Review Question - QID 213810

A 45-year-old woman presents to the urgent care clinic with a swollen, red lesion on her right forearm. She states that the lesion developed over the last 24 hours. On review of systems, she states that she had felt febrile overnight but that she did not take her temperature. She also has had general malaise and a loss of appetite. She denies any respiratory or urinary symptoms, weight loss, diarrhea, or constipation. Of note, the patient lives in Connecticut and works as an ultrasound technologist. She was in Brazil last month working with a medical relief organization and was in Uganda the month before. She reports no blood-borne exposures while abroad. Her temperature is 100.2°F (37.9°C), blood pressure is 126/82 mmHg, pulse is 80/min, and respirations are 12/min. On her right dorsal forearm is an erythematous and indurated 4 cm lesion with no active drainage. There is a small puncture visible at the center. The lesion is tender to palpation. There are no palpable axillary or cervical lymph nodes. The rest of the physical exam is within normal limits, and there are no other abnormal dermatologic findings. A blood smear is shown in Figure A. Which of the following is a responsible vector for this patient’s symptoms?