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: codeine / streptokinase / iodine / bee pollens / narcan attending: chief complaint: altered mental status major surgical or invasive procedure: vp shunt removal vp shunt placement removal of kwires r arm history of present illness: mr. is a 60y/o gentleman with htn, hld, cad s/p mi, afib, tia, colon cancer s/p resection, s/p abdominal trauma with splenectomy and left hand digit amputations, right forearm fracture with plan for hardware removal , as well as complicated hospital course last month for spontaneous sah and pneumonia now s/p trach/peg/vp shunt who was sent from rehab to an osh for altered mental status and was transferred to due to concern for vp shunt complication vs infection. he was admitted to neurosurgery after presenting to an osh with the "worst headache of his life" and being found to have a spontaneous sah in the setting of coumadin use (no trauma and no known cerebral artery malformations). he was intubated in the ed, and was treated by an external ventricular drain. his course was complicated by aflutter requiring dilt drip, vap (treated with vanc/cefepime, d/c'd to rehab on vanc), brief hypotension and pressors, and dvt (was restarted on warfarin). he underwent trach, peg, and v-p shunt placement and was discharged to rehab at . his recent baseline is that he is normally alert and responsive, able to sit at edge of bed but not walking yet, and has no focal neuro deficit. per transfer records, at rehab this morning at 1:30am he was confused, only a+o x1, slow to respond, and only verbalizing the word "yes." per report he had some new right-sided weakness. had temp 102.9 and was noted to have cloudy foul-smelling urine in condom cath. ems was called and he received 800cc ns en route to the osh. at the osh, his vs were t 101.5, bp 167/118, hr 90, rr 16. he had wbc 13.3. cxr with question of consolidation, and ct head w/o contrast with no acute process. received acetaminophen, ceftriaxone 1g iv, azithromycin 250mg iv as well as cefepime 2g iv and was transferred to . in the ed, initial vs were t 97.6, hr 75, bp 110/70, rr 18, pox 98% 3l tm. labs were notable for wbc 15.8 (74% pmns, no bands), ua with 0 epis, 35 wbc, few bacteria, moderate leuks, >182 rbcs (foley had been placed). cxr showed r>l bibasilar opacities. he was evaluated by neurosurgery and underwent vp shunt study which was normal. vp shunt was tapped and csf revealed wbc 425 (87% polys), protein 57, glucose 63. gram stain showed 4+ pmn, 4+ gpcs in pairs/clusters. he received 1l ns and vancomycin 1g iv and was admitted to medicine for further management. vs prior to transfer were 97.6, 67, 10, 170/83, 100%. on arrival to the floor, patient was a&o x3, he denied fever, chills, chest pain, sob, abdominal pain, n/v, dysuria or diarrhea. he reports headache with hip and knee pain that is chronic. he wants to eat, but his daughter emphasize that he is chronically npo because he aspirated. past medical history: type ii diabetes on oral agents systemic lupus erythematosus coronary artery disease s/p mi in hepatitis c copd with emphysema and asthmatic component (fev1 60% predicted ) diastolic congestive heart failure ef 55% in seizure disorder tia 199 colon cancer s/p resection in without chemotherapy s/p abdominal trauma with subsequent splenectomy and amputation of digits of his left hand hyperlipidemia hypertension h/o cocaine abuse neuropathy and chronic pain on methadone chronic atrial fibrillation on coumadin obstructive sleep apnea on home cpap left total knee replacement social history: on disability, former mechanic. quit smoking . denies etoh, h/o cocain abuse, none since . family history: adopted - unknown birth family hx physical exam: admission: vs 98.4, 150/100, 69, 18, 98 on 2l nc, fs 98, 144.2 lbs gen alert, oriented, no acute distress heent ncat mmm eomi sclera anicteric, op clear, perrl neck supple, no jvd, no lad, trach in place pulm scattered crackles at right lung base, no wheezes cv irregularly irregular, normal s1/s2, no mrg abd soft nt nd normoactive bowel sounds, no r/g, g-tube in place ext right forearm splinted, wwp 2+ pulses palpable bilaterally, no c/c/e gu foley draining clear yellow urine neuro cns2-12 intact, motor function grossly normal skin no ulcers or lesions exam on discharge: alert, pleasant, occasionally confused discongigate gaze oriented to location and self, perrl 3-2mm, left nasolabial droop moves all extremities to command, antigravity gait - not tested incision is c/d/i and well approximated, sutures have been removed abd: soft, steris in place, g-tube in place and intact extr: no c/c/e pertinent results: admission: 11:40am blood wbc-15.8* rbc-3.74* hgb-10.9* hct-34.8* mcv-93 mch-29.1 mchc-31.3 rdw-17.4* plt ct-399# 11:40am blood neuts-74.0* lymphs-18.3 monos-7.2 eos-0.1 baso-0.5 11:40am blood pt-12.0 ptt-31.0 inr(pt)-1.1 11:40am blood glucose-93 urean-21* creat-0.6 na-140 k-3.6 cl-99 hco3-34* angap-11 11:40am blood calcium-8.6 phos-3.9 mg-2.0 microbiology: 1:12 pm csf;spinal fluid source: shunt. