A report of first fatal case of H10N8 avian influenza virus pneumonia in the world

Abstract

To report the treatment process of the first case of human pneumonia resulted from H10N8 avian influenza virus infection in the world for providing the data for clinical diagnosis and treatment. On November 30, 2013, the first case of human infection with H10N8 avian influenza virus was discovered in Nanchang City, Jiangxi Province. Its clinical symptoms and epidemiology were analyzed and compared with the characteristics of human infection with H7N9 avian influenza virus. A 73-year old female patient complaining of cough and chest tightness for 3 days and fever for 1 day was admitted to the Department of Respiratory Diseases of the Third Affiliated Hospital of Nanchang University on November 30, 2013. As the illness became worse, the patient was transferred into Intensive Care Unit (ICU) of the Department of Critical Care Medicine on December 2. The patient's condition deteriorated, manifesting multiple organ failure (MOF) on December 5. At 08:30 on December 6, cardiac arrest occurred, and the patient died after inefficient resuscitation. (1) Epidemiological investigation: the patient was an elderly woman, suffering from a variety of chronic diseases (hypertension, coronary heart disease, myasthenia gravis, etc) and impaired immune function (undergone thymectomy), all of them were predisposing factors for deterioration of her health. She had visited the live poultry market one week before admission, and developed symptoms of influenza. The transmission route was the respiratory tract, which was similar to H7N9 avian influenza. (2) CLINICAL MANIFESTATIONS: the patient had flu-like symptoms, such as cough and fever (39.1 centigrade), but no headache or myalgia. Two days later pneumonia accompanied with respiratory distress developed and a large amount of bloody sputum was sucked out through tracheostomy tube (2 000 mL/24 h). Acute kidney injury, acute respiratory distress syndrome (ARDS), septic shock, and unconsciousness occurred, all of which was consistent with the diagnosis of H7N9 avian influenza. (3) Auxiliary examination: with the exception of a decrease in lymphocyte ratio (0.070), aspartate aminotransferase (AST) was slightly increased (57 U/L), C- reactive protein (CRP) was elevated (>200 mg/L), but the platelet count, creatine kinase, lactate dehydrogenase, alanine aminotransferase and myoglobin were not increased, while leucocyte count was increased slightly (10.34×10(9)/L). The changes in above indexes did not match the characteristics of H7N9 avian influenza. However, the aggravated consolidation of the lung conformed to that of H7N9 avian influenza. (4) DIAGNOSIS AND TREATMENT: according to the clinical manifestations, aggravation of consolidation of the lung, and epidemiological evidence, the diagnosis of avian influenza was considered. Though therapeutic dose of oseltamivir was given as antiviral treatment for the early therapy, and other therapeutic measures such as energetic respiratory and circulatory support, and immunosuppressant therapy were given, the patient eventually died from respiratory failure and shock. (5) The Chinese disease prevention and control center (CDC) confirmed that, the patient was infected H10N8 avian influenza virus. No person with close contact with the patient was infected, as screened by Nanchang City and Chinese CDC. Human infection with H10N8 avian influenza was not exactly the same as that of H7N9. It was difficult to get true information from the conventional laboratory examinations, while the clinical characteristic and epidemiology were essential for the diagnosis. Referring to the treatment regime for human infection with H7N9 avian influenza virus, therapeutic dose of neuraminidase inhibitors could not reverse deterioration of pulmonary pathology. Chinese CDC found that the risk of human infection and transmission of H10N8 avian influenza virus through personal contact was low.