CHIEF COMPLAINT: aseptic meningitis with associated bradycardia

PRESENT ILLNESS: 20 yr old man with no past medical history presented to [**Location (un) **]
[**2101-7-13**] with groin pain X 2 days, severe HA, and phtophobia. In
the ED he also complained of n/v and had a fever to 102. A few
days prior to that he had presented to the ED with groin pain
and concern for an STD (genital warts). He had been told that he
had a lymph node enlargement in his groin and was treated with
doxycycline. Cultures were negative. He denies history of STDs,
rashes, and genital lesions. He has had unprotected intercourse
in the last few weeks with one female partner of unknown STD
status.
On the floor at [**Location (un) **] the patient had nausea and vomiting
(treated with phenergan and zofran), fever and chills. He
underwent a head CT which was normal and an LP was performed
with 33 wbc 95% lymphs. He was diagnosed with viral meningitis,
but treated prophylactically until cultures definitively
negative, with vanc/ctx and then doxycycline was added [**7-14**].
Infectious disease was consulted and felt it was ok to hold off
on ACV given patient likely had aseptic meningitis but at 2pm on
[**7-14**] the patient was acutely symptomatic with nuchal rigidity
and severe headache so acyclovir was added to his antibiotic
regimen at that time as well as ampicillin. His headache
persisted despite dilaudid, motrin, and toradol. Because of
nausea/vomiting he has had little PO intake and was started on
D5 NS @ 100mL/hr.
In addition, patient was noted to have a systolic murmur on
admission. He had not had this before that he knew of. He
underwent tte which was pending at the time of discharge. He
also had EKGs that revealed a possible junctional rhythm. A lyme
titer was sent and is pending. He was transferred to [**Hospital1 18**] for
closer monitoring.
On presentation to [**Hospital1 18**] the patient had severe headache. He was
also nauseous. He denied dizziness, light-headedness, chest
pain, palpitations. He denied visual symptoms, dysuria. He did
endorse diarrhea since being on the doxycycline. He denied
recent travel aside from being in [**Location (un) 86**] for training. He denied
recent exposure to ticks/outdoors but does live in the barracks.
He has had no sick contacts. Sexual exposures as above.
.
Review of systems:
(+) Per HPI
(-) Denies cough, shortness of breath, or wheezing. Denies chest
pain, chest pressure, palpitations, or weakness. Denies
constipation, abdominal pain. Denies dysuria, frequency, or
urgency. Denies rashes or skin changes.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
Vitals: T:96.8 BP:118/52 P:36-54 R:18 O2:99RA
General: Alert, oriented, in severe pain (head)
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: bradycardic, irregularly irregular, normal S1 + S2, [**1-1**] SM
best heard at apex, no rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley, tender 1X1cm inguinal LN on right. None on left.
No penile rashes.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A+OX 3, pupils ERRL,
Skin: No rashes, no splinter hemorrhages,

FAMILY HISTORY: Mom has heart murmur. Brother has MR.

SOCIAL HISTORY: Originally from [**State **]. Here at a base near [**Location (un) **] training
for the army. Lives in the barracks. No recent sick contacts,
travel, hiking, swimming in fresh water. Sexually active without
condoms with one female partner.
- Tobacco: Quit 3 weeks ago
- Alcohol: socially
- Illicits: Denies
Unspecified viral meningitis,Pneumonitis due to inhalation of food or vomitus,Other specified cardiac dysrhythmias,Thrombocytopenia, unspecified
Viral meningitis NOS,Food/vomit pneumonitis,Cardiac dysrhythmias NEC,Thrombocytopenia NOS
Admission Date:  [**2101-7-14**]              Discharge Date:   [**2101-7-23**]

Date of Birth:  [**2080-12-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
aseptic meningitis with associated bradycardia

