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: somnolence. major surgical or invasive procedure: brain biopsy. history of present illness: (history obtained from medical record as patient was unresponsive on arrival.) is a 53-year-old right-handed woman, previously healthy, with a left basal ganglia tumor causing increasing somnolence and deteriorating neurological status. she was in her usoh until when she had illegible handwriting and difficulty focusing. a heaad ct at hospital that same day showed left frontal edema. she was then transfered to and woman's hospital where a stereotactic brain biopsy was performed; but pathology was non-diagnostic. she was discharged home 3 days later without complications but developed a right-sided facial droop and weakness on . an mri at that time at and woman's showed left basal ganglia and left frontal enhancement. she was placed on high dose dexamethasone and sent to in , ma with the plan to repeat a brain biopsy. toxoplasmosis serologies were reportedly negative during this span. she began vomiting and had increased right-sided weakness, dysarthria, and lethargy while at rehabilitation and was transferred to on . she had a positive fdg-pet scan and a ct scan showing a 1.5 cm x 2.6 cm hyperdense lesion in the left frontal/basal ganglia region with extensive surrounding edema, 10 mm midline shift, and slight effacement of the left suprasellar cistern indicate possibly early uncal herniation. she had previously been off steroids for a day in anticipation of repeat biopsy, and was given dexamethasone 10 mg iv prior to transfer to . she underwent a second biopsy on , the prelimary pathology from which was reportedly most consistent with cns lymphoma. the gram stain from the biopsy was negative for pmns or organisms. she is hiv negative. staining for toxoplasma was negative. she was admitted to the neuro icu and treated with mannitol and dexamethasone. she was extubated on . she was continued on keppra for seizure prophylaxis (has not had any seizure activity), and bactrim for pcp prophylaxis per id recommendation. despite treatment for increased icp, she was increasingly somnolent, non-verbal, and not following commands. she was seen by dr. of neuro-oncology who recommended transfer to for observation and initiation of high-dose methotrexate therapy on . past medical history: htn hyperlipidemia oophorectomy at young age social history: lives with husband. as special education teacher. she does not use tobacco, alcohol, or illicit drugs. family history: non-contributory. physical exam: adission physical examination to : vital signs: temperature 97.2 f, heart rate 51, blood pressure 119/70, respiratory rate 11, and oxygen saturation 97% with 1 liter via nasal cannula. general: unarousable, non-verbal heent: right pupil 6 mm, l pupil 5 mm, reactive cardiovascular: regular but bradycardic with normal s1 and s2, but no murmur, clicks, or gallops pulmonary: clear to auscultation bilaterally anteriorly no w/r/r abdomen: obese, soft, non-tender, non-distended, positive bowel sounds extremities: warm, dry, positive pedal pulses, trace edema bilaterally neurological examination: her karnofsky performance score is 50. her eyes are close and do not open to commands. cranial nerve examination: her pupils are equal and reactive to light, 6 mm to 5 mm bilaterally. she does not have doll's eyes. she has bilateral corneal reflexes. her face is symmetric. motor examination: she has spontaneous movements in the left hand but they are not purposeful. she moves the left side more than the right. her reflexes are 2+ on the right and 2- on the left. her ankle jerks are absent. she moves her extremities when painful stimuli are applied to her extremities but the movements are not purposeful. her toes are mute. she cannot walk. pertinent results: labs on admission to icu: 147 109 28 -------------<178 3.7 29 0.7 ca: 10.5 mg: 2.2 p: 2.4 wbc 13.3 hct 31.8 plt 265 osms 311 -> 306 7:30 pm swab site: brain -9 brain lesion. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. imaging: ct head - 1. hyperdense lesion measuring 1.5 x 2.6 cm in the left frontal/basal ganglia region with extensive surrounding edema. shift of normally midline structures by approximately 10 mm is noted. 