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: hypotension major surgical or invasive procedure: central line placement history of present illness: ms. is a 57 year old woman with history of hypertension who presented to the ed with throat and mouth pain and hematuria. she notes a swollen left neck which is tender to palpation. she had myalgias and fevers for the past several days, along with gross hematuria for the past two weeks (although she has a history of microscopic hematuria). she denies headache, cough, dysuria. . she was seen three days ago in the ed, where she presented for multiple complaints. a u/a was performed and was negative for infection but grossly bloody. she was discharged with no other interventions. . on the day of admission, she saw her pcp and was sent to the ed with concern for peritonsillar abscess and abnormal labs (elevated white count). at some point she was seen by ent and was started on acyclovir and prednisone 10mg daily for zoster on the tonsils. . in the ed on the day of admission, her vital signs were t98.5, hr 87, bp 91/61, rr 22, sat 93%ra. she received levofloxacin 750mg x 1, ceftriaxone 2g x 1, and vancomycin 1g x 1. initial lactate was 2.8. a ct neck was performed without contrast (given elevated creatinine) with no peritonsillar abscess noted. her temperature was noted to climb to 103f and her blood pressures were dropping, so a right ij was placed. levophed was started in the ed. she received a total of 7l fluid in the ed. . on arrival to the micu, she was mildly short of breath and extremely wheezy. her breathing improved with nebulizer treatments and use of non-invasive ventilation. her blood pressure stabilized off of pressors. she grew gram positive rods anaerobic bottles. she received vancomycin and augmentin. she appeared fluid overloaded from agressive hydration and required supplemental oxygen and nebulizers to help with her breathing. she was stable on transfer to floor. past medical history: - hypertension - history of microscopic hematuria, followed by dr. , with cystoscopy in that showed: urethra- normal without tumors, diverticuli, or calculi; bladder- no tumors, diverticuli, or calculi noted. ureteral orifices were normal in size and location with clear efflux; mild trigonitis social history: originally from , strong family support, speaks and understands some english family history: non-contributory physical exam: vs: t97.7f, bp 117/68, hr 92, sat 94%6lnc gen: pleasant, mildly uncomfortable, no acute distress heent: perrl, eomi, anicteric, dry mucous membranes, op without lesions neck: minimal swelling in left anterior neck without defined mass appreciated; no supraclavicular or cervical lymphadenopathy, unable to appreciate jvpt; rij triple lumen catheter in place resp: diffuse inspiratory and expiratory wheezes bilaterally cv: rrr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, 2+ pulses; trace edema bilaterally skin: appears diffusely swollen neuro: awake, alert pertinent results: admission labs: . venous sat: 7.27/38/41/18 lactate 1.1 o2sat: 68 . na 141 k 3.1 cl 115 hco3 17 bun 52 creat 1.9 <-- 2.9 gluc 103 . ca: 5.3 mg: 1.8 p: 2.1 . alt: 27 ast: 25 ap: 209 tbili: 1.2 alb: 1.8 ldh: 190 : 39 lip: 47 . wbc 7.0 hgb 10.2 hct 30.2 plt 21 n:88.9 band:0 l:10.5 m:0.4 e:0.2 bas:0.1 . pt: 14.1 ptt: 34.8 inr: 1.2 . ekg: normal sinus rhythm, normal axis, normal intervals. isolated q in iii. no ischemic changes. . imaging: cxr : the heart is mild to moderately enlarged in size with a left ventricular configuration. the aorta is mildly tortuous. the mediastinal and hilar contours are grossly unremarkable. the lung volumes are overall low. there is bibasilar atelectasis. no discrete focal opacity is identified. the soft tissues and osseous structures are grossly unremarkable. impression: no acute cardiopulmonary process. . unilat up ext veins us left port : deep vein thrombosis of the left internal jugular vein. . ct neck : 1. limited evaluation secondary to lack of intravenous contrast administration. no definite left tonsillar abnormality. 2. septal thickening and bilateral pleural effusions likely reflect an element of pulmonary edema. clinical correlation recommended. . mra neck w/o contrast : left internal jugular vein and basal left sigmoid sinus thrombosis. left internal jugular vein thrombophlebitis. surrounding induration suggeting infection. no evidence of abscess. . unilat up ext veins us left : occlusive thrombus within the right internal jugular vein, unchanged in appearance and extent compared to 3 days prior. . mrv head w/o contrast : findings on the mrv of the head is suggestive of extension of jugular vein thrombosis to the left sigmoid sinus. otherwise, the mrv of the head is normal. . ct neck w/contrast (eg:parotids) : left internal jugular vein septic thrombophlebitis extending to the skull base with edema in the retropharyngeal space, without convincing drainable fluid collection identified. moderate-sized bilateral pleural effusion with worsening of airspace disease in the right lung apex. . ct head w/o contrast : no intracranial hemorrhage or mass effect. . carotid series complete : no evidence of internal carotid artery stenosis on either site. . cta chest w&w/o c&recons, non-coronary : 1. no pulmonary embolism. 