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: mrs. was admitted to neurosurgery on , for a cerebrospinal fluid leak from her ommaya reservoir site and then transferred to o-med on after the leak had resolved, for further care for a methicillin resistant staphylococcus aureus urinary tract infection, hyponatremia secondary to serum-inappropriate antidiuretic hormone, and neutropenia. briefly, her course during her neurosurgery admission, according to the transfer note and discussion with her attending, was as follows: mrs. is a 62-year-old right-handed indian woman with metastatic breast cancer to the brain (parenchyma and leptomeningeal). she was recently discharged from to hospital on , after undergoing placement of an ommaya reservoir for intrathecal chemotherapy (left frontal ventricular access). she returned to on with a cerebrospinal fluid leak from the site, and had a stitched placed, with no further leakage until , after receiving her most recent it thiotepa (second dose). this has not leaked since, but she does have a lodged area under her scalp which is most likely cerebrospinal fluid, which required no further treatment at that time. she developed a methicillin resistant staphylococcus aureus urinary tract infection and a full workup for this also revealed positive methicillin resistant staphylococcus aureus in her right eye. she began intravenous vancomycin on . other active issues at the time of transfer included a clogged gastrojejunostomy tube which was unclogged in interventional radiology on . her mental status at the time of transfer was that she would open her eyes and speak incoherently to her children, not following commands. she has been on bed rest, and not able to actively participate in physical therapy or occupational therapy. upon transfer to o-med on , her history is as follows: her history is now most significant for neutropenia (white blood cells of 0.4 with an absolute neutrophil count of 320), methicillin resistant staphylococcus aureus urinary tract infection on intravenous vancomycin, and hyponatremia secondary to serum-inappropriate antidiuretic hormone. her sodium had decreased to 125 on to 21, but it slowly trended upward with fluid restriction and sodium tablets to 133 on the day of transfer. the patient is unable to give a history secondary to her mental status changes and language barrier. her children speak english, and provided her history. past medical history: 1. breast cancer, metastatic to brain and leptomeninges; diagnosed in when she presented with arm cellulitis that did not respond to intravenous antibiotics. an excisional biopsy was performed that revealed a 3 cm lesion consistent with both ductal and lobular cancer on pathology. a wide resection revealed axillary lymph nodes on , with 7/7 positive axillary lymph nodes. pathology was consistent with a grade ii lobular carcinoma in situ. in , mrs. presented with frontal headaches, nausea and vomiting. an mri showed metastases to the brain (the right posterior temporal lobe and right cerebellum and leptomeninges). she began treatment with decadron and whole body radiation for ten days. an ommaya reservoir was placed on . in this month, she also was diagnosed with serum-inappropriate antidiuretic hormone associated with mental status changes. a lumbar puncture was done which showed equal opening pressures at the ventricle. a head ct on performed because the patient was somnolent as well as to assess changes in the patient's condition for possible chemotherapy, showed progression of hydrocephalus, but the fourth ventricle was not blocked and with equal opening pressures. they then began chemotherapy (dr. and dr. on . she was started on adriamycin weekly and intrathecal thiotepa. a gastrojejunostomy tube was also placed, and she received her second dose of intrathecal thiotepa on . 2. hypertension 3. serum-inappropriate antidiuretic hormone 4. status post a motor vehicle accident in where she lost her left thumb, suffered a right eye corneal abrasion resulting in right eye blindness. she also lost her husband in this accident. 5. gastrojejunostomy tube placement on or 21 for inability to take food by mouth 6. atypical chest pain with two cardiac admissions since that have had negative workups allergies: augmentin was documented previously, but son denies this is a true allergy. social history: mrs. came to the united states from in . she lives with her son in . she previously was a bicyclist and a physical education teacher. there is no smoking or alcohol use. family history: her brother died of cirrhosis not associated with alcohol use, and there is no history of cancer in the family. medications on transfer to the o-med service: 1. ciprofloxacin 500 mg by mouth every 12 hours 2. metronidazole 500 mg three times a day by mouth 3. vancomycin 1 gram intravenously every 12 hours 4. sodium chloride 1 gram four times a day by mouth 5. zofran 2 mg twice a day