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: pleuritic chest pain. major surgical or invasive procedure: 1. thoracentesis 2. vats and decortication, left lung 3. intubated on . history of present illness: 51 man with a pmh significant only for active tobacco use, presented initially to with 4 days of pleuritic chest pain. pain began suddenly last tuesday () and was described as sharp left sided chest pain, worse with breathing and movement. it had been improving, but worsened on the day of presentation. at , a ct was negative for pe, but showed a 19 mm ill-defined pleural-based mass adjacent to the descending aorta. he was transferred to for further management. . at , the patient was evaluated by thoracic surgery with initial concern for dissection. however, a repeat cta here showed the lesion to have an enhancing rim and internal fluid density, consistent with abscess. labs were significant for a wbc of 13.1. ros was otherwise significant for several episodes of soaking night sweats the week prior to presentation, and a productive cough described as "mucous-like" x 1 day. otherwise, he denied fevers, sob, hemoptysis, n/v. appetite and energy have been good. . patient was initially treated with broad spectrum antibiotics including vanc/levo/flagyl, and dilaudid pca for pain control. on , the patient began experiencing tachypnea and worsening pain w/ splinting. dilaudid pca was increased, however the remained tachypneic (rr 40s) with hiccoughs with each breath. repeat cxr showed sizable interval increase in left pleural effusion, without obvious etiology. abgs showed 7.34/55/66. nebs were given, but patient appeared to be tiring and was intubated on the floor. he was then transferred temporarily to the pacu, then to the micu. a thoracentesis was performed on and 450 ml of partially bloody, purulent fluid was drained. on thoracic surgery performed debridement and decortication of left pleural empyema. . patient is now being transferred from micu to cc7. he now feels sharp left sided pleuritic pain with deep breaths and movement. he also has shortness of breath and mild chills. he had a productive cough and he self suctions. he denies hemoptysis, sweats, nausea/vomiting/diarrhea, abdominal pain, headache, leg pain. his chest pain is well controlled with dilaudid pca. past medical history: -hemorrhoids -status post removal of bullet from l arm -status post circumcision social history: owns and operates a bar. also works part time at a stop & shop. lives with a male partner. sex with men and women, but not currently sexually active. last hiv test was 2 years ago. 2 sexual partners since then, both men without protection. current 0.5 ppd x 40 yrs tobacco. previous alcoholic, sober x 17 years. h/o overnight incarcerations. no recent travel. family history: father died of mi in 50s; mother alive and healthy in 80s. 4 brothers and 1 sister healthy. physical exam: (on admission) vs t 97.9, bp 154/82, hr 80, rr 28, sao2 97% 2l gen: comfortable, nad, incr sob w/ talking heent: mmm, eomi, lad chest: poor air movement but no audible wheezes, rhonchi, crackles. drains in place with one draining serosanguinous fluid and one draining straw fluid. two prior chest tube sites noted. cv: rrr, nl s1, s2, no m/r/g abd: +bs, soft, nt,nd ext: no edema, nicotine patch in place, fentanyl patch in place gu: foley in place pertinent results: microbiology: bcx: no growth. spcx contaminated, no afb on smear pleural fluid cx streptococcus g with following sensitivities: clindamycin----------- s erythromycin---------- 0.25 s penicillin------------ 0.06 s vancomycin------------ 1 s spcx w/1+gpc, 1+gpr pleural fluid: 3+pmn's. no organisms. no malignant cells. spcx w/sparse oral flora pleural tissue: 2+ pmn. strep milleri. bal: negative. no afb. pleural fluid: negative for afb. spcx: beta streptococci. staph aureus coagulase positive. resistant to penicillin. bcx x2: no growth. . . radiographic studies: -mri t-spine (): extremely limited exam due to patient motion artifact. a pleural-based collection within the left inferior lung, immediately adjacent to the aorta, has rim enhancement with a t2 hyperintense core. this could represent an abscess or a neoplasm. aortitis should also be considered given its proximity to the aorta. . -cta chest & abdomen (): 1. no evidence of thoracic aortic dissection. 2. rounded rim-enhancing low density lesion immediately adjacent to the descending thoracic aorta at t9/10. the differential diagnosis of this structure is broad, but includes abscess. 3. very small left pleural effusion. 4. patchy opacities within the right upper lobe may represent an infectious pneumonia. patchy opacities at both lung bases may reflect atelectasis or an infectious process. 