First human case of avian influenza A (H10N3) in Southwest China

First human case of avian influenza A (H10N3) in Southwest China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article First human case of avian influenza A (H10N3) in Southwest China Guiming Liu, Jingyi Dai, Jun Zhao, Jiawei Xia, Pei Zhang, Yadi Ding, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4181286/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In recent years, the avian influenza virus has emerged as a significant threat to both human and public health. Despite this, only two cases of human infection with the H10N3 strain have been documented. Here, we present the initial instance of human infection with avian influenza virus H10N3 in Yunnan Province, Southwest China. The patient, a previously healthy 51-year-old male, presented with recurrent fever peaking at 39℃, accompanied by symptoms such as cough, expectoration, chest tightness, and shortness of breath. Diagnosis revealed severe pneumonia, type I respiratory failure, and infection with avian influenza virus H10N3. Additionally, the patient experienced complications from Candida albicans and Staphylococcus epidermidis infections. Following treatment with appropriate antiviral drugs and antibiotics, the patient's condition improved. Molecular analysis of the viral strain identified four mutations potentially hazardous to human health. This underscores the importance of continuous and vigilant monitoring of the dynamics surrounding the H10N3 subtype of avian influenza virus. Health sciences/Diseases/Infectious diseases/Influenza virus Health sciences/Diseases/Infectious diseases/Viral infection Figures Figure 1 Figure 2 Introduction Influenza A virus belongs to the family Orthomycoviridae. Influenza A viruses can infect a variety of birds, humans, and animals such as pigs, horses, seals and whales 1 . It is an important pathogen that poses risks to both human and animal health. Currently, only two subtypes of influenza A viruses, H1N1 and H3N2, are known to circulate in humans 1 . However, humans can also be infected by other subtypes, collectively referred to as avian influenza viruses (AIV). In recent years, human infection with AIV has been frequently reported around the world, particularly involving subtypes H5, H7, and other 2 – 4 . Among these, human infections with H10 avian influenza virus have been reported globally, including subtypes H10N7, H10N8, and H10N3 5,6 . The H10N3 subtype of avian influenza virus has been circulating among waterfowl and poultry in East and South Asia for decades, with rare instances of human infection 7 . The first recorded human cases of Avian-Origin Influenza A (H10N3) virus occurred in Jiangsu, China, in April 2021 8 , followed by a second case reported in Zhejiang in June 2022 9 . Importantly, no instances of human-to-human transmission were detected in either case. Results A previously healthy 51-year-old male experienced recurrent fever for a week, reaching a maximum temperature of 39°C, along with symptoms of cough, expectoration, chest tightness, and shortness of breath. Despite seeking medical attention at the local community health service center, his symptoms did not significantly improve. Consequently, he was transferred to the Department of Respiratory and Critical Care Medicine at a hospital in Yunnan Province, Southwest China, on March 6, 2024. The patient had a history of raising various birds, including chickens, ducks, geese, pigeons, peacocks, and ostriches. Notably, more than 20 chickens and geese died in the week preceding the onset of his illness, and he had a history of slaughtering these birds. There was no reported contact with individuals exhibiting respiratory symptoms within the preceding month. Upon admission (7 days after the onset of illness), the patient presented with a temperature of 39℃, a pulse rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, oxygen saturation of 78%, and blood pressure measuring 105/70 mmHg. Laboratory tests revealed a low white blood cell count, elevated neutrophil percentage, decreased platelet count, and elevated levels of infectious markers. Additionally, the nucleic acid test for influenza A virus was positive (Table 1 ). Chest computed tomography revealed multiple patchy and increased density shadows in both lungs, characterized by unclear boundaries and uneven density (Fig. 1 ). The initial diagnosis upon admission included severe pneumonia, type I respiratory failure, and influenza attributed to influenza A virus. The patient was administered oseltamivir (150mg, twice daily) and methylprednisolone (80mg, once daily) for treatment. Subsequent sputum culture results revealed infection with Candida albicans and Staphylococcus epidermidis, prompting the administration of appropriate antibiotics. Following this, Samples were sent for mNGS detection on March 8th, processed on March 12th, with the detection of positive influenza A virus on March 13th. Confirmation of the H10N3 subtype was achieved through sequence analysis and alignment on March 14th, and samples were subsequently sent to the CDC (Centers for Disease Control and Prevention). Confirmation of the H10N3 subtype through PCR was obtained on March 15th. Following this, the CDC conducted nanopore sequencing (Nanopore, GridION X5) on the samples and obtained the whole genome information of the samples (GenBank accession number