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.

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).