This case report describes a 23-year-old previously healthy female in Nanning, China, who developed severe pneumonia and ARDS after occupational exposure to poultry, confirmed as the fourth documented human infection with avian influenza A (H10N3). Clinical course, treatment response, and genomic characteristics were compared across all four known human H10N3 cases.
The patient required invasive mechanical ventilation and V-V ECMO (PaO2/FiO2 ratio of 44.1 at nadir) and recovered after ~3 months of intensive care. RT-PCR cleared negative within 48 h of starting combined baloxavir marboxil + oseltamivir. Across all 4 reported human H10N3 cases, 75% (3/4) required mechanical ventilation or ECMO; ARDS onset was typically 8–10 days after symptom onset. The strain carried the human-adapted P221 substitution but lacked G228S, suggesting G228S is not required for human infection. No NAI-resistance mutations were found.
- Single case with no environmental sampling from exposure sites, leaving the spillover pathway uncharacterized. - No seroepidemiological studies in high-risk occupational contacts, so asymptomatic exposure burden is unknown. - Dual antiviral efficacy (baloxavir + oseltamivir) is based on one patient with no comparator arm.
Clinicians should consider avian influenza (including H10N3) in patients with severe, rapidly progressive pneumonia and recent poultry or live-market exposure, especially when standard respiratory pathogen panels are negative. Early mNGS of BAL fluid enabled diagnosis here; baloxavir + oseltamivir achieved rapid viral clearance and the virus showed no NAI resistance.
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