New Zealand

I recently traveled to New Zealand. I had a fabulous time and fortunately, did not look up unique geographic diseases until afterwards.

A 20 year old man does a "farm stay" while backpacking around New Zealand. He has a great time, white water rafting, swimming in lakes, camping in the woods, and hitchhiking. He presents with abrupt onset of fever, rigors, myalgias, and headaches. Review of systems is also positive for nausea, vomiting, diarrhea, and cough.

Routine laboratory tests are nonspecific. He has a left shift, thrombocytopenia, and hyponatremia. Urinalysis shows proteinuria, pyuria, and granular casts.

Challenge: What's your suspicion?

First image is in the public domain, from Wikipedia; second image is shown under Fair Use.