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. Which of the following is the most likely bacterial virulence factor contributing to this patient's condition?

A) Antiphagocytic D-glutamate capsule
B) Antiphagocytic polysaccharide capsule
C) IgG-binding, outer membrane protein
D) Intracellular polyphosphate granules
E) Peritrichous flagella