SUB14344866, PP555666-555673). The patient's fever subsided on March 17th (18 days after illness onset), and on March 19th (20 days after illness onset), the nucleic acid test for influenza A virus returned negative results for the first time. Subsequent test results on March 21st (22 days after illness onset) indicated normalization of the patient's white blood cell count, along with a decrease or return to normal levels of infection markers. However, the patient exhibited prolonged prothrombin time. Chest computed tomography scans showed a reduction in lesions compared to previous scans (Fig. 1 ). Through online analysis using BLASTN software on the GISAID website, it was determined that all eight gene segments of the H10N3 virus strain in our case originated from Eurasian avian influenza viruses. The phylogenetic tree indicated that the H10N3 strain from this patient belonged to the same group as the first patient in Jiangsu and the H10N3 strains found in poultry across various provinces in China (Fig. 2 ). Specifically, the H10N3 strain from this patient showed a closer genetic relationship to a chicken (GISAID#EPIISL15737164) from Jiangsu Province. Molecular characterization revealed a mutation at the 226th amino acid residue in the receptor binding site of the HA protein, where the amino acid changed from Q to L. This mutation makes the virus more adept at binding to human α-2,6-sialic acid receptors, significantly increasing the likelihood of human infection 10 . The mutation D701N in the PB2 protein has been shown to enhance the replication activity of avian influenza RNA polymerase within the human body. This mutation also increases the adaptability and pathogenicity of the virus to the human host, potentially serving as a crucial factor in avian influenza viruses crossing the host species barrier 11 . The presence of the S409N mutation in the PA protein suggests the potential for infectivity in humans and may contribute to increased pathogenicity of this particular virus strain 12 . The S31N mutation in the M2 protein has been associated with resistance to adamantanes, a class of antiviral drugs 13 . Discussion The patient in this case not only exhibited infection with the H10N3 subtype of influenza A virus but also presented with a mixed infection involving bacteria and fungi, making the condition complex. It's worth noting that severe pneumonia patients infected with avian influenza often experience concurrent or secondary bacterial and fungal infections. Therefore, it is recommended to conduct repeated sputum culture, respiratory tract aspirate culture, or metagenomic Next Generation Sequencing (mNGS) detection in clinical settings to identify the types of bacteria or fungi present, as well as their susceptibility or resistance patterns. This approach enables clinicians to make informed decisions regarding antibiotic selection and guide appropriate clinical treatment strategies. The clinical manifestations of avian influenza virus infection vary depending on the virus subtypes involved. For instance, infection with H5N1 and H7N9 subtypes can lead to severe pneumonia and related complications in patients. Conversely, certain subtypes such as H7 and H9 may only induce conjunctivitis or mild respiratory symptoms. It's important for healthcare providers to be aware of these differences in clinical presentation when diagnosing and managing cases of avian influenza virus infection 1 . As of now, only two cases of human infection with the H10N3 subtype have been reported. The symptoms observed in the patient infected with H10N3 in this case closely resemble those documented in the two previously known cases of H10N3 infection. Notably, all cases resulted in severe pneumonia in the affected patients 8 , 9 . In light of our findings, the identification of HA-Q226L, PB2-D701N, PA-S409N, and M2-S31N mutations in the protein of the Yunnan H10N3 virus strain underscores the potential for increased harm posed by H10N3 in humans. Therefore, it is imperative to closely monitor the dynamics of this subtype. The case of human infection with H10N3 avian influenza virus highlighted in this study involved close contact with live birds, particularly through the handling and slaughtering of dead birds. This contact ultimately led to the patient contracting avian influenza and experiencing severe illness. This underscores the importance of paying special attention to instances of unexpected bird deaths and promptly reporting such cases. Moreover, it emphasizes the necessity of establishing a comprehensive avian influenza surveillance system, not only within Yunnan but also globally, to continuously and vigilantly monitor the H10N3 virus strain and its potential impact on human health. Methods Data collection On March 6, 2024 the patient went to Kunming Third People's Hospital for treatment due to continuous fever for many days, and was diagnosed with severe pneumonia, type I respiratory failure and infection by avian influenza virus. After the diagnosis of avian influenza virus infection, the patient investigated by using questionnaires, including demographic information, poultry contact history, basic diseases, etc. Genomic analysis and genome assembly Multiple amplification products were obtained by using influenza A virus genotyping gene targeted amplification kit (BaiyiTech, Hangzhou). The amplified products were purified using ampure