Aeromonas dhakensis is an important ubiquitous Gram-negative and freshwater bacterium detected in different reservoirs. It can cause invasive diseases in humans. Herein, we report the first case in Mainland China of a fulminant death of a 29-year-old man as a result of a new, unexpected association between septicemic A. dhakensis and hepatitis B viral infection (HBV). Herein, the patient died from multiple organ failure 5 d postadmission after the ingestion of Snakehead Fish meal. The isolated bacterium was initially misidentified as Aeromonas hydrophila using VITEK-2, while whole-genome sequencing (WGS) revealed that the isolate is A. dhakensis. WGS revealed the occurrence of three antimicrobial genes of resistance: imiH, cphA2, and blaOXA-12; besides, major virulence factors were detected. In silico, multilocus sequence typing (MLST) showed that our A. dhakensis 17FW001 belonged to a novel sequence type (ST557). A comparative genomic analysis of our isolate with nine selected Aeromonas species was done, which elucidated the pathogenicity of our A. dhakensis. In conclusion, we reported for the first time the association between A. dhakensis and HBV in Mainland China. We revealed that septicemic A. dhakensis could result in severe adverse clinical outcomes that end up with unexpected fulminant death especially when it is accompanied with HBV and sheds light on the virulence of A. dhakensis and the high rate of its misdiagnosis that requires to urgently consider screening of all cases of A. dhakensis for HBV in the future. Besides, caution should be taken while dealing with snakeheads which act as a vector for A. dhakensis.

The 2009 pandemic in Italy has been viewed as a false alarm, and it has not been properly understood based on historical precedents and more in-depth studies that have been conducted in other countries. Some of these studies have pointed to a phenomenon of sudden and fulminant death among healthy children, which is not the sole prerogative of pandemic influenza, but was, in 2009, a more frequent occurrence than in previous years. The purpose of this study is to gather such cases occurring during the 2010-11 and 2011-12 seasons. Google Search was used in order to find cases of children and teens with no reported preexisting conditions of relevance and who died suddenly and unexpectedly after exhibiting flu-like symptoms during the two seasons. During the 2010-11 season, 29 deaths were found to meet the above conditions, 18 of which were fulminant and 11 sudden. For the 2011-12 season, there were ten such cases: five fulminant and five sudden. Most of these cases occurred during the period of maximum circulation of the flu virus. Fulminant deaths were three times more frequent during 2010-11 season and involved children of a higher average age than the more recent season. It is not possible to come to any definite conclusions, but there is reason to suspect that the driver of this significant increase may be the A(H1N1)pdm09 virus. Regardless of how reading these results, it is advisable that the surveillance systems be strengthened and more recent study techniques be adopted in order to determine the causes of similar deaths in the future.
BACKGROUND: Prof. Gaetano Thiene, Department of Medical Diagnostic Sciences and Special Therapies, University of Padua; Prof. Paolo Prandoni, Department of Cardiothoracic and Vascular Sciences, University of Padua; Prof. Pierluigi Lopalco, European Centre for Disease Prevention and Control Stockholm; Sharon Sanders, Editor-in-Chief & President of the International FluTrackers Forum; Giuseppe Michieli, Director of the Italian FluTrackers Forum; Grey A. Drane, Rinaldo Sperotto, my wife and my children.