2. slight effacement of the left suprasellar cistern may indicate early uncal herniation. mr head - 1. significant increase in size, degree of surrounding vasogenic edema and mass effect with effacement of the left perimesencephalic cistern, consistent with uncal herniation, indicating early uncal herniation. 2. right maxillary sinus disease with fluid level again identified. ct head - no significant change in the degree of mass effect or herniation secondary to a hyperattenuating lesion involving the left putamen and globus pallidus. given that this lesion crosses the midline via the corpus callosum, the differential diagnosis is most suggestive of either lymphoma or glioblastoma multiforme. given the hyperattenuating nature, a hypercellular entity is suggested, favoring lymphoma. ct head - 1. slight improvement in mass effect related to known left frontal lymphoma, including slightly decreased shift of midline structures to the right, and slightly decreased left subfalcine herniation. unchanged left uncal herniation. 2. slight reexpansion of the left lateral ventricle. persistent trapping of the right lateral ventricle, with slightly decreased dilatation of the temporal . cxr - in comparison with the study of , there is little overall change. the cardiac silhouette remains within normal limits and there is only mild prominence of pulmonary vessels consistent with a slight elevation of pulmonary venous pressure. no evidence of acute focal pneumonia. the right central catheter extends barely into the subclavian vein. nasogastric tube extends into the stomach, with the side hole close to the esophagogastric junction. ecg - sinus rhythm short p-r interval possible inferior infarct - age undetermined clinical correlation is suggested no previous tracing available for comparison laboratory values upon discharge: 05:00am blood wbc-15.5* rbc-4.03* hgb-12.8 hct-36.1 mcv-90 mch-31.7 mchc-35.4* rdw-13.0 plt ct-256 12:01am blood wbc-18.9* rbc-3.97* hgb-12.5 hct-35.6* mcv-90 mch-31.5 mchc-35.2* rdw-13.3 plt ct-261 06:45am blood wbc-17.0* rbc-3.91* hgb-12.5 hct-35.1* mcv-90 mch-31.9 mchc-35.6* rdw-13.2 plt ct-213 04:37am blood neuts-92* bands-0 lymphs-5* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 06:45am blood neuts-91* bands-1 lymphs-0 monos-2 eos-0 baso-0 atyps-3* metas-3* myelos-0 06:45am blood neuts-91* bands-1 lymphs-0 monos-2 eos-0 baso-0 atyps-3* metas-3* myelos-0 12:01am blood pt-13.3 ptt-27.3 inr(pt)-1.1 05:00am blood glucose-186* urean-33* creat-0.6 na-133 k-4.3 cl-101 hco3-22 angap-14 12:01am blood glucose-154* urean-28* creat-0.5 na-132* k-4.0 cl-99 hco3-24 angap-13 06:45am blood glucose-148* urean-28* creat-0.6 na-135 k-4.3 cl-99 hco3-28 angap-12 03:27am blood alt-69* ast-16 alkphos-62 totbili-0.5 06:45am blood calcium-9.8 phos-2.4* mg-2.4 06:45am blood osmolal-295 brief hospital course: 1. cns lymphoma: this was diagnosed by brain biopsy on , hiv and toxoplasma staining were negative. initial ct scan with mass, shift, edema and possible early herniation. she was transferred to icu for further care, where she was treated with high dose methotrexate and mannitol on . her neurological status slowly improved to the point where she was a&o 2 and following commands with resideual right-sided weakness. while in the icu patient was patient was found to have coagulase negative staphylococcus in her blood and started on vancomycin (see below). patient was then transferred to omed service on . her last head ct done on demonstrated improvement in mass effect and decreased midline shift, with unchanged left uncal herniation. she was kept on keppra 500 mg po bid for seizure prophylaxis. she was also given bactrim daily for pcp prophylaxis while on the steroids. the patient will return to for port-a-cath placement and her second methotrexate therapy on . 2. altered mental status: this is from cns lymphoma with edema, shift and herniation. she was treated with mannitol and dexamethasone. she was tapered off mannitol and was on dexamethasone 4mg q6h at time of discharge. the patient had intermittent delirium, but was re-directable without the need for medication. this delerium resolved by time of discharge. should she need medication, we would recommend low dose zyprexa. 3. gram positive cocci in blood: this is likely contaminant, but clinical status improved significantly on vancomycin. planned to complete 7 day course--last dose on . also had corynebacterium in urine on , which was felt to be covered by vancomycin. 