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: penicillin g / ceftriaxone / phenytoin / meropenem attending: chief complaint: seizure major surgical or invasive procedure: : burr hole and abscess aspiration left craniotomy drainage of brain abscess re-do left craniotomy drainage of brain abscess history of present illness: 18 y/o m in good health first presented to osh following first seizure. pt had generalized seizure, was brought to osh where ct head was in itially interpreted as normal, and patient started on po dilantin. plan for outpatient mri. the patient had no neurologic deficits, constitutional symptoms, or other findings at that time, per report. he returned home, and had progressively worsening headaches over the past 2 days. earlier today, the patient had 2 generalized seizures and was taken again to an osh where ct head with iv contrast demonstrated a 2.5 cm ring enhancing mass in the left temparoparietal lobe. the patient had a temperature of 101.9 at the osh and was administered iv ctx/vanco/flagyl. upon arrival to , the patient is awake and responsive, interviewed in spanish. he describes headaches, but otherwise denies any recent problems. his mother, he usually speaks and undedrstands some english, but has been unable to do so over the past 3 days. past medical history: denies. no history of pediatric infections, recurrent infections. social history: immigrated from republic. lives with family. no recent travel. does not use illicit substances, does not inject drugs. family history: non-contributory physical exam: admission: t: 99.4 bp: 130/64 hr:90 r:18 o2sat:100/2l-nc awake and alert cooperative with exam names objects in spanish makes paraphasic errors and neologisms poor repetition pupils equally round and reactive to light extraocular movements intact bil without abnormal nystagmus facial strength and sensation intact and symmetric hearing intact to voice palatal elevation symmetrical sternocleidomastoid and trapezius normal bilaterally tongue midline without fasciculations normal bulk and tone bilaterally no abnormal movements, tremors strength full power throughout no pronator drift sensation intact to light touch x 4 ext toes downgoing bilaterally non-dysmetric on finger-nose-finger physical exam upon discharge: afebrile, bp 100s/60s, hr 80s, satting 99%ra general: alert, conversant. skin: peeling skin on arms and legs. no erythema or drainage at picc site. heent: line of staples on left occiput. no erythema or discharge surrounding staples. no facial edema. sclera anicteric, conjunctiva clear. neck: supple, jvp not elevated, no lad lungs: ctab, no wheezes, rales, rhonchi cv: rrr, normal s1 + s2, no m/r/g abdomen: soft, nt, nd, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused (brisk cap refill), 2+ pulses, no clubbing, cyanosis or edema. no lesions on palms or soles. neuro:cn 2-12 intact, sensation throughout, stregnth throughout. can walk on heels and toes. pertinent results: : cxr- impression: normal chest. : mri brain- limited planning study. peripherally t1 hyperintense lesion in the left temporo-parietal lobe with surrounding perilesional edema causing mass effect on the ocipital of left lateral ventricle. this has significantly increased in size since the prior ct dated . the differentials for this includes infection (abscess), inflammatory lesion or tumefactive multiple sclerosis or subacute hematoma. given the short term increase compared to the ct head study of , neoplastic etiology is less likely; however, lymphoma related lesion if the pt. is immunosuppressed cannot be completely excluded. correlate with complete mr imaging an labs. ct head: immediately status post left parietal burr hole and aspiration of the ring-enhancing lesion with associated vasogenic edema in the left parietal lobe, apparently representing known abscess (according to the given history). there is a small amount of intralesional gas and blood, post-procedure echo: impression: no valvular vegetations or abscesses appreciated. panorex: there is no evidence of gross decay or dental infection. his 3rd molars appear to be impacted and may require removal in the future. head ct impression: interval increase in the size of a left rim-enhancing brain lesion measuring 1.9 x 3.7 x 3.5 cm. rue u/s impression: no dvt. ruq u/s impression: normal abdominal ultrasound. no intra- or extra-hepatic bile duct dilation. mri head w/ contrast conclusion: continued enlargement of the abscess, now with contact with the ventricle and at least subependymal enhancement. head ct impression: expected post-surgical changes, immediately after left parietal craniotomy for evacuation of an intracranial abscess. pneumocephalus and small intraparenchymal blood at the resection site with surrounding edema are noted. cxr impression: no acute chest abnormality. head mri impression: 1. overall evidence of progression with interval thickening of the abscess cavity, extension of adjacent flair signal and new involvement of the left occipital subependyma. 