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: sulfa (sulfonamides) / tomato / fish product derivatives / peach / citrus derived / egg attending: chief complaint: consulted for subdural empyema major surgical or invasive procedure: 1. bilateral frontal sinus trephine. 2. left external ethmoidectomy. 3. left endoscopic maxillary antrostomy. history of present illness: hpi: 63ym with htn who was transfered from after being found down at 5am at his office bathroom. he was intially thought to have a stroke based on ct and left sided hemiparesis. mri done here shows a frontal sinusitis with resulting empyema along the falx cerebri and along the lateral right frontal lobe. past medical history: pmhx: htn social history: social hx: no tobacco, etoh, drug use, single, lives with sister family history: family hx: father died age 85yo, mother died 85yo w/ chf, grandfather died of brain tumor physical exam: physical exam: o: t: 101.7 bp: 138/63 hr: 92 r16 o2sats 97ra gen: wd/wn, comfortable, nad. heent: pupils: perrl eoms intact neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: asleep, easily aroused, somnolent, mostly cooperative with exam, blunted affect. orientation: oriented to person, place, and date. language: speaks in short sentences with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light, to 2 mm bilaterally. visual fields are full to confrontation. no anopsia or neglect was noted iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone in bilateral upper extremities. increased tone in rle and normal tone lle. no abnormal movements, tremors. strength full power throughout bilateral upper extremities. rle with full strength thoughout. lle with ip ; q ; h ; g, , at 0/5. no pronator drift sensation: intact to light touch, propioception, pinprick and vibration bilaterally. reflexes: b t br pa ac right 2 2 2 2 1 left 2 2 2 2 1 toes equivocal left and downgoing on right no clonus coordination: normal on finger-nose-finger, rapid alternating movements pertinent results: labs: coags 14.1/27.4/1.2 cbc 22.4>39.8<401 diff 88.2/5.5/6/0.1/0.2 lactate 2.6 chem 132/3.5/92/23/41/2.0/142 cmp 9.1/2.7/3.3 ua many bacteria, nitr neg, leuk tr, wbc 21-50, epi 0-2 : head ct: again seen are hypodensities involving the bilateral frontal lobe, along the margins of the falx, with the right frontal lobe more severe than the left. there is also suggestion of a right subdural collection along the anterior right frontal lobe convexity. the ifferential diagnostic considerations includes an acute infarct or cerebritis. the ventricles and sulci are normal in caliber and configuration. there is complete opacification of the left maxillary sinus, with opacification of the left ethmoidal sinuses and frontal sinus. cta: the carotid and vertebral arteries and their major branches are patent with no evidence of stenoses. ct perfusion images reveal slight delayed time to peak involving the right frontal lobe. however, no definite vascular territory abnormality is identified. impression: 1) hypodensity involving bilateral frontal lobes along the falx and the right inferior frontal lobe, with some suggestion of a small subdural fluid collection anterior to the right frontal lobe. although these findings do not correspond to a major vascular territory and the cta images do not reveal any vascular abnormalities, the differential diagnostic considerations still includes an acute infarct or may represent cerebritis. 2) opacification of the left maxillary, ethmoidal, and frontal sinuses. : mra head findings: there is a small extra-axial fluid collection along the interhemispheric fissure as well as along the anterior right frontal lobe. there is corresponding restricted diffusion involving this fluid collection. given the restricted diffusion, this is suggestive that this fluid collection may be an empyema. additionally, there is slight t2 hyperintensity of the frontal lobes bilaterally along the falx, which also exhibit restricted diffusion. these signal abnormalities are not in the expected location of a vascular territory, suggesting that these findings may represent cerebritis rather than an acute infarct. mra images reveal that the intracranial vertebral and internal carotid arteries and their major branches are normal without evidence of stenosis, occlusion, or aneurysm formation. there is opacification of the left maxillary, ethmoid, and frontal sinuses. on t2- weighted images, there appears to be a linear structure that communicates with the opacified frontal sinus and the fluid collection anterior to the right frontal lobe. this may represent a site of abnormal communication leading to underlying empyema. impression: 1. abnormal small extra-axial fluid collection along the interhemispheric fissure as well as along the anterior right frontal lobe, with associated restricted diffusion. this is concerning for an empyema. 2. slight t2 hyperintense signal of bilateral frontal lobes adjacent to the falx and inferior frontal lobes bilaterally. these lesions also exhibit restricted diffusion, and may represent cerebritis associated with the overlying empyema rather than an acute infarction. 