XP beads nucleic acid magnetic bead Purification Kit (Beckman, USA) and the library was constructed. The library was constructed by ligation method with the kit sqk-nbd114.24 (Nanopore, UK). After the library was constructed, it was added to the flo-min 114 sequencing chip (Nanopore, UK), and high-throughput sequencing was performed on the gridion X5 third-generation sequencer. All experimental steps were carried out in strict accordance with the relevant kit instructions and nanopore third-generation high-throughput sequencing requirements. Phylogenetic analysis The nucleotide sequences obtained were analyzed in the Genbank and GISAID databases using the BLASTn tool to initially determine the virus subtypes. Similar HA nucleotide sequences were downloaded for phylogenetic analysis. The nucleotide and amino acid sequences were aligned using MAFFT (v7.310), and the phylogenetic tree was constructed based on the neighbor-joining method using MEGA-X. Declarations Acknowledgements The authors thank the study subject and collaborating clinicians for their participation and contribution to the work. This research was supported by Kunming Science and Technology Bureau (2023-1-NS-007), Kunming Health Commission, Kunming infectious disease precise diagnosis and treatment center 2023-SW(JI)-28. This research was also supported by “The Project of Health Science and Technology Talents Ten Hundred Thousand’ in Kunming” 2021-SW(DAITOU)-06. Author contributions The author contributions are as follows. J.Y.D., J.Z., J.W.X., Y.Y.L. and G.M.L. conceived, designed and supervised the study. J.W.X. treated the patient. P.Z., Y.D.D. and Q.J.L. gathered data and interviewed patients. M.H., X.H.X., Q.Q.J. and Y.Y.L did the laboratory tests, P.Z., Y.D.D. and Q.J.L. performed the data analyses and explored the mutation site. J.Y.D., J.Z., J.W.X., Y.Y.L. and G.M.L. wrote the drafts of the manuscript and interpreted the findings. All authors read the manuscript, provided feedback, and approved the final version. Ethics declaration The patient and his family members signed consent forms approving the investigation, sample collection and its publication. The procedures were in accordance with the Helsinki declaration of 1975, as revised in 1983. According to local regulations in China, institutional review board approval is not required for case reports, but only the written consent of the patient. The Third People’s Hospital of Kunming City ethics committee reviewed this work and determined that institutional review board approval was not required. Competing interests The authors declare that there is no conflict of interest. Data availability statement The sequence data generated in this study have been deposited in the NCBI GenBank database under accession number SUB14344866, PP555666- PP555673. Peer review information Nature Communications thanks the anonymous reviewer(s) for their contribution to the peer review of this work. References Liu, Q., Liu, D. Y. &Yang, Z. Q. Characteristics of human infection with avian influenza viruses and development of new antiviral agents. Acta Pharmacol Sin . 34 , 1257-1269 (2013). Gao, G. F. From "A"IV to "Z"IKV: Attacks from Emerging and Re-emerging Pathogens. Cell 172 , 1157-1159 (2018). Szablewski, C. M. et al. Reported Global Avian Influenza Detections Among Humans and Animals During 2013-2022: Comprehensive Review and Analysis of Available Surveillance Data. JMIR Public Health Surveill . 9 , e46383 (2023). Liang, Y. Pathogenicity and virulence of influenza. Virulence . 14 ,1 (2023). Arzey, G. G. et al. Influenza virus A (H10N7) in chickens and poultry abattoir workers, Australia. Emerg Infect Dis . 18 , 814-816 (2012). Chen, H. et al. Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection: a descriptive study. Lancet . 383 , 714-721 (2014). Wisedchanwet, T. et al. Influenza A virus surveillance in live-bird markets: first report of influenza A virus subtype H4N6, H4N9, and H10N3 in Thailand. Avian Dis . 55 , 593-602 (2011). Qi, X. et al. Human Infection with an Avian-Origin Influenza A (H10N3) Virus. N Engl J Med . 386 , 1087-1088 (2022). Zhang, W., Zhang, Z., Wang, M., Pan, X. & Jiang, X. Second Identified Human Infection With the Avian Influenza Virus H10N3: A Case Report. Ann Intern Med . 176 , 429-431 (2023). Shi, Y., Wu, Y., Zhang, W., Qi, J. & Gao, G. F. Enabling the 'host jump': structural determinants of receptor-binding specificity in influenza A viruses. Nat Rev Microbiol . 12 , 822-31 (2014). Li, Z. et al. Molecular basis of replication of duck H5N1 influenza viruses in a mammalian mouse model. J Virol . 79 , 12058-12064 (2005). Finkelstein, D. B. et al. Persistent host markers in pandemic and H5N1 influenza viruses. J Virol . 81 , 10292-10299 (2007). Pielak, R., M., Schnell, J. R. & Chou, J. J. Mechanism of drug inhibition and drug resistance of influenza A M2 channel. Proc Natl Acad Sci U S A . 106 , 7379-7384 (2009). Table Table 1 Laboratory Test Results Day 7 Day 22 Normal range White Blood Cell (×10 9 cells/L) 2.12 8.58 3.50–9.50 Neutrophil (×10 9 cells/L) 1.80 7.19 1.80–6.30 Neutrophil percentage (%) 84.90 83.90 40.00–75.00 Lymphocyte (×10 9 cells/L) 0.26 0.74 1.10–3.20 Lymphocyte percentage (%) 12.30 8.60 20.00–50.00 Blood platelet (×10 9 cells/L) 79 223 125–350 Prothrombin time (s) 15.9 16.6 14.0–16.0 Hypersensitive C-reactive protein (mg/L) 249.41 21.93 0.00–6.00 Lnterleukin-6 (pg/mL) 78.99 8.26 0.00–7.00 Procalcitonin (ng/mL) 14.040 0.248 < 0.500 pO 2 (mmHg) 32.00 68.40 80.00-100.00 pCO 2 (mmHg) 32.00 52.10 35.00–45.00 Nucleic acid testing for influenza A virus Positive Negative Negative Additional Declarations There is NO Competing Interest. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4181286","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":286985343,"identity":"023a2f03-619f-43c5-b137-7fd020fbec53","order_by":0,"name":"Guiming Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACPmYQacDAw8DAxsDwwcDGjqAWNmQtjDMK0pIJa0FmMvN8OMTYQFALO4/xa56CbTLm/MtSN9sYHGBmYD98dAN+h/GYWfMY3OaxnPHs2O0cgzt8DDxpaTcIaTEGaTG4cbwNqOUZM4MEjxkJWiwMDjM2EKHF+DFYy/m2Y7cZiNPCVsY4B2wLW9rNHoO0ZDZCfuHnP7z5w5s/t+0Nzh8zu/Hjj40dP/vhY3i1gCySAFMSCVAuAeUgwPwBYt8BItSOglEwCkbBiAQAkoVFNVi7xhcAAAAASUVORK5CYII=","orcid":"","institution":"The Third People's Hospital of Kunming City","correspondingAuthor":true,"prefix":"","firstName":"Guiming","middleName":"","lastName":"Liu","suffix":""},{"id":286985344,"identity":"eb92cb12-739b-488d-a560-e1ab1fe5c4c3","order_by":1,"name":"Jingyi Dai","email":"","orcid":"","institution":"The Third People's Hospital of Kunming City","correspondingAuthor":false,"prefix":"","firstName":"Jingyi","middleName":"","lastName":"Dai","suffix":""},{"id":286985345,"identity":"8867f685-dfc9-40e7-82ed-8cb7de8eccd8","order_by":2,"name":"Jun Zhao","email":"","orcid":"","institution":"Hubei University of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Zhao","suffix":""},{"id":286985346,"identity":"81d86d95-6532-47cc-b131-70f73b59cd9d","order_by":3,"name":"Jiawei Xia","email":"","orcid":"","institution":"The Third People's Hospital of Kunming City","correspondingAuthor":false,"prefix":"","firstName":"Jiawei","middleName":"","lastName":"Xia","suffix":""},{"id":286985347,"identity":"773e8eb0-116e-470f-85a8-16aecb89e481","order_by":4,"name":"Pei Zhang","email":"","orcid":"","institution":"The Third People's Hospital of Kunming City","correspondingAuthor":false,"prefix":"","firstName":"Pei","middleName":"","lastName":"Zhang","suffix":""},{"id":286985348,"identity":"3b209ea0-f4b5-40e8-a431-262de19d8bbc","order_by":5,"name":"Yadi Ding","email":"","orcid":"","institution":"The Third People's Hospital of Kunming City","correspondingAuthor":false,"prefix":"","firstName":"Yadi","middleName":"","lastName":"Ding","suffix":""},{"id":286985349,"identity":"66e5d040-68b4-4093-a5cf-0964ffa43e21","order_by":6,"name":"Qiujing Li","email":"","orcid":"","institution":"The Third People's Hospital of Kunming City","correspondingAuthor":false,"prefix":"","firstName":"Qiujing","middleName":"","lastName":"Li","suffix":""},{"id":286985350,"identity":"40338d77-dc26-4d67-8e28-a6195cb8953e","order_by":7,"name":"Min Hou","email":"","orcid":"","institution":"Kunming City Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Hou","suffix":""},{"id":286985351,"identity":"ca35c37a-40b2-4041-95fd-ac34075e0b69","order_by":8,"name":"Xianhui Xiong","email":"","orcid":"","institution":"Kunming City Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Xianhui","middleName":"","lastName":"Xiong","suffix":""},{"id":286985352,"identity":"c19f740b-3003-417e-9a43-f37a385e81e1","order_by":9,"name":"Qianqi Jian","email":"","orcid":"","institution":"Kunming City Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Qianqi","middleName":"","lastName":"Jian","suffix":""},{"id":286985353,"identity":"e0d8ad24-5078-4dd3-857c-4d65abab50fd","order_by":10,"name":"Yanyan Liu","email":"","orcid":"","institution":"Kunming City Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Yanyan","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-03-28 09:56:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4181286/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4181286/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54114445,"identity":"a5ac02ad-06c5-4c3d-8a80-ae5653f8b0f2","added_by":"auto","created_at":"2024-04-04 19:22:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3380082,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComputed tomography of lung. \u003c/strong\u003e(\u003cstrong\u003eA\u003c/strong\u003e and \u003cstrong\u003eB\u003c/strong\u003e). Results on March 6, 2024 showed that multiple patchy and patchy increased density shadows were seen in both lungs, with unclear boundary and uneven density. (\u003cstrong\u003eC\u003c/strong\u003e and \u003cstrong\u003eD\u003c/strong\u003e). Results on March 23, 2024 showed a reduction in lesions compared to previous scans.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4181286/v1/4e81e95462a20536ee7fcba6.png"},{"id":54114443,"identity":"c3ac51b4-5dbb-40b1-ade1-b9de84432272","added_by":"auto","created_at":"2024-04-04 19:22:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":447355,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePhylogenetic tree of 24 H10N3 strains from China. \u003c/strong\u003eThe Phylogenetic tree was downloaded from the GISAID database (https://gisaid.org) using the neighbor-joining method in MEGA X. The diamond indicates the H10N3 strain in this study, and the octagon indicates the H10N3 strain from the first case in Jiangsu.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4181286/v1/512b33ff8275db54e52aacdb.png"},{"id":56156567,"identity":"189c7a0f-d440-4f23-9519-7e7e22e57f7f","added_by":"auto","created_at":"2024-05-09 08:23:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2038736,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4181286/v1/c4b3bfa9-bee0-4626-824c-3d749bd5dfbf.