2. no new parenchymal abscesses identified. head ct impression: expected postoperative changes immediately after left parietal craniotomy for evacuation of intracranial abscess with pneumocephalus, vasogenic edema, and small amount of intraparenchymal blood. peripheral flow cytometry interpretation: non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by b-cell lymphoma are not seen in specimen. correlation with clinical findings and morphology is recommended. abscess cultures 1:05 pm abscess intercranial. **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs and singly. wound culture (final ): streptococcus anginosus (milleri) group. moderate growth. sensitivity testing performed by sensititre. clindamycin mic <= 0.12 mcg/ml. ceftriaxone sensitivity requested by . sensitive to ceftriaxone mic = 0.125mcg/ml, sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml ________________________________________________________ streptococcus anginosus (milleri) group | clindamycin----------- s erythromycin----------<=0.25 s penicillin g----------<=0.06 s vancomycin------------ <=1 s anaerobic culture (final ): no anaerobes isolated. 2:00 pm swab abscess. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): no growth. anaerobic culture (final ): no growth. 10:25 pm swab site: brain left brain abscess deep. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): no growth. anaerobic culture: ___________________________________________ 10:15 pm swab site: brain left access point. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): no growth. anaerobic culture: ___________________________________________ 10:30 pm swab site: brain left brain abscess 2nd focus. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture: ______________________________________________ anaerobic culture: __________________________________________ 7:35 am blood (toxo) toxoplasma igg antibody (final ): positive for toxoplasma igg antibody by eia. 29 iu/ml. reference range: negative < 4 iu/ml, positive >= 8 iu/ml. toxoplasma igm antibody (final ): negative for toxoplasma igm antibody by eia. interpretation: infection at undetermined time. 07:20pm blood aspergillus galactomannan antigen-test - neg 07:42pm urine histoplasma antigen-test 07:20pm blood cysticercosis antibody-test - neg 07:20pm blood b-glucan-test - neg 10:55am blood hiv ab- negative 05:17am blood cd5-done cd23-done cd45-done hla-dr 7-done kappa-done cd2-done cd7-done cd10-done cd19-done cd20-done lambda-done 06:40am blood strongyloides antibody,igg-pnd microbiology - blood cultures 9:00 pm blood culture x 2: no growth 12:39 pm blood culture x 2: no growth 10:00 am blood culture x 2: no growth 3:26 am blood culture x 2: no growth 8:14 pm blood culture x 2: no growth 9:02 am blood culture x 2: no growth 8:44 pm blood culture x 2: no growth 4:48 am blood culture x 2: no growth 9:36 pm blood culture x 2: no growth 7:35 am blood culture x 2: no growth 11:30 pm blood culturex 2: no growth lfts 11:30pm blood alt-22 ast-26 alkphos-103 totbili-0.3 01:43am blood alt-21 ast-27 alkphos-108 totbili-0.3 11:29am blood alt-33 ast-25 alkphos-93 amylase-54 totbili-0.1 04:48am blood alt-89* ast-90* alkphos-82 totbili-0.1 04:57am blood alt-126* ast-123* 05:17am blood alt-144* ast-122* ld(ldh)-381* 05:21am blood alt-158* ast-109* 05:34am blood alt-179* ast-82* 05:49am blood alt-173* ast-70* alkphos-112 totbili-0.3 06:39am blood alt-173* ast-55* alkphos-116 totbili-0.4 06:07am blood alt-117* ast-29 alkphos-105 totbili-0.4 05:44am blood alt-125* ast-40 03:27am blood alt-249* ast-136* ld(ldh)-494* ck(cpk)-36* alkphos-89 totbili-0.3 05:53am blood alt-185* ast-30 05:00am blood wbc-12.4* rbc-3.99* hgb-11.8* hct-36.0* mcv-90 mch-29.5 mchc-32.7 rdw-13.1 plt ct-317 05:47am blood alt-229* ast-72* alkphos-104 04:57am blood alt-240* ast-56* alkphos-117 totbili-0.3 08:16am blood alt-175* ast-47* alkphos-111 totbili-0.5 04:04am blood alt-123* ast-33 alkphos-104 totbili-0.4 02:13am blood alt-113* ast-31 alkphos-106 totbili-0.3 05:34am blood alt-106* ast-33 alkphos-104 totbili-0.4 urinalysis 04:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.5 leuks-neg 08:58pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-tr 06:10am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 04:34pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 09:37pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-tr brief hospital course: 18yo m with no pmh admitted for seizures, fever and ams, found to have brain abscess, cultures positive for s. anginosus s/p i&dx3; treatment course complicated by multiple drug allergies, and red man syndrome in setting of vancomycin infusion. # brain abscess: pt initialy given vancomycin/ceftriaxone/flagyl for broad coverage and on , the pt unerwent burr hole and aspiration without complication. pt given dilantin and keppra for seizure prophylaxis initialy. brain abscess grew out strep anginosus. pt had thorough workup to investigate etiology: panorex of teeth, tte, tee and ct a+p. ct a+p showed cecal thickening and typhlitis, possibly the original source of infection, although pt denied every having gi symptoms. after patient's initial post-op course, he developed daily fevers up to 103 ultimately attributed to antibiotic drug reaction. see below for antibiotic course. after a trial of several antibiotics, it was felt that he had a beta-lactam allergy and he was ultimately switched to vancomycin and flagyl which he ultimately tolerated well. pt had repeat head imaging (head ct , head mri ) which demonstrated enlargement of the abscess. the patient was then taken for a second i&d (), via mini craniotomy. the patient tolerated this procedure well, and returned to the medicine floor that day. post-operative neurologic exam was within normal limits. of