3. left maxillary, ethmoidal, frontal sinus opacification with abnormal linear structure connecting the frontal sinus with the abnormal fluid collection, suggestive of a possible source of communication. sinus ct: there is complete opacification of the left maxillary sinus with opacification of the left ostiomeatal unit, left anterior ethmoidal air cells as well as left frontal sinus. as seen on prior mr, there appears to be a site of potential abnormal communication involving the posterior aspect of the left frontal sinus with the extra-axial space (series 2, image 52). additionally, there is mild mucosal thickening of the left sphenoid sinus as well as the right maxillary and anterior ethmoidal air cells. there is also mild mucosal thickening of the right frontal sinus. the right ostiomeatal unit appears to be patent. the cribriform plates are intact. the anterior clinoid processes are not pneumatized. again seen is hypodensity of the frontal lobes bilaterally, along the margins of the falx as well as a hypodensity involving the inferior frontal lobes. however, this is better appreciated on mri of the brain on the same day. impression: 1. opacification of the left maxillary sinus, left anterior ethmoidal air cells, as well as left frontal sinus, consistent with an obstructive sinusitis. there appears to be a potential site of communication involving the posterior left frontal sinus with the extra-axial space. 2. mild mucosal thickening of the right frontal, right anterior ethmoidal, and right maxillary sinus. 3. hypodensity involving bilateral frontal lobes along the margins of the falx seen on prior mri, without significant change from earlier in the morning. ct of the head without contrast: motion artifact limits the study. since prior exam, there has been interval craniotomy. pneumocephalus is seen, likely related to recent procedure. 4 mm leftward midline shift is noted and unchanged. the right subdural empyema has resolved. hyperdense subdural collection in the right frontal convexity measuring up to 6 mm in (2 a, i 24) is new and likely represents small subdural hematoma. there is effacement of the right frontal sulci, which is unchanged. hyperdense material along the falx is noted consistent with subdural hematoma. unchanged appearance of the paranasal sinuses. impression: 1. interval craniotomy and drainage of right subdural empyema. 2. hyperdense material along the falx cerebri and right frontal convexity consistent with subdural hematoma. 3. small pneumocephalus likely related to recent procedure. unchanged minimal leftward midline shift and effacement of the frontal sulci. ct of the head with and without iv contrast: there is no significant change compared to one day prior. right frontal craniotomy is again seen with a small amount of residual pneumocephalus. small right subdural hemorrhage layering along the right frontal convexity and falx is unchanged. a 4-mm of midline shift is also unchanged. the ventricles are normal in size and configuration. hypodensity along the parafalcine frontal cortex may represent subdural fluid and necrosis related to the patient's empyema. the paranasal sinuses again demonstrate diffuse opacification of the left maxillary sinus and the ethmoid air cells, as well as the frontal sinuses, which both contain drainage catheters. contrast-enhanced imaging does not demonstrate any evidence of dural venous thrombosis. however, this is not a ct venogram, simply a routine post contrast ct scan. if there is concern of sinus thrombosis, an mr venogram, or a ct venogram are suggested. there is again mild hyperenhancement of the right frontal cortex, suggesting persistent cerebritis. impression: 1. relatively unchanged appearance of right subdural hemorrhage/fluid collection. unchanged hypodensities in the right frontal parafalcine cortex related to the patient's cerebritis. 2. no evidence of dural venous thrombosis on routine post contrast ct. a ct venogram was not performed. 3. bilateral frontal sinus drainage catheters in situ. non-contrast head ct. findings: complex hypodensities within the frontal lobes bilaterally are again noted and appear larger in size compared to the previous examination. a large area of hypodensity tracking along the anterior falx measuring approximately 10 x 1.7 cm appears significantly larger compared to the previous examination. low-attenuation material is seen to extend along the right cerebral convexity into the right middle cranial fossa. there is significant associated mass effect with shift of normally midline structures to the left by approximately 12 mm which is dramatically worse compared to the previous examination. there is significant mass effect on the right lateral ventricle with near-complete compression of the occipital . subfalcine herniation is noted. a component of right uncal herniation is also probably present. compared to the previous examination, there has been interval removal of bifrontal drains. the frontal sinuses appear nearly completely opacified with just a few areas pneumocephalus. dense material is again noted within the left maxillary sinus, extending into the left ethmoid air cells. mucosal thickening is also noted within the sphenoid sinus. numerous staples overlie the right frontal bone and there is evidence of a right frontal craniotomy. there is also evidence of a right parietal craniotomy. impression: significant interval progression of right cerebral subdural collections, now extending along the anterior falx and into the middle cranial fossa. significant associated mass effect including leftward shift of normally midline structures as well as subfalcine and uncal herniation. mri of the brain and mrv of the head. brain mri: there is increase in the interhemispheric collection identified, which extends to frontal to the occipital region, also extending along the posterior interhemispheric fissure and along the right side of the tentorium. the previously noted subdural collection along the right side frontoparietal region laterally has also slightly increased. there is now an extensive increased t2 signal seen in both frontal lobes adjacent to the interhemispheric fissure. these signal changes are new. however, previously noted slow diffusion in the brain parenchyma has resolved. this finding indicates development of vasogenic edema. following