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: valium / aspirin / levofloxacin / levaquin attending: chief complaint: headaches on bending, fever major surgical or invasive procedure: 1. removal of right frontal ventricular catheter. 2. removal of right parietal connector and external tubing. 3. placement of new right frontal external ventricular drain and placement of right parietal external ventricular drain. history of present illness: 56 y/o female presents to er with cheif complaint of headaches upon bending. she has a very compilicated history that includes a rt temporoparietal resection in with the placement of a vp shunt. she has significant left sided weakness at baseline. she was recently seen at for a uti and was treated with macrobid. she denied any fever, chills, or nightsweats. upon arrival to , she reports headaches that is made worse when bending. she states this is a new symptom which was first noticed 3 weeks ago. her headaces are located in the posterior occipital area. she denies any photophobia or diplopia. in er, patient was noted to have a tmax of 102.1 and was given steroids and vanc/ceftriaxone for suspected meningitis. neurosurgery was consulted for questionable vp shunt malfunction vs meningitis. past medical history: 1. tle s/p surgery - right temporoparietal resection . has minimal use of her lue & lle, is wheelchair-bound. 2. focal motor seizures. has sz approx once a month -> shaking of her right arm, no loss of consciousness, but the sz affects her tongue so she cannot speak. 3. vp shunt done when temporal lobectomy performed 4. depression 5. ocd 6. htn 7. copd 8. neurogenic bladder 9. eating disorder (anorexia) 10. pud 11. history of chronic left lower extremity edema 12. right hip, fracture to the left, and fracture of the lateral ischial ring on the right side. 13. left hip frequent dislocations status post left hip replacement c/b mrsa inf currently without a left hip 14. secondary hyperparathyroidism 15. iron deficiency anemia 16. severe progressive cervical spondylosis s/p occiput to c4 fusion and c2-c3 laminectomy 17: c2-3 anterolisthesis s/p posterior cervical spine fusion social history: patient lives in a long term care facility () wheelchair to ambulate volunteers at 0 tobacco 0 etoh family history: mother- pancreatic ca grandfather- breast ca, leukemia physical exam: on admission: tm 102.1 bp: 112/71 hr: 70 r: 18 o2sats: 95ra gen: wd/wn, comfortable, nad. heent: pupils: 3-->2 bilaterally eoms intact neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. somewhat slow, slurred speech (aparrently her baseline). orientation: oriented to person, place, and date. recall: objects at 5 minutes. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3 to 2 mm bilaterally. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation slightly superior on right versus left though both intact. with very slight facial droop on right. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: strength 5/5 on right in both upper and lower extremity. left lower extremity with minimal movement and left upper extremity with 2/5 finger extension. labs: ++ua (+ nit, + le, few bacteria) 8>9.0/27.3<293 129 | 93 | 11 < 104 agap=13 3.6 | 27 | 0.3 ca: 8.2 mg: 1.9 p: 2.1 csf: wbc 15 rbc 11 poly 33% lymp 30% mono 6% macroph 26% prot 58 gluc 63 gram stain negative on discharge: alert, oriented to person, place and date. left sided hemiplegia. right side with full strength throughout. slight left sided facial droop. slow speech. pertinent results: ct head w/o contrast ()- 1. interval increase in caliber of the ventricular system, with suggestion of periventricular white matter low attenuation, which could reflect transependymal flow of csf. this may indicate a shunt malfunction. 2. stable area of encephalomalacia in the right temporoparietal and occipital lobes. ct head w/o contrast ()- the lateral and third ventricles have increased in size compared to the prior study. the fourth ventricle is stable. this is concerning for shunt malfunction. there are two intraventricular catheters in stable positions. a right frontal approach catheter terminates in the left frontal , and the second right temporal approach catheter terminates in the right lateral ventricle near the posterior septum pellucidum. portable tte (complete) done at 4:23:21 pm the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. 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 estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the mitral and aortic valve leaflets are mildly thickened, but without discrete vegetation. mitral regurgitation severity is similar. if the clinical suspicion for endocarditis is moderate or greater, a tee is suggested to better define the valve leaflets. ct head w/o contrast study date of 4:28 am 1. stable-appearing enlarged lateral, third and fourth ventricles. possible transependymal flow of csf seen. persistent sulcal effacement, particularly in the right frontal lobe suggestive of mild edema. 