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: history of present illness: this is a 43-year-old female with a past medical history significant only for hypertension, who presents with 3-4 days of fever, malaise, stiff neck, nonproductive cough. in the emergency department, the patient had a fever of 103.0 f, complained of pleuritic chest pain, nausea, headache, diarrhea. according to her husband, she decompensated over the 24 hours leading up to her presentation to the emergency room. in the emergency department, the patient was placed on 100% nonrebreather, but came up to only 90% oxygen saturation. she also started to drop her systolic blood pressure with a low systolic of 75/45. she was placed on levophed in order to support her pressure. she also received 3 liters of normal saline in the emergency department. the patient was empirically given 2 grams of ceftriaxone and 500 mg of levofloxacin. she was also started on vancomycin, and treated as if she had bacterial meningitis. patient was intubated. of note, the patient has no significant past medical history other than her hypertension. there is no travel history. in the micu, the patient was continued on aggressive volume resuscitation with three more liters of normal saline. an a-line was placed. patient met criteria for sirs/sepsis. in addition, she had end-organ dysfunction in the form of hypotension. for this reason, she met criteria to be placed on xigris. a swan-ganz catheter was floated to optimize the patient's fluid status. past medical history: hypertension. outpatient medications: 1. hydrochlorothiazide. 2. zoloft. allergies: no known drug allergies. social history: no tobacco or alcohol use. the patient is married and lives with her husband. physical examination: vitals: temperature 101.0, pulse 90, respiratory rate 24, blood pressure 87/40, and 80% on nonrebreather. general: the patient is lethargic. heent: mucous membranes moist, no neck stiffness or photophobia noted. lungs have coarse rhonchi on expiration, decreased breath sounds in the left lower lobe. cardiovascular: regular, rate, and rhythm, no murmurs, rubs, or gallops. abdomen is soft, nontender, nondistended. extremities: no clubbing, cyanosis, or edema, slightly cool extremities. neurologic: sedated in preparation for intubation. laboratories: white count 14.0 with 36% neutrophils, 56% bands, 1% lymphocyte, hematocrit 40.7, platelets 236. sodium 135, potassium 3.4, chloride 97, bicarb 24, bun 15, creatinine 0.7, glucose 131, calcium 8.8, magnesium 1.3, phosphorus 3.4. arterial blood gas: after intubation on vent setting of ac with tidal volume of 600, respiratory rate of 20, fio2 of 100%, and peep of 15, was ph 7.31, pco2 33, pao2 73, bicarb 17. chest x-ray: significant for left lower lobe pneumonia. hospital course: in short, this is a 43-year-old female with a past medical history significant for only hypertension, who presents with three days of fever, shortness of breath, headache, neck stiffness. presented with hypoxia, hypotension in the setting of left lower lobe pneumonia, and meeting criteria for sirs/sepsis. 1. id: patient presented with a community acquired pneumonia. given her rapid decompensation, she likely developed strep pneumonia. patient has no known history of any immunosuppression that have made her more vulnerable to this infection. patient also presented with headache and complaint of neck stiffness. a lumbar puncture was not done because the patient was too far out on her antibiotics. therefore, she was treated as if she had bacterial meningitis with a 14 day course of vancomycin and ceftriaxone. the patient was also placed empirically on levofloxacin for community acquired pneumonia. hospital course was significant in that she continued to spike despite being on this trial of antibiotics. in addition, her white count continued to go up and her bandemia was not resolving. patient received a chest ct scan on which showed bilateral pulmonary parenchymal air space opacification throughout the posterior aspects of the lower lobes, left greater than right, findings consistent with diffuse pneumonic consolidation. there was no definite evidence of empyema, however, the study was limited by the lack of iv contrast. ct scan was also significant for bilateral pleural effusions and a small pericardial effusion. patient also received a sinus ct scan. this showed mucosal thickening and air fluid levels throughout the maxillary, ethmoid, and sphenoid sinuses bilaterally, but could be also counted by the fact that the patient was intubated. the patient continued to spike. she was tested multiple times for clostridium difficile toxin all of which were negative. the patient had a small volume diarrhea. patient was started empirically on po flagyl on . in addition, the patient's right ij was switched to a left ij on . the catheter tips were negative. after , patient remained afebrile, and her white count came down. all the patient's blood culture data was negative. 2. pulmonary: initially patient was placed on ac mode. esophageal balloon tracings determined that the patient required high peeps secondary to high intrathoracic pressure. initially, the patient met criteria for ards, although, her pao2/fio2 fraction quickly improved. patient was tried multiple times on pressure support, however, failed secondary to episodes of hypoxia. these appeared to be related to poor sedation or moving, but sometimes occurred in the absence of any kind of stimulation. patient had a ct angiogram on to evaluate for possible pe despite prophylaxis. this showed a limited ct angiogram of the chest due to low rate of injection. no pulmonary embolus was noted in the central large pulmonary arteries. however, it also showed multilobar dense consolidation and atelectatic changes with bilateral pleural effusions. thus, the patient had no interval improvement in her chest ct scan from . bilateral lower extremity noninvasive ultrasounds were negative for any deep venous thrombosis. at this time, we believe that the patient still has a large shunt secondary to her multilobar pneumonia which appears to be resolving quite slowly. also, because of her large volume overload for the course of the hospitalization, the patient easily goes into pulmonary edema even if it is not picked up on chest x-ray. at this time, we will continue ac ventilation until further more aggressive diuresis is attained. 3. sepsis: the patient initially met criteria for sirs, in addition to having hypotension. she received 72 hours of xigris, which was stopped secondary to bleeding from a central line site. she received aggressive fluid resuscitation and became 20 liters positive for her admission. patient quickly came off of pressors. 4. fen: as already noted, the patient is 20 liters positive for admission. iv lasix alone was not getting her negative. patient was started on a lasix drip on with excellent diuresis. however, because of this drip, she became hypernatremic with a contraction alkalosis. the patient was given free water boluses for her hypernatremia which adheres to control it. she was also checked q6h for her potassium level and was aggressively repleted. 5. heme: the patient's hematocrit initially was dropping, largely dilutional. however, she kept on having a slow drop. this was thought to be secondary to aggressive phlebotomy. hemolysis laboratories were negative. no transfusions were indicated. 6. acid base: initially, the patient had a metabolic acidosis, nongap, likely from diarrhea, and dilutional component. this resolved. currently, the patient has a metabolic alkalosis likely from aggressive diuresis. patient was started on diamox for bicarb wasting. 7. renal: patient had a decrease in urine output on . she was found to have atn on the basis of multiple muddy-brown casts in her urine. we believe this atn was secondary to hypotension. patient began to autodiurese, and her creatinine came down. 8. endocrine: patient's initial random cortisol was 50, so patient was not started on hydrocortisone. however, she had a random cortisol level on which was only 15. she was started on a seven day course of hydrocortisone 50 mg iv q8h. my dictation stops at this point. further course will follow in a subsequent dictation. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization pulmonary artery wedge monitoring infusion of drotrecogin alfa (activated) diagnoses: acidosis acute kidney failure with lesion of tubular necrosis unspecified essential hypertension hyposmolality and/or hyponatremia severe sepsis unspecified disease of pericardium alkalosis pneumococcal pneumonia [streptococcus pneumoniae pneumonia] meningitis due to unspecified bacterium 

Answer: The patient is high likely exposed to