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"First human case of avian influenza A (H10N3) in Southwest China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfluenza A virus belongs to the family Orthomycoviridae. Influenza A viruses can infect a variety of birds, humans, and animals such as pigs, horses, seals and whales\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. It is an important pathogen that poses risks to both human and animal health. Currently, only two subtypes of influenza A viruses, H1N1 and H3N2, are known to circulate in humans\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. However, humans can also be infected by other subtypes, collectively referred to as avian influenza viruses (AIV).\u003c/p\u003e \u003cp\u003eIn recent years, human infection with AIV has been frequently reported around the world, particularly involving subtypes H5, H7, and other\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Among these, human infections with H10 avian influenza virus have been reported globally, including subtypes H10N7, H10N8, and H10N3 \u003csup\u003e5,6\u003c/sup\u003e. The H10N3 subtype of avian influenza virus has been circulating among waterfowl and poultry in East and South Asia for decades, with rare instances of human infection\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The first recorded human cases of Avian-Origin Influenza A (H10N3) virus occurred in Jiangsu, China, in April 2021\u003csup\u003e8\u003c/sup\u003e, followed by a second case reported in Zhejiang in June 2022\u003csup\u003e9\u003c/sup\u003e. Importantly, no instances of human-to-human transmission were detected in either case.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA previously healthy 51-year-old male experienced recurrent fever for a week, reaching a maximum temperature of 39\u0026deg;C, along with symptoms of cough, expectoration, chest tightness, and shortness of breath. Despite seeking medical attention at the local community health service center, his symptoms did not significantly improve. Consequently, he was transferred to the Department of Respiratory and Critical Care Medicine at a hospital in Yunnan Province, Southwest China, on March 6, 2024. The patient had a history of raising various birds, including chickens, ducks, geese, pigeons, peacocks, and ostriches. Notably, more than 20 chickens and geese died in the week preceding the onset of his illness, and he had a history of slaughtering these birds. There was no reported contact with individuals exhibiting respiratory symptoms within the preceding month.\u003c/p\u003e \u003cp\u003eUpon admission (7 days after the onset of illness), the patient presented with a temperature of 39℃, a pulse rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, oxygen saturation of 78%, and blood pressure measuring 105/70 mmHg. Laboratory tests revealed a low white blood cell count, elevated neutrophil percentage, decreased platelet count, and elevated levels of infectious markers. Additionally, the nucleic acid test for influenza A virus was positive (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Chest computed tomography revealed multiple patchy and increased density shadows in both lungs, characterized by unclear boundaries and uneven density (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The initial diagnosis upon admission included severe pneumonia, type I respiratory failure, and influenza attributed to influenza A virus.\u003c/p\u003e \u003cp\u003eThe patient was administered oseltamivir (150mg, twice daily) and methylprednisolone (80mg, once daily) for treatment. Subsequent sputum culture results revealed infection with Candida albicans and Staphylococcus epidermidis, prompting the administration of appropriate antibiotics. Following this, Samples were sent for mNGS detection on March 8th, processed on March 12th, with the detection of positive influenza A virus on March 13th. Confirmation of the H10N3 subtype was achieved through sequence analysis and alignment on March 14th, and samples were subsequently sent to the CDC (Centers for Disease Control and Prevention). Confirmation of the H10N3 subtype through PCR was obtained on March 15th. Following this, the CDC conducted nanopore sequencing (Nanopore, GridION X5) on the samples and obtained the whole genome information of the samples (GenBank accession number SUB14344866, PP555666-555673). The patient's fever subsided on March 17th (18 days after illness onset), and on March 19th (20 days after illness onset), the nucleic acid test for influenza A virus returned negative results for the first time. Subsequent test results on March 21st (22 days after illness onset) indicated normalization of the patient's white blood cell count, along with a decrease or return to normal levels of infection markers. However, the patient exhibited prolonged prothrombin time. Chest computed tomography scans showed a reduction in lesions compared to previous scans (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThrough online analysis using BLASTN software on the GISAID website, it was determined that all eight gene segments of the H10N3 virus strain in our case originated from Eurasian avian influenza viruses. The phylogenetic tree indicated that the H10N3 strain from