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: patient recorded as having no known allergies to drugs attending: chief complaint: generalized seizure and confusion major surgical or invasive procedure: lumbar puncture on picc line placement (43 cm) history of present illness: mr. is a 58-year-old man with a h/o oligoastrocytoma s/p resection in and radiation that has been complicated by radiation necrosis and infection with bacteroides/citrabacter who presents with confusion after having a seizure. according to his wife, she received a call from the rehab her husband was at indicating that rs had had a "gran mal seizure". he was transfered to hopsital where he underwent a ct scan and was given 2 percocets. his wife noticed that there has been a significant drop in his left-sided motor function from the day before and that he appeared confused and disoriented. he was, therefore, transfered to ed, where he was given 1gm of keppra and blood cultures were sent. mrs. notes that rs's cognitive and motor function had been steadily decreasing since his tumor resection in . she notes that rs gradually lost memory, balance, and dexterity, but was able to take care of himself. however, in , rs was hospitalized after driving his car out of the garage without opening the door and afterwards suffered a notable drop in his functionality. although he was still able to take care of himself, he was no longer able to drive and needed closer supervision. he was again hospitalized in after being found confused and trying to change the channel with the remote backwards in his hand. he was taken to southern medical center, but was later transfered to where mri showed changes from prior imaging. a biopsy demonstrated radiation necrosis. he developed wound breakdown, which was treated with a rotational flap. he then developed a wound infection with bacteroides and citrobacter, which required debridement. he was hospitalized from - and was sent to rehab where he spent the last two weeks. this morning, he had a witnessed generalized seizure for 30 seconds and was afterwards very confused. his wife reports that he is now less confused but still not back to baseline. she notes that his lue is postured so that the hand is fisted and held close to his chest. she notes that he has had this same type of posturing twice in the past ( and ), at which time he also had confusion. those episodes lasted 30-45 minutes and were suspected to be complex partial seizures. a routine eeg done near or on the date of one of those events showed slowing but no epileptiform discharges. he has never had a generalized seizure. ros: he denies any pain, headache, neck stiffness, fevers, chills, vision changes, weakness. past medical history: oligoastrocytoma, right frontal lobe, s/p craniotomy and resection, s/p xrt anxiety panic attacks alcohol abuse shoulder dislocation htn macular edema retinopathy keloids social history: patient is a retired military officer. he has 3 chlildren - 2 from his current marriage (19, 21) and one from a previous marriage (30's). he married his current wife in . his wife notes that he abused alcohol and could drink a six pack and several shots of liquor in one sitting. his last drink was in . he quit smoking 28 years ago, but smoked 2-3 packs/day prior to that for yrs. family history: father, 80s, had a benign brain tumor in his 70s. mother still alive in mid 80's. sister died in from ms complications. physical exam: physical exam: vitals: t: 99.8 p: 80 r: 18 bp: 140/64 sao2: 99%ra general: sleeping, arousable to voice, but continuously dozing off, in nad. heent: wound clean, dry, with sutures in place. no erythema, edema or discharge. drain in place. rest of heent exam limited because patient not awake to cooperate neck: supple, no carotid bruits appreciated pulm: ctabl no wheezing, rales, rhonchi cv: rrr, nl s1, s2, no m/r/g appreciated abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly extremities: no clubbing, pitting edema, pulses palpable bilaterally. skin: scar on chest and on right thigh neurologic examination: mental status: awake and alert, cooperative with exam, flat affect. oriented to person, place, and date. attentive with moyb quick and without errors. speech is fluent with normal comprehension and repetition; naming intact . no dysarthria. intact. registers 0/3 then . recalls at 2 minutes, but 0 at 5. significant right/left confusion on vision and sensory testing. no neglect. cranial nerves: pupils equally round and reactive to light, 