A 4-Year-Old Boy Is Brought to the Physician by His

A 4-year-old boy is brought to the physician by his mother with decreased appetite, abdominal cramps, and diarrhea over the last 3 days.  The stools were initially watery but have now become bloody.  On physical examination, his temperature is 100.4 F (38 C) .  There are signs of dehydration and he has a mildly distended abdomen with diffuse pain elicited on palpation.  Stool studies are positive for fecal leukocytes and occult blood.  Fecal cultures grow non-lactose fermenting, gram-negative rods on MacConkey agar.  The bacteria ferment glucose without gas production, do not generate hydrogen sulfide when grown on triple sugar iron agar, and cannot replicate at refrigeration temperatures.  Which of the following bacterial factors is the most important during the pathogenesis of this patient's disease?

A) Exotoxin production
B) Intestinal colonization
C) Mucosal invasion
D) Proliferation in lymph nodes
E) Survival in the circulation

Correct Answer:

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