A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism. Which of the following medications is not used in the treatment of this disorder? 

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and intraerythrocytic parasites on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism. You suspect babesiosis in this patient. Of the following, which is the characteristic diagnostic feature of babesiosis?

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism.  You suspect babesiosis in this patient.  Regarding the transmission of this disease, which of the following is true? 

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism. Which of the following is the most likely diagnosis in this patient? 

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism. You suspect babesiosis in this patient. Which of the following best explains the pathogenesis of babesiosis?

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in another state. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism.  You suspect Babesiosis in this patient. It is is found in which of the following areas of the United States?

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism.     You suspect babesiosis in this patient. Of the following which organism carries Babesia microbial, the organism responsible for Babesiosis? 

A 22-year-old medical student comes to the urgent care clinic and reports a sudden onset of high fever, chills, severe headache, pain around the eyeballs and behind the eyes, muscle pain, bone pain, nausea and vomiting. She attends a medical school in the Caribbean Islands and is now visiting her family in the United States. On further questioning, she reports that her apartment building is surrounded by many mud pits infested with Aedes mosquitoes and she had many mosquito bites over the last few weeks. One of her classmates got ‘breakbone fever’ last week. On examination, she has a faint, generalized macular rash that looks like ‘islands of white in a sea of red’. Laboratory tests demonstrated thrombocytopenia, monocytosis, elevated albumin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. A PCR test confirmed the diagnosis. When she was told that she was infected with a virus that belongs to the flaviviridae family, she rightly worried about the possibility of a hemorrhagic fever. What is the mainstay of care for this patient?

A 32-year-old woman presents to the emergency department with a four-day history of high-grade fever, severe headache, retro-orbital pain, and muscle aches. She also reports significant fatigue, nausea, and decreased appetite. On the second day of her illness, she developed a skin rash that started on her trunk and later spread to her extremities. She mentions a recent trip to a tropical region. On examination, the patient appeared lethargic and febrile with a temperature of 39.5°C. Her blood pressure was 100/70 mmHg, with a pulse of 100 beats per minute. The rash was erythematous and maculopapular, sparing the palms and soles. Petechiae were noted on her arms, and a positive tourniquet test suggested increased capillary fragility. Laboratory investigations revealed leukopenia with a white blood cell count of 3,000/μL, thrombocytopenia with a platelet count of 90,000/μL, and mildly elevated liver enzymes. Based on her recent travel history, you suspect dengue in this patient. Of the following, which is the most common symptom of dengue?

A 22-year-old medical student comes to the urgent care clinic and reports a sudden onset of high fever, chills, severe headache, pain around the eyeballs and behind the eyes, muscle pain, bone pain, nausea and vomiting. She attends a medical school in the Caribbean Islands and is now visiting her family in the United States. On further questioning, she reports that her apartment building is surrounded by many mud pits infested with Aedes mosquitoes and she had many mosquito bites over the last few weeks. One of her classmates got ‘breakbone fever’ last week.   On examination, she has a faint, generalized macular rash that looks like ‘islands of white in a sea of red’.  Laboratory tests demonstrated thrombocytopenia, monocytosis, elevated albumin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. A PCR test confirmed the diagnosis. When she was told that she was infected with a virus that belongs to the flaviviridae family, she rightly worried about the possibility of a hemorrhagic fever.  What is the most likely diagnosis in this patient?