A 66-Year-Old Man Comes to the Hospital Due to 2

question 118

Multiple Choice

A 66-year-old man comes to the hospital due to 2 days of fever, chills, fatigue, and malaise.  He has had no chest pain, cough, diarrhea, or dysuria.  The patient has a history of lymphoma and underwent a splenectomy 6 years ago.  Prior to the splenectomy, he received vaccinations against Neisseria meningitidis and Streptococcus pneumoniae.  Six months ago, the patient returned from a 2-week trip to India during which he did not take antimalarial prophylaxis.  He has no known ill contacts.  The patient lives in Massachusetts and is a professor at a local college.
Temperature is 38.6 C (101.5 F) , blood pressure is 122/70 mm Hg, and pulse is 110/min and regular.  The patient has mild respiratory distress.  The oropharynx is dry without lesions.  Lung examination reveals bilateral coarse crackles.  The abdomen is soft and mildly tender throughout.  He has no skin rash.
Laboratory results are as follows:

A chest x-ray reveals diffuse bilateral infiltrates.  A peripheral blood smear shows intraerythrocytic inclusions (see exhibit) .
Which of the following is the most likely organism causing this patient's illness?

• A)Anaplasma phagocytophilum
• B)Babesia microti
• C)Borrelia burgdorferi
• D)Ehrlichia chaffeensis
• E)Plasmodium falciparum

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