note, abscess cultures were negative (including fungi and anaerobes). repeat imaging on with mri suggested possible extension of the abscess again. the patient underwent third i&d on . no pus or abscess was found during this procedure (washings were negative) and his prior mri findings were likely attributed to post-op changes rather then progressing abscess infection. pt remained neurologically intact. #surgical interventions for abscess the pt underwent mutiple i&ds for s. anginosus brain abscess: , , . pt is due to get staples removed early (10 days since most recent i+d). # pharmacologic treatment of abscess/red man syndrome/b-lactam allergy: the pt was treated with numerous antimicrobial agents. treatment course was complicated by drug-induced rashes and fevers. pt was placed on empiric antibiotic therapy with vanc/ceftriaxone/flagyl until speciation was determined. pt was then switched to penicillin g. due to rash, penicillin was discontinued and he was then switched to ceftriaxone/flagyl. patient's rash worsened and he had daily high fevers 103, and he was then switched to meropenem. rash temporarily abated, but returned worse than before (morbilliform from head to toe, also with fevers). meropenem was discontinued and pt was placed on vancomycin/flagyl. during his initial vancomycin infusion (), pt developed characteristic 'red man syndrome' with cehst pain, pruritis, redness, agitation during the infusion. the patient was transferred to the micu for further observation and his vancomycin infusion rate was slowed down. he was initialy given solumedrol during his vanco infusions and that was then stopped as his clinical picture and rash improved. he was maintained on vancomycin (slow infusion over 3 hrs) and flagyl for the remainder of his hospital course and tolerated this well. the patient was discharged on vancomycin and flagyl, four week course from the date of third i&d (- ). pt will continued to get weekly cbc with diff, bun, cr, vanco trough, and close follow up with id and neurosurgery. # vancomycin infusion reaction: during patient's vancomycin infusion (), the patient became acutely agitated, tachypneic, and complained of worsened pruritus and sudden-onset chest pain with redness throughout body. the patient was diagnosed with "red man syndrome." the patient was transferred to the micu for supervision of further infusions. infusion rate was slowed (over 3hours). he was initialy "pre-treated" with diphenhydramine and methylprednisolone prior to vanco infusion, to further reduce rash and pruritus. methylprednisolone was eventually discontinued and patient tolerated vancomycin slow infusions without difficulty. # transaminitis: the patient had intermittently elevated lfts. transaminitis was likely due to drug reaction (phenytoin vs beta-lactams). ruq u/s and abdominal ct demonstrated no abnormalities, and bilirubins were normal. lfts trended down and stabalized while on vancomycin and flagyl. # eosinophilia: the patient had a eosinophilia, coincident with rash and transaminitis. eosinophilia was attributed to drug allergy. work up was negative for helminth infection, etc. # seizure prophylaxis: the pt had an apparent seizure after his first i&d. he was placed on phenytoin and levacetiram for seizure prophylaxis. due to concerns that phenytoin was contributing to his rash, fevers, and transaminitis, phenytoin was discontinued later in the hospital course. the patient was maintained on levacetiram throughout. he will follow up with neurosurgery to determine when he can stop this medication. # general infectious work-up: the patient underwent a thorough infectious work-up, including panorex xray, dental consult, tte, tee with bubble study, abdct, serial blood cultures, and assays. abdominal ct with contrast was notable for typhlitis and prominent mesenteric, periaortic, inguinal and femoral lymph nodes. testicular exam was normal. flow cytometry was negative for a lymphoma/leukemia. true etiology of his strep anginosus brain abscess was unclear. ct a+p showed typhlitis, pt denied every having abdominal symptoms. transitional issues: -needs staples removed -will require 4 weeks of antibiotics as of - . pt will get weekly opat labs sent to clinic. -currently on keppra 750mg for seizure prophylaxis. -has allergy to b-lactams: morbilliform rash, lfts, fevers medications on admission: none discharge medications: 1. acetaminophen 650 mg po q6h:prn pain, headache or t > 38.3 do not exceed 4g/day 2. levetiracetam 750 mg po bid rx *levetiracetam 750 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*2 3. vancomycin 1250 mg iv q 8h infuse over 3 hours 4. metronidazole (flagyl) 500 mg po q8h rx *flagyl 500 mg 1 tablet(s) by mouth three times a day disp #*30 tablet refills:*4 rx *metronidazole 500 mg 1 tablet(s) by mouth q 8 hrs disp #*90 tablet refills:*1 5. sarna lotion 1 appl tp rx *sarna anti-itch 0.5 %-0.5 % apply liberally to areas of rash and peeling skin twice a day disp #*600 milliliter refills:*1 6. heparin flush picc line maintenance and heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent. flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 7. outpatient lab work check once a week: cbc with diff, bun, cr, vanco-trough. fax to dr. . 