 Welcome back to our Question of the Week series. Let's get started. As we have been doing, we're going to hide our answer choices until we read the question, so that we don't get distracted by the answer choices. And as always, we start with the last sentence, which is our question before we read the rest of the vignette. What insect is the most likely root of transmission for this patient's illness? A 39-year-old man living in Honduras presents to the clinic complaining of constipation and stomach pains for several months. On cardiac examination, the physician discovers a laterally displaced point of maximal impact. Chest and abdominal x-rays reveal a pulmonary congestion, cardiomegaly, and megacolon. Symptomatic treatment is all that can be offered to this patient. So what insects the most likely root of transmission for this patient's illness? Well, we're looking for something that causes a disease that gives us pulmonary congestion, cardiomegaly, megacolon. That cardiomegaly is what's laterally displacing the point of maximum impact. He's also having constipation and stomach pains. So all that together, we're looking for an organism that's transmitted by an insect. So let's see what we got. A, Anopheles mosquito. B, Exoides tick. C, Reduvid bug. D, Sand fly. Or E, CZ fly. Take a minute. Come up with your answer and write your answer in the comments below. Well, I know that the Anopheles mosquito transmits malaria, and this doesn't seem to fit malaria signs and symptoms. So I'm going to mark that one out. The Exoides tick, that one transmits Lyme disease. We're not seeing any type of indication this is Lyme disease or Babesiosa. And Lyme disease locations don't really fit someone in Honduras. That's going to be more in the United States up in the Northeast towards the central portion of the United States. So the Exoides tick, probably not going to be my answer here. The Reduvid bug. This could possibly be it. So let's leave this here and come back to it. D, Sand fly. Sand flies. This is, we see transmitting stuccalla azar, leishmaniasis. I don't think that any of this is going to be seen with this particular patient. This doesn't seem to fit to me, Sand fly. And then our CtC fly, African sleeping sickness. I remember sleeping fly and African sleeping sickness associated with each other. I don't think that's what this is. Let's just leave it and go back here. Let's look at C, Reduvid bug. Reduvid bug. This is, if everything I remember, shaga's disease. Shaga's disease gives us things that would fit here. That pulmonary congestion is a possible side effect of shaga's disease. Cardiomegaly definitely with shaga's disease. So from what I'm remembering seeing, I think C fits better with this answer. So I'm going to go with C is my final answer. And C is the correct answer. So this is the Reduvid bug that transmits trapanosoma cruzi, which is what causes shaga's disease. So our acute symptoms with shaga's disease can be the shagomas, which are small skin granulomas that it's caused by multiplication of that pathogen along the skin. We can get myocarditis. We can get congestive heart failure. But then in severe cases, we can see or severe or more chronic cases. We can see arrhythmias. We can see dilated cardiomyopathy, which is where we're going to get that displacement of the lateral displacement of the maximum point of maximal impact. Megacolon is another side effect of shaga's disease. As far as treatment goes, like we said here, that symptomatic treatment is all that could be offered to this patient. So how do we treat this? Well, we're going to treat this with nifuridomox, and that helps us with during the acute stages of infection. And oftentimes the Reduvid bug is found in Central and South America. So this fits in with the location of this patient in Honduras.