was 93 years old. Most of the confirmed cases were among people between the ages of 25 and 64 years old. The most common occupation of the confirmed cases was businessman,which accounts for 29.76% (150 cases). Clinical symptoms of the first confirmed case of COVID-19 in Wenzhou occurred on January 4, 2020. Approximately 70% of cases had the first symptoms from January 19 to February 1. The daily number of new cases on January 24 and January 26 were the highest while the number of new cases per day declined significantly after February 2, and there were no new cases after February 14. Among all confirmed cases, the infection source of 61.71% cases were related to Wuhan. As of February 20, 2020, a total of 79 clusters were reported in Wenzhou, which involved 330 cases. Approximately 30% of confirmed cases came to hospitals unaccompanied by community staffs, and cases which confirmed after February 13 were basically found in central isolation locations or by grid checkers. @*Conclusions @#The main reason for the high case numbers of COVID-19 in Wenzhou, in Zhejiang province, was the high number of wenzhou citizens who work in Wuhan. Imported cases account for the most confirmed cases during the early period, while mainly confirmed cases were local cases during the middle and late periods. The outcomes suggest the prevention and control measures employed by Wenzhou government, which included closed-loop control and quantitative control, have achieved remarkable results and the epidemic of COVID-19 in Wenzhou has been initially controlled.