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. fluid culture (preliminary): staph aureus coag +. moderate growth. oxacillin resistant staphylococci must be reported as also resistant to other oxacillin resistant staphylococci must be reported as also resistant to other. rifampin should not be used alone for therapy. _________________________________________________________ staph aureus coag + | gentamicin------------ <=0.5 s oxacillin------------- =>4 r rifampin-------------- <=0.5 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 5:45 pm catheter tip-iv site: catheter right shunt cath tip. wound culture (preliminary): staph aureus coag +. >15 colonies. imaging: cxr: impression: slight worsening of dependent bibasilar opacities, which may reflect an evolving aspiration pneumonia in the setting of fever. wrist xr - in comparison with study of , there is little overall change in the extensive fixation device about previous fracture of the distal radius. widening of the scapholunate interval is not definitely appreciated on this study. overlying cast greatly obscures bony detail. ct head - stable appearance of ventricular catheter and ventricular size cxr - stable b/l lower base opacities suspicious for pneumonia csf culture, source shunt. gram stain: no polymorphonuclear leukocytes seen, no microorganism seen; preliminary fluid culture is no growth. wbc: 240(lymph 14%, mono 23%, polys 63%, rbs 0), tprot: 28, glucose: 76. echo: conclusions the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. overall left ventricular systolic function is mildly depressed (lvef= 40-45%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild symmetric lvh with mild to moderate global hypokinesis. dilated and hypokinetic right ventricle. mild to moderate mitral regurgitation. compared with the prior study (images reviewed) of , overall systolic function is slightly worse and hypokinesis appears global. severity of mitral regurgitation has increased. estimated pulmonary pressures are lower. chest x-ray findings: right lung opacities have slightly worsened since previous exam and are slightly more confluent, suspicious for an infectious process or aspiration. there is no pleural effusion or pneumothorax. stable cardiac contour is moderately enlarged. chest 4:35 a.m., impression: ap chest compared to through . right lower lobe consolidation and small accompanying pleural effusion have improved since . mild-to-moderate enlargement of the cardiac silhouette has improved since , whether due to decreased cardiomegaly and/or pericardial effusion. left lung grossly clear. et tube and right internal jugular line are in standard placements and an upper enteric tube passes into the stomach and out of view. no pneumothorax. 8:22 am portable head ct comparison: prior head cts without contrast from , and dating back to . findings: study is limited due to the presence of artifact produced by eeg electrodes and wires. again seen is a right frontal approach ventricular shunt terminating in the right lateral ventricle. there is persistent enlargement of the visualized lateral ventricles which are significantly unchanged when compared to prior examination. there is opacification of mastoid air cells, likely related to patient's supine position. many of the previously described findings are obscured due to the artifact generated by the eeg electrodes, limiting an adequate comparison. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. cxr findings: as compared to the previous radiograph, the pre-existing right opacity is minimally more extensive than on the previous image. otherwise, there is no relevant change. moderate cardiomegaly, normal-appearing left lung, the monitoring and support devices are constant. video swallow - pending brief hospital course: brief course: mr. is a 60y/o gentleman with htn, hld, cad s/p mi, afib, tia, colon cancer s/p resection, s/p splenectomy, right forearm fracture s/p orif with pins, and recent sah and pneumonia now s/p trach/peg/vp shunt who presented with delirium that is likely due to shunt infection. csf cultures grew coag positive staph aureus. patient underwent vp shunt removal and received iv antibiotics. #. altered mental status: likely infection (uti vs pna vs shunt infxn). he is currently back at his reported neurologic baseline but the morning of presentation he had transient change in speech and level of interactiveness. he had fever and leukocytosis. post-splenectomy status puts him at risk of serious infection with encapsulated organisms. ua suggestive of uti. cxr also suggests possible pna. more concerning is csf with coag positive staph. patient underwent vp shunt removal and received iv vancomycin and ceftazidime. note that he does have hardware in his arm but with no arm pain, not concerning for infection. he is mentating fine, with good urine output and no elevation in lactate so suspicion for shock is low but he certainly is septic. #. sah in s/p trach, peg, vp shunt. his recent baseline is