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: shaking chills major surgical or invasive procedure: picc line placement liver abscess aspiration & drainage history of present illness: 54 y.o. male with hx of hypothyroidism, gerd presenting from park with shaking rigors and fever. the patient reports that symptoms started 2 days ago (night of ), woke up with chills and drenching sweats. he did not take his temp. the following morning went to work - had to change his shirt before leaving, again b/c of drenching sweat. endorses 2 episodes of mild burning on urination, headache, and neck ache - all have resolved except for mild nagging headache. he also reports fatigue. last night he went to a red sox game (drove up from ct) and during the game experienced rigors. he went to first aid and they sent him to the ed. in the ed, his initial vital signs were t 100.8 hr 119 bp 129/65 rr 18 o2 100% on 2l. he was triggered for hypotension to 70s sbp after had been in ed for 2 hours. a central line was placed and he was given 4l of ivfs, started on a levophed drip and received zosyn 4.5g, and vancomycin 1 gram. cxr showed atelectasis b/l bases vs. early infiltrate, and cta was performed and showed no pe, no acute aortic process, and moderate diffuse bronchial wall thickening c/w ?acute bronchitis. . review of systems: - + intentional weight loss 20 lbs in 1.5yrs on low fat, low carb diet - negative cough, nasal congestion, sore throat, ear pain - denies trauma, rash, tick bite, or lacerations - denies recent travel outside of , a few people sick at work, but doesn't know what they have - denies risky sexual behavior or diagnosis of stds - denies persistent neck pain - no lightheadedness past medical history: - hypothyroidism - gerd - hyperlipidemia - fibromyalgia social history: - tobacco: never - etoh: occasional - illicits: family history: - mother: hypothyroidism, heart disease - father: heart disease - sister: breast cancer age 51 - brother: healthy physical exam: admission: gen: nad, mildly diaphoretic vs: 97.7 97/70 26 o2 94% on ra heent: mmm, no op lesions, jvp 7cm, neck is supple, no cervical, supraclavicular, or axillary lad cv: rr, nl s1s2 no s3s4 mrg pulm: ctab abd: bs+, soft, ntnd, no masses or hsm, no stigmata of chronic liver disease limbs: no le edema, no tremors or asterixis, no clubbing skin: no rashes or skin breakdown, no nail lesions neuro: cnii-xii nonfocal, moving all extremities, no gross abnormalities . discharge vitals: tm/c 99.5 123/73 78 18 92ra pertinent results: . imaging: cxr: impression: low lung volumes with hazy basilar opacity. atelectasis is favored. early developing pneumonia cannot be entirely excluded. . tte: impression: no echocardiographic evidence of endocarditis. mild regional left ventricular dysfunction with low normal ejection fraction. mild right ventricular dilation with normal function. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. . cta-chest: impression: 1. no pe or acute aortic syndrome. 2. diffuse bronchial wall thickening. 3. mild pulmonary edema. 4. focal hepatic hypodense lesions. some of these might represent cysts or hemangiomas but are not well-characterized on this study. 5. vague 3.9 cm hypodensity is seen posterior to the caudate lobe, of uncertain significance - suggest mri of the liver to further evaluate this and the other hepatic lesions, particularly if there is concern for hepatic abscess as etiology of the fevers and hypotension. . ruq us: 1. wall edema within the gallbladder which may relate to third spacing given the rigorous fluid resuscitation and/or other etiologies such as superimposed hepatitis (though low elevation in lfts would not support this). the lack of any luminal distention essentially excludes acute cholecystitis and there are no gallstones visualized nor is there a positive son sign. 2. the multiple hypoattenuating lesions within the liver noted on the recent ct chest are not visualized. given the fever and hypotension of unknown origin, hepatic abscesses remain in the differential. if patient could tolerate, this could be best assessed with an mri of the abdomen. if not, a multiphasic liver examination can be performed at which time the pelvis can also be evaluated to exclude a gi source of seeding the portal system. . mri abdomen wet read: predominantly solid liver lesion with central fluid component and central stellate enhancement, in the clinical setting, an evolving liver abscess is possible however the central stellate enhancement also raises the possibility of focal nodular hyperplasia. if there is prior imaging, comparison is recommended. . mri liver impression: 4.5-cm segment vii lesion consistent with liver abscess in the patient's clinical context of sepsis. 12 mm indeterminate left renal mass, likely a complex cyst, to be followed in 3 months with renal-protocol mri. pericholecystic fluid, perinephric fat stranding and bilateral small pleural effusions, most probably representing state of fluid overload. . liver mri impressions: 1. pre-existing posterior right hepatic abscess is increased in size compared to prior mri study, again with complex appearance and thick internal septations. 2. adjacent septic thrombophlebitis involving a posterior branch of the right hepatic vein, also previously present, now propagated further. otherwise patent hepatic vasculature and ivc. 3. new small collection in segment vi of the liver, extending inferiorly from tract from prior intervention/drainage, may represent abscess or hematoma. no extra-hepatic fluid collection seen. 4. increased bilateral pleural effusions, now large on the right and small on the left, with adjacent atelectasis. 5. 13-mm upper pole left renal probable septated cyst is incompletely assessed on this non-dedicated study. dedicated renal imaging is recommended when clinically relevant . liver aspiration 1:00 pm abscess site: liver gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. singly and in pairs. smear reviewed; results confirmed. wound culture (preliminary): streptococcus anginosus (milleri) group. moderate growth. . blood culture, routine (final ): streptococcus anginosus (milleri) group. final sensitivities. sensitivity testing performed by sensititre. clindamycin = sensitive ( <=0.12 mcg/ml ). sensitivities: mic expressed in mcg/ml _________________________________________________________ streptococcus anginosus (milleri) group | clindamycin----------- s erythromycin---------- =>4 r penicillin g---------- 0.06 s vancomycin------------ <=1 s pending: 6:08 am abscess source: hepatic drain. