Several Residents of a Long-Term Care Facility Develop Febrile Illness

Several residents of a long-term care facility develop febrile illness within a short period of time.  Symptoms include fever, nonproductive cough, myalgia, rigors, dyspnea, and diarrhea.  Organisms found in induced sputum samples stain poorly with Gram stain but are visualized easily using silver stain.  Urine testing for bacterial antigens is positive in most of the affected individuals.  Which of the following is the most likely source of this outbreak?

A) Anterior nares of colonized staff
B) Building water-distribution system
C) Contaminated ready-to-eat food
D) Nasopharynx of infected resident
E) Skin flora of affected residents

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