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: penicillins attending: chief complaint: transfer for gpc sepsis major surgical or invasive procedure: picc placement central line placement at intubation at history of present illness: 63 yo m with pmh of htn and transferred from icu for gpc sepsis. patient presented to ed with ams on per his wife. on morning was in normal state of health and went to run an errand for a 15 minutes. when he returned he was rigoring and c/o feeling poorly. that afternoon he episodes of nausea/vomiting/diarrhea with yellow liquid stool and became altered. ems was called and he was brought to er. . in the ed at , he was febrile to 103.7--->104 after tylenol. admitted to icu. received total of 8l ns after dropping pressures to 70's and sinus tach to 100's. he was started on levophed with recovery of pressures to 100's. a l sc cvl was placed. labs remarkable for wbc of 24, cr of 1.5, and blood cultures grew out gpc in chains in bottles. ua negative. uop was poor at 75cc over several hours. treated with ctx, vanco, zofran and tylenol. . upon arrival to the unit here patient is intubated and sedation and appears comfortable. . review of systems: unable to obtain (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: s/p splenectomy after ruptured spleen at age 16 mono htn vertigo social history: works in desk job, lives with wife. - tobacco: none - alcohol: 1 drink/month - illicits: none family history: unable to obtain at the time of admission. physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 05:44am blood wbc-34.6* rbc-3.93* hgb-12.6* hct-37.7* mcv-96 mch-32.1* mchc-33.4 rdw-13.5 plt ct-211 05:46am blood wbc-23.2* rbc-3.51* hgb-10.9* hct-32.9* mcv-94 mch-31.0 mchc-33.1 rdw-14.8 plt ct-290 01:58am blood neuts-82* bands-9* lymphs-4* monos-2 eos-0 baso-0 atyps-0 metas-2* myelos-1* 04:56am blood neuts-85* bands-0 lymphs-7* monos-3 eos-0 baso-0 atyps-3* metas-2* myelos-0 nrbc-1* 02:39pm blood pt-19.9* ptt-50.0* inr(pt)-1.8* 02:31am blood pt-14.1* ptt-25.6 inr(pt)-1.2* 02:39pm blood fibrino-463* 05:44am blood glucose-102* urean-34* creat-1.5* na-142 k-3.7 cl-112* hco3-17* angap-17 05:46am blood glucose-102* urean-19 creat-0.7 na-137 k-4.1 cl-107 hco3-21* angap-13 02:39pm blood ck(cpk)-3263* 01:58am blood ck(cpk)-5664* 09:17am blood ck(cpk)-4502* 02:39pm blood ck-mb-20* mb indx-0.6 ctropnt-0.14* 01:58am blood ck-mb-18* mb indx-0.3 ctropnt-0.14* 09:17am blood ck-mb-14* mb indx-0.3 ctropnt-0.08* 04:56am blood ck-mb-3 ctropnt-0.04* 05:44am blood calcium-6.7* phos-3.7 mg-1.1* 05:46am blood calcium-7.2* phos-2.4* mg-1.9 02:39pm blood d-dimer-* 05:44am blood osmolal-301 06:38am blood lactate-3.8* 03:54am blood lactate-2.0 03:47pm urine color-yellow appear-clear sp -1.027 11:26am urine color-yellow appear-hazy sp -1.022 03:47pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 11:26am urine blood-lg nitrite-neg protein-100 glucose-tr ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 03:47pm urine rbc-19* wbc-8* bacteri-none yeast-none epi-0 11:26am urine rbc-49* wbc-11* bacteri-none yeast-few epi-0 transe-1 11:26am urine castgr-2* 11:26am urine hours-random creat-144 na-48 11:26am urine osmolal-749 10:35pm cerebrospinal fluid (csf) wbc-1 rbc-1* polys-24 lymphs-32 monos-44 10:35pm cerebrospinal fluid (csf) totprot-44 glucose-109 blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient urine urine culture-final inpatient csf;spinal fluid gram stain-final; fluid culture-final inpatient sputum gram stain-final; respiratory culture-final inpatient mrsa screen mrsa screen-final inpatient sputum gram stain-final; respiratory culture-final inpatient urine urine culture-final {gram positive rods} inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final inpatient echocardiography report echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.5 cm <= 4.0 cm left atrium - four chamber length: 5.1 cm <= 5.2 cm right atrium - four chamber length: *5.1 cm <= 5.0 cm left ventricle - septal wall thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.3 cm <= 5.6 cm left ventricle - systolic dimension: 3.4 cm left ventricle - fractional shortening: *0.21 >= 0.29 left ventricle - ejection fraction: 45% >= 55% left ventricle - stroke volume: 38 ml/beat left ventricle - cardiac output: 3.58 l/min left ventricle - cardiac index: *1.71 >= 2.0 l/min/m2 left ventricle - lateral peak e': 0.09 m/s > 0.08 m/s left ventricle - septal peak e': *0.08 m/s > 0.08 m/s left ventricle - ratio e/e': 9 < 15 aorta - sinus level: 3.2 cm <= 3.6 cm aorta - ascending: 3.1 cm <= 3.4 cm aortic valve - peak velocity: 