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: confusion, nausea, vomiting, headache major surgical or invasive procedure: ventriculostomy ventriculoperitoneal shunt placement intrathecal vancomycin history of present illness: 39f transferred from hospital for evaluation of multiple brain lesions. pt had been well until approx 1 month prior to admission when she travelled to via and . patient states that she first noticed problem when "it felt odd when my children touched my left leg". denied pain, pins and needles, loss of bladder/bowel control. following one week in , the pt began to have lbp (no prior hx). pain was over the spine at l3-4 level w/o radiation. several days later the pt developed severe headache w/ nausea and vomiting. on return to the u.s., she noted confusion mostly in regards to getting lost and forgetting what she was doing. presented to hospital where she was noted to have multiple brain lesions on ct, lung mass, liver mass, bony lesions, transferred for further eval. denies f/c/visual changes/or weakness. past medical history: diabetes social history: denies smoke/drink/drugs married, two children trained as m.d., microbiologist at . family history: non-contributory physical exam: 97.1 99/60 71 18 98% ra general: no acute distress heent: perrla. eomi. no nystagmus. anicteric oropharynx clear. neck: no cervical/sm/sc la noted cardiovascular: regular s1, s2. no m/r/g lungs: clear to auscultation bilaterally breast: negative for masses/nodules abdomen: bowel sounds present, soft, nontender nondistended, hepatomegaly (~9cm) no splenomegaly. extremities: no c/c/e. no palmar erythema noted. neuro: cn iii-xii intact 2+dtr's b/l ue, le b/l mild past pointing on finger mentating clearly, able to do days of the week backwards pertinent results: at hospital: wbcc 10..1, hct 37.0, plt 186, mcv88 diff n76, l15, inr 1.1, ptt 26.3 alb 3.5 tbili 0.8, ld 584, ap 219, ast 36, alt 52, cea 17.8 cxr: rounded density in lul and l hilar enlargement ct chest: soft tissue mass in l apex extending to hilum abutting l main pa and l main bronchus. l hilar adenopathy. three mm r lung nodule. ct abd/pelvis: lobulated mass in l hepatic lobe 7.5x3.2cm, suspicious for mets, no splenomegaly, no adrenal mets. ct head: numerous cerebral and cerebellar mass lesions c/w mets. mri head: innumerable ring enhancing lesions, largest on r 2.8x2.2 cm, largest on l is 2.5x1.8. in cerebellum, 2.8x2.4cm. midline shift to l. some lesions demonstate surrounding vasogenic edema. ---- ecg: sinus at 84 w/ l axis deviation. nl intervals. no st-tw abnormalities. 09:30am glucose-334* urea n-15 creat-0.6 sodium-135 potassium-4.1 chloride-99 total co2-22 anion gap-18 09:30am alt(sgpt)-68* ast(sgot)-38 ld(ldh)-762* alk phos-286* tot bili-0.3 09:30am albumin-4.1 calcium-8.5 phosphate-2.8 magnesium-2.1 09:30am wbc-16.6* rbc-4.25 hgb-12.8 hct-37.4 mcv-88 mch-30.0 mchc-34.2 rdw-12.5 09:30am plt count-253 09:30am pt-13.4* ptt-26.6 inr(pt)-1.2 --- radiology final report mr head w & w/o contrast 3:27 pm mr head w & w/o contrast; mr contrast gadolin reason: evaluate lesions medical condition: 39 year old woman with no pmh found to have multiple enhancing lesions on mr at outside hospital. reason for this examination: evaluate lesions indications: enhancing lesions on outside mri. left upper lobe mass, liver mass and lytic lesions of the spine. mri of the brain without contrast: technique: multiplanar pre and post contrast t1w images, axial t2w, susceptibility, and flair images were obtained. findings: there are innumerable areas of susceptibility effect in the cerebellum and cerebrum, many associated with t1 hyperintensity. the lesions enhance peripherally. many are located at the /white matter junction. others lie in the right lentiform nucleus on thalamus. there is a lesion in the dorsal left mid brain on the lateral claviculi. given the history, they are most likely hemorrhagic metastases. largest lesion is in the left cerebellar hemisphere measuring approximately 2.6 cm in maximum dimension. there are 2.3 cm lesions in the lateral left frontal lobe, the medial right parietal lobe and the right lentiform nucleus. there is vasogenic edema, particularly prominent in the parietal white matter, the right posterior temporal region and the right cerebellar hemisphere. there is some shift of septum pellucidum towards the right left. there is minimal right sided mass effect in the fourth ventricle. there is no hydrocephalus. some of the sulci are effaced. the right cerebellar tonsils displace slightly inferiorly into the foramen magnum. there is