Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: sepsis major surgical or invasive procedure: endotracheal intubation central venous catheter placement peripherally inserted central venous catheter 1. incision and drainage of the right masticator space. 2. aspiration of the right lateral pharyngeal space. 3. extraction of tooth #1. history of present illness: 18 f college student, no past medical history, admitted with sepsis, gnr bacteremia, hypoxia, and cranial nerve palsies. patient with 1 week history of right sided neck/throat pain; presented to student health and diagnosed with mono. continued to be ill and presented to yesterday with worsening po intake due to difficulty opening mouth. hydrated overnight. labs notable for leukocytosis with ~25% bandemia, arf to 2.5, platelets of 101k and elevated coags. today, blood cultures grew out gnrs (anaerobic bottle - zosyn given)and she was noted at 2 pm to have r ptosis with inability to open eye; fixed dilated r pupil and gaze abnormalities. noncontrast head and neck ct performed and per report did not show any abnormalities (other than lymphadenoapthy). . patient is a college student at in a dorm, studying biology. notes others in her dorm also ill, one student with pneumonia. currently complains of r facial numbness, feeling of swelling and tenderness in the right side of her neck, mild abdominal pain (similar to menstrual cramping). . review of systems: constitutional: fatigue eyes: no(t) blurry vision cardiovascular: tachycardia, orthopnea respiratory: cough, dyspnea, tachypnea gastrointestinal: abdominal pain integumentary (skin): no(t) jaundice, no(t) rash heme / lymph: lymphadenopathy, anemia, coagulopathy neurologic: numbness / tingling, as per hpi past medical history: none social history: occupation: student at , majoring in biology. drugs: denies tobacco: denies alcohol: denies other: denies sexual activity. family history: hypercholesterolemia physical exam: vitals: t99, hr 106, bp 104/42, r 32, 92% on 2l. general appearance: well nourished, no acute distress, speaking in full sentances. eyes / conjunctiva: r ptosis with minimal ability to open eye. dilated right pupil; minimal to absent constriction to light in the right pupil (normal on the left with normal contralateral response indicating efferent deficit on right). eom on left full; r eye able to gaze fully to right (laterally) with inability to gaze medially, superiorly, and inferiorly. head, ears, nose, throat: normocephalic lymphatic: cervical wnl cardiovascular: (s1: normal), (s2: normal) no murmurs appreciated. peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (breath sounds: clear. decreased bs at bases. breath sounds mildly rhonchorous on left. abdominal: soft, non-tender, bowel sounds present extremities: no edema. skin: warm, no rashes over trunk or extremities. neurologic: eye findings as above. facial muscle strength/rom normal bilaterally. reports hypoaesthesia throughout right side of face, maximal in v2 distribution. tongue midline. uvula deviated to the left but palate elevated symmetrically. peripheral nerve exam including extremity strength and sensation intact. pertinent results: admission: 05:53pm wbc-4.6 rbc-3.85* hgb-9.1* hct-27.3* mcv-71* mch-23.7* mchc-33.4 rdw-17.2* 05:53pm plt smr-very low plt count-43* 05:53pm neuts-87.1* lymphs-9.4* monos-2.8 eos-0.5 basos-0.2 05:53pm pt-16.6* ptt-31.1 inr(pt)-1.5* 05:53pm fibrinoge-331 d-dimer-3509* 05:53pm fdp-10-40* 05:53pm glucose-111* urea n-28* creat-1.6* sodium-140 potassium-3.5 chloride-111* total co2-18* anion gap-15 05:53pm alt(sgpt)-17 ast(sgot)-27 ld(ldh)-229 alk phos-164* tot bili-2.6* 05:53pm albumin-2.4* calcium-7.6* phosphate-1.9* magnesium-2.0 05:53pm hcg-<5 : csf (lumbar puncture) - wbc 9901 rbc 1215* pmn 85 band 2 lymph 10 mono 3. protein 152 glucose 47 discharge: cbc: wbc 8.2 hct 26.3 plt 437 inr: 2.9 cr: 0.6 micro: (only positive results listed) - bcx - fusobacterium species imaging: - tte - the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is high (>4.0l/min/m2). transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). 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. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. - tee - no spontaneous echo contrast is seen in the left atrial appendage. left ventricular wall thicknesses and cavity size are normal. right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the tricuspid and pulmonic valves appear structurally normal, with no regurgitation or abnormal masses. 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 no pericardial effusion. no evidence of asd. no evidence of endocarditis. - cta chest - 1. negative examination for pulmonary embolism. 2. multiple nodular areas of lung consolidation could be due to severe infection, septic emboli. use of toxic substances cannot be excluded. 3. partial atelectasis of left lower lobe, most likely due to malpositioning of endotracheal tube. 4. small amount of free fluid in pelvis. 5. hypodense nodule in left lobe of the thyroid. ultrasound is suggested for further evaluation. 6. 35-mm left adnexal cyst, might be hemorrhagic. pelvic ultrasound is suggested for followup in six weeks for documentation of resolution . 