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: unasyn / zosyn attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation central venous line picc history of present illness: 51m with hx of morbid obesity, htn, hl, transferred from osh for cta. he was in usoh, felt well and worked full day on day of admission when he suddenly developed acute onset left sided popliteal/calf pain radiating to l flank/abdomen and left arm while driving. he did not have any other symptoms until he was in the ed at when he developed shaking chills, sob with laying flat and nausea with emesis x 3. only preceding illness was toe infection for which he had completed antibiotics 1 week prior (keflex and doxy) and which has limited his mobility the last month and a half. wife denies recent illness, fever, night sweats, sick contacts, although does report he had complained of chills at night over the last week. at osh, initial vs 99.3 139/83 103 22 93%ra. he received lovenox 150mg, dilaudid, zofran, spiked fever to 104 and was transferred for cta. in our ed, he was tachycardic 130s, hypotensive to 70s, 87% on nrb on arrival. pt had portable cxr that revealed bibasilar opacities consistent with aspiration vs atelectasis. labs significant for wbc 14 with 24% bands. he was given vanco 1g, zosyn 4.5g, and dopamine was started peripherally for hypotension. he was nasotracheally intubated for airway protection and received propofol and versed/fentanyl. he received duonebs. tmax in ed 100.3. ekg revealed r heart strain, d-dimer was positive at 2120, and cta was ordered and performed on the way up to the micu. . on arrival to the unit, he is intubated but alert and awake. he had episode of bilious emesis which was suctioned. he is unable to provide further history other than above as obtained by his wife. . review of systems: (+) per hpi per wife. otherwise negative. denied recent rash, illness, dysuria, change in bowel habits, travel, bug bites. past medical history: htn hl no known h/o cad or dm psh s/p l slipped epiphyses repair as child with screws in left hip s/p left shoulder surgery (no foreign body) s/p knee arthroscopic procedures with no retained foreign body social history: chef in family restaurant. married. lives with wife and 2 daughters. tobacco. occ etoh. no drugs. 2 cats at home. no known tick bites or other exposures. has camp in nh but does not spend much time outside. family history: non-contributory physical exam: vitals: t: bp: p: r: 18 o2: general: intubated, sedated, no acute distress heent: sclera anicteric, mm dry with blood tinged nasopharynx where nasotracheally intubated neck: thick, supple, jvp not elevated, no lad lungs: coares rhonchorous vented bs bilaterally, no wheezes cv: distant. regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops appreciated abdomen: obese. soft, tender diffusely over left side, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly appreciated ext: warm, well perfused, rle trace edema, lle 1+ edema with erythema and warmth. 2+ pulses, no clubbing, cyanosis or edema. erythematous intertriginous rash on groin. small 1x1cm superficial ulcers x 2 anterior shin, 1 1x1cm pustule left anterior shin, tender. right great toe with effaced nail, mild purulent exudate pertinent results: labs on admission : wbc-14.0* rbc-5.51 hgb-15.5 hct-49.6 mcv-90 rdw-14.5 plt ct-190 neuts-73* bands-23* lymphs-2* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 pt-12.3 ptt-28.1 inr(pt)-1.0 glucose-143* urean-26* creat-1.0 na-142 k-3.9 cl-104 hco3-31 angap-11 alt-28 ast-26 ld(ldh)-223 ck(cpk)-126 alkphos-62 amylase-30 totbili-0.7 lipase-19 calcium-8.9 phos-1.6* mg-1.6 lactate-2.4* . other labs: . 08:55pm blood ctropnt-<0.01 04:49am blood ck-mb-4 ctropnt-<0.01 probnp-1828* 05:07pm blood ck-mb-6 ctropnt-<0.01 . micro: blood cultures : streptococcus dysgalactiae ssp. equisimilis. sputum culture: oropharyngeal flora stool culture: c. diff negative . other studies: . ekg: sinus tachycardia. right axis deviation with s1-q3-t3 pattern consistent with acute or chronic right ventricular strain. diffuse non-diagnostic repolarization abnormalities. no previous tracing available for comparison. . cxr: bibasilar opacities may reflect atelectasis versus aspiration/pneumonia. please refer to ct chest performed subsequently for additional details. . cta: 1. exam extremely limited due to patient body habitus and poor bolus timing. however, no evidence of central or lobar pulmonary embolism. subsegmental pe cannot be excluded on this study. 2. posterior bilateral consolidations concerning for aspiration. . echo: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal for the patient's body size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: suboptimal image quality. hyperdynamic left ventricle . lle u/s: no evidence of left lower extremity dvt. . ct abd/pelvis w/o: 1. limited study due to patient body habitus, but no evidence of nephrolithiasis, intra-abdominal hemorrhage, or large abscess; these were the entities of apparent clinical concern. 2. nasogastric tube in stomach, but side port at or just above ge junction. 