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: elective admission for mucocele major surgical or invasive procedure: :bifrontal craniotomy for skull base defect/mucocele rsxn : lumbar drain placement(interventional radiology) : external ventricular drain placement history of present illness: patient is a 54m w/pmh significant for intranasal substance abuse who was incidentally diagnosed with a large ethmoid mass in . further workup revelead this to be a mucocele. he was electively admitted on to undergo decompression and reconstruction of the skull base. past medical history: -mod-severe copd dx , fev1 25% predicted, bronchoresponsive (though pt doesnt use albuterol because makes him anxious), no intubation, pfts , dr. , last treatment with steroids . -obesity, likely osa-awaiting outpt sleep study-typical symptoms -tobacco abuse, prior 80pack year -cardiomyopathy echo ef 40%-unclear etiology, no known cad, has not had ischemic , no evidence of heart failure currently but may have had some - rll infiltrate and mediastinal wife, since dx with recurrent pna but never cleared, chronic cough since then, never had bronch, last abx levaquin , last ct findings polysubstance abuse, previously on methadone (illicit use), recent cocaine abuse (snorting/smoking), states last use 2months ago (records conflicting), tobacco 80+ pack years -ethmoid sinus large 5x5x5 mucocele-dx , pt thinking about resection, dr. (ent) and dr. (nsg) have evaluated, intiial surgery planned but pt got cold feet, planning to reschedule-no focal neuro deficits -anxiety -gsw s/p partial colectomy/colostomy/reversal, partial splenectomy years ago -inguinal hernia repair (per pt) -testicular torsion repair (per pt) -skin cancer (per chart) social history: married. owns trucking company but works less note. denies etoh. previous 1-2ppd, then quit 2mos ago, now 4cigs per day. previous regular methadone use (purchases on street) and cocaine use--snorting and smoking. family history: sister died of pancreatic ca recently at age 56. father died of dm. mother w/ unknown med hx. daughter with bipolar disorder physical exam: on discharge: the patient is oriented x 3 but is very impulsive. perrl and eoms intact. face symmetric and tongue midline. he frequently walks around the floor and is full strength with all 4 extremities. sensation intact. incision is healing well. pertinent results: labs on admission: 07:04pm blood wbc-8.9 rbc-4.41* hgb-11.9* hct-36.2* mcv-82 mch-27.0 mchc-32.9 rdw-15.1 plt ct-254 07:04pm blood pt-15.2* ptt-28.3 inr(pt)-1.3* 07:04pm blood glucose-140* urean-16 creat-1.1 na-142 k-4.6 cl-108 hco3-27 angap-12 07:04pm blood calcium-9.0 phos-3.7 mg-2.1 labs on discharge: wbc 5.5 hgb 9.5 hct 28.0 plts 370 glu bun creat na k cl hco3 94 19 1.2 142 3.1 108 22 (repleted k) imaging: head ct (post-op): non-contrast head ct: there has been interval resection of the expansile mass centered within the posterior ethmoid air cells with associated surgical fractures of the ethmoid air cells. there is mixed high-density material within this region that could represent postoperative ethmoid hematoma. there is also moderate-sized pneumocephalus. there is bifrontal craniotomy and subsequent cranioplasty. a mesh is seen to project over the frontal ethmoid recess and the frontal lobes. due to artifact from the postoperative mesh it is unclear as to what amount of residual mass is present. blood is also seen to extend into the sphenoid and bilateral maxillary sinuses. there is gyral effacement from the moderate-sized bifrontal pneumocephalus. otherwise, the ventricles and sulci are normal in size and configuration. there are no acute major vascular territorial infarcts and the and white matter differentiation is well preserved. there is no significant midline shift. the perimesencephalic and basilar cisterns are well preserved. impression: post-surgical changes from resection of the expansile lesion centered in the posterior ethmoid air cells with associated hematoma in the paranasal air sinuses and ethmoid air cell surgical fractures. due to artifacts from the frontoethmoid mesh it is unclear as to how much residual lesion is still present. mri head : technique: multiplanar t1- and t2-weighted imaging was obtained through the brain prior to and following administration of contrast. diffusion-weighted imaging was also reviewed. findings: as detailed on the recent ct, multiple postoperative changes are noted following a bifrontal craniotomy and subsequent cranioplasty. a surgical mesh is unchanged in location projecting over the frontoethmoidal recess. there is no evidence of residual ethmoidal mucocele. extensive paranasal sinus disease is unchanged. small foci of hypointensity on gradient echo sequences are indicative of a small amount of intracranial blood. there are no abnormal foci of enhancement. the remainder of the brain parenchyma is unremarkable and the ventricles and sulci are normal in size and configuration. impression: 1. status post resection of ethmoidal mucocele with no evidence of residual mucocele. 2. extensive unchanged paranasal sinus disease. head ct : findings: as on , postoperative change including a bifrontal craniotomy and subsequent cranioplasty is again noted. a surgical mesh underlying the frontal lobes bilaterally, and overlying the frontoethmoidal recess is unchanged in location. a moderate amount of pneumocephalus is noted, decreased since . the brain parenchyma, ventricles and sulci are all unchanged in appearance, with no evidence of shift of normally midline structures or herniation. extensive paranasal sinus opacification is unchanged. a moderate amount of fluid is seen layering posteriorly in the nasopharynx. the patient is intubated. impression: postoperative change as detailed above, with slight interval resolution of pneumocephalus since . there is no evidence of brain parenchymal herniation. head ct : since prior exam, a right frontoparietal approach, evd drain is in place with its tip terminating along the inferior aspect of the falx in the region of the third ventricle. bifrontal extraaxial hematoma adjacent to the central craniotomy site does appear slightly increased in size from most recent examination. no significant midline shift or mass effect is noted. large region of postoperative packing/hemorrhage in the expected location of the ethmoid sinuses has