Major Surgical or Invasive Procedure:
lumbar puncture

History of Present Illness:
20 yr old man with no past medical history presented to [**Location (un) **]
[**2101-7-13**] with groin pain X 2 days, severe HA, and phtophobia. In
the ED he also complained of n/v and had a fever to 102. A few
days prior to that he had presented to the ED with groin pain
and concern for an STD (genital warts). He had been told that he
had a lymph node enlargement in his groin and was treated with
doxycycline. Cultures were negative. He denies history of STDs,
rashes, and genital lesions. He has had unprotected intercourse
in the last few weeks with one female partner of unknown STD
status.
On the floor at [**Location (un) **] the patient had nausea and vomiting
(treated with phenergan and zofran), fever and chills. He
underwent a head CT which was normal and an LP was performed
with 33 wbc 95% lymphs. He was diagnosed with viral meningitis,
but treated prophylactically until cultures definitively
negative, with vanc/ctx and then doxycycline was added [**7-14**].
Infectious disease was consulted and felt it was ok to hold off
on ACV given patient likely had aseptic meningitis but at 2pm on
[**7-14**] the patient was acutely symptomatic with nuchal rigidity
and severe headache so acyclovir was added to his antibiotic
regimen at that time as well as ampicillin. His headache
persisted despite dilaudid, motrin, and toradol. Because of
nausea/vomiting he has had little PO intake and was started on
D5 NS @ 100mL/hr.
In addition, patient was noted to have a systolic murmur on
admission. He had not had this before that he knew of. He
underwent tte which was pending at the time of discharge. He
also had EKGs that revealed a possible junctional rhythm. A lyme
titer was sent and is pending. He was transferred to [**Hospital1 18**] for
closer monitoring.
On presentation to [**Hospital1 18**] the patient had severe headache. He was
also nauseous. He denied dizziness, light-headedness, chest
pain, palpitations. He denied visual symptoms, dysuria. He did
endorse diarrhea since being on the doxycycline. He denied
recent travel aside from being in [**Location (un) 86**] for training. He denied
recent exposure to ticks/outdoors but does live in the barracks.
He has had no sick contacts. Sexual exposures as above.
.
Review of systems:
(+) Per HPI
(-) Denies cough, shortness of breath, or wheezing. Denies chest
pain, chest pressure, palpitations, or weakness. Denies
constipation, abdominal pain. Denies dysuria, frequency, or
urgency. Denies rashes or skin changes.


Past Medical History:
none

Social History:
Originally from [**State **]. Here at a base near [**Location (un) **] training
for the army. Lives in the barracks. No recent sick contacts,
travel, hiking, swimming in fresh water. Sexually active without
condoms with one female partner.
- Tobacco: Quit 3 weeks ago
- Alcohol: socially
- Illicits: Denies


Family History:
Mom has heart murmur. Brother has MR.

Physical Exam:
ADMISSION PHYSICAL EXAM
Vitals: T:96.8 BP:118/52 P:36-54 R:18 O2:99RA
General: Alert, oriented, in severe pain (head)
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: bradycardic, irregularly irregular, normal S1 + S2, [**1-1**] SM
best heard at apex, no rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley, tender 1X1cm inguinal LN on right. None on left.
No penile rashes.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A+OX 3, pupils ERRL,
Skin: No rashes, no splinter hemorrhages,


Pertinent Results:
Labs from OSH:
WBC: 8.8, Hct 40.2, PLt 126
INR 1.3, PTT 35
CSF: Tube 1 colorless, 33 wBC, 75RBC, 6 PMNs, 94% Lymphs, Tube
#4 3 wbcs, 100% lymphs. glucose 60, prot 40
Na 136, K 4, Cl 101, Co2 26, FSBS 127, BUN 12, Creatinine 0.9,
ca 8.9, tprot 7.6, alb 4.4, tbili 0.6, AST 30, ALT 20, APhos 41,
amylase 44, lipase 20.
.
Micro at OSH:
UA trace protein rest negative at osh
Chlamydia/GC PCr negative
Mono screen negative
rapid strep negative
group a strep culture pending
CSF, urine, blood cultures pending from OSH
.

[**2101-7-21**] 05:50AM BLOOD WBC-7.7 RBC-4.42* Hgb-11.8* Hct-33.9*
MCV-77* MCH-26.8* MCHC-35.0 RDW-14.5 Plt Ct-287
[**2101-7-19**] 05:40AM BLOOD Neuts-74.7* Lymphs-18.7 Monos-4.1 Eos-2.1
Baso-0.4
[**2101-7-15**] 03:55AM BLOOD Hypochr-2+ Anisocy-NORMAL Poiklo-1+
Macrocy-NORMAL Microcy-2+ Polychr-NORMAL Ovalocy-1+
[**2101-7-15**] 07:35PM BLOOD Parst S-NEGATIVE
[**2101-7-17**] 05:15PM BLOOD Ret Aut-0.7*

