28th July 2023

A 25 year old man returns from Pakistan after visiting family in a rural area.

A 25 year old man returns from Pakistan after visiting family in a rural area. He has had a 2 week history of fever and abdominal pain. His observations include a temperature of 39.5oC, HR 75 bpm, BP 1110/79, with a normal respiratory rate and oxygen saturation level. On examination, there is a blanching erythematous maculopapular rash. His abdomen is generally tender. His white cell count is normal,l with mild thrombocytopenia. A malaria screen is negative. Blood cultures grow a Gram negative bacilli after 72 hours.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.