1.4 m/sec <= 2.0 m/sec aortic valve - lvot vti: 12 aortic valve - lvot diam: 2.0 cm mitral valve - e wave: 0.8 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 0.80 mitral valve - e wave deceleration time: 163 ms 140-250 ms pulmonic valve - peak velocity: 1.0 m/sec <= 1.5 m/sec findings right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness and cavity size. mild global lv hypokinesis. no resting lvot gradient. no vsd. right ventricle: borderline normal rv systolic function. aortic valve: mildly thickened aortic valve leaflets (3). no as. no masses or vegetations on aortic valve, but cannot be fully excluded due to suboptimal image quality. no ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. no mass or vegetation on mitral valve. no ms. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. no mass or vegetation on tricuspid valve. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: no ps. pericardium: no pericardial effusion. conclusions no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. there is mild global left ventricular hypokinesis (lvef = 45 %). there is no ventricular septal defect. rv with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. if clincally indicated, a tee is suggested to exclude a small valve vegetation. radiology report chest (portable ap) study date of 7:45 am final report indication: ett, nasogastric tube placement. comparison: no comparison available at the time of dictation. findings: the tip of the endotracheal tube projects 4 cm above the carina. the course of the nasogastric tube is unremarkable, there is no evidence of complications, the tip is not visualized on the image. left-sided central venous access line placed over the subclavian vein. the tip of the line projects over the mid svc. again, no complications and notably no pneumothorax is seen. mild retrocardiac atelectasis. mild crowding of the right basal vascular structures. borderline size of the cardiac silhouette without evidence of pulmonary edema. radiology report ct head w/o contrast study date of 12:22 am findings: there is no acute intracranial hemorrhage or cerebral edema. there is preservation of normal -white matter differentiation. all four ventricles are moderately enlarged. however, the sulci are normal in size. no evidence of transependymal csf flow is seen. there is no abnormal extraaxial collection. there is mild mucosal thickening of the maxillary sinuses with a mucus retention cyst of the left maxillary sinus. there is extensive opacification of the ethmoid air cells. there is mild mucosal thickening in the sphenoid sinuses. the mastoid air cells are clear. impression: diffuse moderate ventriculomegaly without sulcal enlargement to suggest underlying atrophy. the chronicity of this finding is unknown in the absence of the previous studies. in the current clinical setting, this appearance is concerning for ventriculitis. mri with gadolinium is recommended for further evaluation. neurosurgical consultation should be considered if there are any clinical signs of increased intracranial pressure. ct chest w/o contrast; ct abdomen w/o contrast; ct pelvis w/o contrast findings: chest: there is a left-sided central venous catheter with tip at the distal brachiocephalic vein. chest wall is unremarkable. there is an endotracheal tube in place. there is a nasogastric tube in place with tip in the stomach. there are bilateral small pleural effusions. the bilateral airspace consolidation at the lung bases are most likely related to passive atelectasis. aorta and pulmonary vasculature are within normal limits. heart is grossly normal with no evidence of pericardial effusion. no significant lymphadenopathy. the tracheobronchial tree is patent. abdomen: no free intraperitoneal air. liver, pancreas, gallbladder, biliary tree, adrenals, and kidneys show no abnormalities. there are splenules in the left upper quadrant. visualized gastrointestinal tract shows no abnormalities. ct of the pelvis: there is a rectal tube in place and a foley catheter in place, in good position. visualized gastrointestinal tract is unremarkable. no pelvic free fluid is seen. no significant lymphadenopathy. urinary bladder and prostate show no abnormalities. bone windows: no suspicious osseous lesions. impression: 1. no evidence of abdominal collections and no acute intra-abdominal abnormalities. 2. bilateral small pleural effusions with adjacent atelectasis. 