this patient belonged to the same group as the first patient in Jiangsu and the H10N3 strains found in poultry across various provinces in China (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Specifically, the H10N3 strain from this patient showed a closer genetic relationship to a chicken (GISAID#EPIISL15737164) from Jiangsu Province. Molecular characterization revealed a mutation at the 226th amino acid residue in the receptor binding site of the HA protein, where the amino acid changed from Q to L. This mutation makes the virus more adept at binding to human α-2,6-sialic acid receptors, significantly increasing the likelihood of human infection\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The mutation D701N in the PB2 protein has been shown to enhance the replication activity of avian influenza RNA polymerase within the human body. This mutation also increases the adaptability and pathogenicity of the virus to the human host, potentially serving as a crucial factor in avian influenza viruses crossing the host species barrier\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The presence of the S409N mutation in the PA protein suggests the potential for infectivity in humans and may contribute to increased pathogenicity of this particular virus strain\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The S31N mutation in the M2 protein has been associated with resistance to adamantanes, a class of antiviral drugs\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe patient in this case not only exhibited infection with the H10N3 subtype of influenza A virus but also presented with a mixed infection involving bacteria and fungi, making the condition complex. It's worth noting that severe pneumonia patients infected with avian influenza often experience concurrent or secondary bacterial and fungal infections. Therefore, it is recommended to conduct repeated sputum culture, respiratory tract aspirate culture, or metagenomic Next Generation Sequencing (mNGS) detection in clinical settings to identify the types of bacteria or fungi present, as well as their susceptibility or resistance patterns. This approach enables clinicians to make informed decisions regarding antibiotic selection and guide appropriate clinical treatment strategies.\u003c/p\u003e \u003cp\u003eThe clinical manifestations of avian influenza virus infection vary depending on the virus subtypes involved. For instance, infection with H5N1 and H7N9 subtypes can lead to severe pneumonia and related complications in patients. Conversely, certain subtypes such as H7 and H9 may only induce conjunctivitis or mild respiratory symptoms. It's important for healthcare providers to be aware of these differences in clinical presentation when diagnosing and managing cases of avian influenza virus infection\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. As of now, only two cases of human infection with the H10N3 subtype have been reported. The symptoms observed in the patient infected with H10N3 in this case closely resemble those documented in the two previously known cases of H10N3 infection. Notably, all cases resulted in severe pneumonia in the affected patients\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In light of our findings, the identification of HA-Q226L, PB2-D701N, PA-S409N, and M2-S31N mutations in the protein of the Yunnan H10N3 virus strain underscores the potential for increased harm posed by H10N3 in humans. Therefore, it is imperative to closely monitor the dynamics of this subtype.\u003c/p\u003e \u003cp\u003eThe case of human infection with H10N3 avian influenza virus highlighted in this study involved close contact with live birds, particularly through the handling and slaughtering of dead birds. This contact ultimately led to the patient contracting avian influenza and experiencing severe illness. This underscores the importance of paying special attention to instances of unexpected bird deaths and promptly reporting such cases. Moreover, it emphasizes the necessity of establishing a comprehensive avian influenza surveillance system, not only within Yunnan but also globally, to continuously and vigilantly monitor the H10N3 virus strain and its potential impact on human health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection\u003c/h2\u003e\n \u003cp\u003eOn March 6, 2024 the patient went to Kunming Third People\u0026apos;s Hospital for treatment due to continuous fever for many days, and was diagnosed with severe pneumonia, type I respiratory failure and infection by avian influenza virus. After the diagnosis of avian influenza virus infection, the patient investigated by using questionnaires, including demographic information, poultry contact history, basic diseases, etc.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eGenomic analysis and genome assembly\u003c/h2\u003e\n \u003cp\u003eMultiple amplification products were obtained by using influenza A virus genotyping gene targeted amplification kit (BaiyiTech, Hangzhou). The amplified products were purified using ampure XP beads nucleic acid magnetic bead Purification Kit (Beckman, USA) and the library was constructed. The library was constructed by ligation method with the kit sqk-nbd114.24 (Nanopore, UK). After the library was constructed, it was added to the flo-min 114 sequencing chip (Nanopore, UK), and high-throughput sequencing was performed on the gridion X5 third-generation sequencer. All experimental steps were carried out in strict accordance with the relevant kit instructions and nanopore third-generation high-throughput sequencing requirements.