Exposure history:
(1) travel to an endemic area
(2) contact with poultry
(3) contact with a sick bird
(4) contact with a sick pig or other animal
(5) contact with a sick human with a respiratory tract infection
Patients most seriously affected: young with no or few comorbid conditions
Clinical findings:
(1) cough, often productive
(2) fever
(3) dyspnea
(4) GI symptoms, with nausea, vomiting, abdominal pain and/or diarrhea
(5) variable sore throat and rhinorrhea
(6) variable headache
(7) variable myalgias
(8) rapid progression to ARDS and respiratory failure
(9) high mortality rate (up to 50-60%)
Radiologic findings:
(1) unilateral or bilateral infiltrate, often extensive
Laboratory findings:
(1) lymphopenia
(2) thrombocytopenia
(3) negative rapid test for Influenza, or positive reaction for Influenza A (a positive result for Influenza B would be against the diagnosis)
(4) elevation of serum ALT and AST
(5) negative findings for other pathogens
Pathology findings:
(1) hemorrhagic pneumonia
(2) hemophagocytosis in a bone marrow biopsy
If a patient meets these criteria:
(1) Place the patient under droplet precautions with careful hand hygiene.
(2) Consider therapy with an appropriate antiviral agent (oseltamivir or zanamivir).
(3) Send samples for viral confirmation and identification.
(4) Communicate with public health officials.
(5) Consider introducing social distancing measures in the community.
