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: history of present illness: on admission, the patient presented as a 77 year old male to the emergency department. he was found by his wife, confused and lethargic. he has been having headaches for three to four days. on admission, cta showed a subarachnoid hemorrhage, likely secondary to a 6 mm aneurysm of the left internal carotid artery at the bifurcation. at the time of admission, he was found to have positive carotid and cardiac enzymes. troponin of 0.4 on admission. past medical history: non insulin dependent diabetes mellitus. no medications. hypertension. no medications. history of atrial fibrillation. carotid stenosis, 70 percent right internal carotid artery blockage. thyroid surgery. status post thyroid carcinoma. gout. chronic obstructive pulmonary disease. past surgical history: he had a thyroidectomy. allergies: no known drug allergies. medications on admission: 1. levoxyl. 2. colace. 3. albuterol. 4. multi-vitamin. physical examination: heart rate of 81; blood pressure 129/52. spot was 97 percent on four liters of nasal cannula. he opened eyes to name. didn't follow commands. he had a right facial droop. pupils were 2 mm, reactive bilaterally. tongue was midline. laboratory data: white blood cell count of 7.8; hematocrit of 32.8; platelets of 196. pt was 13.4; ptt 23.2. inr of 1.2. gases were 7.51, 30, 133, 25, 2. cta at the time of admission showed a diffuse subarachnoid hemorrhage secondary to a 6 mm aneurysm at the bifurcation of the left internal carotid artery and left mca; positive for intraventricular bleed. cervical spine x-rays were negative. the plan at that time was for mr. to have a diagnostic angiogram with possible coiling. attending physician was dr. . hospital course: on , the patient was given a ventricular drain to relieve pressure of his subarachnoid hemorrhage. he was on 25 mg of fentanyl. he was prepped and draped and drain was placed for 7 cm. there were no complications. the patient was intubated and prepped for angiogram the following day. the patient was admitted to surgery. attending surgeon was dr. . on , he underwent an angiogram with coiling of the left internal carotid artery aneurysm. he was neurologically sedated. his vent drain was kept at 15 and he was given ancef for drain prophylaxis. following the procedure, the patient opened eyes to voice, followed some commands. he had left hemiparesis. pupils were reactive. he was neurologically stable at that point. endocrine was consulted regarding his thyroidectomy. cardiology saw the patient on at neurosurgery's request regarding his elevated troponin level and the electrocardiogram changes. at that time, as stated, the electrocardiogram changes were likely representative of cerebral t waves and are unlikely to be due to a myocardial ischemia. the elevated troponin may represent demand ischemia in the setting of an acute illness. the patient was advised to follow-up with cardiology following discharge. endocrinology saw the patient on and agreed that he should continue on his levoxyl dose of 175 mg q. day. otherwise, there were no interventions needed. on , the patient went into respiratory failure. anesthesia felt that it was prudent to intubate the patient at this time and a follow-up magnetic resonance scan was ordered. a follow-up magnetic resonance scan was ordered. on , the patient was reintubated for worsening congestive heart failure. he now had developed a fever. plan was to start impact with fiber and nasogastric tube. for the next several weeks, the patient continued to spike temperatures and blood cultures were ordered. also, cerebrospinal fluid cultures were ordered as well on . at that point, all cultures were negative. on , the patient was seen by ent and the decision was made to put a permanent tracheostomy. the patient was stable status post tracheostomy. on the same day, , the patient was prepped for percutaneous endoscopic gastrostomy. on , the patient's vent drain was at 25 and clamped. his icp ranged from 6 to 11. blood pressure was maintained at 160 to 180. his tracheostomy was a number 7 portex tracheostomy. he was suctioned for a moderate amount of blood, with thick sputum. tracheostomy site was intact. slight blood tinged drainage oozing around the stoma was noted. vent was changed from simv to c-pap with ips. the patient was placed on cefazolin one gram q. eight hours, in response to his constant temperature spikes. continue to follow blood cultures and cerebrospinal fluid cultures. after several stable head ct and neurologic stability, the patient's ventricular drain