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: the patient is an 18-year-old male with no significant past medical history aside from an "innocent" heart murmur diagnosed as a child. he was in his usual state of health until six days prior to admission when he began experiencing a sore throat. three days prior to admission, he began experiencing fever, chills, malaise, sweats, and right sided chest pain. twelve days prior to admission, the patient had been to the dentist and had work done on his teeth. the patient went to his pcp three days prior to admission and was diagnosed with mononucleosis. at that time he had a white blood cell count of 26. the patient continued to feel poorly with shortness of breath, chest pain, cough, and fever. two days prior to admission, the patient presented to hospital, where a chest x-ray showed a possible pneumonia. the patient was started on azithromycin and ceftriaxone. he was noted to have a fever of 103. he was admitted to hospital, where a followup chest ct scan showed septic emboli bilaterally. followup blood cultures grew 4/4 bottles of gram-positive cocci identified as group-c strep and one bottle grew gram-negative rods consistent with fusobacterium. the patient was given vancomycin, zosyn, and clindamycin. the patient continued to be dyspneic, and was transferred from hospital to the emergency department at 2 am on . on arrival in the emergency department, the patient's temperature was 99.8, his blood pressure was 112/45, heart rate 133, respiratory rate was 30, and he was sating 96% on room air. in the emergency department, he was put on 6 liters of oxygen and then continued to , was put on 100% nonrebreather mask. his arterial blood gas showed a ph of 7.33, a pco2 of 52, a pao2 of 210. chest x-ray showed bilateral effusions with right greater than left and a density of the right lung base. echocardiogram was done for the concern of possible septic endocarditis which showed a thickened pulmonic valve and a possible vegetation. no pda. left ventricular function was globally depressed with the left ventricular ejection fraction of 45-50%. the patient underwent thoracentesis in the emergency room and pleural fluid showed a severe parapneumonic effusion with a ph of 7.17, white blood cell count of 2,350, a ldh of 2,860. the patient's breathing remained labored in the emergency room and the decision was made to intubate the patient. followup chest ct scan showed a possible right upper lobe pleural based opacity consistent with a septic embolus in the lung. blood cultures from revealed gram-negative rods anaerobic bottle thought to be fusobacterium. leg pain and swelling along with the fusobacterium raise concern for internal jugular thrombus leading to a neck ultrasound in the medical intensive care unit, which revealed a left internal jugular clot of 1.5 cm. past medical history: murmur noted in childhood thought to be an innocent murmur. allergies: sulfa with an unknown reaction. social history: the patient lives in with his parents. he is a recent high school graduate. he reports two sexual partners with protection and denies iv drug use. denies tobacco. admits to occasional alcohol use. physical examination: on physical exam on admission, the patient's temperature was 101.8, heart rate was 122, blood pressure 110/39. his respiratory rate was 22, and his oxygen saturation was 100% on ventilatory support. in general, the patient was an ill appearing young male lying in bed, intubated, and lightly sedated on propofol. on head, eyes, ears, nose, and throat examination, his pupils are equal, round, and reactive to light and accommodation. his sclerae were anicteric. oropharynx are dry with no exudates. neck was supple with tenderness to palpation noted on the left side greater than the right side and tenderness to rotation on the left with left anterior cervical adenopathy. the left side of the neck was erythematous and warm to touch. chest examination revealed bronchial breath sounds and dullness half way up on the right side and dullness to the left base with crackles a third of the way up on the left. abdominal examination was soft, nontender, nondistended abdomen with positive bowel sounds. extremities examination showed no clubbing, cyanosis, or edema. no osler's, , or splinter hemorrhages. skin examination revealed linear erythematous papular rash on the trunk at the level of t12 in a dermatomal pattern. laboratories at outside hospital: laboratories in the emergency department revealed a sodium of 132, potassium 4.2, a chloride of 98, bicarb of 23, bun of 28, and creatinine of 1.0, glucose of 92, alt is 30, ast of 57, alkaline phosphatase of 89, total bilirubin 0.9, amylase of 42, a cpk of 238 with a mb fraction of 3, and a troponin of less than 0.3. pt of 12.5, ptt of 29.3. white count was 19.9, hematocrit was 39, and platelets were 104. chest ct scan on admission revealed bilateral pleural effusions right greater than left with fluid tracking to the major fissure on the right. in addition, a right upper lobe peripherally based patchy opacity. small focus patchy opacities were scattered throughout both lungs. there was no consolidation