Environment to Human Given the survival of influenza A(H5N1) n the environment, several other modes of transmission are theoretically possible. oral ingestion of contaminated water during swimming and direct intranasal or conjunctival inoculation during exposure to water are other potential modes, as is contamination of hands from infected fomites and subsequent self-inoculation. The widespread use of untreated poultry feces as fertilizer is another possible risk factor signs and symptoms of Avian influenza Avitus Infections in Humans signs and symptoms may depend on which avian influenza A virus caused the infection. Low pathogenic avian influenza Avirus infections of humans have been associated with generally mild non fatal illness. The reported signs and symptoms of low pathogenic avian influenza A virus infections in humans have ranged from conjunctivitis to influenza-like illness(eg, fever cough sore throat, muscle aches) to lower respiratory disease(pneumonia) requiring hospitalization. Highly pathogenic avian influenza A virus infections of humans have been associated with a wide range of illness, illness has ranged from conjunctivitis only. to influenza like illness, to severe respiratory illness(e.g. shortness of breath, difficulty breathing, pneumonia, acute respiratory distress. viral pneumonia, respiratory failure) with mult-organ disease, sometimes accompanied by nausea, abdominal pain, diarrhea, vomiting and sometimes neurologic changes(altered mental status seizures). Sometimes infection with highly pathogenic avian influenza Avirus infection leads to death especially with HPAI H5N1 virus. The accuracy of clinical diagnosis of human infection with avian influenza A viruses on the basis of signs and symptoms alone is limited because symptoms rom ilness caused by other pathogens, including seasonal influenza A or B viruses, can overlap considerably