A 57-Year-Old Woman Is Hospitalized with High-Grade Fevers, Chills, and Right

A 57-year-old woman is hospitalized with high-grade fevers, chills, and right upper abdominal pain.  The patient lives in Wisconsin and has no history of international travel.  Her temperature is 40 C (104 F) .  Physical examination of the abdomen shows rebound tenderness.  Laboratory studies show elevated aspartate and alanine aminotransferases.  Imaging studies reveal a fluid-filled cavity within the right lobe of the liver as shown below. Which of the following microorganism/route combinations is most likely to be the cause of this patient's infection?

A) Chlamydia trachomatis due to ascending cholangitis
B) Cytomegalovirus by direct invasion from a nearby source
C) Entamoeba histolytica due to a penetrating stab wound
D) Staphylococcus aureus by hematogenous route
E) Streptococcus pneumoniae by portal vein

Correct Answer:

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