intravenously as needed for nausea 6. mupirocin cream 2% twice a day to the gastrojejunostomy tube site 7. lansoprazole oral suspension 30 once daily 8. regular insulin sliding scale 9. hydrocodone/acetaminophen one tablet every four to six hours as needed for pain by mouth 10. heparin 5000 units subcutaneously twice a day 11. lasix elixir 40 twice a day by mouth 12. ofloxacin ointment to the left eye 13. bacitracin/polymixin ointment to the right eye laboratory data: on transfer to o-med, white blood cells 0.4, hemoglobin 10.1, hematocrit 30.1, platelets 356. sodium 133, potassium 4.9, chloride 96, bicarbonate 25, bun 25, creatinine 0.3, glucose 121. urinalysis on was yellow and hazy with a specific gravity of 1.01 and a ph of 7.5. it was positive for nitrite, small leukocyte esterase, white blood cells, red blood cells. micro on blood cultures (two sets) had no growth. blood cultures (two sets) also had no growth. urine culture showed methicillin resistant staphylococcus aureus greater than 100,000, gram-positive bacteria greater than 100,000, alpha hemolytic, consistent with strep or lactobacillus species. throat culture was negative for strep, and gynecologic culture was negative for n. gonorrhoeae. studies: 1. ct head without contrast performed on : a. interval development of 5 mm wide water density subdural collection in the left frontoparietal region with associated effacement of the sulci without shift of midline structures. this lesion is most commonly an effect of hemorrhage, in which case the low density suggests chronicity; however, a relation to the drainage catheter needs to be explored; neurosurgical consultation is advised. b. moderately prominent panventricular dilation not significantly changed compared to the prior examination. the pattern is consistent with communicating hydrocephalus. 2. chest x-ray performed on : no evidence of congestive heart failure, pneumonia, or pleural effusion. 3. ultrasound doppler of the upper extremities performed because of an arm swelling with a right-sided picc line showed no evidence of a deep venous thrombosis. 4. ct angio performed on : a. bibasilar atelectasis b. no evidence of pulmonary embolism 5. mri of the head performed on showed: a. left-sided ventricular shunt in position with partial decompression of the left lateral ventricle b. new left-sided subdural fluid collection which was not present on the prior examination and could be related to recent shunting c. diffuse leptomeningeal enhancement along the cerebellar folia and vermis in addition to intra-axial enhancement within the right cerebellar hemisphere and the right inferior temporal lobe. the posterior right temporal lobe appears to be slightly smaller in size on today's examination. further clinical correlation and follow up is recommended. hospital course: 1. neurology: after transfer to o-med, the ommaya reservoir site began to slowly leak cerebrospinal fluid and neurosurgery was reconsulted. on , they put in three stitches at the site, but the shunt eventually had to be removed on secondary to persistent leakage. the culture of the reservoir site was negative. since then, the dressing has been in place and it is not an issue now. the patient's mental status has varied from not being able to open her eyes and communicate, to being able to follow simple commands and answer yes/no questions, to sometimes being responsive and interacting with the physicians, but this is rare. a decadron taper was begun on from a dose of 4 mg every 12 hours for a total of three weeks. this should improve the wound healing around the previous ommaya site, gastrojejunostomy tube site, and buttocks decubiti, as well as decrease blood sugar. she is still on a regular insulin sliding scale for now. dr. from neuro-oncology was reconsulted and is evaluating the future direction of therapy, if indicated, in mrs. . 2. fluids, electrolytes and nutrition: her hyponatremia was treated with intravenous fluid restriction (at most, 50 cc of normal saline when the tube feeds are not on) and salt tabs, as well as lasix elixir. her hyponatremia resolved in one to two days, and has been stable ever since. electrolytes have been repleted as needed. 3. cardiovascular: mrs. was continued on metoprolol 12.5 mg twice a day by mouth for her history of hypertension. there are no other issues. 4. pulmonary: this was stable until , when she desaturated to 88%, new crackles were heard on examination, she had a temperature of 100.4 while on tylenol, and a chest x-ray revealed some ill-defined patchy opacities consistent with an early pulmonary infection in the left middle lobe to left lower lobe as well as some right middle lobe atelectasis. thus ceftazidime and flagyl intravenous was begun for a question of a possible aspiration pneumonia vs. hospital-acquired pneumonia. 