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: xferred from medical center for managment of meningitis major surgical or invasive procedure: picc line placement chest tube placement (left) history of present illness: 63f xferred from medical center for managment of meningitis. . the illness began on with flu-like sx, + malaise, + neck pain, +headache, +subjective fevers/chills, + fatigue, + bilateral knee pain. per report, patient visited her grandkinds on , one of whom had bronchitis and sore throat but was tested negative for strep. patient was getting progressively worse, increased drowsiness, +changes in gait. on , patient collapsed (witnessed--legs weakened, her husband caught her, patient was drowsy but did not lose conscousness)--not syncopal episode. at that time, patient c/o increasing neck and back pain. pt taken to hospital, where meningitis was suspected, and the patient was started on vanc/ctx/steroids. head ct was negative for bleed. ekg per report showed incomplete lbbb. cardiac enzymes were negative per report. reports are incomplete, but apparently the patient was intubated for airway protection given her mental status. she was then transferred to medical center essentially in a near-comatose condition. lp was performed and was profoundly positive for strep meningits and she was started on ctx 2gm iv q12 h. per report, mic was found to be 0.032, which was thought to be sufficient in tx meningtiis. she was stabilized and extubated, but not clear the exact course of events. in addition, she received platelets and 2u prbcs for hct of 22.7. she was also found to be guiaiac +. . the patient was improving from 12th till with increased awareness, increased mental status, working with pt and ot. pt was afebrile. on evening on 22nd, pt once again became lethargic, spiked to 101.6, so vancomycin was also added. pt's family contact and xfer to was arranged. . upon arrival, to the , pt's vss. afebrile, but without iv access. . micu course: : neuro consulted. vanc added given fevers. : performed -> transudate, c/b ptx requiring ct. lenis neg. mri spine with cord enhancement c3-t2. : ct put to water seal, no leak, small residual apical ptx on cxr. arthrocentesis past medical history: l wrist surgery chronic sinus infections, no antibiotics social history: baseline lives with husband, independent, was working as an administrator prior to this illness, no tobacco, no etoh, no ivdu. has 1 dog and 2 cats at home. family history: mother had "unstable blood pressure" and died of a cva. father had and died of chf at age 80, physical exam: heent: perrla, eomi. + meningismus, + neck stiffness. impaired neck flexion, head rotation. resp: ctab, no rales or ronchi cv: s1, s2, rrr. no mrg abd: +bs. soft, slightly distended. per report patient has not had stool. no hepatosplenomegaly. ext: significant for swollen, warm l knee, 1+ pitting edema l leg up to knee neuro: pt is awake and alert, responding to questions appropriately. deaf, not able to communicate verbally. patient has hearing loss. otherwise, cranial nerves intact. proximal ue strength 1/5. prox le strenth . bilateral upgoing babinsky. very stiff in the neck. unable to flex neck. skin: no rashes. pertinent results: 02:02pm wbc-13.0* rbc-3.85* hgb-11.5* hct-35.3* mcv-92 mch-30.0 mchc-32.6 rdw-16.2* 02:02pm neuts-90.7* lymphs-0* monos-7.2 eos-1.0 basos-0 atyps-1.0* nuc rbcs-1* 02:02pm plt count-463* 02:02pm pt-11.7 ptt-22.7 inr(pt)-1.0 02:02pm glucose-109* urea n-20 creat-0.8 sodium-139 potassium-3.6 chloride-105 total co2-24 anion gap-14 02:02pm alt(sgpt)-47* ast(sgot)-29 ld(ldh)-288* alk phos-228* tot bili-0.5 tte: conclusions: the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. 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 no pericardial effusion. impression: no valvular vegetations seen. if clinically indicated, a tee may be better to exclude a small valvular vegetation. mri head () impression: 1. multiple bilateral subcortical white matter infarctions, up to 10 days old, which is suggestive of vasculitis in the setting of meningitis. 2. extensive leptomeningeal edema and enhancement, consistent with meningitis. 3. irregularities in the distal m1 segment of the right middle cerebral artery and at the origin of the left posterior cerebral artery, which may represent atherosclerosis or vasculitis. please note that small-vessel vasculitis may be occult on mra. 4. no evidence of cerebral abscess or subdural empyema. right knee film: impression: 1. there are mild osteoarthritic changes worst in the medial compartment. 