that he is normally alert and responsive, able to sit at edge of bed but not walking yet, has some left-sided weakness. he is continued on tizanidine, gabapentin. #. h/o afib: currently in afib by exam. normally on warfarin but has been off in anticipation of returning to or for ortho surgery and has been bridged with dalteparin. continued on metoprolol. #. cad s/p mi in the past: stable. tte with lvef= 45-50% secondary to hypokinesis of the basal-mid inferior wall, and inferior/anterior septum. he is on a statin and bb. #. htn: bp currently elevated. bp elevated but will permit in the setting of infection. lisinopril was recently uptitrated at rehab. continue lisinopril, metoprolol. #. s/p mva with rt forearm fracture: s/p orif with hardware in place. plans for removal of hardware soon but this will likely be put off in the setting of infection. dr. is his orthopedic surgeon. #. neuropathy and chronic pain: stable. continue methadone, gabapentin and dilaudid, fluoxetine #. h/o dm2 in the past: not on insulin currently. fen: npo with tube feeds (npo after mn), replete electrolytes prn ppx: heparin gtt, colace/senna, methadone/dilaudid access: piv code: full code (confirmed) communication: patient emergency contact: (wife) dispo: medicine floor for now transferred from for fevers, transient neuro symptoms vp shunt removed, evd placed, icp 7 post-op with drain clamped as of 1820oriented, moves all 4 to command readily : evd- open at 20, exam he is awake, alert pupils sluggish bilaterally, gave thumbs up on lue, right arm casted and moved fingers slightly to command, wiggles toes to command. started on sub q heparin, as icp was high, evd unclamped, head ct performed which showed ortho consult was done regarding his r arm fx : on schedule for or with dr. for removal fo kwires on , pt remained stable in the icu and was transferred to step down unit. id was consulted and they recommended csf cultures, legionella test, blood cultures and treatment with vancomycin and ceftriaxone. his vanco trough was 25.5 and thus his dose was held. video swallow evaluated him and recommended he be npo for a repeat study. on , patient's repeat trough was 15.5 at target goal. video swallow was rescheduled for . urine analysis and for legionellar was negative. csf was sent for analysis and culture. the csf wbc was 75 and rbc 125. id recommended continuing the current antiobiotic regimen. his neurologic status remained stable on . on , csf was sent for analysis and culture: wbc 19; rbc 5. he remained neurologically stable. the patient remained afebrile and neurologicly stable. neurologic exam he became more lethargic and ct showed a slight increase in ventricles size. evd was set on 15, his trach was decannulated. : his mental status improved , csf study showed pr:15, glu:74 and no organism in smear. : patient diaphoretic and got an ecg. cardiology was consulted at the request of dr regarding the evaluation and management of altered mental status, diaphoresis, abnormal ecg and positive cardiac troponin t. cardiology recommended: -start unfractionated heparin iv infusion without a bolus, with a goal ptt 50-60 sec. check ptt prior to infusion and adjust percardiac sliding scale. -continue asa 81mg daily after initial dose of 325mg tonight. -switch dosing schedule of metoprolol from 75mg to 50mg q8h (daily dose of 150mg). adjust dose and intervals (q8h, q6h) to achieve a target hr 55-65 bpm. maintain sbp<140 mmhg if ok from a neurosurgical perspective. therapeutic options include conversion of lisinopril to captopril with oral titration to achieve goal bp vs. initiation of ntg iv infusion with eventual transition to long-acting nitrates. -switch simvastatin to atorvastatin 80mg daily starting tonight - continue to cycle cardiac biomarkers (ctnt, cpk, mb q6h until peak) as well as serial ecgs. - keep patient npo in anticipation of possible cardiac catheterization. please check coags (ptt, inr in am). - pt has a reported allergy to iodine. this needs to be further clarified by the primary team, as contrast for cardiac catheterization contains iodine and may cross-react. he has had prior catheterizations and ct with contrast with no documentation of pre-treatment. - he may require stenting which will mean at least 1 month of asa and clopidogrel. he also has a recent dvt and chronic af with a chads2 score of 4 that requires, ideally, warfarin indefinitely. : patient went to the or for a vp shunt placement. aspirin was held and 1 unit of platelets were given prior to the procedure. : last night his o2 sat went down to 70s and after suctioning came back to 99. cxr which did not show any infiltration. respiratory therapist got involved and found tube feeding fluid in the lung. he remained afebrile. : exam stable. vomited x1 s/p pills. med rec increasing metoprolol to 10mg iv q4 hours until taking po. : hr 60-70 overnight. 