2. stable post-surgical encephalomalacic changes in the right frontal, temporal, and parietal lobes with stable right-sided craniotomy and craniectomy. ct head w/o contrast study date of 6:11 am intraventricular catheters remain in place, with interval decrease in size of the lateral and third ventricles compared to . diffuse sulcal effacement persists. head ct : findings: intraventricular shunts are unchanged in position, including right frontal approach terminating in the left lateral ventricle and the right parietal approach terminating near the atrium of the right lateral ventricle. compared to study, there is no significant change in size and configuration of the lateral or third ventricles. moderate periventricular white matter hypodensity is unchanged, with no evidence of transependymal migration of csf. diffuse sulcal effacement is stable in appearance. there is a large area of cystic encephalomalacia involving right temporoparietal lobe. the craniotomy changes and fixation hardware are again seen. there is no acute intracranial hemorrhage or shift of normally midline structures. with the exception of right maxillary small mucus-retention cyst, imaged paranasal sinuses and mastoid air cells are well-aerated. impression: 1. no change in size or configuration of the lateral and third ventricles compared to . 2. unchanged diffuse sulcal effacement. 3. no hemorrhage. head ct : findings: there is large-volume pneumocephalus in bilateral anterior frontal horns and in the right temporal region. there has been interval redistribution of pneumocephalus which may have slightly decreased in size compared to the previous examination. overall examination is limited by streak and motion artifact. large-volume fluid collection in the right temporal lobe with encephalomalacia appears stable. there is diffuse sulcal effacement likely due to the presence of mild hydrocephalus and large-volume pneumocephalus. the right frontal and right temporal approach catheters' tips terminate in the left frontal and right posterior septum pellucidum respectively. patient is status post right craniectomy with probable dural graft. no areas of acute hemorrhage are present. hypodensities are present in the white matter in bilateral frontal horns likely due to the presence of transependymal flow. there is occipital and cervical fixation hardware, which appear stable. impression: 1. stable appearance to large-volume pneumocephalus which has undergone mild re-distribution. 2. broad distribution sulcal effacement due to large-volume pneumocephalus which appears stable. 3. unchanged appearance to right temporal fluid collection with encephalomalacia. 4. right frontal and right temporal approach ventriculostomy catheters in stable position compared to previous examination. ekg : sinus rhythm. borderline low voltage. since the previous tracing of probably no significant change. intervals axes rate pr qrs qt/qtc p qrs t 87 136 80 342/389 60 7 80 ct head : findings: there is decreased pneumocephalus compared to the previous examination. ventricular size appears stable. right frontal and parietal approach catheters are in unchanged position. there is unchanged large fluid collection in the right temporoparietal lobe status post right parietotemporal lobe resection with encephalomalacia. -white matter differentiation appears unchanged with persistent sulcal and gyral effacement. calcifications are stable along the posterior tentorium. the patient is status post right craniotomy with a dural calcification. multiple bur holes are stable. fixation of hardware appears unchanged. paranasal sinuses, ethmoid and mastoid air cells remain well aerated. impression: 1. slight interval decrease in volume of pneumocephalus with stable ventricular size. 2. the ventriculostomy catheters are in unchanged position. 3. stable appearance to -white matter differentiation, no areas of hemorrhage. lenis : bilateral lower extremity venous ultrasound: -scale and doppler son examination was performed of the both common femoral, superficial femoral, and popliteal veins. the study demonstrates normal low, respiratory variation, augmentation, and compressibility. no intraluminal thrombus is seen. normal compressibility is also demonstrated in the calf veins bilaterally. impression: no evidence of dvt seen in either lower extremity. brief hospital course: 56 y/o female presents to 4 days ago with a uti that was treated with macrobid. she has a history of r temporoparietal resection with left sided weakness at baseline. patient returns to er on complaining of headaches on bending that was first noticed 3 weeks ago. she states that her headaches are located in the posterior occipital area and are made worse when bending. while in the er, she was observed to have a tmax of 102.1 and treated with vanc/ceftriaxone for suspected meningitis. ct scan revealed mild to moderate increase in ventricular size with vp shunt catheter in place. vp shunt was tapped under sterile conditions in the er where the opening pressure was 11 cm h2o. neurosurgery was consulted for vp malfunction. patient was then taken to the or for suspected shunt infection and cultures were obtained. operative procedure: 1. removal of right frontal ventricular catheter. 2. removal of right parietal connector and external tubing. 