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: no known allergies / adverse drug reactions attending: chief complaint: chief complaint: cough reason for micu transfer: septic shock major surgical or invasive procedure: picc placement central line removal history of present illness: 43 year old man who presented to on with productive cough, fever and pleuritic chest pain. he was found to be hypoxemic on arrival with sats 86% on ra, abg 7.36/32/71/18. he reported associated pleuritic chest pain, generalized weakness, diaphoresis and anorexia. initially was noted to be in svt, given adenosine with conversion to sinus. cxr showed moderate rll consolidation, small rul consolidation, patchy infiltrates in lul (differential included pneumonitis, pulmonary hemorrhage versus ards). he was intubated for respiratory failure and concern for ards. sedation was difficult and required fentanyl, ativan, propofol and vecuronium. he was ventilated on pressure control. he had hypotension requiring both norepinephrine and vasopressin for pressor support. he was given ceftriaxone, azithromycin and vancomycin. sputum culture grew strep pneumonia and albicans on . bronchoscopy showed diffuse thick dark yellow secretions throughout the entire tracheobronchial tree. bal grew strep pneumonia (pcp and fungal cultures pending). influenza negative. fungal cultures including acid fast bacilli cultures are pending. blood cultures were positive for strep pneumonia on . opportunisitic infections were considered, but hiv testing was not obtained. he was also noted to have acute kidney injury with creatinine 3.7 and bun 64. he was seen by nephrology at the osh who suspected atn and recommended continued iv hydration. creatinine trended down to 1.9 prior to transfer. . on arrival to the micu, he was intubated and sedated, on pressure support ventilation, comfortable appearing. pressors weaned on arrival with map >65. . review of systems: unable to obtain due to sedation and intubation past medical history: ruptured appendix and appendectomy social history: works as a realtor, lives with a male partner. smokes 1 pack/day for past 20 years. drinks one drink 4 times per week. sexually active with partner, has been hiv negative by report in past. family history: mother died age 73 of pancreatic cancer. father had pmr, died age 75. physical exam: admission exam: vitals: 98.7 92 109/68 on pressure control, changed to ac 26 450ml 100% fio2 and peep 10 on arrival, sedated with fentanyl and propofol general: intubated, sedated, not responding to voice heent: sclera anicteric, mmm, oropharynx clear, perrl neck: supple, right subclavian line c/d/i cv: rrr, normal s1 + s2, no murmurs, rubs, gallops lungs: rhonchi anteriorly, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . discharge exam: pertinent results: admission labs: 07:37pm blood wbc-13.3* rbc-3.31* hgb-10.1* hct-31.7* mcv-96 mch-30.6 mchc-32.0 rdw-15.4 plt ct-169 07:37pm blood neuts-84* bands-7* lymphs-1* monos-5 eos-0 baso-0 atyps-1* metas-1* myelos-1* 07:37pm blood pt-11.9 ptt-26.9 inr(pt)-1.1 07:37pm blood glucose-112* urean-61* creat-2.5* na-145 k-3.9 cl-121* hco3-20* angap-8 07:37pm blood alt-10 ast-45* ld(ldh)-340* totbili-0.6 07:37pm blood albumin-2.4* calcium-7.1* phos-6.7* mg-3.3* iron-16* 07:37pm blood caltibc-73* hapto-447* ferritn-1563* trf-56* 07:48pm blood lactate-0.9 . pertinent labs: . micro: . imaging: cxr: the patient is intubated. the tip of the endotracheal tube is located directly at the carina. the tube should be pulled back by 2 to 3 cm. the patient has a right subclavian line. the tip of the line projects over the lower svc. there are extensive areas of lung parenchymal opacities and consolidations, slightly more extensive on the left than on the right, with extensive air bronchograms but no evidence of pleural effusions. borderline size of the cardiac silhouette. despite the history of streptococcal infection, the possibility of ards should be considered. . echo: the left atrium and right atrium are normal in cavity size. no atrial septal defect is seen by 2d or color doppler. 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). tissue doppler imaging suggests 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 stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal study. no valvular pathology or pathologic flow identified. . ct chest w/o con: 1. extensive ground-glass opacity is consistent with diffuse infection. an additional component of pulmonary edema is possible, given the accompanying septal thickening. 2. three large thick-walled cavitary lesions likely represent a necrotizing pneumonia in this patient with prior streptococcal bacteremia. a fourth smaller caviation and non-cavitary consolidation are also present. note that the plain radiographic appearence of diffuse pulmonary opacity has improved since . . ct head w/o con: 1. no acute intracranial process. 2. bilateral mastoid air cell fluid-opacification. given the documented streptococcus pneumoniae infection, this may represent infectious otomastoiditis, rather than simply effusions due recent intubation and prolonged supine positioning. . mri head w/ and w/o con: 1. no evidence of infection, inflammation, infarction, or hemorrhage within brain. 