4. thrush: treated with nystatin. 5. hypertension: continued on lisionpril, hydrochlorothiazide and low dose metoprolol added for intermittent tachycardia (mostly associated with delirium). 6. hyperlipidemia: continued on statin. 7. fen: once facial droop/neurological examination improved, patient seen by speech and swallow and was cleared for a regular diet and thin liquids. she tolerated a regular diet and can feed herself. 8. disposition: the patient was transferred back to facility. she will return on for port placement and her second cycle of methotrexate. she has a picc line and was full code. medications on admission: meds on admission: decadron 2 mg keppra 500 mg lovenox 40 mg daily hydrochlorothiazide 12.5 mg daily lisinopril 10 mg daily omeprazole 20 mg daily simvastatin 20 mg daily pnv w/o calcium-iron meds on transfer: mannitol 20% 25 g iv q6 decadron 8 mg iv q6 keppra 500 mg iv bid bactrim ds 1 tab po daily lisinopril 10 mg po daily pantoprazole 40 mg iv q24h simvastatin 20 mg po daily acetaminophen 325-650 mg po q6h:prn riss discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 4. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 5. bactrim ds 160-800 mg tablet sig: one (1) tablet po once a day. 6. levetiracetam 500 mg tablet sig: one (1) tablet po twice a day. 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 8. dexamethasone 4 mg tablet sig: one (1) tablet po every six (6) hours. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. 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. 11. sodium chloride 0.9% flush 3 ml iv prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 12. vancomycin 1000 mg iv q 12h duration: 4 days please complete treatment by 13. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): please provide sliding scale as inpatient at . see scale provided. 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 15. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 16. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed for constipation. 17. phenol-phenolate sodium mouthwash sig: one (1) spray mucous membrane q4h (every 4 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: central nervous system lymphoma hypertension hyperlipidemia thrush bacteremia discharge condition: hemodynamically stable. discharge instructions: you were admitted to from an outside hospital with confusion and difficulty writing. upon your arrival here, you had a brain biopsy (brain test) that showed that you have a cancer called brain lymphoma. because of the brain swelling, you were admitted to our intensive care unit, where you were monitored and your brain swelling was treated. you were also started on treatment for your lymphoma with a drug called methotrexate by dr. . your brain swelling decreased and your confusion and mental state improved singificantly. you continued to have difficulty moving the right side of your body. you were also treated for prevention of seizures and prevention of infection (see medications below). you should continue to take these medications. during your stay, you were also suspected to to have a blood infection, for which you are being treated with antibiotic (vancomycin). you should continue to take this for an additional 4 days. because of the swelling in your brain, you were also placed on steroids, you should continue to take these as prescribed. you were discharged in a hemodynamically stable condition, with improved mental functioning and confusion. should you experience any fevers, chills, shortness of breath, chest pain, severe headaches, new weakness, numbness, balance difficulties, double vision or any other symptom concerning to you, please call the health care provider at your facility for further assisstance or go to the emergency room. followup instructions: you should follow up with dr. upon your arrival at today. you will return to for another treatment of high dose methotrexate on with dr. . (. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances closed [percutaneous] [needle] biopsy of brain injection or infusion of cancer chemotherapeutic substance diagnoses: unspecified essential hypertension candidiasis of mouth bacteremia cerebral edema encephalopathy, unspecified large cell lymphoma, lymph nodes of head, face, and neck 

Answer: The patient is high likely exposed to