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: found down major surgical or invasive procedure: 1. right craniectomy with evacuation of sdh and partial frontotemporal lobectomy 2. debridement and irrigation of craniotomy wound 3. lumbar puncture 4. endotracheal intubation 5. placement of peg tube 6. tracheostomy 7. central venous line placement 8. placement of ventriculoperitoneal shunt 9. right cranioplasty 10. placement of inferior vena cava filter history of present illness: 27 y.o. male, found down on sidewalk by ems. at scene, pt unconscious, exibiting decorticate posturing with no response to painful stimuli. intubated in the field and brought emergently to . past medical history: none social history: ukranian grad student at ; family in family history: non-contributory physical exam: in the ed vitals: temp: 91.4 hr 60 bp 90/p sats 100% on bmv gcs 3t gen: unreponsive, c-collar in place, intubated, sedated on propofol heent: pupils 8mm and fixed, left periorbital contusion, large hematoma over right parietal scalp, tm clear, no obvious oralpharyngeal trauma, midface stable neck: no crepitus, trachea midline chest: equal bs bilaterally cv: rrr abd: sntnd, fast neg rectal: nl tone, no gross blood, heme neg pelvis: stable to ap and lateral compression back: no step-offs on palpation of tl spine, no obvious abrasions ext: no long-bone deformities, no abrasions, lacerations neuro: decorticate posturing, no withdrawal to painful stimuli, no gag, no corneal reflex pertinent results: study date of echo: normal lvef ct head w/o contrast 10:48 am impression: 1) s/p craniectomy with herniation of the right cerebral hemisphere from the craniectomy defect 2) interval resolution of the subdural hematoma. improved grey white differentiation and reduced effacement of the sulci on the left cerebral hemisphere. 4) widened subdural cerebrospinal fluid spaces on the right. 5) opacification of multiple paranasal sinuses as described above. ct c-spine w/contrast 6:28 am impression: normal study. no evidence of fracture or subluxation. ct head w/o contrast 6:27 am impression: large, acute right sided subdural hematoma with subfalcine and uncal herniation. fractures of the right frontoparietal calvarium and left lamina papyracea. * csf culture: : no growth, no fungus, neg gs : no growth, neg gs * blood cultures: : mycolytic cx: parapsilosis : mycolytic cx: coag-negative staph, parapsilosis : anaerobe/aerobe cx:neg x1/1 : mycolytic cx: coag neg staph x 1 (final) : anaerobe/aerobe:neg x 2 (final) : coag neg staph x 1 : (left iv tip) coag neg staph : anaerobe/aerobe cx:neg x 2 (final read) : mycolytic cx: neg x 1 (final read) : anaerobe/aerobe cx:neg x 2 : blood cx : coag neg staph : mycolytic cx: coag neg staph : blooc cx : coag neg staph : no growth , , , negative x2 each set * urine cx : no growth : pseudomonas and klebsiella : no growth : no growth , , , , , : contamination with mixed bacterial flora * ua 9/16,9/17,: positive nitrite, many bacteria, but 0-2 wbc brief hospital course: 1. traumatic brain injury/ right subdural hemorrhage: pt was admitted on and was unresponsive with fixed pupils. emergent ct revealed a large acute r subdural hematoma with subfalcine and uncal herniation, as well as fractures of the right frontoparietal calvarium and left lamina papyracea. pt was taken to the or for emergent evacuation. he underwent a r craniectomy with evacuation of subdural hemorrhage and frontotemporal lobectomy. he was transferred to the trauma surgery icu for further care and was begun on mannitol to lower icp (discontinued ) and dilantin to prevent seizure (discontinued ). pt was closely followed but remained basically unresponsive. sedation was weaned, but pt remained basically unresponsive and without spontaneous movement, gag, or corneal reflexes. pt was noted to have extensor posturing to painful stimuli on upper extremities. a neurology consult was called to help evaluate for prognosis. on , an eeg showed r hemispheric subcortical dysfunction and mild encephalopathy, without evidence of ongoing seizure. it was thought that his prognosis ranged from limited verbal abilities and a dense left hemiparesis to a persistent vegetative state. pt was transferred to the floor on , where he continued to be followed by neurology and neurosurgery. multiple family meetings were held throughout hospital course to discuss the prognosis, both in the tsicu and on the floor, in conjunction with social work. on , pt was noted to have fluid draining from the wound site. this was felt to be necrotic brain fluid. neurosurgery placed additional sutures on , and the issue resolved. serial head cts were performed to evaluate for interval changes. on , head ct showed increased size of the ventricles after the ventricular