8. vancomycin vancomycin 1250 mg iv q 8h. infuse over 3 hours. disp: 4 week's supply. premedicate with benadryl 25mg po. 9. diphenhydramine 50 mg po q8h give prior to vancomycin dose hold for sedation rr < 12 discharge disposition: home with service facility: , discharge diagnosis: intracranial abscess hyperexia tonic clonic seizures beta lactam allergy "red man syndrome" discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , thank you for the privilege of participating in your care. you were admitted to the because you were found to have an infection in your brain (an "abscess"). we still do not know where this infection came from. we do not know why you developed this infection in your brain. we performed a very thorough workup to investigate where this infection might have come from. a ct scan of your abdomen showed a possible inflammation or infection which might have been the original source of infection. the imaging of the teeth, chest, heart, rest of your body is all reassuring. the brain abscess required treatment with surgery and antibiotics. after your first surgery, imaging showed that the infection could be getting bigger. for this reason, you had to have two more surgeries. the most recent surgery was reassuring that the infection appears to be gone at this time. laboratory cultures from the first surgery showed infection with bacteria. cultures from the second and third operation did not grow any bacteria, indicating that the antibiotics were treating the infection well. also, the neurosurgeons did not see any infection during the third surgery. this is strong evidence that the infection is disappearing. during your hospitalization, you had a very itchy rash, and many high fevers. the rash and fevers were most likely caused by the antibiotics you took after your first surgery. these antibiotics that you seem to have an adverse reaction to are: penicillin, ceftriaxone and meropenem. you are currently on vancomycin and flagyl antibiotics that are fighting the infection. you are tolerating these medications well. you will need to continue the vancomycin and flagyl for a total 4 week course since your last surgery. thus, you should take it through . the infectious disease doctors when to stop these medications. when you leave the hospital, it is very important that you continue to take all antibiotics as prescribed. if you do not take all your medicines, it is possible that the infection could come back. a nurse will come to your home to help you with the medications. it is also important to take the medication keppra, 1 pill twice a day. this medication will prevent seizures. you should continue this medication until the neurosurgeons tell you that you can stop. it will likely be for several months. please schedule an appointment with your primary care doctor, dr. . also, please go to the appointments scheduled with the neurosurgery and infectious disease teams. it is very important that you go to these appointments. your doctors to be sure that you continue to recover well. you will also have more imaging of your head, to be sure that the infection is getting smaller. here are some instructions from the neurosurgery team: - your sutures should stay clean and dry until they are removed. - do not wash your head where the wound is until . (10 days after surgery) at that point you can then wash your hair. ?????? have a friend or family member check the wound for signs of infection such as redness or drainage daily. ?????? exercise should be limited to walking; no lifting >10lbs, straining, or excessive bending. ?????? do not take any anti-inflammatory medicines such as motrin, aspirin, advil, or ibuprofen etc. until follow up. ?????? do not drive until your follow up appointment. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with one of the physician assistant in days from the time of surgery for staple removal ( you will be due to have the sutures removed). ??????you will need a ct of the brain with contrast in the future. you have an appointment scheduled on per the neurosurgeons. is the office phone number for the neurosurgeons. please see appointment time and date below. ?????? you need to follow up with infectious disease on with dr and dr. . you need the following labs sent weekly to them: cbc with diff, bun, cr, vanco trough, fax to: dr . the visiting nurses will be notified to do this for you. department: infectious disease when: wednesday at 11:30 am with: , md building: lm bldg () campus: west best parking: garage department: radiology when: wednesday at 9:15 am with: cat scan building: cc campus: west best parking: garage department: neurosurgery when: wednesday at 10:45 am with: , md building: lm campus: west best parking: garage , 8:30am infectious disease office medical building, , basement 8:00am with dr . neurologist. building clinical center, . procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart other incision of brain other incision of brain other incision of brain other repair of cerebral meninges other computer assisted surgery diagnoses: anemia, unspecified other convulsions intracerebral hemorrhage hypotension, unspecified cerebral edema dermatitis due to drugs and medicines taken internally enlargement of lymph nodes other specified antibiotics causing adverse effects in therapeutic use intracranial abscess leukocytopenia, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b other conditions of brain eosinophilia disturbances in tooth eruption other drug allergy 

Answer: The patient is high likely exposed to