5. hematology/oncology: mrs. was begun on g-csf for neutropenia and ciprofloxacin for prophylaxis. the neutropenia resolved by , and the ciprofloxacin was discontinued at that point. heparin subcutaneously was used for deep venous thrombosis prophylaxis. procrit weekly was begun for her anemia on , and she got a transfusion on . restaging mris of the head and spine as well as a bone scan are planned for either monday, , or tuesday, , in order to assess the direction of any further treatment in this patient. 6. gastrointestinal: the patient's gastrojejunostomy tube was declogged by interventional radiology on , and then again on , and then another time on . the latter time it was changed to a gastrostomy tube of larger caliber and put to gravity for 24 hours. tube feeds will resume on the 8th. she was tolerating tube feeds to a goal of 60 cc/hour. mrs. also had occasional bouts of water diarrhea during her admission that were always c. difficile negative and treated with good response to lomotil. zofran was used for nausea. 7. pain management: several different pain regimens were used to help control constant pain that the patient was experiencing that she usually couldn't specify where it was. sometimes she complained of pain everywhere in her body. intravenous dilaudid seemed to work very well for her, according to the son. in general, though, her pain has been poorly controlled, but the son objects to frequent narcotics, especially a patch, which does not clear the system quickly, as she becomes drowsy on these medications. we recently just began trying a lidocaine patch to her back. she also received tylenol every four hours and vioxx as well, but this was recently discontinued, as the son thought it was not helping her. 8. peripheral access: the right arm had been used for peripheral intravenous lines, and a picc line will probably be placed on or 9 for her intravenous antibiotics and intravenous dilaudid. her left arm cannot be used, as the tumor burden was high there, and the risk of clot is great. 9. skin: grade ii decubiti on the buttocks, healing well with duoderm. the stoma nurse will be consulted to see the patient on to care for the gastrojejunostomy tube site. 10. infectious disease: mrs. finished a ten day course of vancomycin for the methicillin resistant staphylococcus aureus urinary tract infection, and subsequent urinalysis and cultures have revealed only . at first the foley was changed and it was rechecked, however, it again showed , fluconazole will be given by mouth once the gastrojejunostomy tube is resumed. miconazole powder to general area to prevent vaginal infection. intravenous ceftazidime and flagyl was started on for a question of an early left middle lobe or left lower lobe pneumonia. a full infectious disease workup was done at that time as well, and blood and urine cultures were negative. of note, blood cultures have always been negative during this admission. 11. the patient is full code. discharge status: on , mrs. care was transferred to dr. and a new o-med team, and the rest of the hospital course and the discharge medications will be dictated as an addendum to this discharge summary by her. current medications as of : 1. dexamethasone taper 2. maalox as needed 3. tylenol every four hours 325 mg 4. ofloxacin solution to left eye four times a day, two drops 5. regular insulin sliding scale 6. salt tabs, two tabs three times a day 7. heparin subcutaneously 5000 units twice a day 8. metoprolol 12.5 mg twice a day by mouth 9. zofran 2 mg intravenously every 12 hours 10. mupirocin cream to gastrojejunostomy tube site 11. bacitracin to the right eye 12. lasix elixir 40 twice a day 13. lansoprazole suspension 30 once daily 14. duoderm to buttocks 15. ceftazidime intravenously begun on . flagyl 500 every eight hours begun on . intravenous/by mouth dilaudid 0.5 to 2 mg every four to six hours as needed 18. mso4 elixir sublingual 5 to 10 mg every four to six hours as needed when gastrojejunostomy tube is blocked 19. lidocaine patch to back 20. toradol as needed for pain 21. promod without fiber tube feeds, with a goal of 60 cc/hour 22. nystatin swish and swallow 23. neurontin 100 by mouth three times a day and titrate up slowly per dr. , to start when the gastrojejunostomy tube is patent 24. actonel 5 by mouth once daily per dr. to start when gastrojejunostomy tube is patent 25. os-cal plus vitamin d 500 mg by mouth once daily per dr. to start when gastrojejunostomy tube is patent 26. fluconazole 150 mg x 1 by mouth to be given when gastrojejunostomy tube is patent 27. reglan to use as needed when the gastrojejunostomy tube is blocked , m.d. dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances other repair of cerebral meninges diagnoses: pneumonia, organism unspecified obstructive hydrocephalus urinary tract infection, site not specified other nervous system complications secondary malignant neoplasm of brain and spinal cord attention to gastrostomy malignant neoplasm of other specified sites of female breast 

Answer: The patient is high likely exposed to