7. non-specific hypodense wedge-shaped area in the right kidney that could represent an area of infarction or pyelonephritis - ct neck - 1. multiple hypodensities within the pterygoid muscles, parapharyngeal space, longus with faintly hyperintense rims suggestive of early abscess formation. no discrete abscess is identified. right neck soft tissue swelling with intracranial extension. associated superficial thrombosed vein. - mri head/neck - 1. massive right neck soft tissue swelling involving the pterygoid and masseter muscles with associated lymphadenopathy, most prominent at stations two and five of the neck consistent with right external neck infection. there is intracranial extension of infection through the foramen ovale with associated right cavernous venous thrombosis and diffuse meningitis. there is no definitive fluid collections on this mr study that would be indicative of abscess. - mri head - 1. interval development of decreased caliber of the right internal carotid artery in the cavernous and the carotid segments, with decrease in the flow voids and associated enhancement along the margins of the artery since . this has been described on the study done on and is soemwhat worsened since then. this likely indicates possible ongoing thrombosis of the artery, secondary to the cavernous sinus thrombosis, with or without inflammation. further evaluation with mr angiogram of the head is necessary, to assess the patency of this artery. 2. diffuse increased signal in the mastoid, middle ear cavity and the petrous bones, and the air cells, from fluid and mucosal thickening. 3. no obvious intraparenchymal abscess. - cta head - 1. no evidence of hemorrhage or mass effect on the ct of the head. 2. markedly narrowed petrous and pre-cavernous as well as cavernous right internal carotid artery, which could be secondary to inflammatory changes of the wall as seen on the previous mri. 3. filling defect is seen in the right cavernous sinus secondary to inflammatory changes but flow is visualized in its lateral portion. no evidence of distention of the superior or inferior ophthalmic veins identified to suggest collateral venous flow. 4. other changes as described above including normal appearance of the arteries around the circle of with fenestration of the anterior communicating artery is an incidental finding. op report: - postoperative diagnoses: 1. abscess/cellulitis of right infratemporal space. 2. pericoronitis of the impacted upper right third molar tooth. 3. cavernous sinus thrombosis. procedure: 1. incision and drainage of the right masticator space. 2. aspiration of the right lateral pharyngeal space. 3. extraction of tooth #1. brief hospital course: ms. is an 18 year old female presenting with septic shock, with likely odontogenic infection resulting in cavernous sinus thrombosis, fusobacterium bacteremia/lemierres, and dic. 1) septic shock. patient initially presented with sepsis progressing to hypotension despite fluid resuscitation during the first several hours of her admission. she had central line placement and norepinephrine drip was required to keeps maps above 60 for a period of several hours. broad spectrum antibiotics were initiated. respiratory support as below. she improved with treatment of underlying infection as detailed below. 2) septic cavernous sinus thrombosis. patient with right ptosis and dilated pupil as well as gaze palsies upon admission. given these findings, attention raised for possibility of cavernous venous thrombosis. mri/mra/mrv performed and confirmed this. spinal tap performed with 990 wbcs, elevated opening pressure to 52, elevated protein, mildly low glucose. no growth of csf, gram stain negative, hsv pcr negative. likely all consistent with septic thrombosis of that region. blood cultures from osh eventually grew fusobacterium, consistent with concurrent diagnosis of likely lemierres disease. . , neurosurgery, and id, ent consulted and followed patient while here. neuro exam initially stable. anticoagulated with heparin for thrombus with goal ptt of 50-60. regarding antibiotic management, she was initially treated with cefepime (at cns dosing), high dose flagyl, vancomycin, acyclovir, and ampicillin. transitioned to flagyl and ceftriaxone. the likely inciting source to the infection was pharyngitis with resulting seeding of an impacted wisdom tooth which eventually spread to the masseter space, ptyerigoid region, and eventually to cavernous sinus with resulting meningitis. she underwent a tooth extraction and aspiration of fluid collection in this region. also initially managed with iv dexamethasone, which was tapered down. repeat imaging with ct and mri studies of head and neck were performed. the cavernous sinus portion of the right internal carotid artery showed marked narrowing likely from inflammatory changes around the artery. she had no additional focal neurologic findings corresponding to arterial insufficiency. she will complete 6 weeks of antibiotics and anticoagulation therapy (with day 1 being the last date of positive blood culture). she will complete the steroid taper as an outpatient. she will have close follow-up with her new pcp, , infectious disease and ent. she will have repeat imaging of her brain in ~ 6 weeks. 3) respiratory failure. patient with initial o2 requirement by nasal cannula, which worsened quickly. became tachypneic with increased o2 requirements, required intubation. ct chest showing likely septic emboli, which fits with clinical diagnosis of lemierres. also required diuresis to correct volume overload componenet of respiratory difficulties. she was extubated without difficulty after initial stabilization of the above infection. prior to discharge, the patient was ambulating without use of supplemental oxygen. 