was discontinued on . to follow cerebrospinal fluid cultures, serial lumbar punctures were performed. the patient's intracranial hemorrhage remained stable through serial cat scans. the patient continued to spike fevers and had difficulty with his tracheostomy and cta showed bilateral large pulmonary effusions. infectious disease felt effusions were consistent with congestive heart failure and fever. the patient was followed throughout his course by infectious disease and was placed on vancomycin, cefazolin and flagyl. they continued to follow cerebrospinal fluid cultures, sputum cultures, blood cultures and urine cultures. on , culture showed nosocomial meningitis, pseudomonas. the patient was continued on cefazolin and started on 4 mg intrathecal gentamycin q. 12 hours. following cerebrospinal fluid, white blood cell count dropped. protein was dropping and glucose was rising. on , infectious disease said that the patient still had pseudomonas meningitis and was being treated with systemic cefazolin and intrathecal gentamycin. he was to be continued on vancomycin and flagyl for now. they advised continued surveillance of sputum, blood cultures, urine cultures when febrile. on , the patient developed a fever still with nosocomial meningitis. the patient had a complete fever work- up at this time. infectious disease had advised to add gentamycin systemically; watch the fever specifically with gentamycin intrathecally as inflammatory reaction could cause this. they advised to continue vancomycin and flagyl empirically and continue ceptaz for pseudomonas and consider repeat chest x-ray if still with fevers. for the next several weeks, infectious disease recommendations were followed, i.e. intrathecal gentamycin, systemic gentamycin, vancomycin and flagyl. at this time, the patient's neurologic status continues to improve. on , on the advice of infectious disease, intrathecal gentamycin was discontinued, continue ceptaz. culture if spikes. okay to discontinue the vancomycin. at this time, the patient is being considered for ventriculoperitoneal shunt. we will perform serial lumbar punctures to follow his protein, glucose and culture cerebrospinal fluid. infectious disease agrees that if cultures are negative, it is okay to proceed with ventriculoperitoneal shunt. on , the patient had a lumbar drain placed and the patient was prepped and draped in the usual way, positioned and a lumbar drain was placed without complications at l3, l4. initial attempt was complicated by venous bleeding. instructions were to drain 10 cc per hour, monitor icp periodically with greater than 20. please call attending. the patient, at that time, was neurologically stable. the patient continued to show elevated white blood cells and pnmt's with high protein and low glucose in his cerebrospinal fluid, suggestive of recurrent nosocomial meningitis. the patient's final shunt cerebrospinal fluid profile prior to discontinuing drain was quite benign and initial lumbar puncture soon after, we discontinued the drain. there was concern to the infectious disease people that prior antibiotics were not adequately distributed throughout cerebrospinal fluid. infectious disease felt that nosocomial meningitis regimen should be reinstituted. this lumbar drain was placed so that we could start it gentamycin regimen should be reinstituted. this lumbar drain was placed so we could start it gentamycin via lumbar drain. at this time, infectious disease felt that it would be prudent to start meropenem two grams q. 8 hours intravenously and restart intrathecal gentamycin via lumbar drain, 4 mg q. 24 hours. also felt to start intravenous gentamycin at the same dose, 180 mg q. 12 hours intravenously. neurosurgery would like to place a ventriculoperitoneal shunt when all cultures are negative. as of , all cultures have been negative. the patient's examination continues to be the same but does not follow commands. he opens his eyes to voice, localizes his upper extremities and withdraws his lower extremities. plan at this time, on , is to place ventriculoperitoneal shunt when cerebrospinal fluid protein is down and a renal consult is requested due to rising bun with creatinine levels. endocrine follow-up on , patient still with nosocomial meningitis. endocrine would like to change levoxyl to 150 mg intravenous q. day, check tft's in one week. will follow-up with repeat tft's are back next week. on , the patient was still with lumbar drain. blood pressure was below 160. beta blocker to keep heart rate around 60. follow-up still following infectious disease recommendations. patient on subcutaneous