Review Question - QID 212645

A 34-year-old man reports to his primary care provider after developing a 5-day history of fevers, chills, and muscle aches. The patient is normally healthy, physically active, and does not take any medications other than a daily multivitamin. When the patient first developed symptoms, he assumed it was a common cold, but he has not had any upper respiratory symptoms and his fever and pain have not been improving. On further questioning, the patient reports that he had been hiking 2 weeks prior, but he did not recall getting bitten. On exam, the patient’s temperature is 100.9°F (38.3°C), blood pressure is 110/84 mmHg, pulse is 87/min, and respirations are 14/min. On a full body skin exam, a slightly erythematous welt is seen on his posterior thigh. The physical exam is otherwise unremarkable. Further lab testing is performed and a blood smear is shown in Figure A. Which of the following is the most likely vector for this patient’s disease?