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: percocet attending: chief complaint: abdominal pain major surgical or invasive procedure: vp shunt removal endotracheal intubation history of present illness: 63 y/o m w/ non-small cell lung cancer metastatic to the brain with vp shunt placed for obstructive hydrocephalus who p/w abdominal pain to osh. prior to his presentation, he reportedly had not had any fevers, chills, nausea, vomiting, or altered mental status. he did not have fever or leukocytosis. he was treated with levofloxacin and metronidazole, followed by ceftriaxone and vancomycin. mental status was waxing and , which was attributed to narcotic therapy used for severe abdominal pain. an abdominal ct showed a 3 cm ruq fluid collection at the distal tip of the vp shunt. he underwent ultrasound-guided aspiration of this fluid collection on with drainage of purulent material. a ruq drain was left in place. he was transferred to for neurosurgical evaluation given the concern for vp shunt infection. past medical history: nsclc met to brain - diagnosed ; s/p whole brain xrt, avastin, taxol, carboplatin completed ); s/p resection parietal lesion c/b obstructive hydrocephalus w/ vp shunt placement copd bph diverticulosis sbo s/p ex-lap (childhood) s/p tonsillectomy social history: married, lives with wife. children. occupation: former auto parts salesman drugs: denies tobacco: smoked 1 ppd x 20 yrs; quit one year ago alcohol: formerly drank approx 6 beers/night; drank beers/night up until cancer diagnosis in family history: mother died of pancreatic cancer; two uncles died of lung cancer; one brother died of esophageal cancer; another brother died of head/neck cancer physical exam: admission physical exam v/s t 97.3 hr 99 rr 23 o2sat 97% general: lying in bed with eyes closed and intermittently moaning heent: no scleral icterus, dry mucous membranes neck: supple, no cervical/supraclavicular lymphadenopathy chest: scattered rhonchi and loud upper airway sounds cv: regular rate/rhythm, normal s1s2, no murmurs abdomen: soft, mildly distended, no guarding but significantly tender to palpation especially on right side; (+) rebound tenderness; normal bowel sounds; (+) upper right flank drain with whitish liquid drainage extremities: warm, no edema, 2+ pt pulses skin: no jaundice or rashes neurologic: alert, disoriented and inattentive, intermittently following commands; cn 2-12 intact, though exam limited by poor attentiveness/cooperation; 4/5 strength in bilateral deltoids, biceps, triceps, wrist extensors, hip flexors/extensors, ankle flexors/extensors; 2+ biceps reflexes bilaterally; unable to elicit patellar reflexes pertinent results: 7/28/098 mri head w/ conrast there are changes from a right frontal and left parietal craniotomy. there is slight decrease in the soft tissue swelling overlying the left parietal craniotomy. the soft tissue overlying the right frontal cranitomy is stable. there is a right frontal ventricular catheter with its tip just past the left frontal . there is a postoperative cavity in the left parietal lobe with blood products within it, which appears to be relatively stable in terms of size and mild associated enhancement. enhancing lesion in the right cerebellum appears to be stable. no new enhancing foci are seen. previously noted subdural fluid collections and dural enhancement have decreased to a large degree. there has been progression of confluent periventricular hyperintensity, which may reflect post-treatment sequela. the ventricles are mildly enlarged compared to the prior study. the post-gadolinium enhancing volume of the right cerebellar lesion measures 1.16 cm3. in the right cerebellum, the flair volume measures 239.9 mm3 . impression: postoperative changes, no new enhancing foci are seen. stable enhancement in the right cerebellum and in the left parietal operative bed. progression of white matter hyperintensity which may reflect radiation sequela. . cxr there are low lung volumes. there is no pneumothorax or pleural effusion. there is atelectasis in the right base. ill-defined opacity in the right apex is consistent with patient's known lung cancer. cardiomediastinal contours are unremarkable. impression: no evidence of acute cardiopulmonary abnormalities. . ct chest: 1. negative examination for pulmonary embolism. 2. increase in size of the previously described spiculated lesion in the right upper lobe, now extending to the pleura. 3. new lung nodules as described above. 4. atelectasis of the right lower lobe, associated with effusion; no pleural nodule. 