drain had been removed; neurosurgery did not believe that this represented an increase in icp. there were intermittent changes in the amount of bulging at the r craniectomy site, thought to represent liquefaction necrosis as well as hydrocephalus. on , the amount of bulging was significantly greater, and another head ct was performed, which showed significantly worsening hydrocephalus. on , therefore, a vp shunt was placed, and a repeat head ct on showed interval improvement of the hydrocephalus. in mid-, pt was noted to have slow improvement of mental status, and was able to respond to voice, move his r fingers, and begin to follow simple commands. his family continued to work with him, and he slowly improved. eventually, he was able to answer yes/no questions with finger movements and to follow more commands. on , repeat head ct showed foci of relative within the right temporal lobe, which could be consistent with parenchymal hemorrhage, but pt's hydrocephalus was improved. as pt was reporting headaches, another ct was performed on , which revealed an area of acute hemorrhage inferior to the frontal portion of the infarct along the inferior edge of the craniotomy, more dense than on the previous ct. neurosurgery felt there was no indication for surgical intervention, and this remained stable on repeat head ct . pt had no further episodes of acute hemorrhage, and overall his neurological status continued to improve. on , pt underwent an elective r cranioplasty to repair the defect in his skull. he tolerated the procedure well. of note, a repeat head ct on showed no interval hemorrhage. pt will get a repeat head ct to evaluate for interval bleed on , and will follow up with dr. . 2. infectious disease: a. pod #4 s/p craniotomy and sdh evacuation - - pt was febrile, and sputum grew h. influenza; was started on zosyn for aspiration pneumonia. repeat sputum culture did not grow h flu. b. suspected encephalitis - pt treated with levofloxacin c. mrsa/pseudomonas pneumonia (lll) - vancomycin was begun on , and was given for 3 weeks given the concomitant meningitis (see below); for pseudomonal coverage, pt was treated with ceftazidime 2g iv q8h x 10 days () d. mrsa meningitis/infection of head wound - frank pus was expressed from head wound by neurosurgery; a lumbar puncture on eventually grew mrsa. pt was taken to or for washout/debridement of wound edges and subcutaneous tissue on , and a ventricular drain was placed. tissue culture eventually grew sparse coag + staph. for the mrsa meningitis, pt was treated with vancomycin 2g iv q12h x 21 days. repeat lp on showed wbc 585, rbc 8, protein 132, and glucose 38, bacterial and fungal cultures remained negative. id felt that elevated wbc was most likely secondary to brain injury and not infection since cultures remained negative. it was felt that mrsa meningitis was resolved. e. parapsilosis fungemia - blood cultures from and were positive for yeast, and ambisome was begun. when the culture data returned with parapsilosis, pt was switched to fluconazole. ophthalmology was consulted, and they found vitritis of the right eye, which they did not feel was specific to fungal endophthalmitis. he completed two weeks of antifungal therapy. f. positive urine cultures for klebsiella and pseudomonas - this was felt to be colonization in the setting of an indwelling foley x2 months and was not treated. g. within 24 hours after the vp shunt was placed, pt became hypotensive and tachycardic. he was started on meropenem/vancomycin empirically, but all cultures were negative and no source found. pt's hypotension resolved with fluids. antibiotics discontinued. h. low grade temps - found to have dvt - see below 3. deep venous thrombosis: bilateral lenis on revealed no evidence of dvt. pt was noted to have left leg swelling back in . however, in the setting of his traumatic subdural hemorrhage, as well as his poor neurologic prognosis at that time, the risks of anticoagulation were thought to outweigh the potential benefits, and so pt was not imaged at that time. this was discussed with the family at length. pt was continued on subcutaneous heparin for dvt prophylaxis. however, after the elective cranioplasty on , pt was noted to have daily temperature spikes. all cultures were negative including 8 sets of blood cultures, 4 urine cultures, 4 cxr with only atelectasis, abd ct negative. neurosurgery thought that accessing the shunt was unnecessary given his improving ms and minimal headache. at this point dvt was considered again. lenis were performed on , which revealed l superficial femoral and l common femoral dvts. after discussion with neurosurgery it was felt that his immediate risk of bleed is high but that it should decrease after 6 weeks or so, to the point where he may be able to be anticoagulated with coumadin. an ivc filter of intermediate duration was placed on ; this retrievable filter was placed with the plan for removal in 6 weeks if he has no further bleeding. pt continued to have low-grade fevers, but all cultures were negative and this was attributed to the presence of dvts, and possible atelectasis. plans are made for followup to have the ivc filter removed in weeks. 