2 doses of lopressor held overnight. re-started tube feeds. changed iv lopressor to po. continued captopril 25mg tid. vanc discontinued per id recs. : increased lethargy, hand tremors noted, desaturation, thick sputum. sputum was sent for analysis. he also underwent a cxr and non-contrast head ct. he became diaphoretic-ua sent- foley d/ced and replaced. blood cultures and electrolytes were sent. : eeg, csf sent, desat overnight. he was intubated and tx to icu- likley pna. : the sputum culture showed staph aureus coag + : mr. was extubated. tube feedings were re-started and his neurologic status remained stable. : he remained neurologically stable. hypertensive in pm. required hydralazine and additional doses of metoprolol. : patient had some questionable seizure activity charecterized by a hand tremor as visulized by his daughter. on we started the patient on keppra and restarted the patient on his coumadin for his atrial fib. now dod, patient is afebrile, vital signs stable and neurologically stable. he received his first dose of coumadin (5mg) today for a goal of 2.0-3.0 for afib. his incision is clean, dry, intact without evidence of infection. he is tolerating tubefeeds. he is currently non-ambulatory but is working with pt/ot. he is set for discharge to rehab in stable condition and will follow-up with dr. accordingly. medications on admission: the preadmission medication list is accurate and complete. 1. bisacodyl 10 mg po/pr daily 2. chlorhexidine gluconate 0.12% oral rinse 15 ml oral 3. docusate sodium (liquid) 100 mg po bid 4. esomeprazole magnesium *nf* 40 mg po/tube daily 5. fluoxetine 60 mg po/ng daily 6. gabapentin 600 mg po/ng tid 7. petroleum jelly, white *nf* (white petrolatum) instill under eyelid as directed topical qid 8. senna 1 tab po/ng hs 9. simvastatin 20 mg po/ng daily 10. tizanidine 4 mg po/ng hs 11. fluticasone propionate 110mcg 1 puff ih 12. metoprolol tartrate 75 mg po bid 13. methadone 10 mg po/ng tid 14. lisinopril 30 mg po daily 15. dalteparin (porcine) *nf* 12,500 unit/0.5 ml subcutaneous daily 16. acetaminophen 650 mg po/ng q6h:prn pain/fever 17. albuterol inhaler 4 puff ih q4h:prn sob/wheezing 18. polyethylene glycol 17 g po/ng daily:prn constipation 19. hydromorphone (dilaudid) 2 mg po/ng q4h:prn pain discharge medications: 1. acetaminophen 650 mg po q6h:prn pain/fever 2. bisacodyl 10 mg po/pr daily 3. fluoxetine 60 mg po daily 4. gabapentin 600 mg po q8h 5. methadone 10 mg po tid 6. metoprolol tartrate 50 mg po tid 7. senna 1 tab po hs 8. tizanidine 4 mg po hs 9. albuterol 0.083% neb soln 1 neb ih q6h:prn wheeze 10. famotidine 20 mg po q12h 11. levetiracetam 500 mg iv bid 12. atorvastatin 80 mg po daily 13. multivitamins 1 tab po daily 14. vancomycin 750 mg iv q 12h 15. warfarin 5 mg po qmowefr 16. warfarin 7.5 mg po qtuthsasun 17. docusate sodium (liquid) 100 mg po bid 18. fluticasone propionate 110mcg 1 puff ih discharge disposition: extended care facility: - discharge diagnosis: primary: vp shunt infection vp shunt replacement dysphagia pneumonia confusion nstemi atrial fibrillation lethargy seizures hypertension r arm radial fracture revision discharge condition: ?????? mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: ??????take your pain medicine as prescribed. ??????exercise should be limited to walking; no lifting, straining, or excessive bending. ??????you may shower, please keep wound clean and dry - steri strips will fall off on their own ??????increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ??????unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. followup instructions: provider: , .d. phone 10 date/time 12:20 provider: function lab phone: date/time: 1:10 provider: , .d. phone: date/time: 1:30 provider: ,interpret w/lab no check-in intepretation billing date/time: 1:30 provider: . : please call to schedule a follow up within 4-6 weeks with a repeat head ct scan. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances ventricular shunt to abdominal cavity and organs arterial catheterization closed [endoscopic] biopsy of bronchus removal of ventricular shunt removal of implanted devices from bone, radius and ulna central venous catheter placement with guidance insertion or replacement of external ventricular drain [evd] diagnoses: pneumonia, organism unspecified systemic lupus erythematosus subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery obstructive hydrocephalus unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation other and unspecified hyperlipidemia other specified cardiac dysrhythmias other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site chronic obstructive asthma, unspecified accidents occurring in residential institution mononeuritis of unspecified site gastrostomy status tracheostomy status foreign body in larynx inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation infection and inflammatory reaction due to nervous system device, implant, and graft pain in limb physical restraints status staphylococcal meningitis chronic combined systolic and diastolic heart failure other complications due to other internal orthopedic device, implant, and graft 

Answer: The patient is high likely exposed to