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: confusion major surgical or invasive procedure: brain abscess drainage bronchoscopy with biopsy history of present illness: 78 f presents from for acute mental status changes and bilateral frontal mass lesions. she began prednisone therapy for 4 days ago for boop. she complained of a headache on over the weekend, which was unusual for her. her family noted increasing confusion x a few days, then yesterday she was noted to have some slurred speech and then this morning she couldn't speak - could only say "..." and "no." she was not able to bathe herself this am as she forgot what to do. she normally cares for herself and is high functioning. she was taken to her pcp (dr ), where a mini mental was given, she could only do about half the items on the test -- this is a dramatic change for her. therefore, she was sent to the ed. ct revealed 2.4 cm lesion in the l frontoparietal region and a 20 mm lesion in the right frontal lobe. at osh ed given decadron 24 mg x1. transferred to for neurosurg eval. the patient developed what was thought to be "the flu" in ; this then developed into pneumonia in . the pneumonia did not go away despite a few rounds of antibiotics. a biopsy was performed which showed "metaplastic alveolar epithelial cells, fibroblasts and rare inflammatory cells" thought to be consistant with boop. she was started prednisone 4 days prior to admission. she has not had a colonoscopy. she has yearly mammograms that have been fine. her daughter is not sure about her history. in the ed: neurosurgery was consulted. she was loaded with dilantin. she was admitted to medicine for further workup. past medical history: 1. copd 2. boop- diagnosed 3 weeks ago by ct guided biopsy 3. pneumonia () 3 days admission- 4. glaucoma 5. anxiety 6. bipolar d/o -- well controlled x 20 years 7. cataract 8. fluid retention 9. neuropathy 10. hyperlipidemia social history: lives at home with daughter, completes most adls. smoked 3ppd for many years, quit over 20 years ago. no etoh. family history: father- lung ca, cad physical exam: gen: nad heent: mmm. perrl, eomi. cv: rrr pulm: cta, minimal fine crackles at bases abd: obese, soft, nt/nd le: warm, no edema neuro: alert, oriented to person and place. speech is slow, mostly limited to yes and no responses. seems to have some wordfinding difficulty. cranial nerves grossly intact. moves all 4 ext with good strength, no gross sensory deficits. pertinent results: 06:10am blood wbc-13.2* rbc-3.62* hgb-11.2* hct-33.2* mcv-92 mch-31.1 mchc-33.8 rdw-16.5* plt ct-135* 05:49am blood wbc-14.0* rbc-3.62* hgb-11.1* hct-33.2* mcv-92 mch-30.5 mchc-33.3 rdw-16.2* plt ct-143* 06:54am blood wbc-19.7* rbc-3.86* hgb-11.9* hct-35.4* mcv-92 mch-30.8 mchc-33.5 rdw-16.2* plt ct-163 05:29am blood wbc-14.9* rbc-3.87* hgb-11.7* hct-35.0* mcv-91 mch-30.2 mchc-33.4 rdw-16.3* plt ct-171 05:40am blood wbc-14.0* rbc-3.67* hgb-11.1* hct-33.2* mcv-91 mch-30.3 mchc-33.4 rdw-15.7* plt ct-163 06:54am blood neuts-64 bands-0 lymphs-21 monos-7 eos-5* baso-0 atyps-2* metas-1* myelos-0 06:10am blood glucose-86 urean-14 creat-0.5 na-143 k-4.2 cl-105 hco3-33* angap-9 05:49am blood glucose-80 urean-14 creat-0.6 na-143 k-4.2 cl-104 hco3-33* angap-10 06:54am blood glucose-67* urean-14 creat-0.6 na-145 k-4.0 cl-104 hco3-31 angap-14 05:29am blood glucose-105 urean-12 creat-0.5 na-139 k-4.0 cl-102 hco3-32 angap-9 05:29am blood calcium-8.5 phos-3.4 mg-2.1 ========================================================== microbiology: : bld culture x 1 negative : urine cx x 1 negative : tissue cx left frontal brain abscess wall: pmn leukocytes 2+, no micro-organisms. bal: pmn leukocytes, no microorganisms, no fungus, no afbs rul tissue (during bronchoscopy) gram stain: polymorphonuclear leukocytes, no microorganisms seen. no grwoth anaerobic culture: no growth. fungal culture (preliminary): no fungus isolated. acid fast smear: no acid fast bacilli seen on direct smear. brain abscess drainage gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. reported by phone to @ 00:08a . smear reviewed; results confirmed. tissue (final ): viridans streptococci. sparse growth. not viable for sensitivities. viridans streptococci. rare growth. second morphology. not viable for sensitivities. anaerobic culture (final ): no anaerobes isolated. fungal culture (preliminary): no fungus isolated. acid fast culture (preliminary): acid fast smear (final ): no acid fast bacilli seen on concentrated smear. brief hospital course: ## brain abscess: pt was admitted to from an outside hospital following her history of altered mental status as well evidence of frontal bilateral masses. pt underwent a ct scan and mri which showed the appearance of cystic lesion. pt was started on iv steroids and neurosurgery were consult. on the night of admission pt underwent an open bone flap and drainage to assess whether lesion was metastatic versus an infection. pus was noted and drained noted to have brain abscess on biopsy/drainage performed on . pt was then admitted and observed in the neurosurgical icu where she underwent a second procedure to remove her remaining rt sided lesion. streptococcus viridans was cultured and pt was started on a course of vancomycin and then transitioned to ceftriaxone per infectious disease recommendations 2gm iv q 12hrs on . per neurosurgery recommendations pt was started on keppra for seizure prophylaxis. pt currently has two sutures in place at time of discharge, the largest will dissolve, the second will need to be removed during a follow up visit to dr. office on 11:30. pt will need a repeat ct scan as an outpatient which has been scheduled for 2:00, after ct head scan pt will see dr. . pt will need a minimum of a 4 week course of ceftriaxone 2gm iv q12hrs. pt will have, during this duration, a follow up infectious disease clinic appointment where they will decide whether she needs additional treatment. pt underwent a tte that did not show any endocarditis. tee was deferred as it would not change management and was felt to be a high risk procedure per our cardiology team. the most likely etiology of her brain abscesses is seeding from her lung infection (see below) or from