52-year-old woman is evaluated due to 2 weeks of fever, fatigue, nonproductive cough, and dyspnea, which began shortly after visiting her family in Ohio. She also lost 1.5 kg (3.3 lb) over the same period. The patient has a history of rheumatoid arthritis and has been taking adalimumab for the past 6 months. She had negative tuberculosis skin testing prior to beginning the drug. Temperature is 38 C (100.4 F), blood pressure is 130/70 mm Hg, pulse is 92/min, and respirations are 18/min. Physical examination reveals bilateral lung crackles, mild generalized lymphadenopathy, and hepatosplenomegaly. Chest x-ray shows bilateral nodular densities and hilar lymphadenopathy. Urine testing is positive for a fungal antigen. Which of the following pathogenic processes is most important during the development of this patient's infection?
1) Intracellular proliferation within the macrophages
2) Invasion of the vascular endothelial lining
3) Overgrowth and tissue invasion by endogenous flora
4) Production of an antiphagocytic polysaccharide capsule
