title: Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection: a descriptive study.
abstract: BACKGROUND
  Human infections with different avian influenza viruses--eg, H5N1, H9N2, and H7N9--have raised concerns about pandemic potential worldwide. We report the first human infection with a novel reassortant avian influenza A H10N8 virus.
  
  
  METHODS
  We obtained and analysed clinical, epidemiological, and virological data from a patient from Nanchang City, China. Tracheal aspirate specimens were tested for influenza virus and other possible pathogens by RT-PCR, viral culture, and sequence analyses. A maximum likelihood phylogenetic tree was constructed.
  
  
  RESULTS
  A woman aged 73 years presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A novel reassortant avian influenza A H10N8 virus was isolated from the tracheal aspirate specimen obtained from the patient 7 days after onset of illness. Sequence analyses revealed that all the genes of the virus were of avian origin, with six internal genes from avian influenza A H9N2 viruses. The aminoacid motif GlnSerGly at residues 226-228 of the haemagglutinin protein indicated avian-like receptor binding preference. A mixture of glutamic acid and lysine at residue 627 in PB2 protein--which is associated with mammalian adaptation--was detected in the original tracheal aspirate samples. The virus was sensitive to neuraminidase inhibitors. Sputum and blood cultures and deep sequencing analysis indicated no co-infection with bacteria or fungi. Epidemiological investigation established that the patient had visited a live poultry market 4 days before illness onset.
  
  
  CONCLUSIONS
  The novel reassortant H10N8 virus obtained is distinct from previously reported H10N8 viruses. The virus caused human infection and could have been associated with the death of a patient.
  
  
  BACKGROUND
  Emergency Research Project on human infection with avian influenza H7N9 virus, the National Basic Research Program of China, and the National Mega-projects for Infectious Diseases.
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: HaiYing
authors: H
authors: Chen
authors: Jiangxi Provincial Disease Control and Prevention, Nanchang, China.
authors: Hui
authors: H
authors: Yuan
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Rongbao
authors: R
authors: Gao
authors: The First Hospital of Nanchang, Nanchang, China.
authors: Jinxiang
authors: J
authors: Zhang
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Dayan
authors: D
authors: Wang
authors: Jiangxi Provincial Disease Control and Prevention, Nanchang, China.
authors: Ying
authors: Y
authors: Xiong
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: GuoYin
authors: G
authors: Fan
authors: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Fan
authors: F
authors: Yang
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Xiaodan
authors: X
authors: Li
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Jianfang
authors: J
authors: Zhou
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Shumei
authors: S
authors: Zou
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Lei
authors: L
authors: Yang
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Tao
authors: T
authors: Chen
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Libo
authors: L
authors: Dong
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Hong
authors: H
authors: Bo
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Xiang
authors: X
authors: Zhao
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Ye
authors: Y
authors: Zhang
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Yu
authors: Y
authors: Lan
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Tian
authors: T
authors: Bai
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Jie
authors: J
authors: Dong
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Qun
authors: Q
authors: Li
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: ShiWen
authors: S
authors: Wang
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: YanPing
authors: Y
authors: Zhang
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: Hui
authors: H
authors: Li
authors: Jiangxi Provincial Disease Control and Prevention, Nanchang, China.
authors: Tian
authors: T
authors: Gong
authors: Jiangxi Provincial Disease Control and Prevention, Nanchang, China.
authors: Yong
authors: Y
authors: Shi
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: Xiansheng
authors: X
authors: Ni
authors: Jiangxi Provincial Disease Control and Prevention, Nanchang, China.
authors: Jianxiong
authors: J
authors: Li
authors: Jiangxi Provincial Disease Control and Prevention, Nanchang, China.
authors: Jun
authors: J
authors: Zhou
authors: Donghu District Center for Disease Control and Prevention, Nanchang, China.
authors: Jiyi
authors: J
authors: Fan
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: Jingwen
authors: J
authors: Wu
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: Xianfeng
authors: X
authors: Zhou
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: Maohong
authors: M
authors: Hu
authors: The First Hospital of Nanchang, Nanchang, China.
authors: Jianguo
authors: J
authors: Wan
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: WeiZhong
authors: W
authors: Yang
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: DeXin
authors: D
authors: Li
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China.
authors: Guizhen
authors: G
authors: Wu
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: ZiJian
authors: Z
authors: Feng
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: George F
authors: GF
authors: Gao
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Yu
authors: Y
authors: Wang
authors: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Qi
authors: Q
authors: Jin
authors: Nanchang City Disease Control and Prevention, Nanchang, China.
authors: Mingbin
authors: M
authors: Liu
authors: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. Electronic address: yshu@cnic.org.cn.
authors: Yuelong
authors: Y
authors: Shu
mesh_terms: D000368:Aged; D000818:Animals; D000998:Antiviral Agents / Q000494:pharmacology; D002681:China; D003132:Commerce; D004279:DNA, Viral / Q000032:analysis; D017809:Fatal Outcome; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D053127:Influenza A Virus, H9N2 Subtype / Q000302:isolation & purification; D009980:Influenza A virus / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D005585:Influenza in Birds / Q000821:virology*; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D008239:Lysine / Q000378:metabolism; D009102:Multiple Organ Failure / Q000821:virology*; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D010802:Phylogeny; D011200:Poultry / Q000821:virology*; D012324:RNA-Dependent RNA Polymerase / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D014132:Trachea / Q000821:virology; D014764:Viral Proteins / Q000378:metabolism
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; C057027:PB2 protein, Influenzavirus A; D014764:Viral Proteins; D018698:Glutamic Acid; D012324:RNA-Dependent RNA Polymerase; D009439:Neuraminidase; D008239:Lysine