5. colonic diverticulosis, without evidence of diverticulitis. . -cxr (): 1. no definite pneumothorax with stable appearance of bilateral basilar plate-like atelectasis and layering left-sided effusion/postoperative edema. 2. air noted in the region of left cardiophrenic sulcus likley represents small locule of air with surrounding collapsed lung but difficult to exclude a focal pneumomediastinum. attention is suggested on followup radiographs. . -cxr #1 (): cardiac size is normal. there are low lung volumes with bibasilar segmental atelectases which are unchanged. there is no pneumothorax. left pleural effusion is small. two left chest tubes are in place. . -cxr #2 (): in the interval, one of the left chest tubes has been removed. if any, there is a tiny left apical pneumothorax with no clinical significance. left chest basal tube remains in place. bibasilar atelectasis are unchanged. cardiomediastinal contour is unremarkable. a small left pleural effusion and/or pleural thickening is unchanged. . cxr (): small residual pneumothorax, best visualized on the lateral view. bibasilar atelectasis and/or scarring. small amount of pleural thickening. . -echo (): the left atrium is elongated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. 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. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no echocardiographic evidence of endocarditis. normal global and regional biventricular systolic function. biatrial dilation. . labs: 05:47am blood wbc-8.8 rbc-4.55* hgb-12.3* hct-38.1* mcv-84 mch-27.0 mchc-32.2 rdw-13.1 plt ct-371 05:47am blood pt-12.7 ptt-31.7 inr(pt)-1.1 05:47am blood glucose-87 urean-15 creat-0.9 na-135 k-4.4 cl-98 hco3-30 angap-11 05:47am blood calcium-8.7 phos-3.5 mg-2.4 06:00am blood wbc-11.0 rbc-4.68 hgb-12.8* hct-39.6* mcv-85 mch-27.3 mchc-32.3 rdw-13.1 plt ct-417 03:30am blood wbc-18.4* rbc-4.66 hgb-13.3* hct-38.9* mcv-83 mch-28.6 mchc-34.3 rdw-13.1 plt ct-274 04:30pm blood wbc-13.1* rbc-5.35 hgb-15.1 hct-45.9 mcv-86 mch-28.2 mchc-32.8 rdw-13.2 plt ct-305 06:20am blood neuts-74.5* lymphs-17.6* monos-7.1 eos-0.6 baso-0.3 04:35am blood plt ct-352 04:35am blood pt-12.5 ptt-30.3 inr(pt)-1.1 06:00am blood plt ct-417 03:30am blood pt-14.6* ptt-33.1 inr(pt)-1.3* 04:30pm blood pt-11.6 ptt-32.0 inr(pt)-1.0 06:00am blood glucose-110* urean-12 creat-0.8 na-134 k-4.3 cl-96 hco3-29 angap-13 04:30pm blood glucose-127* urean-19 creat-0.7 na-136 k-4.3 cl-101 hco3-26 angap-13 05:04am blood alt-30 ast-41* ld(ldh)-275* alkphos-89 amylase-102* totbili-0.5 03:30am blood amylase-35 03:01am blood ld(ldh)-280* 04:30pm blood ck(cpk)-150 05:04am blood lipase-115* 04:30pm blood ctropnt-<0.01 06:00am blood calcium-8.8 phos-3.6 mg-2.2 05:35am blood calcium-9.4 phos-2.8 mg-2.1 05:35am blood hiv ab-negative 03:17am blood type-art temp-38.4 rates- tidal v-600 peep-5 fio2-40 po2-128* pco2-49* ph-7.43 caltco2-34* base xs-7 -assist/con intubat-intubated 08:30pm blood type-art rates-17/ tidal v-550 peep-5 fio2-50 po2-72* pco2-45 ph-7.44 caltco2-32* base xs-5 -assist/con intubat-intubated 03:24pm blood type-art po2-76* pco2-41 ph-7.45 caltco2-29 base xs-3 02:48am blood type-art po2-66* pco2-55* ph-7.34* caltco2-31* base xs-1 03:24pm blood lactate-1.4 03:08am blood lactate-1.0 brief hospital course: hospital course/assessment/plan: 51 year old man with past medical history significant for active tobacco use, admitted for strep g positive left-sided empyema, complicated by respiratory failure, now status post vats and decortication. . 1) abscess in pleural space: initially, patient treated with broad spectrum antibiotics including vancomycin, levofloxacin, and flagyl. dilaudid pca for pain control. on , the patient began experiencing tachypnea and worsening pain with splinting. dilaudid pca was increased, however the remained tachypneic (rr 40s) with hiccoughs with each breath. repeat cxr showed sizable interval increase in left pleural effusion, without obvious etiology. abgs showed 7.34/55/66. nebulizers were given, but patient appeared to be tiring and was intubated on the floor. he was then transferred to the micu. a thoracentesis was performed on and 450 ml of partially bloody, purulent fluid was drained. on thoracic surgery performed debridement and decortication of left pleural empyema. he was then transferred to the floor. culture of the empyema/abscess was noted to be strep milleri positive, sensitive to penicillin. broad spectrum antibiotics were switched to penicillin and flagyl, per recommendations of infectious disese team. picc line placed for prolonged antibiotic course. oxygenation saturation 99% on room air on discharge. blood cultures at have been negative (though all acquired after initiating broad spectrum