A 36-year-old female presents to the emergency department with fever and chills, which have been ongoing for the past two days. She describes paroxysms of shaking chills, which last about an hour then are followed by high-grade fevers. She also reports malaise, generalized body aches and joint pain. She notes that her urine in the morning seemed unnaturally dark. She just returned from a missionary trip in Cameroon (Central Africa) where she volunteered for two weeks as a teacher. She can’t remember taking any medicine before or after traveling. Her room in Cameroon got very hot at night so she never used the mosquito net, which was provided. On physical exam, she is noted to have pale conjunctivae, mild jaundice and splenomegaly. Vital signs:
