A 34-Year-Old Man, Who Is a Military Veteran, Comes to the Office

A 34-year-old man, who is a military veteran, comes to the office because of a 2-day history of fever, headache, myalgias, and a lesion on his face. He first noticed a blister on his right cheek, which gradually progressed into a dark sore. He denies recent insect bites, rodent exposure, or animal bites or scratches, but he scratched his face on the ground during a combat exercise. One week ago, he returned from a 1-year deployment in Afghanistan where he worked as an infantry soldier. The patient's medical history is unremarkable. He appears ill and fatigued. His temperature is 38.3°C (101°F) . Physical examination shows a 2-cm painless cutaneous ulcer over the right cheek that is surrounded by an edematous halo; the center of the lesion is necrotic. He has multiple abrasions on his face and elbows. There is cervical lymphadenopathy. The toxin causing edema around this patient's ulcer has a mechanism of action most similar to a different toxin produced by which of the following bacteria?

A) Bordetella pertussis
B) Clostridium botulinum
C) Clostridium difficile
D) Shigella dysenteriae
E) Streptococcus pyogenes