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003ePhylogenetic analysis\u003c/h2\u003e\n \u003cp\u003eThe nucleotide sequences obtained were analyzed in the Genbank and GISAID databases using the BLASTn tool to initially determine the virus subtypes. Similar HA nucleotide sequences were downloaded for phylogenetic analysis. The nucleotide and amino acid sequences were aligned using MAFFT (v7.310), and the phylogenetic tree was constructed based on the neighbor-joining method using MEGA-X.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the study subject and collaborating clinicians for their participation and contribution to the work. This research was supported by Kunming Science and Technology Bureau (2023-1-NS-007), Kunming Health Commission, Kunming infectious disease precise diagnosis and treatment center 2023-SW(JI)-28. This research was also supported by \u0026ldquo;The Project of Health Science and Technology Talents Ten Hundred Thousand\u0026rsquo; in Kunming\u0026rdquo; 2021-SW(DAITOU)-06.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author contributions are as follows. J.Y.D., J.Z., J.W.X., Y.Y.L. and G.M.L. conceived, designed and supervised the study. J.W.X. treated the patient. P.Z., Y.D.D. and Q.J.L. gathered data and interviewed patients. M.H., X.H.X., Q.Q.J. and Y.Y.L did the laboratory tests, P.Z., Y.D.D. and Q.J.L. performed the data analyses and explored the mutation site. J.Y.D., J.Z., J.W.X., Y.Y.L. and G.M.L. wrote the drafts of the manuscript and interpreted the findings. All authors read the manuscript, provided feedback, and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient and his family members signed consent forms approving the investigation, sample collection and its publication. The procedures were in accordance with the Helsinki declaration of 1975, as revised in 1983. According to local regulations in China, institutional review board approval is not required for case reports, but only the written consent of the patient. The Third People\u0026rsquo;s Hospital of Kunming City ethics committee reviewed this work and determined that institutional review board approval was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sequence data generated in this study have been deposited in the NCBI GenBank database under accession number SUB14344866, PP555666- PP555673.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePeer review information\u003c/strong\u003e \u003cem\u003eNature Communications\u003c/em\u003e thanks the anonymous reviewer(s) for their contribution to the peer review of this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLiu, Q., Liu, D. Y. \u0026amp;Yang, Z. Q. Characteristics of human infection with avian influenza viruses and development of new antiviral agents. \u003cem\u003eActa Pharmacol Sin\u003c/em\u003e. \u003cstrong\u003e34\u003c/strong\u003e, 1257-1269 (2013).\u003c/li\u003e\n \u003cli\u003eGao, G. F. From \u0026quot;A\u0026quot;IV to \u0026quot;Z\u0026quot;IKV: Attacks from Emerging and Re-emerging Pathogens. \u003cem\u003eCell\u003c/em\u003e \u003cstrong\u003e172\u003c/strong\u003e, 1157-1159 (2018).\u003c/li\u003e\n \u003cli\u003eSzablewski, C. M. et al. Reported Global Avian Influenza Detections Among Humans and Animals During 2013-2022: Comprehensive Review and Analysis of Available Surveillance Data. \u003cem\u003eJMIR Public Health Surveill\u003c/em\u003e. \u003cstrong\u003e9\u003c/strong\u003e, e46383 (2023).\u003c/li\u003e\n \u003cli\u003eLiang, Y. Pathogenicity and virulence of influenza. \u003cem\u003eVirulence\u003c/em\u003e. \u003cstrong\u003e14\u003c/strong\u003e,1 (2023).\u003c/li\u003e\n \u003cli\u003eArzey, G. G. et al. Influenza virus A (H10N7) in chickens and poultry abattoir workers, Australia. \u003cem\u003eEmerg Infect Dis\u003c/em\u003e. \u003cstrong\u003e18\u003c/strong\u003e, 814-816 (2012).\u003c/li\u003e\n \u003cli\u003eChen, H. et al. Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection: a descriptive study. \u003cem\u003eLancet\u003c/em\u003e. \u003cstrong\u003e383\u003c/strong\u003e, 714-721 (2014).\u003c/li\u003e\n \u003cli\u003eWisedchanwet, T. et al. Influenza A virus surveillance in live-bird markets: first report of influenza A virus subtype H4N6, H4N9, and H10N3 in Thailand. \u003cem\u003eAvian Dis\u003c/em\u003e. \u003cstrong\u003e55\u003c/strong\u003e, 593-602 (2011).\u003c/li\u003e\n \u003cli\u003eQi, X. et al. Human Infection with an Avian-Origin Influenza A (H10N3) Virus. \u003cem\u003eN Engl J Med\u003c/em\u003e. \u003cstrong\u003e386\u003c/strong\u003e, 1087-1088 (2022).\u003c/li\u003e\n \u003cli\u003eZhang, W., Zhang, Z., Wang, M., Pan, X. \u0026amp; Jiang, X. Second Identified Human Infection With the Avian Influenza Virus H10N3: A Case Report. \u003cem\u003eAnn Intern Med\u003c/em\u003e.\u003cstrong\u003e176\u003c/strong\u003e, 429-431 (2023).\u003c/li\u003e\n \u003cli\u003eShi, Y., Wu, Y., Zhang, W., Qi, J. \u0026amp; Gao, G. F. Enabling the \u0026apos;host jump\u0026apos;: structural determinants of receptor-binding specificity in influenza A viruses. \u003cem\u003eNat Rev Microbiol\u003c/em\u003e. \u003cstrong\u003e12\u003c/strong\u003e, 822-31 (2014).