[**2101-7-14**] 10:54PM BLOOD ALT-15 AST-19 AlkPhos-39* TotBili-0.3
[**2101-7-16**] 04:08AM BLOOD ALT-25 AST-28 LD(LDH)-302* AlkPhos-51
TotBili-0.6
[**2101-7-17**] 05:15PM BLOOD LD(LDH)-258* TotBili-0.3 DirBili-0.1
IndBili-0.2
[**2101-7-15**] 03:55AM BLOOD cTropnT-<0.01
[**2101-7-21**] 05:50AM BLOOD Calcium-8.7 Phos-4.1 Mg-2.3
[**2101-7-17**] 05:15PM BLOOD Hapto-231*
[**2101-7-16**] 04:08AM BLOOD calTIBC-215* Ferritn-371 TRF-165*
[**2101-7-14**] 10:54PM BLOOD HIV Ab-NEGATIVE
[**2101-7-17**] 04:41AM BLOOD Type-ART Temp-38.2 Rates-/23 Tidal V-500
PEEP-5 FiO2-30 pO2-153* pCO2-41 pH-7.44 calTCO2-29 Base XS-4
Intubat-INTUBATED Vent-SPONTANEOU
[**2101-7-17**] 03:43AM BLOOD Type-ART Temp-38.2 Rates-14/15 Tidal
V-450 PEEP-5 FiO2-42 pO2-213* pCO2-42 pH-7.46* calTCO2-31* Base
XS-6 Intubat-INTUBATED
[**2101-7-17**] 03:43AM BLOOD Lactate-0.8
[**2101-7-16**] 02:26AM BLOOD Lactate-2.6*
[**2101-7-16**] 05:43AM BLOOD freeCa-1.11*
.
CXR: No acute cardiopulmonary process.
.
ECG: Junctional rhythm. Prominent precordial lead QRS voltage
may be within normal
limits given patient's age. Delayed R wave progression.
Borderline
prolonged/upper limits of normal QTc interval. Findings are
non-specific.
Clinical correlation is suggested. Since the previous tracing of
[**2101-7-17**]
delayed R wave progression is more prominent.
.
ECG: Junctional rhythm followed by two consecutive probable
sinus beats. Borderline
prolonged/upper limits of normal QTc interval is non-specific.
Clinical
correlation is suggested. Since the previous tracing of the same
date
junctional rhythm is now present.
.
MRI head: No significant abnormalities are seen on MRI of the
brain with
and without gadolinium. No evidence of acute infarcts, mass
effect or
abnormal enhancement. No evidence of tentorial or foramen magnum
herniation
or signs of brain edema seen. Slight asymmetry of the ventricles
again noted
and appears to be a normal variation.
.
CT head: 1. Asymmetry of the lateral ventricles, likely
reflecting chronic congenital
insult.
2. Possible mild cerebral edema.
3. No mass lesions identified on CT. However, MR is more
sensitive, and
should be ordered if there is continued clinical concern.

ATTENDING NOTE: Basal cisterns are patent. Despite patient's
young age,
paucity of sulci and slightly low position of tonsils are
concerning and an
MRI can help as suggested above. Asymmetry of larteral
ventricles can be a
normal variation.
.
ECHO: The left atrium is elongated. A small secundum atrial
septal defect is present. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). Transmitral and tissue Doppler imaging suggests
normal diastolic function, and a normal left ventricular filling
pressure (PCWP<12mmHg). There is no ventricular septal defect.
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. The mitral
valve appears structurally normal with trivial mitral
regurgitation. There is mild pulmonary artery systolic
hypertension. There is no pericardial effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. No pulmonary hypertension or clinically-significant
valvular disease seen. Probable PFO/small secundum ASD.
.
Possible ectopic atrial bradycardia. Short P-R interval without
other signs of
pre-excitation. Non-specific intraventricular conduction delay.
Poor R wave
progression. Non-specific ST-T wave changes. Tracing has
baseline artifact.
No previous tracing available for comparison.