also a 16 mm peripherally enhancing pineal mass, probably also a metastases in an unusual location. impression: there are innumerable lesions in the brain parenchyma with associated blood break down products and enhancement most consistent with multiple metastases. the largest are on the order of 2.5 cm in size. there is some shift of the septum pellucidum towards the left but no dilatation of the ventricular system. there is a large right cerebellar lesion with some edema but only minimal mass effect on the fourth ventricle. an unusual peripherally enhancing pineal mass is noted, probably also a metastases. the outside study is not available for comparison. dr. approved: tue 9:44 pm --- ct abd w&w/o c 5:08 pm ct abd w&w/o c; ct pelvis w/contrast reason: possibility for tissue sample, either via bronchoscopy or li field of view: 30 contrast: optiray medical condition: 39 year old woman with multiple cerebral lesions, l lung lesion, and large liver mass. reason for this examination: possibility for tissue sample, either via bronchoscopy or liver biopsy. contraindications for iv contrast: none. indication: multiple cerebral lesions, left lung lesion, large liver mass. comparison: outside ct from . technique: helically aquired contiguous axial images were obtained from the lung apices through pubic symphysis following the administration of 150 cc of iv optiray. nonionic contrast was used secondary to patient debilitation. multiphasic images of the liver were also obtained. ct chest with iv contrast: within the apex of the left upper lobe, there is an ill defined mass present, measuring 2.4 x 3.2 cm. contiguous with this mass and just inferior to it are several, smaller, ill defined nodules within the left upper lobe and left hilar region, the largest of which measures 1.5 x 1.2 cm. additionally within the right middle and right lower lobes, there are at least four, 1-2 mm, noncalcified pulmonary nodules identified. there is narrowing of the left upper lobe bronchus by the left hilar mass. otherwise, the airways are patent to the level of the segmental bronchi bilaterally. an enlarged prevascular lymph node is identified adjacent to the aorta measuring approximately 11 mm. an ill defined left hilar mass is identified which appears to consist of a conglomeration of smaller pulmonary parenchymal nodules and left hilar lymph nodes, which narrows the left upper lobe bronchus. no other pathologically enlarged axillary lymphadenopathy is seen. the heart, pericardium and great vessels are unremarkable. no pleural or pericardial effusion is present. ct abdomen w/o&w iv contrast: within the left lateral segment of the liver, there is a large, heterogeneously enhancing mass present which measures approximately 4.0 x 7.7 cm. within the dome of the right lobe of the liver, there is a second, enhancing, low attenuation lesion present measuring 2.1 x 1.3 cm. multiple, smaller, heterogeneously enhancing, low attenuation lesions appear to be present throughout the liver, findings suggestive of innumerable metastatic lesions. there is no intrahepatic biliary duct dilatation. the portal vein is patent. the gallbladder, pancreas, spleen, adrenal glands, kidneys, ureters, stomach, and loops of large and small bowel are all within normal limits. there is no free air or free fluid. there is no significant mesenteric or retroperitoneal lymphadenopathy. ct pelvis with iv contrast: the rectum, sigmoid colon, uterus, adnexa, distal ureters, and bladder are all within normal limits. there is no free fluid. there is no pelvic or inguinal lymphadenopathy. bone windows: multiple lytic lesions are noted within the t6, t12, l2, and l4 vertebral bodies with the most destructive changes noted within the l4 vertebral body. no definite extension into the spinal canal is present. additionally a lytic lucency is identified within the posterior right iliac . impression: large ill defined mass within the left upper lobe of the lung concerning for a primary neoplastic process. heterogeneously enhancing low attenuation lesions within the liver as well as lytic lesions within the bones are concerning for hepatic and osseous metastases. the large mass within the left lateral segment of the liver would be amenable to ultrasound guided biopsy. the findings have been discussed with dr. on . the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 2:17 pm --- specimen received: spinal fluid specimen description: received 1ml cloudy fluid. prepared 1 thinprep slide. clinical data: none provided. previous biopsies: liver mass report to: dr. . diagnosis: positive