4) thrombocytopenia/dic. elevated inr/ptt, decreased platelets. platelet nadir in 40s. received platelets prior to a dental extraction with subsequent stability and normalization. fibrinogen did not go below 200. serial dic labs were followed closely and hematology also followed her during the admission. 5) septic emboli. found to have septic emboli on chest ct (consistent with diagnosis of lemierres with ij thrombus, though ij thrombus was not seen by the time she had imaging). also noted to have possible renal ?infarct concerning for left and right sided infarction. no other identified potential systemic lesions. tee showed no asd, though did not evaluate with agitated saline for pfo. no vegetations. 6) renal failure. likely pre-renal arf, resolved with ivfs. seen by renal who did not feel this is consistent with ttp-hus. received several contrast loads in past few days, got mucomyst and hydration. prior to discharge, her renal function had returned to . 7) delerium. post extubation, likely due to med effect (benzos +/- steroids). resolved without intervention. medications on admission: none at home discharge medications: 1. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 5 weeks: last dose . disp:*105 tablet(s)* refills:*0* 2. ceftriaxone 2 gram recon soln sig: two (2) grams intravenous twice a day for 5 weeks: last dose on . disp:*qs bags* refills:*0* 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 4. outpatient lab work please have the following labs draw each thursday until : cbc, alt, ast, alk phos, total bili. forward results to dr. (fax ) 5. picc care picc line care per neht protocol. 6. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic qid (4 times a day) as needed. disp:*1 tube* refills:*0* 7. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day for 2 weeks. disp:*14 capsule, delayed release(e.c.)(s)* refills:*0* 8. clotrimazole 10 mg troche sig: one (1) troche mucous membrane qid (4 times a day) for 6 days. disp:*24 troche(s)* refills:*0* 9. warfarin 1 mg tablet sig: two (2) tablet po at bedtime: take 2 mg daily until inr check on . disp:*60 tablet(s)* refills:*2* 10. dexamethasone 2 mg tablet sig: three (3) tablet po twice a day: tablet once daily x 2 days then stop. disp:*60 tablet(s)* refills:*0* 11. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po twice a day. 12. outpatient lab work please draw the following lab on monday : pt/inr. forward result to (fax ) discharge disposition: home with service facility: home health services discharge diagnosis: primary: septic cavernous sinus thrombosis septicemia complicated by septic shock acute renal failure hypoxic respiratory failure septic pulmonary embolism wisdom tooth impaction complicated by abscess disseminated intra-vascular coagulation secondary: chronic blood loss anemia discharge condition: stable. ambulating without assist. tolerating oral medication and nutrition. right eye with ptosis, lateral deviation, fixed dilated pupil. discharge instructions: you were evaluated for a severe infection in the veins behind your sinuses. your course was complicated by low blood pressure, damage to your kidneys, trouble breathing, and low platelet counts. these issues dramatically improved over the course of your hospital stay. you also had a wisdom tooth pulled that was a potential source to the infection. please take your medications as prescribed. please make and attend the recommended follow-up appointments. you need to have your inr checked on monday . the result will be followed-up with the anticoagulation nurses. if you develop any new or concerning symptom such as weakness orf your arms or legs, slurred speech or trouble speaking, weakness, fever, headache or mouthache, pain or redness at the picc line; please come to the emergency room immediately. followup instructions: primary care doctor: dr. on at 3pm. in the clinical center . please call with questions. you should have an mri (head) in 6 weeks, drs. can help coordinate this. ear-nose-throat: dr. (ent) at 12pm. , ma on rt from movie theater. please call with questions. dental: please call your dentist to schedule a follow-up appointment to be seen within 4 weeks. infectious disease: dr. , md phone: date/time: 8:30. medical office building - basement. : dr. on at 4:30pm in 4. the telephone number is ; please call with questions. **you should discuss the duration of your steroid treatment at this appointment. you will have weekly blood tests with the antibiotic company to monitor the antibiotics and the infection. you will have your inr measured on monday . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization extraction of other tooth transfusion of packed cells transfusion of platelets drainage of face and floor of mouth diagnoses: acidosis thrombocytopenia, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) severe sepsis acute respiratory failure defibrination syndrome septic shock other septicemia due to gram-negative organisms phlebitis and thrombophlebitis of intracranial venous sinuses unspecified disorder of autonomic nervous system phlebitis and thrombophlebitis of other sites disturbances in tooth eruption septic pulmonary embolism acute periodontitis 

Answer: The patient is high likely exposed to