noted at the bases. a ct scan of the abdomen was read as within normal limits. a ct scan of the pelvis was read as within normal limits. a ct scan of the head revealed no hemorrhage, no mass effect or shift and clear paranasal sinuses. the bone windows on the ct scan of the pelvis were read as no lytic or blastic lesions noted. a neck ultrasound revealed partially occluded thrombus in the left internal jugular vein with flow around the thrombus. assessment: the patient is an 18-year-old male with some history what he felt previously to be an innocent heart murmur. he presented 12 days after a dental cleaning with fevers, cough, positive blood cultures, and a bedside echocardiogram suspicious for a pulmonic thrombic lesion. considered was endocarditis with septic emboli to the lungs, however, a neck ultrasound revealed a left internal jugular clot and this was thought to be the source of septic emboli. thus, the patient was given the diagnosis of lemierre's syndrome. problem list by system: 1. lemierre's with septic pulmonary emboli (septic thrombophlebitis of internal jugular vein). infectious disease was immediately consulted and recommended treatment with ceftriaxone, flagyl, and gentamicin to cover group c streptococcus and anaerobic gram-negative rods. a head, chest, pelvis, abdomen ct scan was done to evaluate for a possible further emboli. the ct scan showed no lesions in the head, abdomen, or pelvis with multiple nodules in the lungs consistent with septic emboli and decreased signal in the left internal jugular vein. ultrasound of the neck showed a 1.5 mm clot in the left internal jugular vein. xigris was considered for sepsis, but the patient did not meet the criteria as he is not in shock, and there was concern for anticoagulation with his bloody thoracentesis fluid. cultures were requested from hospital. otolaryngology was consulted to evaluate for possible internal jugular vein ligation. they recommended heparinization to prevent propagation of the clot and mentioned that surgery was not indicated unless the clot progressed after 24 hours of antibiotics. therefore, a repeat ultrasound was planned for 24 hours. the patient remained febrile overnight with a maximum temperature of 105.0 and a steady temperature of 102.4. the patient received a cooling blanket. a morning chest x-ray was more worrisome for increased pulmonary emboli and increased pleural effusions. infectious disease recommended starting acyclovir at 900 mg iv for a possible herpetic rash. the following day, ultrasound showed extension of the clot past the mandible. the proximal thrombosis was not visualized with decreased flow noted in the internal jugular vein with near total occlusion. otolaryngology felt that internal jugular ligation was not warranted at that time. they recommended ordering a transesophageal echocardiogram and a mrv/mra to evaluate for excessive fluid collection and documentation of further pulmonary events. the transesophageal echocardiogram showed no signs of vegetation on any of the valves of the heart. mrv/mra of the chest and neck showed left lower lobe collapse, smaller embolic events on the left. since the patient was not improving, his antibiotic coverage was changed to penicillin, gentamicin, and flagyl. when the gram-negative rods was identified at hospital as porphyromonas asatchrolytica (bacteroides species) on for increased efficacy. otolaryngology was being consulted in light of the poor ct scan of the chest and worry of continuous septic emboli. they recommended that surgery would not improve clinical outcome. heparin was started and initially discontinued for seizure-like activity. a followup ct scan of the head was negative for bleed. a mrv in diffusion lighted scan was read as extensive internal jugular vein involvement and possible cavernous sinus clot. heparin was restarted due to proposition of the thrombus. neurosurgery consult was obtained and also supported in anticoagulated the patient. infectious disease recommended stopping penicillin and clindamycin as they were seizuregenic and restarting ceftriaxone and vancomycin. on , vancomycin was discontinued since the patient had no signs of mrsa. on , ceftriaxone was changed to penicillin 4 mg iv q4 as no seizures were noted on followup electroencephalogram and these drugs were felt to be the ideal drugs for the organism. a ct scan of the neck was obtained with contrast to evaluate for a drainable absence, no fluid collection was seen, however, stranding in the subcutaneous fascia and thickened cervical fascia was seen. a repeat neck ct scan on to assess for clot progression or abscess formation showed no progression of the clot and no abscess collection. therefore, the patient was continued on penicillin, gentamicin, and metronidazole. he was also continued on heparin with a goal of a ptt from 50-80. infectious disease recommended a repeat mrv as well as a repeat neck ultrasound before discharge and follow up with infectious disease upon discharge. 