gadolinium, extensive enhancement of the meninges is identified along the collections. the collection itself demonstrated an area of low signal in the interhemispheric region on t2 and flair images. the persistent soft tissue changes seen in both frontal sinuses. there is mass effect on the right lateral ventricle, which is partially obliterated. there is also mass effect with partial obliteration of the basal cisterns. soft tissue changes are seen in bilateral mastoid air cells. impression: increase in size of interhemispheric and convexity subdural collections with extensive enhancement along the margins indicative of empyema. there is persistent slow diffusion seen within these collections. however, presence of low signal intensity areas within the collection also indicatea an associated hemorrhagic component. the mass effect on the right lateral ventricle and obliteration of the right hemispheric sulci has increased since the previous study. there is now extensive vasogenic edema seen in both frontal lobes. mrv of the head: the mrv of the head demonstrates slightly narrowed but patent superior sagittal sinus. the right transverse sinus, also demonstrate normal flow signal. the left transverse sinus is not well visualized on the projection images, but on the source images it is partially visualized and could be congenitally small. impression: no definite evidence of superior sagittal sinus thrombosis. ct of the head. findings: again identified is an interhemispheric subdural collection along the right side of the falx with high density posteriorly indicative of blood products. since the previous study the air within the collection has resolved. the collection is now better defined and visualized. bifrontal hypodensity secondary to brain edema are again noted. a small right-sided frontal parietal convexity collection is also again identified. compared to the prior study the mass effect has decreased with slight decrease in the midline shift. there is also decreased distortion of the brainstem indicative of improvement in uncal herniation. there is no hydrocephalus identified. there is no new area of hemorrhage seen. impression: decrease in mass effect compared to the prior ct of with improvement in uncal and subfalcine herniations. there is persistent interhemispheric collection identified better visualized on the current study, possibly secondary to resolution of edema in this right cerebral hemisphere. convexity, small subdural collection is again identified as before. no new area of hemorrhage seen. upper extremity ultrasound with doppler: real-time ultrasound evaluation of the left upper extremity deep venous system using grayscale, color, and pulse wave doppler demonstrates a clot in the cephalic vein extending more peripherally toward the elbow. no flow is identified in the cephalic vein, and the vein is not compressible. the basilic vein, brachial vein, and left internal jugular vein demonstrate normal flow and compressibility. impression: superficial venous clot in the cephalic vein. no evidence of deep venous thrombosis. bilateral lower extremity venous ultrasound: grayscale doppler and pulse wave son of the bilateral lower extremities demonstrate non-compressibility, lack of flow and echogenic thrombus in the right lesser saphenous vein. the bilateral common femoral, superficial femoral, and popliteal veins demonstrate normal compressibility, augmentation, and flow. impression: 1. occlusive thrombus in the right lesser saphenous vein. 2. no evidence of thrombosis in the deep venous structures of bilateral lower extremities. ct head without contrast: findings: again identified is an interhemispheric subdural collection along the right side of the falx high-density posteriorly consistent with blood products, unchanged appearance from the prior study allowing for subtle differences in patient positioning. interval resolution of the postoperative pneumocephalus. bifrontal hypodensities secondary to edema without interval change. small right-sided frontoparietal temporal extra-axial collection, not significantly changed. there is persistent 5-mm rightward shift of normally midline structures. basal cisterns are not effaced. no new foci of hemorrhage. persistent moderate paranasal sinuses opacification. calcification of the mastoid air cells persists. the patient is status post right frontal and right posterior parietal craniotomies. skin staples are in place. impression: 1. no significant short interval change in persistent posterior interhemispheric collection and extra-axial collection overlying the right cerebral convexity. 2. stable bifrontal edema with persistent 5 mm subfalcine herniation. brief hospital course: mr. was admitted to the icu for a right frontal subdural empyema. on , he underwent a bilateral frontal sinus trephine, left external ethmoidectomy and a left endoscopic maxillary antrostomy by dr. on the ent service. on , mr. had three right-sided craniotomies for subdural empyema drainage. he was taken to the icu postoperatively and was intubated. on the patient was extubated and put on a face mask with an oral airway. the preliminary cultures on the brain abscess fluid from the drainage revealed streptococcus milleri growing in the sinus tissue samples. on he started having problems with hypertension requiring a labetolol drip. on , a dobhoff tube was placed for enteric nutrition. on a picc line was placed and the patient opened his eyes spontaneously for the first time after his surgery. on , the infectious diseases team recommended keeping the patient on at least 4 weeks of antibiotics. mr. became tachypneic to the 40s on and was reintubated for airway protection. he also had a spike in his temperature at that time to a max of 102 degrees farenheit. on , a repeat ct of the head was worse. an mri was performed which showed an empyema. an mrv showed no evidence of a venous thrombus in the brain. on , mr. was taken back to the or for a sterotactic drainage of the abscess. 