2. pansinusitis and bilateral mastoid opacification. brief hospital course: 43 year man with history of etoh abuse who presented to on with productive cough, fever, bandemia and respiratory failure, found to have strep pneumonia with septic shock and transferred to for further evaluation. . # septic shock: secondary to strep pneumonia with positive blood and sputum cultures at . he was treated initially with ceftriaxone, later broadened to cefepime and ciprofloxacin due to lack of improvement on the ventilator. blood cultures on revealed gpc in clusters, prompting intitiation of vancomycin. bronchoscopy with bal was performed on to evaluate for additional pulmonary pathogens and was negative. there was initial concern for hiv, however cd4 count was wnl and hiv viral load was undetectable. he was initially improving on the antibiotics but then spiked fevers on and . ct chest on revealed three large thick-walled cavitary lesions likely represent a necrotizing pneumonia. id was consulted and he was treated empirically for vap with linezolid, cefepime, tobramycin, and flagyl. he continued to improve so antibiotics were narrowed to ceftriaxone with transition to levofloxacin and flagyl and the patient will complete a 14-day course of levofloxacin and flagyl which will end on . . # ards: suspected due to underyling strep pneumonia. he was ventilated with ards net protocol although sedation was very difficult (likely due to underlying alcohol use of 4+ drinks daily). he was initially sedated with propofol, fentanyl and versed. propofol was stopped on once hypertriglyceridemia (tg 1000s) was noted. he was extubated on , and was able to be weaned to room air on the floor with ambulatory o2 saturations >92% on room air. . # acute renal failure: suspected atn secondary to septic shock. creatinine trended down and was 1.7 upon call-out from the micu, and was 1.2 upon discharge. . # agitation: patient was extremely agitation while on the ventilator, rquiring large doses of fentanyl and versed. he was started on seroquel, haldol prn, and methadone, with improvement in agitation. his agitation also continued to improve post-extubation. lp was negative for infection and ct and mri head were both negative for acute process. psychiatry was consulted and recommended tapering the above medications over the next 4-5 days, starting from the day of micu call-out (). by , mr. was off of methadone, and his seroquel was prn. he did not require haloperidol on the floor, and became progressively more oriented to the point at which upon discharge he was not disoriented at all and his attention had returned nearly to baseline. medications on admission: medications home: none medications on transfer: hydrocortisone 100mg q8h lorazepam 2mg q6h metoclopramide 10mg q6h vasopressin drip acetaminophen 650mg q4h prn vancomycin 1000mg iv bid fentanyl drip norepinephrine drip azithromycin 500mg daily heparin sq 5000 units tid ns continuous artificial tears qid chlorhexidine tid insulin regular sliding scale levalbuterol 1.25mg nebs q4h propofol drip vecuronium prn q8h ceftriaxone 1g daily pantoprazole 40mg daily discharge medications: 1. calcium carbonate 500 mg po qid:prn heart burn rx *antacid 200 mg calcium (500 mg) every 4 hours disp #*60 tablet refills:*0 2. levofloxacin 750 mg po daily duration: 5 days start: in am start , end rx *levaquin 750 mg daily disp #*5 tablet refills:*0 3. metronidazole (flagyl) 500 mg po q8h last day of abx will be on rx *flagyl 500 mg every 8 hours disp #*17 tablet refills:*0 4. multivitamins 1 tab po daily rx *daily multi-vitamin daily disp #*30 tablet refills:*0 5. ondansetron 4 mg po q4h:prn nausea rx *ondansetron hcl 4 mg every 4 hours disp #*30 tablet refills:*0 discharge disposition: home discharge diagnosis: severe cavitary pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were admitted with a severe pneumonia, and were in the intensive care unit for two weeks intubated. we were able to treat this serious pneumonia with antibiotics, and your pneumonia improved. we were able to wean you off of the ventilator and wake you up. while you were intubated, you were quite agitated, and after you woke up you were a fair bit disoriented. this improved over time. initially you were a bit weak on your feet after you woke up from being intubated and sedated, but were able to improve to an acceptable functional status for home once you worked with physical therapy for a few days. you were on no medications at home, we recommend that you start the following medications: levofloxacin 750mg daily for 5 more days until metronidazole (flagyl) 500mg every 8 hours for 5 more days until multivitamin ongoing for nutrition zofran as needed for nausea calcium carbonate as needed for heartburn it is very important that you continue to not smoke. smoking likely contributed to this very severe and life threatening pneumonia. you have not smoked while you were admitted, and you are no longer addicted to the nicotine. don't smoke again! you can do it! it is the single best thing you can do for your health. followup instructions: we are working on a follow up appt in the pulmonary department in five weeks. you will be called at home with the appointment. if you have not heard or have questions, please call . name: ,md specialty: primary care address: , , phone: when: we are working on a follow up appointment in the next week. you will be called with an appointment. if you have not heard in two days, please call above number for status. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus injection or infusion of oxazolidinone class of antibiotics central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified essential hypertension severe sepsis constipation, unspecified pneumonitis due to inhalation of food or vomitus alkalosis septic shock other acquired absence of organ abscess of lung pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] hyperosmolality and/or hypernatremia drug withdrawal alcohol abuse, continuous examination of participant in clinical trial alcohol withdrawal delirium bilious emesis 

Answer: The patient is high likely exposed to