\u003c/li\u003e\n \u003cli\u003eLi, Z. et al. Molecular basis of replication of duck H5N1 influenza viruses in a mammalian mouse model. \u003cem\u003eJ Virol\u003c/em\u003e. \u003cstrong\u003e79\u003c/strong\u003e, 12058-12064 (2005).\u003c/li\u003e\n \u003cli\u003eFinkelstein, D. B. et al. Persistent host markers in pandemic and H5N1 influenza viruses.\u003cem\u003e\u0026nbsp;J Virol\u003c/em\u003e.\u003cstrong\u003e\u0026nbsp;81\u003c/strong\u003e, 10292-10299 (2007).\u003c/li\u003e\n \u003cli\u003ePielak, R., M., Schnell, J. R. \u0026amp; Chou, J. J. Mechanism of drug inhibition and drug resistance of influenza A M2 channel. \u003cem\u003eProc Natl Acad Sci U S A\u003c/em\u003e. \u003cstrong\u003e106\u003c/strong\u003e, 7379-7384 (2009).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eLaboratory Test Results\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDay 7\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDay 22\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal range\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite Blood Cell (\u0026times;10\u003csup\u003e9\u003c/sup\u003ecells/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.50\u0026ndash;9.50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNeutrophil (\u0026times;10\u003csup\u003e9\u003c/sup\u003ecells/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.80\u0026ndash;6.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNeutrophil percentage (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.00\u0026ndash;75.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLymphocyte (\u0026times;10\u003csup\u003e9\u003c/sup\u003ecells/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.10\u0026ndash;3.20\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLymphocyte percentage (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.00\u0026ndash;50.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood platelet (\u0026times;10\u003csup\u003e9\u003c/sup\u003ecells/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e223\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125\u0026ndash;350\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProthrombin time (s)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.0\u0026ndash;16.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypersensitive C-reactive protein (mg/L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e249.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u0026ndash;6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLnterleukin-6 (pg/mL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.00\u0026ndash;7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProcalcitonin (ng/mL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.040\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.248\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.500\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003epO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.00-100.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003epCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.00\u0026ndash;45.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNucleic acid testing for influenza A virus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNegative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNegative\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4181286/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4181286/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn recent years, the avian influenza virus has emerged as a significant threat to both human and public health. Despite this, only two cases of human infection with the H10N3 strain have been documented. Here, we present the initial instance of human infection with avian influenza virus H10N3 in Yunnan Province, Southwest China. The patient, a previously healthy 51-year-old male, presented with recurrent fever peaking at 39℃, accompanied by symptoms such as cough, expectoration, chest tightness, and shortness of breath. Diagnosis revealed severe pneumonia, type I respiratory failure, and infection with avian influenza virus H10N3. Additionally, the patient experienced complications from Candida albicans and Staphylococcus epidermidis infections. Following treatment with appropriate antiviral drugs and antibiotics, the patient's condition improved. Molecular analysis of the viral strain identified four mutations potentially hazardous to human health. This underscores the importance of continuous and vigilant monitoring of the dynamics surrounding the H10N3 subtype of avian influenza virus.\u003c/p\u003e","manuscriptTitle":"First human case of avian influenza A (H10N3) in Southwest China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-04 19:22:25","doi":"10.21203/rs.3.rs-4181286/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"46290c1c-02c2-465e-9e5f-72b1aa7b1bea","owner":[],"postedDate":"April 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30207242,"name":"Health sciences/Diseases/Infectious diseases/Influenza virus"},{"id":30207243,"name":"Health sciences/Diseases/Infectious diseases/Viral infection"}],"tags":[],"updatedAt":"2024-05-09T08:15:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-04 19:22:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4181286","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4181286","identity":"rs-4181286","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}