A 38-Year-Old Woman Comes to the Office for Evaluation of a Skin

A 38-year-old woman comes to the office for evaluation of a skin lesion.  It began as a pink papule on her right arm and has progressively enlarged over several weeks.  The lesion is not pruritic or painful and has not been associated with fever or other systemic symptoms.  The patient returned from a trip to Costa Rica 5 weeks ago.  During her travel, she stayed at a beachside resort and hiked in the rainforest.  Skin examination findings are shown below.  Biopsy of the lesion reveals intracellular, round-oval protozoa with rod-shaped kinetoplasts.  Which of the following most likely led to this patient's current condition?

A) Bite from infected sand fly
B) Contact with infected person
C) Exposure to decaying vegetation
D) Handling of infected animal
E) Swimming in contaminated water

Correct Answer:

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