A 24-Year-Old Man Develops Mild, Nonexudative Pharyngitis Shortly After Travel

A 24-year-old man develops mild, nonexudative pharyngitis shortly after travel to Eastern Europe.  Throat swab culture in tellurite-containing, selective media yields black, iridescent colonies.  Microscopy shows club-shaped, gram-positive bacilli in a palisade arrangement, which are identified as nonpathogenic Corynebacterium diphtheriae.  These bacteria can acquire virulence to become pathogenic through which of the following mechanisms?

A) Bacterial conjugation permitting pili expression
B) Chromosomal mutation permitting endotoxin production
C) Environmental influences permitting toxin synthesis
D) Phage conversion permitting exotoxin production
E) Transformation permitting capsule formation

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