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: lipitor attending: chief complaint: transfer from with right facial and eye swelling. major surgical or invasive procedure: : neck exploration, irrigation and debridement of necrotizing fasciitis of right face and neck and left neck. : placement of cvl (left scl), placement of a-line (r forearm) : neck exploration, irrigation and debridement of necrotizing fasciitis of inferior neck. : neck exploration, wash out and debridement of neck. history of present illness: the patient is 79 yo m w/hx cva who was transferred from to with right facial and periorbital swelling. two days prior to admission the patient developed a sore throat that worsened in pain, accompanied by facial erythema and edema. + subjective fever, + chills. + loss appetite. the day of admission the patient awoke unable to open his right eye with severe periorbital and right facial swelling, pain, and erythema that extended down into his neck. given the rapid progression of his symptoms he was transferred to . past medical history: stroke "a few years ago" x2 with residual mild right hemiparesis and broca's aphasia; per wife pt has mild weakness in right arm but no right leg weakness peripheral neuropathy, unknown etiology hypertension osteoarthritis s/p lap chole social history: lives with wife, who is a nurse. retired, used to work in a rolling mill w/ metal sheets. he has been home-bound for some time. no smoking; occasional etoh. has six children, grandchildren, most of them living nearby. family history: colon ca in mother, renal ca in brother, no strokes or cad physical exam: upon discharge: alert, oriented but fatigued, nad vss perrl, eomi, anicteric cn grossly intact r temporal incision healing well, no erythema/edema mouth poor dentition, multiple caries neck lateral necks clean/dry/intact; sternal notch healthy appearing tissue oozing serosanguinous fluid, no surrounding erythema/edema, no ttp rrr no m/r/g, though soft hs ctab soft nt/nd sacrum/scrotum red, raw skin; area of breakdown (st ii) at sacrum penis circumcised no c/c/e 1+ dp b/l neuro able to move all extremities, intermittent confusion at night psych intact pertinent results: 07:16am blood wbc-8.6 rbc-3.26* hgb-10.1* hct-30.5* mcv-93 mch-31.0 mchc-33.2 rdw-16.2* plt ct-666* 03:52am blood wbc-17.9* rbc-2.21* hgb-6.8* hct-20.1* mcv-91 mch-30.8 mchc-33.9 rdw-15.1 plt ct-608* 02:09pm blood wbc-20.0* rbc-3.40*# hgb-10.6*# hct-30.1*# mcv-89 mch-31.0 mchc-35.0 rdw-15.8* plt ct-619* 08:35pm blood wbc-23.7*# rbc-4.01* hgb-12.9* hct-35.1* mcv-87 mch-32.0 mchc-36.6* rdw-13.4 plt ct-308 07:16am blood neuts-74.9* lymphs-16.8* monos-5.7 eos-2.1 baso-0.5 07:16am blood glucose-93 urean-17 creat-0.9 na-136 k-4.9 cl-103 hco3-26 angap-12 04:30am blood glucose-185* urean-54* creat-2.1* na-135 k-3.3 cl-103 hco3-20* angap-15 07:02am blood alt-16 ast-24 alkphos-173* totbili-0.4 brief hospital course: principal diagnosis: septic shock with necrotizing fasciitis of the right temporal region and anterior right and left neck secondary to group a beta-hemolytic streptococcus operations during admission : neck exploration, irrigation and debridement of necrotizing fasciitis of right face and neck and left neck. : neck exploration, irrigation and debridement of necrotizing fasciitis of inferior neck. : neck exploration, wash out and debridement of neck. : complex wound closure of the neck and right temporal area measuring approximately total of 20 centimeters. procedures during admission : placement of cvl (left scl), placement of a-line (r forearm) : rewiring of cvl consultations during medical intensive care unit surgical intensive care unit infectious disease oral maxillo-facial surgery plastic surgery opthalmology general surgery medicine brief hospital course the patient was admitted to the micu on given the rapid progression of his facial swelling and periorbital edema. in the ed he was noted to be febrile to 102 but hemodynamically stable with a creatinine of 2.1, leukocytosis of 23.1. he was given vancomycin, ceftriaxone, and flagyl and admitted to the micu. he was seen by opthalmology and otolaryngology. on the patient became progressively hemodynamically unstable and was started on levophed for pressure support. ct scan of the head and neck and cta revealed subcutaneous inflammatory changes, subgaleal soft tissue edema, right greater than left, extending into the right preauricular and preseptal areas and neck down to the level of the thyroid, but no evidence of drainable fluid collection, subcutaneous emphysema, gas formation, or thrombus. his erythema and edema were thought initially to be improving on antibiotics, but given his hemodynamic instability and concern for necrotizing fasciitis the patient was taken to the operating room by otolaryngology on for neck exploration, irrigation and debridement of necrotizing fasciitis of right face and neck and left neck. pathology results showed necrosis of fibroadipose and muscle, no fascia seen, abscess, and gpcs in pairs/clusters/chains. postoperatively the patient entered florid sepsis; he became more hemodynamically unstable and acidemic to 7.2, his wbc rose to a high of 41, and he was placed on three pressors, (levophed, neo, and vasopressin), though he continued to have urine output. eventually he became more hemodynamically stable, but given his continued need for pressors, leukocytosis, and spreading erythema down the chest, the patient was taken to the or again on for neck exploration, irrigation and debridement of necrotizing fasciitis of inferior neck. infectious disease had been consulted, and from - the patient was maintained on linezolid, flagyl, and ceftazidime. on he was weaned off pressors, and his white count decreased, but he developed atrial fibrillation