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: no known allergies / adverse drug reactions attending: chief complaint: found down in bathroom major surgical or invasive procedure: : left hemicraniectomy & evd placement : tracheostomy/gastrostomy history of present illness: (patient intubated and no witness to provide information) 50 yo m with hx of htn, polysubstance abuse (cocaine, heroin, alcohol), hepc presented to hospital with headache and ?fall hitting his head. gcs on arrival was 11 and patient found to have right sided hemiplegia. nchct done at that time revealed large l basal ganglia bleed with minimal midline shift. pt found to deteriorate from there with subsequent intubation on propofol. patient was given mannitol 70g and started on nitroprusside gtt for bp > 180. past medical history: htn hepc substance abuse/ ivda social history: polysubstance abuse, prior cocaine/heroin alcohol, family history: non-contributory physical exam: admission: o: t: bp: 155/ 86 hr: 60 r 12 o2sats 98% gen: intubated sedated cranial nerves: i: not tested ii: pupils equally round and reactive to light, 2-->1 on r and 3-->2 on left. visual fields not assessed v, vi: intact doll's eyes vii: ix, x: palatal elevation symmetrical ---------- pertinent results: 07:40am wbc-6.2 rbc-4.36* hgb-11.5* hct-35.6* mcv-82 mch-26.5* mchc-32.5 rdw-15.5 07:40am neuts-67.0 lymphs-26.8 monos-4.8 eos-1.0 basos-0.4 07:40am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 07:40am urine color-straw appear-clear sp -1.018 07:40am urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-pos amphetmn-neg mthdone-neg 07:40am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 07:40am glucose-113* urea n-36* creat-2.5* sodium-136 potassium-4.2 chloride-102 total co2-23 anion gap-15 08:52am glucose-102 lactate-1.9 na+-128* k+-4.0 cl--100 08:52am hgb-10.1* calchct-30 nchct impression: increasing size of a large left basal ganglia intraparenchymal hematoma, now measuring 4.3 x 2.7 cm. increasing mass effect with progressive subfalcine herniation measuring 6mm well as well as concern for impending downward transtentorial herniation. increasing intraventricular hemorrhage with dilatation of the temporal of the right lateral ventricle, new from prior and concerning for developing obstructive hydrocephalus. ct c-spine impression: no acute cervical spine fracture or malalignment. a large expansile cystic lesion in the left mandible associated with an unerupted tooth, likely represents a dentigerous cyst. eeg impression: this is an abnormal eeg because of continuous left hemispheric slowing with sharp features in the left frontocentral region. these findings are suggestive of a focal structural lesion in the left hemisphere. there is diffuse background slowing, indicative of a mild to moderate diffuse encephalopathy, which is etiologically non-specific. there were no clear epileptiform discharges. there were no electrographic seizures. portable nchct impression: slight interval decrease in size of left parenchymal hemorrhage with persistent but slightly improved mass effect. renal us: no evidence of renal artery stenosis. no evidence of hydronephrosis, renal stones, or renal masses. nchct: left basal ganglia intraparenchymal hemorrhage has decreased in density. surrounding white matter edema persists. mild rightward shift of midline structures and mass effect on the left lateral ventricle are not appreciably changed since prior. no new hemorrhage. detailed assessment of parenchymal changes can be better performed with mri if necessary and if not ci. status post left hemicraniectomy with expected evolution of adjacent soft tissue hematoma and fluid collection. ekg : sinus bradycardia with sinus arrhythmia. short p-r interval without other signs of pre-excitation. left ventricular hypertrophy by voltage criteria. compared to the previous tracing of the heart rate is slower. peaked p waves are no longer seen. intervals axes rate pr qrs qt/qtc p qrs t 49 106 92 35 wbc count 8.4 4.0 - 11.0 k/ul lymphocytes, percent 24 18 - 42 % absolute lymphocyte count #/ul cd3 cells, percent 78 % absolute cd3 count 1 #/ul cd4 cells, percent 25 % absolute cd4 count #/ul cd8 cells, percent 52 % absolute cd8 count 1043* 193 - 685 #/ul cd4/cd8 ratio 0.5* 0.84 - 3.0 ratio 8:49 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and chains. respiratory culture (final ): rare growth commensal respiratory flora. streptococcus pneumoniae. heavy growth. penicillin sensitivity testing performed by etest. staph aureus coag +. rare growth. 