A twenty three year old white male was seen in infectious diseases clinic in April 2011 for a large facial sore and a sore throat.

He had recently returned from a five to six month stay in South America where he and his fiancé had visited multiple countries in a combined adventure/work experience. He began his odyssey in October 2010 in Ecuador including a visit to the Galapagos. In late November he proceeded to the Amazon region of Peru. While his fiancé studied macaws as part of a research project, he did filming for local resorts for the production of promotional video. On one occasion in early January 2011 while filming in a remote area along the Heath River (which forms a portion of the Peru-Bolivia border), he recalled in particular numerous bug bites, primarily on his lower extremities, but likely elsewhere as well.

He and his fiancé then proceeded on to Cochabamba, Bolivia for the next two months of their sojourn. There he continued working on video projects as well as participated in volunteer work including installation of solar panels and assisting disadvantaged children.

It was while in Bolivia in February 2011 that he first noticed a small "pimple" on his right cheek. This slowly and progressively enlarged and ulcerated such that by March it had become an relatively large open ulceration. He saw a physician in La Paz who administered an intramuscular antibiotic and prescribed an oral antibiotic and topical anti-fungal cream.

He returned to the United States in late March and sought care from his primary care physician. He was prescribed ciprofloxacin and ampicillin/clavulanate without apparent benefit. He was referred to a dermatologist who performed a skin biopsy, and he was thereupon referred for infectious diseases consultation.

In mid-late April shortly before being seen in the ID clinic he had also developed sores on his pharynx (see lower left). His facial lesion at that time had become quite large (see upper left) although it remained painless. He was previously healthy, and at the time of his ID evaluation routine laboratory data including CBC and comprehensive metabolic panel were normal. An HIV antibody was negative. He was referred to an ENT physician for biopsy of the pharyngeal lesions.

Of the choices below what was most likely the vector of this disease?