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): anaerobic culture (preliminary): brief hospital course: 54 yo m with gerd, hypothyroidism, who presented with rigors, fever, and hypotension. pt was admitted to the icu for pressor requirement and sepsis. he was found to be bacteremic with strep mileri and extensive work up including echo revealed a liver abscess as the most likely source. pt was transferred to the floor where he underwent an ir guided attempt at drainage. this yeilded a small amount of purulence which was positive for gpcs but the procedure was complicated by a perihepatic hemorrhage and transient hypotension that responded to ivf and did not require a blood transfusion. pt was switched iv ceftriaxone for the pansensitive strep species and underwent repeat imaging of the liver which showed mild enlargement of the abscess with an associated septic thrombophlebitis. pt had a second attempt at drainage and successful placement of catheter. he was followed closely by infectious disease and interventional radiology. decision was made to monitor the septic thrombophlebitis given its small size, location and his increased risk for significant bleeding, and anticoagulation was deemed unnecessary. pt is being discharged home with iv ceftriaxone and a hepatic drain in place. pt was discharged home with vna to help provide line care and ceftriaxone 2grams daily. pt has been scheduled with id and will need serial imaging to assess for resolution of the abscess. we anticipate that the patient will need at least 3 weeks of iv ceftriaxone, althought he may require 6 weeks or longer. we recommend q week cbc to check his wbc while the liver drain is in place, followed by 3x/week cbc for a week following drain removal. the liver drain can likely be removed within the next several days. we recommend obtaining a follow up mri 1 week following hepatic drain removal, and again prior to discontinuing antibiotics. he is welcome to follow up with our infectious disease and interventional radiology departments, however considering the travel distance, it would be preferable for him to obtain specialists nearby that can follow him for these issues. our specialists would be happy to discuss with local providers to facilitate the transition of care. medications on admission: - protonix 40mg po daily - synthroid 88mcg po daily - lipitor 10mg po daily - benadryl 50mg po qhs - lexapro 10mg po daily discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 3. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 4. diphenhydramine hcl 25 mg capsule sig: two (2) capsule po hs (at bedtime) as needed for insomnia. 5. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) infusion intravenous q24h (every 24 hours): at least x 3 weeks; final duration to be determined in outpatient follow up. disp:*7 infusion* refills:*3* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. tizanidine 2 mg tablet sig: one (1) tablet po three times a day as needed for muscle spasms for 1 weeks. disp:*30 tablet(s)* refills:*0* 8. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*30 tablet(s)* refills:*0* 9. acetaminophen 325 mg tablet sig: two (2) tablet po three times a day as needed for pain. 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain for 1 weeks: on 12 hours/ off 12 hours. disp:*7 adhesive patch, medicated(s)* refills:*0* discharge disposition: home with service facility: critical care systems discharge diagnosis: primary: sepsis bacteremia liver abscess . discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with fevers and found have a blood infection secondary to a liver abscess. this has been treated with iv antibiotics and had two liver aspirations with placement of the catheter for continued drainage. you will need to continue receiving iv ceftriaxone 2grams daily via the picc line until you are seen in follow up by infectious disease doctors. you will need to continue iv antibiotics for a minimum of 3 weeks, but this may be extended to 6 weeks and sometimes longer. . please note the following changes to your medication regimen: ceftriaxone 2grams daily via picc line tizanidine 2 mg three times daily for spasms oxycodone 5-10 mg every 4-6 hours as needed for pain followup instructions: name: , a. address: , , phone: appt: at 1:30pm department: infectious disease when: thursday at 9:50 am with: , md building: lm bldg () campus: west best parking: garage although we recommend obtaining an infectious disease specialist more locally to follow you. our infectious disease specialists are happy to communicate with a local id physician to facilitate this transition. your primary care physician will follow you for your liver drain as well, and he may refer you to a local specialist for consideration of having this removed in the near future. we would recommend consideration of drain removal within the next several days to week. we recommend checking a cbc 3 times/week during the first week after discontinuation of the liver drain, and at least once per week that the drain remains in place. we recommend a follow up mri approx 1 week after discontinuation of the drain, and just prior to the discontinuation of antibiotics; sooner if the wbc increases or if fevers return. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified thoracentesis other incision of pleura transpleural thoracoscopy percutaneous aspiration of liver percutaneous aspiration of liver diagnoses: esophageal reflux severe sepsis unspecified acquired hypothyroidism hematoma complicating a procedure dysthymic disorder other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure septic shock abscess of liver hypoxemia streptococcal septicemia other symptoms referable to back myalgia and myositis, unspecified phlebitis and thrombophlebitis of other sites other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to