A woman developed fevers to 102°F (38.9°C), aches, abdominal pain, and vomiting after visiting Lake Tahoe and the Sierra Nevadas the previous month. On the 5th day, the temperature was 102°F (38.9°C). The abdomen was tender, with a palpable spleen. The white count was 4300 cells/µl (normal 4000 - 11,000), with neutrophils 70% and bands 15%, and platelet count 18,000/µl (nl 150,000 - 400,000). The peripheral smear is shown.
The most likely diagnosis is which of the following?
What is the diagnosis?
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