for malignant cells. rare atypical cells present, consistent with metastatic carcinoma. note: previous cytology slides of liver fna (c04-) were reviewed. cytologic features of rare malignant cells seen in csf specimen are similar to that of liver fna specimen. dr. notified of the diagnosis by dr. . via e-mail on . diagnosed by: , ct(ascp) , m.d. , m.d. --- complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 09:35am 3.4* 3.07* 9.9* 29.8* 97 32.4* 33.4 17.9* 98* 08:00am 3.1* 3.15* 10.1* 30.1* 95 31.9 33.4 17.6* 102* basic coagulation pt ptt plt ct inr(pt) 09:35am 98* 08:00am 102* 08:00am 12.01 25.8 0.9 1 note new normal range as of 12am of chemistry renal & glucose glucose urean creat na k cl hco3 angap 09:35am 111* 13 0.4 140 3.8 103 26 15 08:00am 109* 16 0.4 140 3.2* 103 26 14 chemistry totprot albumin globuln calcium phos mg uricacd iron 09:35am 8.3* 3.6 1.8 08:00am 8.3* 5.1* 1.9 --- ct head w/o contrast 10:31 pm reason: any hydrocephalus or indication of shunt malfunction? medical condition: 39 year old woman with nsclc mets to brain, s/p vp shunt 2 days ago now with fairly severe ha for several hours. reason for this examination: any hydrocephalus or indication of shunt malfunction? contraindications for iv contrast: none. indication: severe headache for several hours, status-post vp shunt two days ago, metastatic non-small cell lung cancer to brain. comparison is made to the prior ct scan dated . technique: noncontrast head ct. findings: there is again demonstrated a small amount of residual intraventricular hemorrhage in the left occipital of the lateral ventricle. there has been interval removal of the right-sided intraventricular drain with a small amount of hemorrhagic products along the course of the prior drain. there has been interval placement of a left-sided intraventricular drain with the tip in the frontal of the left lateral ventricle. there are again demonstrated innumerable metastatic brain lesions. the ventricles, sulci and cisterns are unchanged in configuration. there is no shift of normally midline structures or hydrocephalus. the visualized paranasal sinuses and osseous structures are unremarkable. skin staples are seen overlying the course of the vp shunt. impression: 1. interval placement of vp shunt with removal of prior right intraventricular drainage. a small amount of hemorrhage products are noted along the course of the prior drainage catheter. 2. otherwise stable appearance of the brain with innumerable brain metastases. brief hospital course: 39f recent onset of paresthesias, low back pain, headache accompanied by nausea and vomiting, and confusion, transferred from outside hospital, with multiple intracranial, pulmonary, bony, and hepatic masses. 1) altered mental status associated with multiple intracranial masses: patient was transferred to on . diagnosis of metastatic large cell lung cancer was made by ultrasound guided liver biopsy, and multiple metases noted throughout spine and brain by mri (l spine metases, loss of l4 disc space, foraminal narrowing; multiple enhancing lesions in brain, largest of 2.5 cm with hemorrhage). carboplatin/taxol chemotherapy was administered, however, over several days, patient began to have decreased level of consciousness, increased headache, nausea, and vomiting with no relief from narcotics or acetaminophen. on day 4 following chemotherapy, patient became unresponsive to verbal stimuli and somnolent with decreased tone; this was thought to be possibly a non-convulsive status event. ct head at the time indicated new metastases, effacement of sulci and herniation into the foramen magnum. patient was given a bolus of 10mg decadron q6hours, and transferred to the icu for q1hour neuro checks. patient was administered whole brain radiation therapy (total dose 2,000 cgy). a right frontal evd was placed, and mannitol and decadron were administered to reduce edema and increased intracranial pressure. mental status/neurolic function slowly improved with increased response to commands and increased amount of communication. however, over the next several days, it was determined that the evd was infected with coagulase negative staphylococcus, which was treated with both intravenous and intraventricular vancomycin until cultures from csf were negative for seven consecutive days. the evd was then removed and a ventriculoperitoneal shunt was placed without complication. the patient's mental status continued to improve and at the time of discharge, decadron had been weaned to 4mg qd. the patient was placed on a regiment of keppra 750 to maintain seizure prophylaxis. 