The Lancet, Early Online Publication, 5 February 2014
Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection: a descriptive study
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.
Findings
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.
Interpretation
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.
Funding
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.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960111-2/fulltext