5. bronchomalacia of the right main bronchus and intermedius bronchus, evoked by expiration. non-contrast head ct 1. no evidence of intracranial abscess or vp shunt infection. however, ct has significantly limited sensitivity in this regard, compared to mri. 2. known enhancement in the left cerebellum and at the left parietal surgical site, seen on the mri, is not appreciated due to differences in technique. 3. increased hemispheric white matter hypodensity without mass effect, likely related to radiation therapy. further evaluation of tumor burden may be performed by mri. . non-contrast head ct the patient is status post right vp shunt removal with a small locule of air noted non-dependently within the left frontal in addition to a trace amount of likely post-surgical intraventricular hemorrhage noted dependently within the left occipital . examination is otherwise unchanged from . there is stable appearance to the left parietal surgical resection bed. small extra-axial fluid collections are unchanged. subcutaneous emphysema and a mild amount of edema is noted along the external old vp shunt site. mild mucosal thickening within the ethmoid air cells and sphenoid sinus is stable as is partial opacification of the mastoid air cells bilaterally. impression: 1. trace amount of blood within the left occipital , otherwise no significant interval change status post vp shunt removal. . r humerus xray: two views. there is an oblique fracture of the proximal shaft of the humerus. there is callus formation at the fracture site, although the fracture line is partially visible. fracture fragments are not significantly displaced. bones are osteopenic. there is no evidence of dislocation. mild degenerative arthritic change is present in the shoulder joint. a picc line is present. impression: healing fracture proximal humerus. . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:40am 11.0 3.00* 10.7* 31.7* 106* 35.5* 33.6 16.5* 135* 05:55am 12.5* 3.07* 11.3* 32.7* 107* 36.8* 34.5 16.6* 132* diff added @ 12:08 05:20am 12.8* 3.12* 11.1* 32.8* 105* 35.6* 33.9 16.5* 139* 04:59am 9.3 2.92* 10.5* 30.2* 103* 36.1* 34.9 16.4* 141* source: line-picc 05:30am 8.8 2.77* 10.1* 29.5* 106* 36.5* 34.3 15.9* 126* source: line-picc 04:39am 9.8 2.58* 9.5* 26.9* 105* 36.9* 35.3* 16.2* 133* source: line-picc 02:40am 10.8 2.58* 9.4* 27.6* 107* 36.6* 34.3 16.1* 127* source: line-right picc 03:07am 8.8 2.77* 10.3* 29.4* 106* 37.1* 35.0 16.3* 122* source: line-piv 04:00am 9.7 2.99* 11.0* 32.1* 107* 36.9* 34.4 16.1* 118* source: line-piv 03:07am 7.1 2.93* 10.5* 30.5* 104* 35.9* 34.4 16.2* 121* 02:52am 6.1 2.79* 10.0* 29.6* 106* 35.9* 33.9 16.4* 122* 08:40pm 5.3 2.74* 10.0* 28.5* 104* 36.5* 35.1* 16.3* 115* 02:32am 7.7 2.81* 10.3* 29.5* 105* 36.5* 34.9 16.0* 129* 05:27am 11.1* 2.95* 10.5* 31.0* 105* 35.8* 34.0 16.5* 143* 09:36pm 10.2 2.97* 10.9* 32.1* 108* 36.8* 34.0 16.4* 175# . antibiotics vanco trough 04:00am 17.5 . 7:52 pm foreign body valve and ventricular catheter of vp shunt. **final report ** wound culture (final ): staphylococcus, coagulase negative. staph aureus coag +. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s penicillin g---------- =>0.5 r trimethoprim/sulfa---- <=0.5 s . 7:51 pm foreign body vp shunt abdominal catheter. **final report ** wound culture (final ): lactobacillus species. . 2:44 pm peritoneal fluid peritoneal fluid. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): no growth. anaerobic culture (preliminary): fungal culture (preliminary): brief hospital course: #hypercapnic respiratory failure - secondary to copd exacerbation in the setting of narcotic analgesia and aspiration pneumonitis. treated with mechanical ventilation followed by noninvasive ventilation, high-dose corticosteroid taper, nebulized bronchodilators, incentive spirometry, and antibiotics as above. ambulatory oxygenation improved with physical therapy. o2sat mid-high 90s on ra prior to discharge. . #vp shunt infection - given changes in mental status with an indwelling catheter, the patient was continued on broad-spectrum abx and the vp shunt was removed . culture grew mssa. he was continued on vancomycin for cns penetration to complete a 14 day course via right brachial picc beginning on the day of shunt removal. mental status progressively improved and the patient did not have any signs or symptoms of residual neurological deficit. . #ruq fluid collection - ultrasound-guided drainage of this collection at the osh reportedly revealed purulent material, most likely an infected pseudocyst which formed at the distal site of the vp catheter. a drain placed at the osh was removed prior to discharge. peritoneal fluid