2. pulmonary effusions/emboli: thoracentesis on admission showed a complicated pleural effusion. thoracic surgery was consulted, and placed a right chest tube which drained 310 cc of serosanguinous fluid immediately, and 600 cc of fluid overall. a left chest tube was placed on with drainage of 700 cc overall and expansion of the collapsed left lower lung. the right lower lung continued to remain atelectatic with no further drainage. therefore, a repeat chest ct scan on was done to evaluate the effusion, and the possibility of placing a second right sided chest tube. this ct scan showed a right upper lobe embolus with cavitation and a mid sized right effusion, large area with right lower lobe atelectasis and a right lower lobe effusion. ct surgery felt that the chest tube was in the correct place and that no further chest tubes were warranted. bronchoscopy was therefore performed because of persistent fevers and a high white count that revealed thick upper airway secretions, but no bronchiolar plugs. bronchial lavage was sent which did not reveal any organisms on gram stain and did not grow out any organisms. on , the patient's right chest tube was removed as it had drained less than 100 cc in the last 24 hours. 3. dermatology: the patient was noted to have a linear erythematous rash on his trunk in t12 dermatomal distribution. he was briefly on acyclovir, but a followup hsv was negative for varicella zoster virus. the next day vesicular erythematous lesion was also noted on the patient's right medial shin. there was concern for toxic shock syndrome with the picture of fevers and rash. dermatology was consulted to swab these lesions. preliminary cultures did not grow any herpes zoster virus, so acyclovir was discontinued on . the rash on the trunk was treated with cortisone cream per dermatology recommendations and was resolving on transfer to the floor. 4. cardiac: a transesophageal echocardiogram was done on and showed no vegetations. the patient was maintained on telemetry while in the micu, and no conduction abnormalities or electrocardiogram abnormalities were noted. 5. neurology: the patient was noted to have seizure-like activity after his heparin bolus on . the patient developed fine tremors, upper extremity posturing, and downward gaze. a seizure evaluation by neurology consult recommended dilantin loading. the patient became hypotensive with dilantin and was therefore switched to fosphenytoin. a subsequent electroencephalogram was negative, and neurology recommended continuing dilantin prophylactically and re-evaluating when off sedation. an anticoagulation panel was sent and was still pending at time of transfer to the floor. the patient's dilantin was discontinued on after evaluation by neurology, while the patient was awake, alert. electroencephalogram was repeated at this time and was negative. 6. pulmonary: patient was intubated for hypoxia and hypercapnic respiratory failure. the patient did well on ventilation settings of assist control 450, 520 with 40% fio2. compliance was calculated at 26 and was thought to be a combination of suppination, pleural effusions, septic emboli, and fluid overload. on , the patient's sedation was lightened so he can be tried on pressure support of 20 and peep of 5. the patient did well from 6 am to 4 pm, and then self extubated. the patient was placed on 100% nonrebreather mask with oxygen saturations from 98-100%. initially, the respiratory rate was 20-40. the patient was given fentanyl for pain control and improved. the patient was switched to dilaudid for better pain control and did well subsequently on 5 liters nasal cannula. 7. renal: the patient maintained good renal function throughout his hospital stay with no change in creatinine and no decrease in urine output. the patient's renal function was monitored closely given his ct dye load, gentamicin, vancomycin, and acyclovir. he was given nitrite boluses and ................ 8. the patient received prophylactic proton-pump inhibitor on heparin during his micu stay. 9. pain control: after the patient extubated and woke up, pain control became an issue. the patient was initially started on fentanyl, but due to decreased pain control and increased nausea, he was switched to dilaudid. the patient did better on dilaudid pca with decreased nausea and much better pain control. the patient was discharged to the floor on . discharge medications: 1. metronidazole 500 q8. 2. gentamicin 450 mg q24h iv. 3. penicillin 4 units iv q4. 4. lamivudine 150 mg . 5. dilaudid pca. 6. heparin at units per hour. 7. ativan 1 mg tid. 8. regular insulin-sliding scale. condition on discharge: fair. discharge status: discharged to floor. discharge diagnosis: lemierre's syndrome. followup: the patient was to have a followup chest ct scan prior to discharge. in addition, he was to have a followup mrv of the neck and ultrasound of the neck prior to discharge. the patient was to followup with infectious disease after discharge. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified severe sepsis acute respiratory failure other septicemia due to gram-negative organisms streptococcal septicemia empyema without mention of fistula phlebitis and thrombophlebitis of intracranial venous sinuses phlebitis and thrombophlebitis of other sites 

Answer: The patient is high likely exposed to