The correct answer is E. Whenever you see a question on a gardener who works with roses, think "Sporothrix schenckii." This organism is responsible for "rose gardener's disease," knowntechnically as sporotrichosis. The organism enters through skin breaks in the fingers or hands,causing a chancre, papule, or subcutaneous nodule with erythema and fluctuance. Ulceratinglesions appear along lymphatic channels, but the lymph nodes are not commonly infected.Potassium iodide is the treatment of choice for the subcutaneous manifestations.Aspergillus (choice A) causes pulmonary aspergillosis–a systemic mycotic infection. Thereis an allergic type that is caused by a hypersensitivity reaction to the organism and aninfectious type that occurs more commonly in the immunocompromised. Hemoptysis is a commonsymptom.Malassezia (choice B), specifically M. furfur, causes tinea versicolor, a superficial mycoticinfection.Onchocerca (choice C), specifically O. volvulus, causes river blindness. This organism is ahelminth that is transmitted by black flies in Africa, Central America, and South America.Rhizopus (choice D) causes rhinocerebral infections in diabetics with ketoacidosis.A 33-year-old man in Arkansas presents to the local clinic with fever, chills, headache, and generalizedmyalgias and arthralgias. On physical examination, an ulcer with a black base is apparent onhis right hand, and epitrochlear lymphadenopathy is noted. A careful history reveals that theman is a hunter and trapper, recently trapping and skinning rabbits. Which of the followingorganisms is the most likely cause of this man's illness?A. BorreliaB. BrucellaC. FrancisellaD. LeptospiraE. ListeriaExplanation:The correct answer is C. The disease is tularemia, which may be spread by handling rabbits or rabbit skins, or by bites from ticks that feed on the blood of wild rabbits. The causativeorganism is Francisella tularensis, a gram-negative coccobacillus. The disease begins as arupturing pustule followed by an ulcer, with involvement of regional lymph nodes. More seriouscases can be complicated by bacteremia, splenomegaly, rash, pneumonia, or endotoxemic shock.Borrelia(choice A) spp. cause relapsing fever (transmitted by ticks and lice) and Lyme disease(transmitted by ticks).Brucella(choice B) causes brucellosis after ingestion of contaminated milk or contact withinfected livestock.Leptospira (choice D) causes leptospirosis and Weil's disease; the organism is acquired byingestion of water contaminated with animal urine.Listeria (choice E) causes listeriosis after contact with contaminated milk, vegetables, or with transplacental transmission.