was not consistent with peritonitis and culture grew lactobacillus. the patient was treated with ceftriaxone and flagyl to complete a 14 day course per id recommendations. his abdominal symptoms and exam progressively improved prior to discharge. . #metastatic nsclc - most recent mri showed stable metastatic disease in the cerebellum. seen in consultation by the palliative care service who provided information to the patient and his wife regarding end of life care. the patient has scheduled follow-up with his oncologist 2 weeks after discharge, at which time he is due for a repeat mri. . #htn - the patient did not carry the diagnosis of hypertension prior to admission but had bp 160-180/80-100 in the setting of corticosteroid therapy. was started on amlodipine which was uptitrated to 10 mg daily with improvement in bp. blood pressure should be closely monitored during steroid taper, and amlodipine may be decreased or discontinued accordingly. . #prophylaxis - given pneumoboots for dvt ppx, and ppi and iss while on steroids. medications on admission: medications on transfer: hydromorphone 2mg im/sc q4h prn ondansetron 4 mg iv q4h prn heparin sc 5000 units tid ceftriaxone mg iv q12h ( - ) vancomycin 1000 mg iv q12h ( - ) home medications: fluticasone/salmeterol 250/50 1 puff fluticasone nasal 50 mcg esomeprazole 40 mg daily multivitamin once daily calcium citrate once daily folic acid 1 mg daily thiamine 100 mg daily levetiracetam 1000 mg polyethylene glycol once daily metoclopromide 10 mg four times daily megace 625 mg daily prochlorperazine 10 mg prn (rarely takes) lorazepam 1 mg prn (very rarely takes) loratadine/pseudoephedrine prn tiotropium 1 puff daily discharge medications: 1. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily): hold for sbp<100, hr<55. 4. ipratropium bromide 0.02 % solution sig: one (1) inh inhalation q6h (every 6 hours). 5. fentanyl 12 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inh inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 8. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 1 days. 9. prednisone 10 mg tablet sig: one (1) tablet po daily (daily) for 3 days: . 10. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 12. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 13. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal twice a day. 14. multivitamin capsule sig: one (1) capsule po once a day. 15. folic acid 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: northeast - discharge diagnosis: 1) hypercapnic respiratory failure 2) ventriculoperitoneal shunt infection s/p shunt removal 3) chronic obstructive pulmonary disease 4) non-small-cell lung cancer discharge condition: asymptomatic with stable vital signs. discharge instructions: you were admitted to the hospital with an infection of your ventriculoperitoneal shunt. your infection was successfully treated with antibiotics. you also had a copd flare treated with mechanical ventilation, nebulizer breathing treatments and a course of steroids which is scheduled to be completed on wednesday . please call the office of dr. at to arrange a follow-up appointment in weeks. please attend your mri appointment on monday at 1:15 pm prior to your appointment with dr. at 3:00 pm. please call your physician or return to the emergency department if you experience fever, chills, sweats, dizziness, lightheadedness, headache, confusion, aversion to light, changes in vision, chest pain, cough, shortness of breath, back pain, abdominal pain, vomiting, bloody or dark stools, leg pain or swelling, numbness, weakness, tingling, or falls. followup instructions: please call the office of dr. at to arrange a follow-up appointment in weeks. please attend your mri appointment on monday at 1:15 pm prior to your appointment with dr. at 3:00 pm. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube percutaneous abdominal drainage removal of ventricular shunt diagnoses: thrombocytopenia, unspecified cellulitis and abscess of trunk unspecified essential hypertension obstructive chronic bronchitis with (acute) exacerbation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site malignant neoplasm of other parts of bronchus or lung accidents occurring in other specified places surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation subdural hemorrhage diverticulosis of colon (without mention of hemorrhage) iatrogenic cerebrovascular infarction or hemorrhage other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes infection and inflammatory reaction due to nervous system device, implant, and graft 

Answer: The patient is high likely exposed to