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. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ streptococcus pneumoniae | staph aureus coag + | | clindamycin----------- <=0.25 s erythromycin---------- =>1 r =>8 r gentamicin------------ <=0.5 s levofloxacin---------- <=0.5 s 0.25 s oxacillin------------- =>4 r penicillin g---------- 1 s rifampin-------------- <=0.5 s tetracycline---------- <=1 s <=1 s trimethoprim/sulfa---- 4 r <=0.5 s vancomycin------------ <=1 s <=0.5 s 10:10 am mini-bal **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and chains. respiratory culture (final ): ~1000/ml commensal respiratory flora. streptococcus pneumoniae. >100,000 organisms/ml.. sensitivities performed on culture # 341-9661e on . haemophilus influenzae, beta-lactamase negative. 10,000-100,000 organisms/ml.. beta-lactamse negative: presumptively sensitive to ampicillin. confirmation should be requested in cases of treatment failure in life-threatening infections.. staph aureus coag +. ~8ooo/ml. sensitivities performed on culture # 341-9661e 0n . 3:35 pm bronchoalveolar lavage right lower lobe. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. 10,000-100,000 organisms/ml.. sensitivities performed on culture # 342-8513w, . staph aureus coag +. 10,000-100,000 organisms/ml.. of two colonial morphologies. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. 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---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=0.5 s fungal culture (preliminary): no fungus isolated. brief hospital course: brief history: 55 yo m h/o htn, hiv, hep c, substance abuse p/w depressed loc and found to have a large l basal ganglia hemorrhage with ivh. he was initially treated with mannitol and an emergent ventriculostomy briefly, then he was taken to the or for emegent hemicraniectomy. post-operatively, he was managed in the neuro icu with his primary issues being hypertension, respiratory difficulty, infection, and persistent depressed loc. . iph/ivh - his l basal ganglia iph and ivh were thought to be secondary to hypertension from cocaine abuse. he did reportedly fall prior to admission, but the deep location of the bleed makes traumatic a less likely etiology. his repeat nchcts did not show any significant expansion of the hemorrhage or resultant hydrocephalus. his prior deficits from the hemorrhage were depressed loc, inattention, l gaze preference, and r hemiplegia. . hypertension - in order to manage his hemorrhage, the patient was placed on several oral antihypertensives but he had poor response to most of them except clonidine. his ng clonidine however resulted in periodic drops in his bp below the desired range (sbp 100-160), so he was switched to a clonidine patch. he intermittently required a nicardipine infusion for further control. he was eventually started on lisinopril 40 and hctz 25 (he did not respond well to hydralizine ng or amlodipine ng for which he was on high doses). his most recent bp regimen is listed below in his discharge medications. please titrate as necessary. . ventilator-associated pneumonia, tracheostomy, stridor - he was intubated perioperatively for respiratory support but twice extubation with excessive stridor and respiratory distress. the etiology of the stridor is unknown. he eventually was transitioned to a tracheostomy and his respiratory requirements were downgraded to supplemental o2 by trach mask only. ??????he twice required broad-spectrum iv antibiotic treatment with vancomycin and piperacillin-tazobactam for streptococcus pneumonia/h. influenzae and coagulase-positive staphylococcus pneumonia. please ensure that he completes his course such that last dose received on . . gastrostomy, pneumoperitoneum - he underwent gastrostomy placement but the next day had abdominal discomfort with a finding of free air under his diaphragm. there was concern for bowel injury so an exploratory laparotomy was performed. there fortunately was no significant pathology found on the open operation. he subseuqently tolerated tube feeds and medications via gt. he has been tolerating replete tube feeds without difficulty on discharge. . hiv - it was confirmed with his pcp/outpatient id physician that he does have hiv. however, the recommendation at this time from id (who discussed this case with his outpatient id physician) was that haart therapy was not indicated at this time. . goals of care and guardianship - his code status was presumed full. his daughter () was contact and updated, but she did not desire to be his guardian as he has not been a part of her life. the patient's sister is his legal guardian. pending studies: none transitional care issues: - please make sure to have the patient follow up with the neurosurgery department at . medications on admission: enalapril (dose unknown) discharge medications: 1. senna 8.8 mg/5 ml syrup sig: one (1) tablet po daily (daily). 2. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q 24h (every 24 hours): last dose . 3. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours): last dose on , . 4. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 5. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 6. labetalol 200 mg tablet sig: one (1) tablet po tid (3 times a day). 7. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for pain. 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 9. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 10. amlodipine 5 mg tablet sig: four (4) tablet po daily (daily). 11. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for oral thrush. 12. therapeutic multivitamin liquid sig: one (1) tablet po daily (daily). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 15. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 16. hydralazine 50 mg tablet sig: one (1) tablet po q6h (every 6 hours). 17. oxycodone 5 mg/5 ml solution sig: one (1) po q4h (every 4 hours) as needed for pain. 18. clonidine 0.2 mg/24 hr patch weekly sig: one (1) transdermal once a day. discharge disposition: extended care facility: hospital - discharge diagnosis: left cerebral intraparenchymal hemorrhage - history of hypertension - history of cocaine abuse/dependence - history of hiv infection - history of hepatitis c discharge condition: mental status: not examinable level of consciousness: intermittently follows simple appendicular commands with his left side. activity status: bedbound, dependent for all adls examination on discharge: thin male, normal cardiopulmonary examination with eyes open. does not blink to threat from right visual fields. reactive and equal pupils. skull absent on left. tracheostomized and gastrostomized. spontaneous purposeful movements of the left arm and responds to commands. discharge instructions: mr. was admitted to the neuro-intensive care unit and neurology wards of the for the evaluation of a fall and head injury that he sustained following the use of cocaine. he was found to have a large intraparenchymal hemorrhage in his left basal ganglia which ultimately required the placement of an endoventricular drain and a hemicraniectomy. his icu course was complicated by the development of difficult weaning from the ventilator (requiring a tracheostomy), percutaneous gastrostomy to deliver nutrition and medications as well as two rounds of antibiotics for ventilator associated pneumonia. - please ensure that mr. is able to see us in follow up at the dates/times listed below. - please bring mr. to the ed should you notice a change in his neurological examination, persistent fevers, low blood pressures, or any other unexplained signs or complaints. - do not hesitate to contact us should any concerns or questions arise. - in eight weeks (on or around ) please schedule a follow up appointment for mr. to see mdphd from stroke neurology at . this can be done by calling . followup instructions: ** please follow up with dr. from the department of neurosurgery at on - ct scan of head 9:30am ( building ) - meeting with dr. at 10:30am ( ) ** please have your rehabilitation staff set up a follow up appointment for mr. to see mdphd from stroke neurology at . this can be done by calling . - if you would like to follow up with your assigned pcp, call dr. at to set up a follow up appointment. md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances laparoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus other craniotomy insertion or replacement of external ventricular drain [evd] diagnoses: anemia, unspecified chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified candidiasis of mouth intracerebral hemorrhage chronic kidney disease, unspecified opioid type dependence, continuous compression of brain other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site hyperosmolality and/or hypernatremia ventilator associated pneumonia accidents occurring in residential institution asymptomatic human immunodeficiency virus [hiv] infection status cocaine dependence, continuous acute respiratory failure following trauma and surgery 

Answer: The patient is high likely exposed to