2. predominantly peripherally located, mostly wedge-shaped pulmonary opacities without areas of cavitation could be consistent with early septic emboli. however, other infectious and inflammatory etiologies should be considered. 3. partial occlusion of the left brachiocephalic vein with extension of clot from the left internal jugular vein. possible occlusion of the left axillary vein, although this is incompletely assessed on this study. if there is clinical concern for left-sided venous obstruction, a dedicated ultrasound venous exam should be performed. 4. moderate pleural effusions. . ct neck w/contrast (eg:parotids) : 1. again demonstrated is thrombosis of the left internal jugular vein likely extending cephalad up to the sigmoid sinus. 2. there are no abscesses of the neck. 3. no significant change in the cervical lymph nodes. 4. again seen are moderate bilateral pleural effusions and ground-glass densities of the right lung apex. . tte : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. 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 leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: 57yf with no major past medical history who presented with fever, hypotension, and left neck swelling and found to have l ij septic thrombophelbitis, strep milleri bacteremia, and basal left sigmoid sinus thrombosis. . # septic shock: this resolved within 24 hours in the icu upon initiation of antibiotics. the source is felt to be septic thrombophlebitis of l ij. blood cultures on admission grew strep milleri bactermia. please see below. . # septic thrombophlebitis of l ij and strep milleri bactermia: patient initially presented with septic shock and was able to remain off pressors. initially pt was discontinued off acyclovir and prednisone and started on unasyn and vancomycin for broad coverage. ent was consulted to evaluate for abscess, of which none was found, and followed the patient. pt quickly stabilized and was transferred to the medical floor. blood cultures on admission grew strep milleri. id was consulted, and patient was transitioned to ceftriaxone and metronidazole for coverage of strep milleri bactermia and other oropharyngeal microorganisms x 4 weeks. surveillance cultures were all negative. a cta chest shows septic emboli. an tte did not show evidence of valvular vegetations. there is a still a question of the source of infection as the patient had no recent dental work and her monospot was negative. she will follow up with clinic and have weekly cbc and chem 7 faxed to the clinic. pt will also follow up with ent. . # sigmoid sinus thrombosis: neurology was consulted and recommended heparin gtt with ptt goal of 50-70. this was initiated after mrv with gradient of the head ruled out microscopic venous bleeding. she also had frequent neurochecks. she was transitioned to warfarin and discharged with lovenox bridge. her inr will be followed by her pcp. may be considered as outpatient. . # hypoxia: pt initally required supplemental o2. this was gradually weaned off and by discharge ambulated in halls with o2 sat of 97%. this was likely due to combination of pulmonary edema and septic emboli in the lungs. she was ruled out for mi by cardiac enzymes and ekg. . # pulmonary edema: this was likely due to capillary leak from sepsis in setting of fluid resuscitation and responded to aggressive diuresis. echo showed lvef of >55%. . # septic pulmonary emboli: ij septic thrombosis is highly associated with septic pulmonary emboli. cta showed suggestive evidence of septic emobli in the lung. no sig. pe seen on cta chest. . # acute renal failure: arf was likely secondary to atn in the background of glomerulonephritis. creatinine improved to 1.1, her baseline, by discharge. . # glomerulonephritis: pt has a history of hematuria. renal was consulted and felt the pt may have iga nephropathy. aso titer was neg. c3, c4 were wnl. given elevated protein to creatinine ratio of 1.2-1.6, pt was started on lisinopril per renal recommendations. pt will follow up with nephrology as an outpatient. . # anemia: iron studies suggest anemia of chronic disease but high ferritin may have reflected the infection. retic count was initially low likely to bone marrow suppression from infection but later recovered. vit b12 and folate were wnl. hemolysis labs were negative. heme/onc was followed and she will follow up with heme/onc as an outpatient. . # thrombocytopenia: heme/onc was consulted and felt this was most likely sepsis. this resolved upon discharge. . # htn: her outpatinet anti-hypertensives metoprolol and hctz were discontinued on admission given septic shock. as her bp recovered, she was started on ace-i for her proteinuria per nephrology. the bp was well-controlled on lisinopril 5 mg. . # hyperglycemia: pt had no h/o dm. this was likely infection and resolved prior to discharge. she was initially placed on a humalog ss and this was eventually discontinued as her blood sugars normalized with treatment of the infection. medications on admission: hydrochlorothiazide atenolol fosamax acyclovir 400mg prednisone 10mg discharge medications: 1. ceftriaxone 1 gram recon soln sig: one (1) gram intravenous q24h (every 24 hours): last dose 12/30. disp:*qs until * refills:*0* 2. outpatient lab work cbc and chem 7 q week (monday) starting until . please fax results to: (. 