A 5-Year-Old Child Is Brought to the Emergency Department Due

A 5-year-old child is brought to the emergency department due to difficulty breathing and a low-grade fever.  The patient's family recently moved to the United States from rural Nepal.  Temperature is 38.1 C (100.6 F) .  Physical examination shows a grayish pharyngeal exudate, enlarged cervical lymph nodes, and partial soft palate paralysis.  A sample of the pharyngeal exudate is obtained by oropharyngeal swab.  Bacteria isolated from the exudate demonstrate exotoxin production in the laboratory.  Which of the following best describes the mechanism of action of the exotoxin?

A) Autoimmune activation by antigenic mimicry
B) Degradation of lecithin
C) Inactivation of the 60S ribosomal subunit
D) Increased sensitivity to histamine
E) Intracellular protein ribosylation

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