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A 19-year-old woman is admitted to a Colorado hospital immediately after returning from anextended hiking trip in the mountains. She presents with malaise and a diffuse red rash over most of her body except the palms of her hands and the soles of her feet. Physical examination is remarkable for fever, tachycardia, elevated respiratory rate, and orthostatic hypotension. No obvious signs of infection are found. The patient reports that this is the fourth day of her menstrual cycle. When questioned, she reports that she has only changed her tampon once during this period due to the circumstances of being outdoors. She denies alcohol use, drug use, or recent exposure to febrile individuals. The patient is immediately started on intravenous antibiotics and gradually improves.
Which of the following is the most likely causative agent in this patient’s condition?
(A) Clostridium perfringens enterotoxin
(B) Disseminated Staphylococcus aureus infection
(C) Rickettsia rickettsii
(D) Staphylococcus aureus exotoxin
(E) Treponema pallidum
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