Review Question - QID 215139

A 48-year-old man presents to his primary care doctor after having days of muscle pains and fevers. He reports that his maximum temperature reached 101.0°F (38.3°C) at home. The symptoms started 3 days prior, and the patient has not had any upper respiratory symptoms. He also complains of feeling weak and tired and has had chills and sweats. The patient denies any gastrointestinal symptoms and has not had any new sexual partners. He denies any recent travel except going to Massachusetts 2 weeks prior with his family. On exam, his temperature is 100.0°F (37.8°C), blood pressure is 110/80 mmHg, pulse is 82/min, and respirations are 14/min. His labs were drawn and demonstrate the following:

Leukocyte count and differential:
Leukocyte count: 16.9 x 10^3/mm^3
Segmented neutrophils: 30%
Lymphocytes: 50%
Monocytes: 15%

Hemoglobin: 11.1 g/dL
Platelet count: 150,000/mm^3
Reticulocyte count: 15%
Lactate dehydrogenase: 850 U/L (Normal: 140-280)
Haptoglobin: < 8 mg/dL (Normal: 50-220)
Total bilirubin: 5.4 mg/dL
Direct bilirubin: 0.5 mg/dL

A blood smear is performed for this patient, shown in Figure A. Which of the following is the most likely vector for this patient’s illness?