3. splenules in the left upper quadrant. radiology report mrv head w/o contrast study date of 5:02 pm findings: mri head: there is focal t2 signal hyperintensity in the left subinsular white matter and anterior limb of the left internal capsule, likely due to chronic microvascular infarction. the ventricles are enlarged for the patient's age of 63 years, out of proportion to sulcal size. there is no evidence of transependymal csf flow. there is no edema or mass effect. there is no slow diffusion to suggest acute ischemia. following administration of intravenous gadolinium, there is no evidence of abnormal enhancement. there is mucosal thickening with probable mucus retention cysts in both maxillary sinuses, the sphenoid sinuses, frontal sinuses, and opacification of multiple bilateral ethmoid air cells, without fluid levels to suggest acute sinusitis. there is opacification of the mastoid air cells bilaterally. fluid is also noted in the nasopharynx, a nonspecific finding. mrv head: there is asymmetry of the transverse sinuses, left smaller than right, a normal variant. there is no evidence of a filling defect within the dural venous sinuses on the postcontrast mprage images to suggest thrombosis. impression: 1. no evidence of intracranial infection or acute infarction. 2. ventricular enlargement out of proportion to sulcal size, without evidence of subependymal migration of cerebrospinal fluid. while there are no signs of vetriculitis, this appearance may represent communicating hydrocephalus (including, but not limited to, normal-pressure hydrocephalus). alternatively, this appearance could be secondary to predominantly central cerebral atrophy. recommend clinical correlation for further evaluation. 3. bilateral mastoid air cell opacification. please correlate clinically to exclude infection. 4. no evidence of dural venous sinus thrombosis. neurophysiology report eeg study date of findings: abnormality #1: throughout the recording, the background rhythm consisted of a low voltage mixed theta/delta activity. background: as above. there are technician notes of a head tremor which is seen on eeg to be a 3.5-4 hz movement artifact in the bioccipital leads without apparent epileptiform features. there is no evidence of electrographic seizures associated with these movements. hyperventilation: could not be performed due to the patient being intubated. intermittent photic stimulation: produced no activation of the record. sleep: no normal waking or sleep morphologies were seen during this recording. cardiac monitor: showed a generally regular rhythm with an average rate of 72 bpm. impression: this is an abnormal extended routine eeg due to slowing and disorganization of the background rhythm suggestive of a moderate to severe encephalopathy. medications, toxic/metabolic disturbances and infections are common causes. no epileptiform discharges or electrographic seizures were seen during this recording. brief hospital course: # strep pneumo sepsis: initially thought to be due to lung source, given small infiltrate seen on cxr at , and with since he had had a splenectomy when he was younger he was at increased risk of bacteremia. however, on arrival to imaging did not show any sign of pneumonia, and prior to his becoming ill did not have any localizing symptoms other than some nasal congestion, no tooth pain, shortness of breath or abdominal pain. he arrived from intubated, sedated, on pressors and on broad spectrum antibiotic coverage pending speciation results from his blood cultures. once his blood cultures grew out strep pneumo his antibiotic coverage was changed to ceftriaxone. during his icu in attempt to discern the source of the bacteremia, and due to his initial presentation with altered mental status a ct of his head was done, which showed enlarged ventricles, which was concerning for an intracranial process or possible meningitis. a lumbar puncture was done, two days after presentation due to dic, with an opening pressure of 26, neurology and neurosurgery were both consulted, and an mri was done which showed enlarged ventricles but no other concerning findings other than diffuse sinus disease. a ct of the torso and a tte were done to further evaluate source of infection were done but these were normal. lp cultures were negative, but it was decided that he would complete a 14 day course of meningitis dosing of ceftriaxone given altered mental status on admission. although, it was thought that due to the large amount of sinus disease that his sinuses were likely the source of infection. he remained intubated in the icu until when he self extubated, did very well post extubation and was soon transferred to the medicine service. his condition continued to improve while on the