A 36-Year-Old Immigrant from Peru Comes to the Office Due

A 36-year-old immigrant from Peru comes to the office due to difficulty swallowing liquids.  He also has difficulty belching.  Eating slowly and extending the neck partially relieves his symptoms.  The patient has had no fever, weight loss, chest pain, cough, dyspnea, or neurologic symptoms.  He has no chronic medical problems and takes no medications.  He has been an active smoker for the last 18 years but does not use alcohol or illicit drugs.  The patient is afebrile with normal vital signs.  BMI is 24 kg/m².  On examination, the abdomen is soft, nondistended, and nontender, with no masses or organomegaly.  Bowel sounds are normal.  Other examination findings are unremarkable.  Barium swallow shows a dilated esophagus, and manometry confirms absent peristalsis in the smooth muscle portion of the esophagus.  If this patient's symptoms are caused by an infection, which of the following organisms is the most likely cause?

A) Candida albicans
B) Clostridium botulinum
C) Cytomegalovirus
D) Helicobacter pylori
E) Schistosoma mansoni
F) Trypanosoma cruzi

Correct Answer:

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