endocarditis. ## lung lesion: pt underwent a biopsy of lung mass recently that was positive for boop. as the possibility of malignancy still existed the pt's rul mass went to the bronchoscopy suite where she underwent 6 biopsies, bal, brush examination. biopsies showed alveolar and peribronchial tissue with mixed inflammatory infiltrate, suggestive of acute pneumonia. bronchial mucosa with mildly increased goblet cells and focal acute inflammation. no malignancy was identified. pt was discharged with a 7 day steroid taper per interventional pulmonary. pt will f/u with a repeat ct chest with contrast scan on 1030 to check the rul mass. results will be faxed to dr. , pt will follow up with dr. on 17:15. ##. mobility: pt had bone flap removed for abscess drainage. she will need to wear the helmet whenever she is mobile. she will later need a graft however this will not be performed until several months from now. ## leukocytosis: pt's wbc was noted to trend up and then down prior to discharge. pt noted to have thrush as well as yeast in her urine. pt was started on a 14 day course of oral fluconazole. - continue total 14 days course of fluconazole ## endometrial thickening: on cat scan pt's endometrial lining. recommend pt undergo a transvaginal u/s to evaluate endometrial thickening as an outpatient. ## fen: pt underwent bedside and swallow evaluation. per speech and swallow recommendations pt was started and tolerated a soft diet with thin liquids. ## psych: pt has history of bipolar disorder, for which she usually takes thoridazine. after discussion with neurosurgery it was decided that the thoridazine would have a potential to interfere with the pt's neurological examination. pt will be re-evaluated by dr. on , at that time a decision will be made whether thoridazine can be restarted. - recommend discussing with dr. on whether pt can start her thoridazine again. ## copd: pt noted intermittently to be wheezing on examination during the first days of admission. pt was discharged on tiotropium bromide. ## code status: full code medications on admission: prednisone 20 mg daily (started ) gabapentin 300 mg tid hctz 25 mg daily simvistatin 20 mg daily spiriva 18 mg daily albuterol betaxolol ophth susp 0.25% thioridazine 40 mg qhs discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 4. betaxolol 0.25 % drops, suspension sig: one (1) drop ophthalmic (2 times a day). 5. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 6. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 7. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) intravenous q12h (every 12 hours) for 33 days: your last day of antibiotics will be on . 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 10. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 11. fluconazole 100 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 28 days: your last dose will be . 12. prednisone 5 mg tablet sig: three (3) tablet po daily (daily) for 13 doses: please follow taper. please take 15mg of prednisone once a day. please take 10mg of prednisone once a day. please take 5mg of prednisone once a day. please take 2.5mg of prednisone once a day. discharge disposition: extended care facility: - discharge diagnosis: bilateral brain abscesses discharge condition: stable, afebrile discharge instructions: you were admitted to the hospital after it was found that you had two brain abscesses. you were taken to the operating room by the neurosurgeons who drained your abscesses. the abscesses were positive for a bacteria called streptococcus viridans. we checked your blood cultures, performed an echo of yor heart check for a source of the infection, all were negative. we consulted the infectious disease specialists who recommended a minimum 4 weeks of antibiotics. they will see you as an outpatient to see whether you will need more antibiotics. prior to leaving the hospital you were fitted for a helmet which you will need to wear whenever you are walking as a part of you skull was removed for the abscess drainage. please take your medications as prescribed: you will be on a prednisone taper:- please take 15mg of prednisone once a day. please take 10mg of prednisone once a day. please take 5mg of prednisone once a day. please take 2.5mg of prednisone once a day. you were also started on two antibiotics: 1. ceftriaxone 2gm iv every 12 hours, your last dose currently will be given on . 2. fluconazole for the yeast in your urine and oral thrush. please take 100mg fluconazole once a day day. your last dose will be . please follow up with all of your appointments. you have been scheduled for 2 cat scans. your first scan is of your head and will be followed by dr. , this is to check the progression of your abscesses and if they have come back. it is scheduled for 14:00 and it will be on the of . the second cat scan is of your chest to see the progression of the mass in your chest that was biopsied by dr. and us. the results will be faxed to dr. . it is scheduled for 10:30 and it will be on the of the building. if you experienced any seizures, fevers, chills, difficulty breathing please call your doctor or return to the ed. followup instructions: you will continue to receive antibiotics for a total of 4 weeks. you can call to reach the infectious disease doctors for any questions. suture removal appointment: (dr. office) 11:30 office located at provider: scan phone: date/time: 2:00 provider: , md phone: date/time: 2:30 provider: , md phone: date/time: 11:30 provider: scan phone: date/time: 10:30 provider: , md date/time: 17:15 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified closed [endoscopic] biopsy of bronchus other incision of brain closed endoscopic biopsy of lung diagnoses: pneumonia, organism unspecified candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified unspecified glaucoma candidiasis of mouth other and unspecified hyperlipidemia anxiety state, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus bipolar disorder, unspecified mononeuritis of unspecified site intracranial abscess benign essential hypertension other specified alveolar and parietoalveolar pneumonopathies other cataract 

Answer: The patient is high likely exposed to