Brief Hospital Course:
# Aseptic Meningitis: Patient with lymphocyte-predominant CSF at
OSH.  Pt also initially presented with bradycardia, so some
concern that it could be lyme, but also could be enterovirus,
HSV, HIV, CMV, EBV. Given recent groin lymphadenopathy and
sexual exposures concern for HIV/HSV.  he was started
empirically on vancomycin, CTX, acyclovir, and doxycycline.  On
PE, the patient showed meningeal signs with nuchal rigidity, and
has severe HA and photophobia.  We tried multiple narcotics,
compazine, and IV caffeine for what was presumed to be post-LP
HA (LP done at [**Location (un) **]) with little relief.  His Head CT showed
some cerebral edema at the time of admission.  When we attempted
to get an MRI, he was found to have AMS and unable to hold
still.  We decided to do an LP, and his opening pressure was 54
cm H2O though pt not in left lateral decub position.  His repeat
CSF was Poly predominant (376 WBCs with 73% of Polys, 23%
lymphs, 2% monos).  He was also acutely altered after the LP,
and a code purple was called (combative, disoriented).  Given
the opening pressure, he was intubated and sent to MRI and NSG
was called to c/s for the high opening pressure.  The MRI was
reassuring to the NSG team and further intervention was
deferred.  We kept him on Q1H serial neuro checks with a low
threshold to repeat head CT with any change (did not occur)
After this episode o/n, he stabilized and was extubated on HD 3,
and his MS began to return to baseline. He was transferred to
the floor and continued to have baseline mentation. He had
recurring severe headaches, nuchal rigidity, and nausea/vomiting
the following day. Given negative cultures (bacterial and HSV),
antibiotics and acyclovir were stopped. All viral cultures
eventually came back negative and first Lyme serum Ab negative
(second one pending at time of discharge). Because of the pt's
persistent headaches and febrile episodes, and with inconsistent
findings of second CSF with viral meningitis, we decided to do a
third LP. Tap was dry and were unable to measure opening
pressure or collect fluid. However, pt improved the following
day with around-the-clock tylenol, ibuprofen, and PRN fioricet
and zofran. He did not spike fevers any more but continued to
have episodic headaches and chills with few episodes of
vomiting. Pt declined another attempt at LP and after discussion
with neuorology, it was decided that viral meningitis was still
the most likely etiology and pt was improving overall. Pt was
discharged home with tylenol, ibuprofen, fioricet and zofran
(PRN) and instructed to follow up with PCP immediately upon
returning to [**State **]. Second Lyme serology pending at time of
discharge and we will contact PCP with results if positive. If
pt is not improving after discharge and Lyme serology is
negative, it should be considered to recheck given that it has
been about 2 weeks since onset of illness and it can take this
long for serum Lyme to convert. Pt was given copy of ALL lab
results to give to PCP upon return.
.
.
(contact at state lab is [**Name (NI) **] [**Name (NI) 8271**] [**Numeric Identifier 86912**], pager
[**Numeric Identifier 86913**]). [**Location (un) **] will send specimen to State lab on [**7-18**].
Follow up with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8271**] re results later in week.
.
Most likely causal organism for pt's viral meningitis is
enterovirus given season and geographic prevalence, [**Location (un) **]
assays were negative but did not test for echovirus or other
enteroviruses. As mentioned early, Lyme should still be
considered as less likely possibility, pending results of second
serum test and pt's clinical improvement.
.
# Bradycardia: Pt developed bradycardia since admission, as low
as high 20s though mostly in 30s-50s throughout admission. ECG
done in MICU showed junctional rhythm with no block. (There was
initial concern for AV block at outside hospital and thus Lyme
was high on differential, though there was no evidence of AV
block on ECG/telemetry here). Electrophysiology team was
consulted several times and concluded that bradycardia was
likely due to high vagal tone in an athletic young patient and
that pain/infection may be concomitant on already low resting
HR. Pt was asymptomatic with bradycardia and monitored on tele
throughout admission. He should have ECG repeated by PCP or army
medic and HR should be followed up. An echo was done here which
was normal (except small ASD) and revealed no structural
abnormalities or valvular problems.
.

Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every [**3-1**]
hours as needed for fever or pain.
2. Ibuprofen 200 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for fever or pain.
3. Fioricet 50-325-40 mg Tablet Sig: One (1) Tablet PO every [**5-3**]
hours as needed for headache: do not exceed 6 tablets a day.
Disp:*25 Tablet(s)* Refills:*0*
4. Zofran 4 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours as
needed for nausea.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Viral meningitis
Bradycardia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to [**Hospital1 18**] with headache, fever, and groin pain.
You were found to have meningitis and we did a spinal tap to
determine that it was not bacterial. We sent many tests from
your blood and cerebrospinal fluid which were all negative. The
most likely cause of your meningitis is viral and given this
time of year, the most likely pahtogen is enterovirus. This is
not contagious and other people in your barrack will not need to
take prophylaxis. We gave you IV fluids and anti-inflammatory
medications to help control your pain and fevers. You began to
improve after about 3 days. You should continue to take tylenol
and motrin as needed for pain and fever. You should only take
fioricet if tylenol and motrin do not control your pain because
continually taking fioricet can cause you to get rebound
headaches.

While at the hospital, you were also found to have bradycardia
(slow heart rate). The cardiologists saw you and felt that this
was most likely due to you being young and healthy and having a
low resting heart rate with pain and infection causing a vagal
response that further lowered your rate. You were monitored on
telemetry and your bradycardia improved throughout the
admission. You should follow-up with your primary care doctor
and army medic to get an EKG of your heart and measure your
heart rate to ensure that it is improving.