with a regular ventricular rate but with resulting hypotension, and so was started on amiodarone. his cultures from in the blood at grew group a beta hemolytic strep; his wound cultures on grew out staph coag negative and , , grew group a beta-hemolytic strep. given these results on his antibiotics were changed to clindamycin and penicillin g per id recommendations. the erythema on his chest continued to spread, however, and so he was given one dose of vancomycin and then placed on linezolid for its toxin-fighting effects, with discontinuation of clindamycin, per id. he was also taken back to the operating room on for concern with worsening necrotizing fasciiting; he underwent neck exploration, wash out and debridement of neck. the tissue following debridement was noted per report to be healthy without signs of infection. postoperatively the patient's erythema was noted to be decreasing and his hemodynamics improving. on he was placed on po amiodarone but then put back on iv on as he converted back to af, and he was started on a heparin drip. on he was started on a lasix drip in order to diurese him as he was now hemodynamically stable but 21 liters positive. on the patient was extubated without difficulty. on he was thought to be moving the right hand less than the left, and so given his previous periods of hypotension he underwent a nchct, that was negative for acute infarct. on his wbc rose to 24 from 16.7 and so given concern for alternate sources of infection he was checked for c dif, his cvl was changed, a ua was negative, and cxr showed b/l pleural effusions. he remained with a persistent leukocytosis and thrombocytosis, so on omfs was consulted given concern for odotogenic source of infection. though the patient had may carious teeth, they did not find any abscess or explanation for his abnormal lab values. clinically, however, he was improving with his wound granulating and the erythema dramatically decreasing. of note, no source for his infection was found, though given that his symptoms began as a sore throat he most likely had a streptococcal tonsillitis with spread across fascial planes and resulting necrotizing fasciitis. on - the wound, initially oozing while he was on heparin, stopped with surgicel and the cessation of heparin gtt as the patient converted back into sinus rhythm. his iv amio was converted to po amio on . in the setting of persistent oozing he was transfused four units of prbc on for a hct of 20 down from 28. opthalomology came to see the patient again, and noted periorbital edema but no endopthalmos or damage to the optic nerve from the infection. the patient was also started back on his home antihypertensive agents, his lasix drip discontinued, and he was started on lasix. a speech and swallow consulted recommended nectar thick liquids and pureed softs foods for a pleasure diet, with primary feeds through the ngt, an advancement from his prior failed study. on he was deemed stable to be transferred to the floor. his cvl was removed. on he underwent a medicine consult for control of his blood pressure, hx cva and diuresis mangement as he was initially 21, now 10 liters positive from admission. clinically he remained slightly edematous. on he underwent partial surgical closure by plastic and reconstructive surgery of his neck wound. he tolerated the procedure well and was returned to the floor after a short stay in the pacu. on repeat speech and swallow recommended thin liquids, pureed foods, and pills with pureed foods and supervision. his tube feeds were discontinued and the dophoff removed. the patient was converted back to his home antihypertensive regimen (nifedipine, lisinopril, toprol). his aspirin was continued throughout his stay. his foley catheter was removed. on the linezolid was discontinued per id. he was also seen by physical therapy again, who, though noted improvement, recommended short term rehab given his recent infection. the patient had a persistent leukocytosis of unclear etiology following the third operation; he was pancultured without effect; c dif was negative, cxr, ua unremarkable. the wbc normalized following wound closure on . he also had a thrombocytosis that similarly began dropping following wound closure; these most likely were reactive to his open wound. the patient also underwent a wound care consult for skin breakdown secondary to loose stool from the tube feedings in spite of regular turning. he was started on antifungal cream and placed on an air mattress. his foley catheter was removed on . throughout his stay he was maintained on gi and dvt prophylaxsis. the patient is being discharged today in stable condition. primary issues on discharge: 1. necrotizing fasciitis secondary to group a strep: the infection has resolved. the wound remains partially open at the sternal notch and needs to be dressed with wet to dry sterile gauze with xeroform qd on the incisions all covered with kerlex until deemed necessary at the patient's follow-up appointment with dr. . the patient needs penicillin g with last day tuesday . id also recommended follow-up panorex dental films per id to fully evaluate for an infection source; omfs recommended follow up extraction of teeth # 5, 12, 11, 19. 2. atrial fibrillation: af with regular vr occurred in the context of his infection and was well controlled with iv then po amiodarone. the patient's primary care physician shall have to decide whether to continue the patient on long-term amiodarone as well as on anticoagulation ( 4 per medicine consult). anticoagulation was held as per medicine consult given the patient had an open wound with recent surgery during his hospitalization. given that his af occurred during sepsis it may be that he does not require anticoagulation or antiarrythmics at all. he should have lfts and thyroid function tests done in one week. 3. type ii diabetes mellitus: the patient was not taking any meds for dm prior to admission; here has required high doses of insulin while on tube feeds. his nph was decreased to 15 from 30 when his diet was changed from tube feeds to po intake. the sliding scale remained the same. this may be titrated as an outpatient as the patient's diet changes. the patient may also be changed to oral medications as seen fit by his primary care doctor. 