OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.