Question # 1 A 3-year-old boy is brought to the emergency department for 2 days of fever, cough, and worsening shortness of breath. The patient's parents report that he recently recovered from prolonged diarrhea due to Giardia infection. Medical history is significant for recurrent ear infections treated with antibiotics since age 6 months and lobar pneumonia requiring hospitalization. Temperature is 38.7 C (101.7 F), pulse is 140/min, and respirations are 60/min. Physical examination reveals small tonsils and crackles in the lower lobe of the right lung. The child's weight is at the 40th percentile. Which of the following is the most likely cause of this patient's recurrent infections?