3. outpatient line care saline 5-10 cc sash prn heparin 100 units/ml 3-5 cc sash prn 4. lovenox 60 mg/0.6 ml syringe sig: one (1) syringe subcutaneous twice a day for 1 days. disp:*2 * refills:*0* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. warfarin 2 mg tablet sig: one (1) tablet po daily16 (once daily at 16). disp:*30 tablet(s)* refills:*2* 7. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 weeks: please continue until . disp:*63 tablet(s)* refills:*0* 8. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 10. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed. discharge disposition: home with service facility: homecare discharge diagnosis: primary: septic thrombophlebitis sigmoid sinus thrombosis pulmonary edema thrombocytopenia acute renal failure . secondary: anemia hypertension discharge condition: stable discharge instructions: you were admitted for neck pain and was found to have an infected blood clot in one of your neck veins. you were treated with antibiotics. you will need to take the antibiotics ceftriaxone and metronidazole until . while you are on the antibiotics, you will need weekly labs tests, which need to be faxed to the infectious clinic. you will follow up with infectious diseases and ear/nose/throat as an oupatient. . you are also being treated with blood thinners. you will to take the blood thinners for at least 6 months. you will need frequent blood tests to monitor how thin your blood is. the blood tests are called pt and inr. depending on how thin your blood is, your warfarin will be adjusted. while your blood reaches an adequate level of thinness, you will need to take lovenox (another type of blood thinner that is injected into your belly) today and tomorrow. your primary care physician . will follow these blood tests; she has been notified. you will also follow-up with neurology service as an outpatient. . you have evidence of losing protein in your urine. the nephrology (kidney) service has been following you. you will follow-up with nephrology as an outpatient. . your red blood cell count has also been low. you will need to follow-up with hematology as an outpatient. . please take your medications as prescribed. in addition to the antibiotics and blood thinner warfarin, you have been started on lisinopril for you kidneys. the hematology service also recommended that you take folic acid to help increase your blood counts. we have discontinued your hydrochlorothiazide, atenolol, acyclovir, and prednisone. . if you develop fever, worsening neck pain, worsening headache, muscle weakness, numbness or tingling, or any other concerning symptoms, please call your primary care physician . at or go to the emergency department. followup instructions: your appointment with your primary care physician . is on at 9:45 am. the clinic number is . . you also have an appointment with dr. of ear nose and throat on at 1:15pm. please call the clinic number ( to confirm and for directions. . you have an appointment with infectious diseases on at 1:30. the clinic number is (. you will also need weekly blood working including complete blood count and chemistry panel that need to be faxed to the clinic. . your appointment with dr. of nephrology (kidney) is on at 3pm. the clinic number is (. . your appointment with dr. of neurology on at 1:30pm. the clinic is trying to schedule an earlier appointment for you and will call you at home when one is scheduled. . please also follow up with dr. and dr. of hematology (blood) within 3 weeks. the clinic has been contact and it working on scheduling an appointment for you. please call the clinic at ( to confirm your appointment. procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation injection or infusion of other therapeutic or prophylactic substance injection of antibiotic diagnoses: anemia of other chronic disease acute kidney failure with lesion of tubular necrosis unspecified pleural effusion unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified pulmonary collapse defibrination syndrome septic shock streptococcal septicemia systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction other abnormal glucose acute edema of lung, unspecified phlebitis and thrombophlebitis of intracranial venous sinuses phlebitis and thrombophlebitis of other sites septic pulmonary embolism 

Answer: The patient is high likely exposed to