A 65-Year-Old Man Comes to the Emergency Department Due to Fevers

A 65-year-old man comes to the emergency department due to fevers and malaise for the last 48 hours.  The patient initially experienced fevers and chills, which subsequently progressed to fatigue to the point that he had difficulty performing routine tasks this morning.  He has also had a mild headache.  The patient lives in eastern Massachusetts with his wife.  He is retired and spends time gardening and swimming at a local public pool.  The patient traveled to Thailand 2 years ago with his family and to Florida 2 months ago.  Temperature is 38.9 C (102 F) , blood pressure is 122/70 mm Hg, and pulse is 114/min and regular.  The oropharynx is dry and has no lesions.  Lung examination demonstrates coarse crackles bilaterally.  The abdomen is soft and mildly tender throughout with palpable splenomegaly.  He has no rash or open wounds.  Peripheral blood smear is shown in the exhibit.
 
Which of the following is the most likely source of this patient's infection?

A) Aedes mosquito
B) Brown recluse spider
C) Dog bite
D) Freshwater consumption
E) Ixodes tick
F) Scratch from a garden bush
G) Spore inhalation

Correct Answer:

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