3. large left inguinal lymph node with adjacent inflammatory stranding of unclear significance. . ct ble w/o: benign-appearing osseous lesion of distal femoral diaphysis on the left. . cxr: as compared to the previous radiograph, nasogastric tube and endotracheal tube have been removed. also removed is the right-sided central venous access line. the lung volumes are mildly increased. better visible are bilateral basal and medial opacities with air bronchograms that could both correspond to aspiration. no other focal parenchymal opacities are present. unchanged size of the cardiac silhouette. . lle u/s: no evidence of dvts in left leg. brief hospital course: this is a 51m with htn, osa, morbid obesity now with acute onset of hypoxic hypercarbic respiratory failure and fever with leukocytosis and bandemia. . . # hypoxic hypercarbic respiratory failure: pt admitted with acute onset of hypoxic hypercarbic respiratory failure in the setting of left leg pain and fever which is concerning for pe vs infection/pna. a cta was obtained that was not suggestive of pe. leni's were done twice and were negative. initial ekg was suggestive of rv strain, but repeat ekgs and tte showed no evidence of rv strain. . the patient was intially started on empiric antibiotics of pneumonia, but once the endotracheal sputum sample showed no bacteria, his antibiotics were stopped. his blood culture was positive for streptococcus dysgalactiae. the underlying cause of most likely his lower extremity cellulitis rather than pneumonia. he was treated with unasyn and clindamycin. his respiratory failure was likely to a toxic shock picture related to his strep bacteremia. chest imaging also suggested an aspiration process, pneumonia vs. pneumonitis. he improved on his antibiotic course and tolerated extubation well on . however the patient had a high oxygen demand. he was on 5l nc during the day and needed 60% high flow in addition at night. the etiology of continued hypoxia was thought to be volume overload on top of underlying pickwickian syndrome. he improved with physical and respiratory therapy, antibiotics, and diuresis with lasix. on discharge, he was 96% on room air and 92% on ambulation/climbing stairs. he also has a history of cpap and was stabilized on hospital cpap with o2 sats in 90's and no awakenings. a sleep study is recommended for new cpap mask for home. . # hypotension: likely related to sepsis. the patient was initially managed with pressors, but this issue resolved with antibiotics. an echo was done that showed a preserved ef. an mi was ruled out with cardiac enzymes. the patient was restarted on his home antihypertensives. # sepsis/strep cellulitis: the patient presented with a septic picture, with hypotension, respiratory failure as above. blood cultures grew group c strep (streptococcus dysgalactiae). the source was thought to be left lower extremity cellulitis. a ct of his lower extremeties was not suggestive of necrotizing fascitis or osteomyelitis. the patient was treated with unasyn and clindamycin. however, the patient developed a severe rash, thought to be drug reaction to unasyn. urine showed rare eosinophils. the rash improved when unasyn stopped on . the patient was continued on iv clindamycin until day of discharge, and was then switched to po clindamycin to complete a 14 day total course (last day ). . # hyperglycemia: likely related to infection. it was treated with an insulin sliding scale. normoglycemic for remainder of course. # ecg changes: pt had lateral st depressions when tachycardic, likely demand related, have since have resolved with rate improvement. an mi was ruled out with cardiac enzymes and cardiology was consulted that agreed it was likely demand ischemia. # hypertension: after his hypotension resolved the patient started to gradually return to his baseline hypertensive state. he was restarted on his home bp medications. his blood pressure was within normal range on discharge. medications on admission: lisinopril 40mg po daily norvasc 5mg po bid lasix 20mg po bid metoprolol allopurinol 300mg po daily clonidine simvastatin asa 81mg discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 2. clindamycin hcl 300 mg capsule sig: two (2) capsule po q8h (every 8 hours) for 2 days: please continue until . disp:*12 capsule(s)* refills:*0* 3. lisinopril 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 4. aspirin 81 mg tablet sig: one (1) tablet po once a day. 5. amlodipine 5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. lasix 20 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 7. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 8. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 9. clonidine 0.1 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary: sepsis due to bactermia and cellulitis respiratory failure sleep apnea discharge condition: the patient was discharged in good condition, afebrile, hemodynamically stable. ambulating well with good oxygenation. discharge instructions: you were admitted to the hospital due to a severe infection. you required intubation to support your breathing. you were treated with antibiotics for the infection which came from your leg and spread into your blood. you were treated with lasix to improve your breathing. we treated your sleep apnea with cpap. . the following changes were made to your home medications: --> you will need to take clindamycin 3 times daily until . . you should call your pcp or seek medical attention if you experience fevers, chills, shortness of breath, diarrhea, or any other symptoms. followup instructions: please follow-up with dr. from infectious disease to ensure your leg infection is resolving and you do not need to continue antibiotics for longer. location: medical office bldg, . phone number: you will be contact by the clinic regarding appointment information. if you do not hear from them by friday, , please call. . please follow-up with your primary care provider, . date and time: , at 1:00pm location: medical bldg. post office square, , ma phone number: . md: drs. , : pulmonary sleep date and time: tuesday, @ 8:40am location: 8 phone number: ( special instructions if applicable: please have pt bring current cpap prescription if possible . md: drs. / : pulmonary date and time: thursday, @ 2pm for pft, 2:30pm to see the mds above location: 7 phone number: procedure: 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 diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension severe sepsis acute respiratory failure cellulitis and abscess of leg, except foot septic shock morbid obesity dermatitis due to drugs and medicines taken internally streptococcal septicemia penicillins causing adverse effects in therapeutic use other hyperalimentation dermatomycosis, unspecified 

Answer: The patient is high likely exposed to