antibiotics). transthoracic echo was negative for vegetations or regurgitation. given clear view of valves on study and clinically low suspicion for endocarditis, tee fellow felt transesophageal echo was not necessary at this time. tuberculosis was ruled out by sputum smear and three negative cultures. hiv was negative. legionella negative. as above, infectious disease specialists recommended iv penicillin g (4 million units q4hr) and flagyl for four weeks. patient to be seen in clinic on . weekly blood draws for lfts, bun/cr, cbc. patient to be seen by pcp . ct chest with contrast recommended upon termination of antibiotic course. pain controlled initially by dilaudid pca. changed to po ms contin and dilaudid for breakthrough. added transdermal lidocaine patch. . 2) pain control: patient initially placed on a dilaudid pca. on discharge, pain managed with po ms contin and dilaudid and transdermal lidocaine patch. discussed with patient that he shouldn't drive or operate any machinery while taking these medications, or before speaking with his pcp. . 3) fen: placed on regular diet. . 4) prophylaxis: placed on sc heparin and a bowel regimen. . 5) access: right picc placed on . . 6) code: full. . 7) communication: partner . sister . medications on admission: none. discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation: for constipation. disp:*30 30* refills:*0* 2. nicotine 14 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). disp:*30 patch 24hr(s)* refills:*0* 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 4. sodium chloride 0.65 % aerosol, spray sig: sprays nasal (2 times a day) as needed. disp:*5 5* refills:*0* 5. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed: for excess abdominal gas and bloating. disp:*30 tablet, chewable(s)* refills:*0* 6. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 weeks. disp:*84 tablet(s)* refills:*0* 7. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation every 4-6 hours as needed. disp:*2 2* refills:*0* 8. outpatient lab work please have weekly labs drawn: cbc, bun, creatinine, and lfts. fax the results to dr. at . 9. heparin flush 10 unit/ml kit sig: one (1) intravenous every four (4) hours for 4 weeks. disp:*112 * refills:*0* 10. saline flush 0.9 % syringe sig: one (1) injection every four (4) hours for 4 weeks. disp:*112 * refills:*0* 11. oxycodone 20 mg tablet sustained release 12hr sig: three (3) tablet sustained release 12hr po q12h (every 12 hours) for 3 days. disp:*18 tablet sustained release 12hr(s)* refills:*0* 12. oxycodone 5 mg tablet sig: one (1) tablet po q2-3h (every 2-3 hours) as needed for breakthrough pain for 3 days. disp:*20 tablet(s)* refills:*0* 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qd () for 3 days: apply one patch for 12 hours each day and remove for the following twleve hours. repeat each day. disp:*3 adhesive patch, medicated(s)* refills:*0* 14. penicillin g potassium in d5w 2,000,000 unit/50 ml piggyback sig: two (2) intravenous every four (4) hours for 4 weeks. disp:*168 * refills:*0* discharge disposition: home with service facility: home therapies discharge diagnosis: primary: -left lower lobe empyema. pleural fluid positive for strep milleri. discharge condition: afebrile, stable vital signs, tolerating pos, ambulating without difficulty. discharge instructions: -you were admitted with a left lung empyema. you were started on antibiotics and will need to continue on these antibiotics for the next four weeks. the lesion in your lung improved after surgical and antibiotic treatment. you will require follow-up in infectious disease clinic and by your pcp (see below). . -you will need to have weekly blood work and fax the results to dr. at . . -please take all medication as prescribed. . -please attempt to make all medical appointments (see below). . -if you develop any chest pain, shortness of breath, worsened cough, fever, or any other concerning symptoms, please call your pcp or return to the ed immediately. followup instructions: -you have an appointment with your pcp, . (affiliated with dr. ), on thursday, at 11:45 am. the office is located at in (). . -you have an appointment with dr. in the department of infectious disease on at 10am. the office is located at , , ma (). . -you need to have weekly blood tests performed and fax results to dr. at . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube thoracentesis decortication of lung closed [endoscopic] biopsy of bronchus other incision of pleura diagnoses: acute respiratory failure pneumococcal pneumonia [streptococcus pneumoniae pneumonia] empyema without mention of fistula streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group g 

Answer: The patient is high likely exposed to