Case history #1
A previously healthy 32-year-old Egyptian woman who raises backyard chickens acutely develops overwhelming fatigue and a temperature of >38.8°C (102°F) for 2 days. She has a new cough, bloody sputum production, dyspnoea, and pleuritic chest pain. She has vague abdominal pain, as well as some watery diarrhoea. Her respiratory status declines over the following 2 days, prompting her family to bring her to hospital. A chest radiograph shows multi-lobar consolidation. Her lymphocyte and platelet counts are low, and her AST and ALT are high. No family members have been sick. They report that many poultry are sick or have died in the area recently, and the patient recently prepared and ate ill-appearing chickens.
Case history #2
A 55-year-old Vietnamese-American man with hypertension develops progressive fever, productive cough, and shortness of breath soon after returning to the US in the winter from Southeast Asia. He had spent the prior 3 months in a rural area of Vietnam. His family reports that there were widespread deaths among poultry in the village where he had stayed. He had handled backyard poultry that had died 5 days before the onset of his symptoms, and he recently purchased live chickens and ducks at a live poultry market. He is tachypnoeic, has an oxygen saturation of 90%, and has decreased breath sounds on the posterior base of his left lung. A chest radiograph demonstrates left lower lobe consolidation. Laboratory findings include leukocytosis, anaemia, thrombocytosis, and hypoxaemia.
Early illness is manifested by signs and symptoms consistent with a febrile upper respiratory tract infection. Clinical progression to severe lower respiratory tract disease typically occurs in patients at about days 3 to 6.  Multi-organ failure may occur. Encephalitis and meningoencephalitis have been reported. Clinically mild disease (fever and symptoms of upper respiratory tract infection) has been documented, especially in children in Egypt presenting for care early, and in other countries. At admission, most patients have fever and clinical findings similar to those of severe community-acquired pneumonia.
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