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: bactrim attending: chief complaint: altered mental status major surgical or invasive procedure: intubation/extubation ventricular drain placement history of present illness: ms is aged 61 year-old and is right-handed. she has a history of chronic right posterioir tibial osteomyeltitis, hypertension & lue dvt on coumadin theraphy, presented with acute mental status change upon waking up at 8am this morning. according to her daughter, she found ms lying in bed moaning. she openned her eyes and was verbal. there were no complaints of headache or pain. ms stood up and was unstable. she returned to bed where she vomited once. there was no loc but she was noted to have blank staring spell which lasted for less than a minute. no convulsive seizure episode was witnessed. ems brought mrs to hospital, where initial inr was 3.5. given ffp & vit k once each. her head ct revealed intraventricular bleed (l) with no underlying mass effect on the preliminary read. vitals were stable at osh (sbp 130-150's). patient was stabilized and transferred to for further management (no neurosurgery available at osh). at er, she was noted to be increasing drowsy, lethargic. vitals were stable (sbp 150-165) with rr between 14-16 on 2 liter nasal canula. initial gcs was 12. however, due to concern for respiratory support patient was intubated. she had difficulty speaking, general weakness. she did not have a headache, and complained of pain in her right leg. past medical history: -lue dvt: thrombus identified within the left subclavian and left brachial vein. likely picc associated from admission. -: i&d right proximal tibia wound with excision of posterior sinus and removal of antibiotics beads. -hypertension for ~20 years -s/p gsw in s/p surgical repair social history: she lives with her daughter and her two grandsons in an apartment in plain. originally from , republic. moved to area in . denies tobacco, etoh, or other drugs. family history: mother died three months ago of a heart attack in her 70s, she had diabetes. father alive, healthy in the dr. 5 siblings, with hypertension, one with diabetes. physical exam: vitals: t: p:85/min; r:16/min; bp:157/70, sao2: *prior to intubation general: stuporous, lethargic; arouses to voice and can respond verbally heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. neurologic: -mental status: lethargic, oriented to place & person. verbal with decrease fluency. decrease arousal but obeys command. no dysarthria, no spontaneous speech. responds to verbal command and deep pressure. -cranial nerves: olfaction not tested. perrl 2 to 1mm sluggishly reactive. opens and closes eyes spontaneously. no ptosis bilaterally. unable to perform funduscopic exam. conjugated gaze and limited upgaze with no nystagmus. facial sensation intact to pressure. no facial droop, facial musculature symmetric. hearing intact grossly. able to protrude tongue in midline. -motor: decrease bulk ue/le, normal tone. unable to test for pronator drift. no adventitious movements noted. no asterixis noted. unable to perform formal strength testing. spontaneous movement of upper extremities against gravity, lower extremities limited to bilateral toe flexion/extension with spontaneous leg movements. mild rue weakness on active movement. -sensory: no deficits to light touch, pinprick, cold sensation, vibratory sense, proprioception throughout. no extinction to dss. -coordination: no intention tremor, dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. - reflex: no clonus, no pathlogic reflexes tri bra pat an toes c5 c7 c6 l4 s1 cst l2 2 2 2 2 down r2 2 2 2 2 up -gait and coordination: unable to formally assess. prior to discharge, in terms of her neurological examination, her short-term memory was still selective. however, her motor exam was virtually normal. pertinent results: labs hematology cbc wbc rbc hgb hct mcv mch mchc rdw plt ct 5.0 2.64* 8.6* 24.9* 95 32.6* 34.5 14.9 297 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 05:41am 297 import result chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:41am 98 20 1.9* 137 3.9 102 29 10 antibiotics vanco 05:41am 40.8* import result imaging ct head near complete resolution of hemorrhage along the old ventriculostomy tract. mild decrease in extensive intraventricular hemorrhage with trace increase in size of the ventricular system. continued followup is recommended. ct head diffuse intraventricular hemorrhage in the left greater than right lateral ventricles and extending into the third and fourth ventricle. there is resulting hydorcephalus. there is no evidence of midline shift. there is global predominantly left sided sulcal effacement with no herniation. there is extensive periventricular and white matter hypodensity which likely represent chronic microvascular infarct. brief hospital course: the pt is a 61 year-old right-handed, female, with history of chronic right posterioir tibial osteomyeltitis, hypertension & lue dvt on coumadin theraphy who presented with mental status change. head ct from osh showed large intraventricular blood most of which is in the left lateral, third, and fourth ventricles; hydrocephalus; no evidence of midline shift; no intraparenchymal hemorrhage; 3 mm low attenuation density in the pons which may be a lacunar infarct of indeterminate age; moderate periventricular white matter chane most likely small vessel occlusive disease. inr up to 3.5 at