3. placement of new right frontal external ventricular drain and placement of right parietal external ventricular drain. patient transferred to tsicu. csf cultures were obtained and id consulted. r frontal evd drained at 20 and r parietal at 15 cc h2o. na level monitored for a level at 125. on , na level drops from 125-120 and patient placed on 2gm salt tabs, fluid restrictions of 500cc, and 3% hypertonic solution at 20/hr. na was monitored q4h and her antibiotic, vancomycin, was double concentrated in ns. in am, na level increased from 120 to 130, 3% hypertonic solution was discontinued and patient's na monitored q4h. patient became more lethargic and disoriented on , ct scan in am showed hydrocephalus and evds were dropped to 5 cmh2o. infectious disease changed her antibiotics to nafcillin to treat mssa meningitis. on , patient a&o x3, evds at 5 and draining. csf cultures resent on request for id, and nafcillin double concentrated in ns for a na level of 127. follow up ct scan showed interval decrease in ventricle size from previous scan. pt is a&ox3, evds remain draining at 5. csf cx pending. patient remained stable and na was stable, her water restriction was changed to 1l daily and then 1500cc daily. her csf cx also showed no growth on and she completed her 2 weeks course of abx. on , she was taken to the operating room for internalization of her external drain. she tolerated this procedure well. on a non-contrast head ct was done, and this showed ongoing resolution of pneumocephalus. she was seen and evaluated by physical and occupational therapy who determined she would be safe to return to her facility. she was discharged on . medications on admission: acetaminophen (tylenol) prn baclofen (lioresal) 5 mg tid detrol 4 mg daily dulcolax (bisacodyl) twice weekly effexor (venlafaxine xr) 300 mg daily fosamax 70 mg weekly motrin (ibuprofen) 600 mg am- to stop multi vitamin daily evista 60 mg daily phenobarbital (phenob)30 mg am and 4 pm; 60 mg at hs risperdal (risperidone)0.5 mg am; 1.5 mg at hs tegretol (carbamazepine) 400 mg vicodin (hydrocodone w/apap) 5/500 mg prn rarely demeclocycline 450 mg discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 3. alendronate 70 mg tablet sig: one (1) tablet po qfri (every friday). 4. demeclocycline 150 mg tablet sig: three (3) tablet po bid (). 5. phenobarbital 30 mg tablet sig: one (1) tablet po bid (2 times a day). 6. phenobarbital 30 mg tablet sig: two (2) tablet po hs (at bedtime). 7. raloxifene 60 mg tablet sig: one (1) tablet po daily (). 8. risperidone 0.5 mg tablet sig: one (1) tablet po daily (daily). 9. risperidone 0.5 mg tablet sig: three (3) tablet po hs (at bedtime): a total of 1.5mg at bedtime. 10. venlafaxine 75 mg capsule, sust. release 24 hr sig: five (5) capsule, sust. release 24 hr po daily (daily). 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 12. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 13. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 14. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 16. oxycodone 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for sever pain. 17. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 18. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 19. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po bid (2 times a day). 20. potassium & sodium phosphates 280-160-250 mg powder in packet sig: one (1) powder in packet po qid (4 times a day). 21. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for indigestion. 22. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 23. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day). 24. carbamazepine 100 mg tablet, chewable sig: three (3) tablet, chewable po qid (4 times a day). 25. meclizine 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 26. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain . 27. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 28. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 29. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 30. vancomycin 500 mg recon soln sig: 1250mg recon solns intravenous q 12h (every 12 hours) for 9 days. 31. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: center - discharge diagnosis: meningitis in setting of vp shunt post-op pneumocephalus hyponatremia discharge condition: neurologically stable discharge instructions: ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may wash your hair only after sutures have been removed. ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? you have been prescribed an anti-seizure medicine(carbamazepine and phenobarbitol), take it as prescribed and follow up with laboratory blood drawing in one week. please have results faxed to . ?????? clearance to drive and return to work will be addressed at your post-operative office visit. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please return to the office in days from your date of surgery for a wound check and for suture removal. you will also need to schedule an appointment for to see dr. , so that he can sample your v-p shunt. ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified incision of peritoneum replacement of ventricular shunt gingivoplasty replacement of ventricular shunt gingivoplasty ventriculopuncture through previously implanted catheter diagnoses: obstructive hydrocephalus unspecified essential hypertension hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified depressive disorder, not elsewhere classified bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site secondary hyperparathyroidism (of renal origin) hemiplegia, unspecified, affecting unspecified side hip joint replacement obsessive-compulsive disorders personal history of methicillin resistant staphylococcus aureus epilepsia partialis continua, without mention of intractable epilepsy neurogenic bladder nos infection and inflammatory reaction due to nervous system device, implant, and graft staphylococcal meningitis 

Answer: The patient is high likely exposed to