E.H. is a 28 year old male who comes to see you for 1 day history of nausea, loss of appetite, headache, dizziness, and overwhelming fatigue. He states that he has not had any fevers or cold-like symptoms. A few of his co-workers have had gripa (the flu). He has only taken a few Tylenol for his headache which has helped some. Your exam reveals no focal findings. You make the initial diagnosis of influenza, give him reassurance and discuss some supportive measures for his symptoms. You instruct him to return to the office if his symptoms worsen.

Two days later, you are called emergently to the ER at your local hospital. E.H.'s child, who is 3 years old, was brought to the ER after having a seizure at home. E.H. tells you that his child has had exactly the same symptoms as he has over the last 2-3 days. His child has never had seizures before, and this is his first. When you ask E.H. about how he feels, he states that his symptoms continue, but in addition is having blurred vision and diaphoresis now. 

E.H. informs you that he works for Ivanhoe's Apple Orchards, and he and his family live right next door to the orchard that he works in. He is responsible for preparing the pesticide mixture (mevinphos) for the spraying machinery that other co-workers use to apply the spray. 

On exam of his child, you find no focal neurological findings, and he is no longer seizing. However, you note a red rash on the child's arms, legs and torso. 

On exam of E.H., you find that he is pale, appears weak, is diaphoretic and has a fine tremor. 

You order the proper lab tests and acute treatment, and arrange for hospital admission for both patients. 

What do you think is going on with E.H.'s child? Do you still think that E.H. has influenza? Please proceed to the next section for more information...