4 to 2 mm bilaterally. difficult to formaly test vf with his l/r confusion, but blinks to threat bilaterally. disc margins intact. extraocular movements intact bilaterally but poor effort/attention, no nystagmus. sensation intact v1-v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact motor: normal bulk bilaterally. tone increasd in lue and lle. motor exam limited because patient not awake and not terribly responsive. sensation: when pain stimuli provided, patient was able to localize the pain with his hands. his response on the left side was considerably slower. sensation to pain on the left was notably decreased. other tests could nt be performed. reflexes: +1 and symmetric throughout both upper extremities. 2+ knees. absent ankles. babinski: up in left, down in right. gait/coordination: could not be assessed. pertinent results: 06:10am blood wbc-11.0 rbc-4.39* hgb-13.2* hct-38.4* mcv-88 mch-30.0 mchc-34.2 rdw-12.6 plt ct-254 06:37am blood wbc-6.2 rbc-3.66* hgb-11.0* hct-32.3* mcv-88 mch-29.9 mchc-33.9 rdw-12.9 plt ct-311 10:08am blood neuts-76.5* lymphs-16.0* monos-6.3 eos-0.9 baso-0.4 06:25am blood neuts-68.4 lymphs-20.2 monos-8.9 eos-2.1 baso-0.3 10:08am blood pt-12.3 ptt-27.2 inr(pt)-1.0 10:08am blood glucose-95 urean-13 creat-0.9 na-137 k-4.2 cl-97 hco3-31 angap-13 06:37am blood glucose-125* urean-5* creat-0.7 na-139 k-3.9 cl-103 hco3-28 angap-12 12:39pm blood alt-14 ast-16 ld(ldh)-152 alkphos-70 totbili-0.5 12:39pm blood albumin-3.4 calcium-8.6 phos-2.8 mg-1.9 06:37am blood albumin-pnd calcium-8.5 phos-3.3 mg-1.8 06:10am blood tsh-0.35 06:37am blood vanco-17.8 06:37am blood phenyto-18.4 10:08am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg eeg (): please refer to mri report from one day prior for full evaluation of the brain. on this post-contrast study, there is mild enhancement adjacent to the frontal of the right lateral ventricle adjacent to the surgical site, however, this has decreased since and likely reflects radiation changes, or less likely residual tumor. no diffusion abnormality to suggest abscess. extensive periventricular flair hyperintensity consistent with vasogenic edema, is not significantly changed. the extra- axial fluid collection overlying the resection site is unchanged measuring 11 mm in greatest diameter. no new areas of enhancement are identified. mr () please refer to mri report from one day prior for full evaluation of the brain. on this post-contrast study, there is mild enhancement adjacent to the frontal of the right lateral ventricle adjacent to the surgical site, however, this has decreased since and likely reflects radiation changes, or less likely residual tumor. no diffusion abnormality to suggest abscess. extensive periventricular flair hyperintensity consistent with vasogenic edema, is not significantly changed. the extra- axial fluid collection overlying the resection site is unchanged measuring 11 mm in greatest diameter. no new areas of enhancement are identified. ct (): small right-sided subdural hemorrhage, right frontal encephalomalacia, cerebral white matter periventricular hypodensities are unchanged. similarly, unchanged hyperdense foci in the pons likely representing calcifications are noted. there is no evidence of acute interval hemorrhage in the brain. the ventricles and extra-axial csf spaces are prominent but unchanged. patient is status post right frontal craniotomy. picc line placement (): uncomplicated ultrasound and fluoroscopically guided double lumen picc line placement via the right brachial venous approach. final internal length is 43 cm, with the tip positioned in svc. the line is ready to use. x-ray left foot (): no signs of osteomyelitis brief hospital course: patient is a 58 yo man with pmh of oligoastrocytoma s/p craniotomy and xrt in , s/p repeat bx several months ago with finding of necrosis complicated by chronic citrabacter/bacteroides infection and poor wound healing, now presenting with confusion and first generalized seizure. . based on his posturing of his left hand noted on physical examination along with confusion, there was concern for seizure activity. therefore he was given an extra 1g of keppra and his home dose was increased. an eeg did not show any continued non-convulsive status. an mri showed decreased enhancement in the surgical site and unchanged vasogenic edema likely reflective of post-treatment changes and less likely residual tumor. there was also no suggestion for an abscess formation. . given his history of citrabacter/bacteroides