4. fluid overload: the patient was aggressively given ivf while septic and then diuresed, though still clinically not back to his baseline weight. he has no diagnosis of congestive heart failure and no clinical evidence, and so diuresis was discontinued on per medicine recommendations. 5. hypertension: tirate as necessary. the patient was discharged on his home medications. 6. incontinence: the patient has been incontinent of stool and urine. he will need careful attention to cleaning to prevent further skin breakdown. medications on admission: lisinopril 30 mg daily toprol 50 mg daily nifedipine er 30 daily assa 325 daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 4. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). 5. petrolatum ointment sig: one (1) appl topical tid (3 times a day) as needed. 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 7. lisinopril 20 mg tablet sig: 1.5 tablets po daily (daily). 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. acetaminophen 160 mg/5 ml solution sig: one (1) po q4h (every 4 hours) as needed. 11. nifedipine 30 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 12. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 13. penicillin g potassium 20,000,000 unit recon soln sig: one (1) recon soln injection q4h (every 4 hours) for 4 days: last day . 14. sodium chloride 0.9 % 0.9 % solution sig: one (1) ml injection q8h (every 8 hours) as needed for line flush. 15. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day): this may be discontinued as the patient recovers from his illness. 16. insulin nph human recomb 100 unit/ml suspension sig: one (1) 15 units nph subcutaneous q breakfast, q dinner: please check blood glucose ac and hs; insulin doses will need to be titrated as the patient's diet changes. 17. insulin lispro 100 unit/ml cartridge sig: one (1) sliding scale subcutaneous qac and hs: sliding scale: 2 units for every blood glucose > 120; increase by 2 units of lispro as the blood glucose increases by 20 (eg 141 4 units, 161 6 units etc). 18. outpatient lab work please check blood glucose ac and hs prior to administering insulin and titrate fixed and sliding scale as necessary for tight glucose control. 19. outpatient lab work the patient should have outpatient laboratory cbc, chemistry, lfts, thyroid function tests drawn in one week. discharge disposition: extended care facility: discharge diagnosis: 1. necrotizing fasciitis secondary to group a streptococcus 2. septic shock 3. atrial fibrillation with regular ventricular rate that occurred in the context of infection 4. type ii diabetes mellitus pmx: cva w/broca's aphasia, r sided weakness, cva with residual mild right hemiparesis and broca's aphasia peripheral neuropathy, unknown etiology hypertension osteoarthritis s/p lap chole discharge condition: stable discharge instructions: 1. take your medicines as prescribed. pills should be crushed and given with pureed foods under supervision. 2. activity: as prescribed by rehab services, wbat 3. diet: diabetic/consistent carbohydrate, thin liquids with pureed foods 4. wound care: -sternal notch wet to dry sterile gauze q8h -incisions: xeroform qd. -wrap both incisions and sternal notch with kerlex -right temporal area: wet to dry sterile gauze q8h until sufficiently closed that it no longer requires. -buttocks/sacral area (stage ii)/scrotum: please apply critic clear af daily and prn. please keep area clean and dry as possible. 5. if you develop any fever > 101.5, chills, foul smell from your wound, pus or excess fluid oozing from your wound, redness or swelling around the wounds, chest pain, or shortness of breath, or any other concerning symptoms, then please call our office and/or go to the emergency room. 5. please see discharge summary for remainder of instructions on medications that will need to be titrated as an outpatient; namely, amiodarone, insulin sliding scale. followup instructions: 1. dr. , otolaryngology: monday 1:45 pm. , . 2. dr. , plastic surgery: wednesday at 9:30 am () 3. dr. , your primary care doctor. tuesday 1:45 pm. fax 4. oral surgery; please call to schedule an appointment for dental extractions procedure: venous catheterization, not elsewhere classified insertion of endotracheal tube fiber-optic bronchoscopy other intubation of respiratory tract excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue other incision of thyroid field other myectomy other myectomy injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified unspecified essential hypertension unspecified septicemia severe sepsis atrial fibrillation hematoma complicating a procedure acute respiratory failure septic shock cellulitis and abscess of upper arm and forearm other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation hypoxemia staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus accidents occurring in residential institution unspecified hereditary and idiopathic peripheral neuropathy stridor cellulitis and abscess of other specified sites difficulty in walking cellulitis and abscess of face essential thrombocythemia necrotizing fasciitis cellulitis and abscess of neck streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a orbital cellulitis other disorders of ear 

Answer: The patient is high likely exposed to