heparin, dilantin, gastrointestinal prophylaxis. neurologic examination remains unchanged. renal consult was obtained on . the patient is a 77 year old male in mild acute renal failure, developed slowly over the past ten days. renal failure starting 10 to 12 days after beginning high dose gentamycin, in the setting of vancomycin and fevers consistent with gentamycin toxicity. this would fit with his high urine sodium. suggest hold ace inhibitors for now. hold all lasix. would give 250 cc of free water q. six hours. vancomycin levels less than 15. check daily level. intravenous gentamycin was discontinued and would also consider changing intrathecal gentamycin to other as even small systemic penetration will up his total gentamycin dose that accumulates and, if this is gentamycin toxicity, it can take days to weeks after discontinuing gentamycin to see resolution. renal attending agreed with this and states that he has been on intravenous gentamycin for treatment of meningitis for two courses. his creatinine started to rise on in the middle of the second cycle. agreed that he has atn due to prerenal gentamycin toxicity, renal function can be very slow to recover with gentamycin toxicity. please add on serum gentamycin level to determine whether there is a continuing effect from the it therapy. agree with free water repletion given hypernatremia. on , renal consult, gentamycin toxicity leading to mild acute renal failure, is improving slowly. hypernatremia. please make euvolemic. continue to follow renal consult. on , the patient had completed 14 days of vancomycin and intrathecal gentamycin course on antibiotics to be discontinued today. antibiotics to be discontinued today. discontinue lumbar drain. check lumbar puncture for cerebrospinal fluid culture off antibiotics ideally for a few days and then place ventriculoperitoneal shunt. , the patient is stable. examination remained stable. the patient opens eyes, does not follow commands, withdraws upper extremities to pain, withdraws lower extremities to deep stimulation. lumbar puncture is to be performed daily. over the next several days, the patient's lumbar puncture continued to show elevated intracranial pressures. opening pressure between 12 and 20. cultures and laboratory studies continued to be negative. protein was decreasing. glucose was increasing over several days. on , the patient was pre-opped. the patient was brought to the operating room for ventriculoperitoneal shunt placement. the patient underwent an electrocardiogram. negative chest x-ray. was made n.p.o. signed a consent. his laboratory studies were all within normal limits. on , the patient was taken to the operative suite for ventriculoperitoneal shunt placement. surgeon was dr. . he was assisted by dr. . his preoperative diagnosis was hydrocephalus. postoperative diagnosis was the same. ventriculoperitoneal shunt was placed without complication and he was sent to the post anesthesia care unit in stable condition. on , the patient was neurologically stable. he was attentive and alert. all vital signs were stable. rehabilitation screening was completed. the patient could be discharged on in stable condition. discharge instructions: the patient neurologic status should be monitored closely. he is to follow-up with dr. in one month. discharge medications: levothyroxine sodium 275 mcg p.o. q. day. insulin subcutaneous sliding scale and fixed dose, per insulin flow sheet. metoprolol 37.5 p.o. three times a day. hold for systolic blood pressure less than 110 or heart rate of less than 160. bisacodyl 10 mg p.r. h.s. prn. docusate sodium 100 mg p.o. twice a day. albuterol. ferrous sulfate 300 mg p.o. three times a day. heparin 5000 units subcutaneous q. 12 hours. miconazole powder 2 percent one application topically four times a day prn. lansoprazole oral suspension 30 mg nasogastric q. day. the patient is discharged in stable condition to center. , dictated by: medquist36 d: 20:17:43 t: 21:12:22 job#: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances other permanent tracheostomy percutaneous [endoscopic] gastrostomy [peg] arteriography of cerebral arteries ventricular shunt to abdominal cavity and organs intravascular imaging of intrathoracic vessels transfusion of packed cells endovascular (total) embolization or occlusion of head and neck vessels diagnoses: obstructive hydrocephalus acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified subarachnoid hemorrhage hyperosmolality and/or hypernatremia meningitis due to gram-negative bacteria, not elsewhere classified 

Answer: The patient is high likely exposed to