2. the large joint effusion seen on has markedly improved. cxr: there is no appreciable left pneumothorax or pleural effusion. left posterior pleural drains still in place. left lower lobe consolidation is stable. lungs otherwise clear. heart size is normal. thoracic aorta is very tortuous but not dilated. tip of the left pic catheter projects over the left brachiocephalic vein. there is no positive micro data from this hospital. brief hospital course: 1) pneumococcal meningitis: at osh, pt was started on broad spectrum abx with ctx, vanco and amp. once cultures returned for pneumococcus, this was narrowed to ctx only. however, after a period of improvement, pt worsened again around with fever and lethargy. vanco was restarted at this time though no focus of infection was identified. this was discontinued again on . id consultation obtained, and ctx was deemed appropriate therapry. she was initially on 2grams q12hours. day#1 was . mri with multiple subacute infarcts and concerned for vasculitis/embolic disease. she was started on asa. surface echo showed no evidence of endocarditis. a tee was attempted to definitively rule this out but the pt could not tolerate it under conscious sedation and it was felt the risk of doing in under general anesthesia outweighed the benefit given low suspicion. the patient's delerium and mental status improved on a daily basis so no further workup was pursued for these brain lesions as they were likely secondary to vasculitis from infection. her ctx dose were changed to 2g once a day. her carotid us was negative. . 2) septic arthritis of b/l knees: initially discovered at osh where arthrocentesis was performed.this was treated with antibiotics as above. once arrived to , rheumatology was consulted. repeat arthrocentesis showed improved cell counts. she was also improving clinically with decreased effusions, pain. she will complete a 6 week course of ceftriaxone for this. pain control with tylenol. . 3) pneumothorax: while in micu, here pt had a diagnostic left thoracentesis given fevers. the pleural fluid was transudative but the procedure was complicated by pneumothorax. a chest tube was placed for several days and taken out on without event. the patient has poor healing of skin at the site and is getting wound care but respiratory status is stable and post ct films show no ptx. . 4) delerium: the workup was as above for meningitis and brain lesions. she also had tsh, b12, rpr sent which were unremarkable. her delerium was partly due to hearing loss and subsequent disorientation. however, it improved throughout the admission on a daily basiss. . 5) hearing loss: likely sensineural secondary to meningitis. formal audiology testing can be done as an outpatient. . 6) anemia: workup consistent with anemia from acute inflammation. hct was stable. . 7) rash: several days prior to discharge pt developed rash on her thighs. it was thought ctx could be the culprit. she was started on h2b and benadryl with complete resolution. the histamine blockers were stopped without recurrence. . 8) constipation: pt will need continued bowel regimen and possibly enemas as she remains constipated. medications on admission: at home: none discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 2. docusate sodium 50 mg/5 ml liquid sig: one y (150) mg po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 5. ceftriaxone-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) gram intravenous q24h (every 24 hours) for 17 days. 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 8. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: pneumococcal meningitis, septic athritis, delerium discharge condition: good. discharge instructions: 1. take medications as prescribed. 2. follow up as below. 3. you will attended to by physicians at rehab--please address any medical concerns with them or dr. . followup instructions: infectious diseases: provider: , md phone: date/time: 10:00 pcp: you leave rehab, you should follow up with your primary care doctor, dr. , in 1 to 2 weeks. rheumatology: please call ( to make an appointment to follow up with a rheumatologist regarding the septic arthritis in your knees. the doctor that you saw you was dr. but you can see any doctor. if you need to see an audiologist for hearing testing here, please call ( to make an appointment. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified thoracentesis arthrocentesis arthrocentesis diagnoses: anemia, unspecified unspecified pleural effusion constipation, unspecified retention of urine, unspecified dermatitis due to drugs and medicines taken internally other alteration of consciousness arteritis, unspecified effusion of joint, lower leg pyogenic arthritis, lower leg unspecified antibiotic causing adverse effects in therapeutic use pneumococcal meningitis 

Answer: The patient is high likely exposed to