infection, a lumbar puncture was performed with csf results as follows: 88 protein, 64 glucose, 22 wbc (96 polys/2 lymphs) and 0 rbc. his ertapenem was changed to meropenem at admission. a blood culture from his picc line on grew coagulase negative staph. his antibiotics were changed to vancomycin, ceftriaxone and flagyl per id recommendations. . a ctv was obtained on for evaluation of venous thrombus given his worsened left hemiplegia and left neglect and was negative. . he received swallow tests on both , , and , which he failed, passed and passed respectively. the recommendation was for him to remain on soft solids and advance as tolerated. . fevers resolved on and he remained stable until when the patient went into status epilepticus for about 30 minutes. ativan (10mg total) was administered with little improvement. he was then loaded with dilantin 1g with seizure resolution after ~10 minutes and then transfered to the neurological icu. . in the icu, he was loaded again with dilantin 1g based on a level of 5.9 on and with another 300mg on for a level of 11.7. his dilantin was also increased to 200mg . on , he was noted to have spontaneous movements of his left extremities, was able to speak and with mild residual left visual neglect. on , his mental status appeared improved from admission. patient able to state months of the year backwards and follow basic commands, though some memory and cognitive dysfunction still evident. his dilantin level on was 18.4 and his dosing was changed to 300mg q hs. . picc line placed on . picc is 43 cm long. patient left foot appeared erythematous, warm and swollen. given his bacteremia, there was concern for osteomyelitis. plain foot films were obtained and showed no signs of infection or osteomyeltis. his blood culture from showed no growth. prior to discharge follow up labs were obtained (esr and crp) discussed with the infectious disease team. final plan with respect to his antibiotics regimen and follow up was determined at that point as outlined below. medications on admission: ertapenem 1gm q24 hours keppra 500 pepcid lisinopril 20 daily dulcolax asa 81 hctz 25 discharge medications: 1. levetiracetam 500 mg tablet sig: three (3) tablet po bid (2 times a day). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. phenytoin sodium extended 100 mg capsule sig: three (3) capsule po qhs (once a day (at bedtime)). 4. ceftriaxone 2 gram piggyback sig: one (1) piggyback intravenous twice a day for 7 days: last day should be . 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po twice a day for 14 days: please start after the course of ceftriaxone has been completed (), and continue through . 6. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 21 days: please continue through . 7. vancomycin 1,000 mg recon soln sig: one (1) dose intravenous twice a day for 13 days: please continue through . please check trough . 8. lisinopril 2.5 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis: seizure, status epilepticus line bacteremia parameningeal infection resolving wound infection secondary diagnosis 1. oligoastrocytoma, right frontal lobe, as per above 2. htn 3. anxiety 4. retinopathy 5. macular edema discharge condition: stable residual frontal behavioral deficit, at baseline improving weakness of the l arm and leg mild residual neglect to the l. discharge instructions: you were admitted with seizures and fever. please: 1. continue ceftriaxone 2g iv bid through , then change to ciprofloxacin 500mg po bid through . 2. continue flagyl 500mg po q 8hrs through . 3. continue vancomycin 1000mg iv bid through . 4. please check weekly cbc with differential and lfts. have results faxed to infectious disease at . 5. please check dilantin & vancomycin trough level on . please follow up with your primary medical doctor. please go to the nearest emergency department if you experience severe headache, seizures, or new neurological symptoms such as weakness or numbness. followup instructions: 1. provider: , md, phd: date/time: 1:30 2. provider: , md phone: date/time: 12:00 3. patient will be followed up by dr. at . md procedure: venous catheterization, not elsewhere classified spinal tap incision of lung diagnoses: other postoperative infection unspecified essential hypertension sepsis grand mal status other and unspecified infection due to central venous catheter personal history of malignant neoplasm of brain meningitis, unspecified other staphylococcal septicemia 

Answer: The patient is high likely exposed to