A middle-aged poultry worker with fever, cough and fatigue

A 45-year-old poultry farm worker presented to the emergency department with a five-day history of fever, cough, body pain and fatigue. She has a medical history of asthma and is a smoker. She also reported experiencing shortness of breath, sore throat and fatigue. Despite taking over the counter medications her symptoms worsened. Additionally, she noted that there was unexplained reason of other poultry workers experiencing similar symptoms.  

On physical examination, her vital signs were noted as blood pressure as 135/80 mmHg, heart rate of 105 bpm, respiratory rate of 22 breaths per minute, oxygen saturation of 91% on room air. The patient appeared fatigued. Cardiovascular examination reveals tachycardia with a regular rhythm. The respiratory examination showed bilateral crackles and wheezing with the use of accessory muscles. A complete blood count indicates an elevated white blood cell count. A chest X-ray revealed bilateral infiltrates suggestive of viral pneumonia. A nasopharyngeal swab tested positive for H5N2.