A 33-year-old man is evaluated in the emergency department in July for respiratory distress. He recently returned from an extended business trip through Guangdong Province of China, Saudi Arabia, and Liberia. Over the final 3 days of the trip, he noted feeling short of breath with exertion with dry cough, headache, nausea, and diarrhea. He is unaware of known exposure to ill contacts. Medical history is otherwise unremarkable, and he takes no medications. He has received all recommended travel-related immunizations.
On physical examination, temperature is 39.1 °C (102.4 °F), blood pressure is 110/72 mm Hg, pulse rate is 98/min, and respiration rate is 22/min. BMI is 28. Oxygen saturation is 91% breathing ambient air. No lymphadenopathy is detected. Pulmonary auscultation reveals diffuse bronchial breath sounds and rhonchi. He has no abdominal tenderness or hepatosplenomegaly, and no rash is present. The remainder of the examination is normal.