Please call your PCP to schedule an appointment. We will fax
over a copy of your discharge summary to his/her office. Fax#
[**Telephone/Fax (1) 86914**]

We will follow up the results of your pending tests (West [**Doctor First Name **],
Eastern Equine) and call/fax your PCP if they are positive. The
Lyme test is pending, if it is positive we will call you to let
you know. You can talk to your PCP about repeating another serum
Lyme test.

Call your PCP immediately if there is recurrent severe headache,
fever/chills, vomiting or if condition worsens.

We are giving you the following medications:
Fioricet 1 tab every 4-6 hours as needed for pain (has 325mg
Tylenol)
325mg Tylenol - as needed for pain (do not exceed 4000mg daily)
Ibuprofen 200mg - every 4-6 hrs as needed for pain
Zofran sublingual - use for nausea every 6-8 hrs as needed

Followup Instructions:
PCP and army medic


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

Completed by:[**2101-7-26**]
{'Unspecified viral meningitis,Pneumonitis due to inhalation of food or vomitus,Other specified cardiac dysrhythmias,Thrombocytopenia, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: aseptic meningitis with associated bradycardia

PRESENT ILLNESS: 20 yr old man with no past medical history presented to [**Location (un) **]
[**2101-7-13**] with groin pain X 2 days, severe HA, and phtophobia. In
the ED he also complained of n/v and had a fever to 102. A few
days prior to that he had presented to the ED with groin pain
and concern for an STD (genital warts). He had been told that he
had a lymph node enlargement in his groin and was treated with
doxycycline. Cultures were negative. He denies history of STDs,
rashes, and genital lesions. He has had unprotected intercourse
in the last few weeks with one female partner of unknown STD
status.
On the floor at [**Location (un) **] the patient had nausea and vomiting
(treated with phenergan and zofran), fever and chills. He
underwent a head CT which was normal and an LP was performed
with 33 wbc 95% lymphs. He was diagnosed with viral meningitis,
but treated prophylactically until cultures definitively
negative, with vanc/ctx and then doxycycline was added [**7-14**].
Infectious disease was consulted and felt it was ok to hold off
on ACV given patient likely had aseptic meningitis but at 2pm on
[**7-14**] the patient was acutely symptomatic with nuchal rigidity
and severe headache so acyclovir was added to his antibiotic
regimen at that time as well as ampicillin. His headache
persisted despite dilaudid, motrin, and toradol. Because of
nausea/vomiting he has had little PO intake and was started on
D5 NS @ 100mL/hr.
In addition, patient was noted to have a systolic murmur on
admission. He had not had this before that he knew of. He
underwent tte which was pending at the time of discharge. He
also had EKGs that revealed a possible junctional rhythm. A lyme
titer was sent and is pending. He was transferred to [**Hospital1 18**] for
closer monitoring.
On presentation to [**Hospital1 18**] the patient had severe headache. He was
also nauseous. He denied dizziness, light-headedness, chest
pain, palpitations. He denied visual symptoms, dysuria. He did
endorse diarrhea since being on the doxycycline. He denied
recent travel aside from being in [**Location (un) 86**] for training. He denied
recent exposure to ticks/outdoors but does live in the barracks.
He has had no sick contacts. Sexual exposures as above.
.
Review of systems:
(+) Per HPI
(-) Denies cough, shortness of breath, or wheezing. Denies chest
pain, chest pressure, palpitations, or weakness. Denies
constipation, abdominal pain. Denies dysuria, frequency, or
urgency. Denies rashes or skin changes.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
Vitals: T:96.8 BP:118/52 P:36-54 R:18 O2:99RA
General: Alert, oriented, in severe pain (head)
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: bradycardic, irregularly irregular, normal S1 + S2, [**1-1**] SM
best heard at apex, no rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley, tender 1X1cm inguinal LN on right. None on left.
No penile rashes.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A+OX 3, pupils ERRL,
Skin: No rashes, no splinter hemorrhages,

FAMILY HISTORY: Mom has heart murmur. Brother has MR.

SOCIAL HISTORY: Originally from [**State **]. Here at a base near [**Location (un) **] training
for the army. Lives in the barracks. No recent sick contacts,
travel, hiking, swimming in fresh water. Sexually active without
condoms with one female partner.
- Tobacco: Quit 3 weeks ago
- Alcohol: socially
- Illicits: Denies 

### Response:
{'Unspecified viral meningitis,Pneumonitis due to inhalation of food or vomitus,Other specified cardiac dysrhythmias,Thrombocytopenia, unspecified'}