medicine service. meningitis dose ceftriaxone was continued and the patient remained afebrile. he was discharged with picc line and services to complete a 14 day course of ceftriaxone at home. . #. ams: patient presented with altered mental status. this was thought to be due to acute delirium in the setting of bactermia/sepsis. neurology was consulted for further evaluation of this, ct scan findings of dilated ventricles and tremulous movements that the patient was found to be exhibiting. an eeg was done and it ruled out seizure activity. his mental status improved with treatment of his septic shock and it returned to baseline prior to transferring to the medical service. . # acute kidney injury: cr 1.5 on admission and on repeat, thought to be due to atn in setting of sepsis. his creatinine improved during his stay as his underlying infection and blood pressures improved, making atn the likely diagnosis. his renal function was within normal limits upon discharge. . # atrial fibrillation: patient went into a.fib with rvr while he was intubated and on pressors during transport for a ct scan. he underwent the initial loading of amiodarone, and converted to a bradycardic sinus rhythm. he was not continued on amiodarone and was not started on anti-coagulation. his bradycardia improved throughout his hosptitalization. . # dic: patient's micu course was complicated by dic as he was found to have elevated markers on admission. ffp transfusion was attempted but had to be stopped because the patient became febrile. supportive therapy was continued and this subsequently resolved. medications on admission: pravachol aldactozide discharge medications: 1. pravastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) grams intravenous q12h (every 12 hours) for 7 days. disp:*28 grams* refills:*0* 3. augmentin 875-125 mg tablet sig: one (1) tablet po every twelve (12) hours as needed for fever: take if you develop fevers but only after your iv ceftriaxone course has finished. disp:*6 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: pneumococcal bacteremia secondary diagnosis: htn dl discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were transfered to the for management of your serious infection. you intially went to the medical intensive care unit were you required fluids and medications to maintain your blood pressure and a ventilator for assistance with breathing. you were treated with antibiotics and your condition improved. while on this medication to maintain the blood pressure you developed an abnormal heart rhythm called atrial fibrillation. you were treated with medications and this resolved but you subsequently had a slow heart rate. once you were not requiring medication to maintain your blood pressure and a ventilator for assistance breathing you were transfered to the medical floor. your condition continued to improve and your slow heart rate improved as well. you will need to finsh a 14 day course of the antibiotic ceftriaxone for your infection the last day being . you will also need to be vaccinated with the pneumonia, meningitis and h-influenza vaccines as an outpatient. medication changes: continue: ceftriaxone for 5 more days to complete a 14 day course, the last day is stop: aldactazide and discuss re-strating this medication with your pcp : augmentin every 12 hours take if you develop fevers but only after your iv ceftriaxone course has finished followup instructions: name: ,md address: , , phone: when: , at 10am **please request a referral to see dr. from dr. . fax referral to . **please discuss appropriate vaccinations after splenectomy with your pcp department: neurology when: tuesday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart arterial catheterization diagnoses: subendocardial infarction, initial episode of care anemia, unspecified acute kidney failure with lesion of tubular necrosis unspecified pleural effusion unspecified essential hypertension severe sepsis atrial fibrillation pulmonary collapse other and unspecified hyperlipidemia acute respiratory failure defibrination syndrome other specified cardiac dysrhythmias septic shock other acquired absence of organ fever, unspecified pneumococcal septicemia [streptococcus pneumoniae septicemia] metabolic encephalopathy electrolyte and fluid disorders not elsewhere classified benign paroxysmal positional vertigo unspecified sinusitis (chronic) unspecified sinusitis (chronic) cardiac rhythm regulators causing adverse effects in therapeutic use essential and other specified forms of tremor 

Answer: The patient is high likely exposed to