2) metastatic lung cancer: although it was felt that the patient had an overall poor prognosis, it was felt that she may still benefit from a palliative standpoint from aggressive treatment. completed one cycle of /taxol (as above). was scheduled for repeated chemotherapy but delayed due to evd infection. the patient was started on iressa (egfr inhibitor) 250mg qd, since shown to have some benefit in metastatic lung ca to brain as 2nd line to chemo/xrt. 3) non-sustained ventricular tachycardia: had multiple runs of nsvt and was started on amiodarone infusion. evaluated by cardiology who felt that the rhythm was polymorphic, and likely catecholamine mediated vt which would be best treated with a beta-blocker. amiodarone was discontinued. felt to be not a candidate for icd given her metastatic disease. also felt to have some component of brugada syndrome (but does not strictly meet criteria for this). at the time of discharge, patient's blood pressure and heart rate were stable without ectopy, and patient was discharged on 25mg metoprolol . 4) hyperglycemia: likely steroid-induced. diabetic diet initiated with good glucose control. sliding scale insulin administered while on daily decadron to good effect. 5) pain control: patient was continuing to have headaches despite recovery of her mental status. repeat head ct showed residual blood in the ventricles, likely from removal of the evd. it was felt that her headaches were likely due to this residual blood, and that the vp shunt was still patent and functioning. patient's pain was fairly well controlled with morphine pca, then converted to oxycontin with oxycodone for breakthrough pain. 6) patient will follow up with neurosurgery the day after discharge. medications on admission: meds at home: ocp meds on transfer: decadron 4mg po q6 protonix 40mg po qd discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po qd (once a day) as needed. 3. levetiracetam 750 mg tablet sig: one (1) tablet po bid (2 times a day). 4. iressa 250 mg tablet sig: one (1) tablet po once a day (). 5. kaolin-pectin 5.85-0.13 g/30 ml suspension sig: 30-60 mls po prn (as needed) as needed for give with stools. 6. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. psyllium 58.6 % packet sig: one (1) packet po tid (3 times a day) as needed. 8. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 10. oxycodone hcl 20 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours). 11. oxycodone hcl 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 12. dexamethasone 4 mg tablet sig: one (1) tablet po qd (once a day). 13. ondansetron hcl 2 mg/ml solution sig: intravenous q6h (every 6 hours) as needed for nausea. 14. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 15. insulin regular human 100 unit/ml solution sig: sliding scale units injection asdir (as directed). 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day: hold for rr<10, sbp<110. discharge disposition: extended care facility: - discharge diagnosis: metastatic non small cell lung cancer (liver, brain, and bone metastases) central nervous system infection discharge condition: good discharge instructions: 1) follow up with your neurosurgeon tomorrow as directed. 2) continue taking your medications as directed. 3) if you have fever, chills, extreme headache, weakness, seizures, or confusion, call your doctor who will decide if you should come to the emergency room. some headache is to be expected, and you should take your pain medication. however, if it associated with mental status changes or weakness, you should call your doctor immediately (). 4) continue to follow up with your primary care physician, , and neurosurgeon as directed. followup instructions: provider: . (neurosurgery) . date/time: 11:00 am. provider: , multi-specialty multi-specialty thoracic unit-cc9 where: clinical ctr. - 9th fl. multi date/time: 8:30 provider: , /oncology-cc9 where: /oncology phone: date/time: 8:30 md procedure: closed (percutaneous) [needle] biopsy of liver ventricular shunt to abdominal cavity and organs intravascular imaging of intrathoracic vessels injection or infusion of cancer chemotherapeutic substance other radiotherapeutic procedure diagnoses: obstructive hydrocephalus malignant neoplasm of liver, secondary intracerebral hemorrhage paroxysmal ventricular tachycardia secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung secondary malignant neoplasm of bone and bone marrow infection and inflammatory reaction due to nervous system device, implant, and graft 

Answer: The patient is high likely exposed to