likely been evacuated with a more simple-appearing low- attenuation fluid within this region identified. a small amount of hemorrhage may still persist within the remaining anterior ethmoid air cells. underlying mesh is again noted and without significant change. there has been interval increase in degree of pneumocephalus likely related to recent procedure. hyperdense secretions within the left sphenoid sinus persist with opacification of the right sphenoid sinus and scattered opacification of bilateral mastoid air cells appearing stable. complete opacification involving the maxillary sinuses persists as well. discrete degree of soft tissue swelling especially along the orbital roof bilaterally appears slightly increased from . impression: no findings to suggest intracranial herniation. status post new right- sided evd with interval increase in pneumocephalus due to interval procedure. lenis : bilateral lower extremity ultrasound: color doppler and grayscale imaging of the right and left common femoral, superficial femoral, and popliteal veins demonstrate normal compression, augmentation, waveforms and flow. there is no evidence of intraluminal thrombus. the peroneal veins are unremarkable. impression: no lower extremity dvt. brief hospital course: patient was electively admitted on to undergo resection and reconstruction of skull base mucocele. post operatively, the patient was transferred to the icu for continued close monitoring. because of the nature of the surgery, and frailty of the dural membrane intraoperatively, infectious disease services was involved immediately post-op. on pod#1, the patient went to interventional radiology to undergo lumbar drain placement to assist in the managment of csf leak. drain placement was successful, however on pod#2, the drain ceased to work and was subsequently removed. on , he underwent stereotactic placement of external ventricular drain to further treat the csf leak, and such that intrathecal antibiotic therapy could be initiated. he continued to be intubated until it could be definitively identified if a csf leak was present. on , flurosceine contrast was instilled, while ent surgery observed with the use of a scope intranasally for csf leak. no csf leak was identified at this time. neurologically he continued to be stable. on , flurosceine testing was again repeated and determined that there was not an active csf leak. given this finding, he was then extubated without incident. on his external ventricular drain was removed, and two staples placed to approximate the wound. head ct was done immediately thereafter, and no hemorrhage was present. neurologically, he is alert, oriented to person, place and date, with small amounts of intermittant confusion. his strength was full throughout upper and lower extremities. given his marked clinical improvement, he was determined appropriate to transfer to the neurosurgical floor. on , he was noted to be draining a small amount of ? csf from the left nare. ent came by to evaluate with a scope, and did not appreciate any of this drainage. unfortunatley, due to the minimal quantity of drainage, it could not be evaluated by the lab to be definitively determined csf. on the morning of , he was again challenged at the bedside to assess for csf leak and there was no drainage. pt/ot recommended rehab and was scheduled to go to on at 3pm. however the patient eloped and was last seen in his room approximately 12:45pm. he was discovered missing at about 2pm. security and nursing looked for him but he was not found. medications on admission: advair", albuterol , , lasix 20mg', tiopropium inhaler. discharge medications: 1. outpatient lab work please have weekly cbc w/diff and chem 7 drawn and results faxed to dr. ,(infectious disease) @(. please call ( with any questions 2. amphotericin b liposome 50 mg suspension for reconstitution sig: 600mg suspension for reconstitutions intravenous q24h (every 24 hours): doses to continue until . weekly cbc and chem 7 to be faxed per id recommendations. 3. ceftazidime 2 gram recon soln sig: 2gm recon solns injection q8h (every 8 hours): doses to continue until . 4. vancomycin 1,000 mg recon soln sig: one (1) intravenous q 12h (every 12 hours): doses to continue until . 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po every twelve (12) hours as needed for constipation. 11. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 12. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 13. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 14. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 15. diphenhydramine hcl 50 mg/ml solution sig: one (1) injection q8h (every 8 hours) as needed. 16. phenytoin 50 mg tablet, chewable sig: five (5) tablet, chewable po bid (2 times a day). 17. acetazolamide 250 mg tablet sig: one (1) tablet po q8h (every 8 hours). discharge disposition: extended care facility: - - discharge diagnosis: skull base mucocele csf leak hypernatremia discharge condition: neurologically stable discharge instructions: general instructions ?????? have a friend/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, or excessive bending. ?????? 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. ?????? you have been prescribed dilantin (phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. this can be drawn at your pcp??????s office, but please have the results faxed to . ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. 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, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances intravascular imaging of intrathoracic vessels other exploration and decompression of spinal canal other repair of cerebral meninges other craniotomy insertion of skull plate intracranial ventricular shunt or anastomosis intranasal antrotomy ethmoidectomy control of epistaxis, not otherwise specified diagnoses: other primary cardiomyopathies obstructive sleep apnea (adult)(pediatric) tobacco use disorder acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation cocaine abuse, unspecified other nervous system complications compression of brain hemorrhage complicating a procedure acute respiratory failure obesity, unspecified hyperosmolality and/or hypernatremia opioid abuse, unspecified other heart block other disease of nasal cavity and sinuses 

Answer: The patient is high likely exposed to