40cc of purulent material was drained at that time. on , mr. was started on keppra for seizure prophylaxis. on , the patient was taken back to the or for evacuation of the remaining abscess fluid. the preliminary results of the abscess fluid revealed no growth of any micro organisms. mr. also had another picc line placed at this time for antibiotic access. on a left upper extremity ultrasound revealed a superficial venous clot in the cephalic vein without evidence of deep venous thrombosis. on this same day, dr. arranged for a family meeting but the family was not available to meet due to inclement weather. on , purulent material was noted to be coming out from his penis, around the foley catheter. the catheter was removed and a new one was put in place. also on , mr. had a bilateral lower extremity ultrasound which revealed an occlusive thrombus in the right lesser saphenous vein but no evidence of thrombosis in the deep venous structures of bilateral lower extremities. the patient was extubated on this day and did well off of the ventilator. mr. was deemed appropriate to transfer to the floor on . he was given a bedside swallow study which determined that he could have a thin pureed diet with 1:1 supervision at all times. subsequent s/s evaluation determined that he was safe to tolerate regular diet, which he tolerated for several days prior to discharge. on the id team recommended starting iv flagyl for positive c-diff infection. he will be on the iv form for 14 days and then will be switched back to the po form of flagyl. the patient's staples were removed on as well. to date all of the cultures are negative except for the positive clostridium difficile for which the patient is being treated. pt with slightly elevated bps upon arrival to floor - lisinopril added, with inmprovement in readings. family and patient are aware and agree with the transfer to . medications on admission: all: sulfa medications prior to admission: atenolol, asa discharge medications: 1. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours): stop on then change dose to po. 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 3. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 5. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4h (every 4 hours) as needed. 6. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 8. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): 1 q6 hour through then change to q8 then stop on . 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 10. levetiracetam 500 mg tablet sig: three (3) tablet po bid (2 times a day). 11. heparin lock flush (porcine) 100 unit/ml syringe sig: mls intravenous daily (daily) as needed. 12. ceftriaxone 2 gram piggyback sig: one (1) intravenous twice a day: stop on . 13. vancomycin 1,000 mg recon soln sig: one (1) intravenous q 12h (every 12 hours): titrate to trough of 20 will continue to . 14. outpatient lab work weekly cbc, bun, creatinine, ast,alt,alk phos, ldh please fax results to 15. lisinopril 10 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: subdural empyema discharge condition: neurologically stable discharge instructions: discharge instructions for craniotomy/head injury ?????? have a family member check your incision daily for signs of infection ?????? take your pain medicine as prescribed ?????? exercise should be limited to walking; no lifting, straining, excessive bending ?????? you may wash your hair only after sutures and/or staples have been removed ?????? you may shower before this time with assistance and use of a shower cap ?????? increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, ibuprofen etc. ?????? if you have been prescribed an anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing as ordered ?????? clearance to drive and return to work will be addressed at your post-operative office visit call your surgeon immediately if you experience any of the following: ?????? new onset of tremors or seizures ?????? any confusion or change in mental status ?????? any numbness, tingling, weakness in your extremities ?????? pain or headache that is continually increasing or not relieved by pain medication ?????? any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? fever greater than or equal to 101?????? f followup instructions: follow up in the clinic: provider: , md phone: date/time: 9:00 need head ct on and call radiology to confirm time follow up with dr in 4 weeks call for an appointment you will need a ct with contrast at that time antibiotic instructions: vancomycin 1g iv q8h through at least ; goal trough 15-20 ceftriaxone 2g iv q12h through at least flagyl 500 mg po q8h through at least po vancomycin 125 mg po q6h through , then 125 mg po q8h through , then 125 mg po q12h through , then stop. laboratory monitoring required weekly safety labs (cbc, bun/cr, lfts) and vanco trough to be drawn and results faxed to at . all laboratory results should be faxed to infectious disease r.ns. at (. all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. at procedure: incision of cerebral meninges other cranial puncture other cranial puncture intracranial ventricular shunt or anastomosis intranasal antrotomy ethmoidectomy other operations on nasal sinuses diagnoses: pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified compression of brain intestinal infection due to clostridium difficile intracranial abscess hemiplegia, unspecified, affecting unspecified side other acute sinusitis 

Answer: The patient is high likely exposed to