A 64-Year-Old Man Comes to the Emergency Department Due to Worsening

A 64-year-old man comes to the emergency department due to worsening left lower extremity pain, swelling, and redness over the past 3 days.  The patient has had no trauma but reports feeling feverish.  Medical history is significant for hypertension and obesity.  Temperature is 38 C (100.4 F) , blood pressure is 130/86 mm Hg, pulse is 92/min, and respirations are 18/min.  BMI is 35 kg/m².  Physical examination shows diffuse erythema extending up to the left midcalf with indistinct border.  There is increased warmth, tenderness, and edema of the left leg.  No areas of fluctuation or purulent exudate are present, but the interdigital skin of the feet is macerated and fissured.  Laboratory testing shows neutrophilic leukocytosis, and Doppler ultrasonography is negative for deep venous thrombosis.  Infection with which of the following organisms is most likely responsible for this patient's current symptoms?

A) Beta-hemolytic streptococci
B) Candida albicans
C) Clostridium perfringens
D) Mycobacterium marinum
E) Pseudomonas aeruginosa
F) Staphylococcus epidermidis

Correct Answer:

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