4. cardiovascular, pulmonary, gastrointestinal, renal, endocrine: no acute problems since transfer to the general medical floor. 5. supportive care: a tracheostomy was placed on . over the course of the hospitalization, the trach size was changed to a smaller size on , and a passy muir valve was ultimately introduced to maximize pt's ability to speak on , which was in place only during waking hours. a peg tube was placed on , and nutrition followed pt. he was at goal tube feeds for the majority of his hospitalization, at 80cc/hr. a repeat speech and swallow evaluation on confirmed that pt was aspirating all consistencies of liquid. however, there was concern that the family may have been feeding him, as residuals showed unexpected material once and pt with apparent crumbs all over chest the week before discharge. pt's family was made aware of the grave danger of feeding this aspirating patient and they acknoledged the importance of not feeding him by mouth. pt had meticulous skin care and never developed a sacral decub. physical and occupational therapy continue to work with the patient, and his progress has been remarkable. medications on admission: none discharge medications: 1. albuterol sulfate 0.083 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed. 2. methylphenidate hcl 10 mg tablet sig: one (1) tablet po bid (2 times a day). 3. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 4. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 5. docusate sodium 150 mg/15 ml liquid sig: one hundred (100) mg po bid (2 times a day). 6. artificial tear ointment 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 7. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 8. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 9. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day). 10. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 14. morphine sulfate 8 mg/ml syringe sig: 2-4 mg injection q4h (every 4 hours) as needed for pain. 15. triamcinolone acetonide 0.025 % ointment sig: one (1) appl topical (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary: 1. subdural hemorrhage, status post right craniotomy and partial frontotemporal lobectomy, ventriculoperitoneal shunt placement, and elective cranioplasty secondary: 1. left common femoral and left superficial femoral deep vein thrombosis 2. mrsa meningitis, now resolved 3. mrsa pneumonia, pseudomonas pneumonia, now resolved 4. fungemia with parapsilosis, now resolved discharge condition: able to communicate yes and no questions, mental status good, with trach and peg tube in place discharge instructions: please let the staff know if you are in pain or have any other symptoms that are concerning to you. followup instructions: : provider: scan where: radiology phone: date/time: 8:45 you have an appointment with dr. on at noon, after the head ct, so that interval change can be evaluated. : provider: scan where: cc clinical center radiology phone: date/time: 8:00 you should not have tube feeds three hours before this study. provider: study where: cc clinical center radiology phone: date/time: 8:30 you have an appointment with dr. (neurosurgery) at 1:30pm on . this islocated in the (3b) of the on . phone number is (. you have an appointment with dr. (interventional radiology) to discuss when the ivc filter should be removed on at 10am. this is located on the of the clinical center on the . phone number is (. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain interruption of the vena cava enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] ventricular shunt to abdominal cavity and organs temporary tracheostomy closure of skin and subcutaneous tissue of other sites operations on two or more extraocular muscles involving temporary detachment from globe, one or both eyes lobectomy of brain elevation of skull fracture fragments ventricular shunt to extracranial site nec insertion of skull plate application or administration of an adhesion barrier substance diagnoses: pneumonia due to pseudomonas pneumonitis due to inhalation of food or vomitus disseminated candidiasis assault by unspecified means pneumonia due to klebsiella pneumoniae communicating hydrocephalus non-healing surgical wound closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level staphylococcal meningitis 

Answer: The patient is high likely exposed to