Review Question - QID 213437

A 52-year-old man presents to an urgent care center in Missouri for evaluation of a lesion on his right hand, which initially appeared 4 days ago as a raised red bump. He denies trauma to the hand, other than a tick bite that he noticed last week. He also reports 3 days of headache, fatigue, myalgias and diaphoresis. He has no chronic medical conditions, takes no medications, lives alone, and has no pets. He works as a park ranger at a nearby state park, and likes to hike and hunt in his spare time. He eats a balanced diet of fruits, vegetables, eggs, and wild game. Physical exam is notable for a moderately ill-appearing man with tender lymphadenopathy of the right axilla, with overlying erythema. Temperature is 102°F (38.9°C), blood pressure is 120/75 mmHg, pulse is 109/min, and respirations are 21/min. A photograph of the patient’s right hand is shown below (Figure A). Which is the most likely causative agent of this patient’s illness?