osh, given 2 u ffp and vitamin k 10 mg iv. neurologic exam on admission limited but significant for increase lethargy, somnolence. neurologic exam on day 2 of admission: intubated, attends to examiner, not clearly following commands, perrl, horizontal eye movement but not vertical, gag intact, moves bilateral ue and le against gravity, localizes pain in all 4 extremities, reflexes brisker on left (4+ in left biceps and brachioradialis), toes downgoing bilaterally. her icu course and treatment plan was as follows: -s/p ventricular drain with neurosurgery, initially on ancef 2 gm iv q8hr while drain was in place -received intraventricular tpa x2 days. increased pressure on to drain 10->15 on , however altered mental status after that so decreased pressure back down to 10, plan now is to clamp drain and remove as tolerated (culture tip upon d/c) -goal icp 5-18 -spiked temp to 102.1 on , f/u cxr, blood cx, csf cx, ua showed neg leuk/neg nitr, 0-2 wbc, no bact, f/u urine cx. started vancomycin 1 gm iv q12, ctx 2 gm iv q12 -continued to spike temp to 102.4 on , f/u lenis, repeat cxr -bp controlled with sbp goal 140-160, and her home bp meds were restarted: lisinopril 20 po daily, avapro 75 mg daily, atenolol 50 mg po increased to , hctz 25 mg daily -coumadin/asa were held in setting of ivh -doxycycline, fluconazole for chronic suppression of osteomyelitis per id recs -speech and swallow: thin liquids and small bites of soft solids, pills may be given crushed or whole with puree on id were consulted regarding the growth of multi-resistant staphylococcus epidermidis from the evd tip that had been pulled, approximately a week ago. they recommended that she continue on vancomycin until , trough between 15-20. unfortunately, her creatinine increased, and her vanc level was supratherapeutic, so the antibiotic was held for several doses. id also recommended continuing her fluconazole and doxycycline for her chronic osteomyelitis, they will follow her up as an outpatient. discussions with heme onc and the line services advised the placement of a picc line (right), as her central line needed changing. her picc line was taken out prior to her discharge. despite holding her vanc, her cr trended upwards, so her ace inhibitor and were stopped, and a renal artery us were requested. renal ultrasound did not show renal artery stenosis. she constantly needs encouragement to eat, drink and go to the bathroom. her course of vancomycin was also completed prior to discharge. medications on admission: -coumadin 4mg daily (started ) -atenolol 50 mg tablet (daily). -aspirin 81 mg tablet (daily). -cholecalciferol (vitamin d3) 400 unit(daily). -calcium carbonate 500 mg (2 times a day). -alendronate 70 mg qfri (every friday). -lisinopril 20 mg daily -hydrochlorothiazide 12.5 mg daily -lovenox 60 mg = d/c -avapro 75 mg once a day. discharge medications: 1. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*0 capsule(s)* refills:*0* 2. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*0 tablet(s)* refills:*0* 3. alendronate 70 mg tablet sig: one (1) tablet po qfri (every friday). disp:*0 tablet(s)* refills:*0* 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*0 tablet, chewable(s)* refills:*0* 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*0 tablet(s)* refills:*0* 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). disp:*0 * refills:*0* 7. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*0 tablet(s)* refills:*0* 8. atenolol 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*0 tablet(s)* refills:*0* 9. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for to groin as needed for irritation. disp:*0 * refills:*0* 10. magnesium oxide 400 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*0 tablet(s)* refills:*0* 11. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or temp > 100. disp:*0 tablet(s)* refills:*0* 12. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*0 tablet(s)* refills:*0* 13. sodium chloride 0.9% flush 3 ml iv prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 14. hydralazine 10 mg iv q6h:prn sbp >160 page ho if giving 15. heparin flush (10 units/ml) 1 ml iv prn 16. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 17. sodium chloride 0.9% flush 3 ml iv prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: - discharge diagnosis: intraventricular hemorrhage discharge condition: problems with short term memory and motivation, needs to be encouraged to eat. in terms of her strength, she is able to walk and is almost back to her baseline. discharge instructions: you have been admitted with bleeding within the ventricles of your brain. if you have any of the following symptoms: worsening headache, alteration of consciousness, weakness on any one side of your body, or any other change in your function, please go to your nearest emergency department. followup instructions: with dr in weeks, please call the office to organize a convenient time . for follow-up with dr (infectious diseases on ), she will need liver function tests drawn prior to this appointment, and fax'd to . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent ventricular shunt to extracranial site nec diagnoses: unspecified essential hypertension acute kidney failure, unspecified intracerebral hemorrhage long-term (current) use of anticoagulants personal history of venous thrombosis and embolism other and unspecified coagulation defects 

Answer: The patient is high likely exposed to