Case history
Case history
A 38-year-old man presents with fever of 38.5°C (101.2°F), chills, myalgias, cough, and dyspnoea. Other than tachypnoea, tachycardia, and bibasilar rales, the rest of the physical examination is normal. He reports that this happens almost every month the day after he cleans out the bird cages in which he keeps the pigeons that he breeds and races.
Other presentations
Other, less common presentations can occur when there is an intermittent, moderate level of exposure: for example, in a home with a leaky roof that harbours thermophilic Actinomycetes. An individual may present after weeks or months of exposure with symptoms of dyspnoea, productive cough, and malaise with no temporal relationship to exposure. Alternatively, the exposure may be low and occur over months to years. An example is a person living in an apartment above, and sharing a ventilation system with, a pet store that specialises in birds. After years of living in the apartment, the individual with HP may present with vague, insidious symptoms such as dyspnoea, weight loss, malaise, and cough. Clubbing occurs in approximately one half of such HP patients.[5][6]
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