Fever in a returned French sailor.

Figure 1. Three Giemsa-stained smears (A, B, and C) of peripheral blood (original magnification, ϫ1000) A previously healthy 26-year-old French sailor presented to our hospital with a 5-day history of fever accompanied by chills. He reported having participated in a mission 6 months earlier that involved travel to Bombay, India; Abu-Dhabi, Saudi Ara-bia; Monbassa, Kenya; and Djibouti, Republic of Djibouti. He had received appropriate pretravel vaccinations, as well as dox-ycycline for malaria prophylaxis. He stayed mostly in harbor but ventured to rural areas for safari in Kenya. He denied contact with sick persons and unprotected sexual activity. The findings of a physical examination of the patient were unre-markable, except for persistent fever (40ЊC). The results of laboratory tests were notable for the following values: WBC count, 6200 cells/mL with 65% polynuclear neutrophils; platelet count, 111,000 platelets/mm 3 ; and C-reactive protein level, 96.2 mg/L. The results of the remainder of the patient's chemistry analyses were normal. Examination of peripheral blood film revealed ring forms within RBCs with brown dots and also revealed several serpentine forms (figure 1). What is your diagnosis?