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: transfer from osh after seizure in setting of recent spinal cord surgery and meningitis. major surgical or invasive procedure: femoral central line placement history of present illness: pt is a 78 yof with pmh of t2dm, spinal stenosis who was admitted to on for elective decompression of spinal stenosis. she underwent decompressive l3, l4, l5 laminectomies and radical left l5 and s1 formainectomies. ?l4 level dural perforation, reporedly no spillage of csf in notes. she had serosanguineous drainage from surgical wound. pt febrile to 101.5 postop day 1 she had received peri op oxicillin. she was transfereed to tcu for rehab. on pt noted to have increased confusion and per family had visual hallucinations. this was attributed to discontinuation of cymbalta. cymbalta was restarted and her symptoms improved. she had a urine culture sent which grew pseudomonas ( to zosyn, ceftz and amikcin). head ct at the time unremarkable. she continued to have drainage from back. area noted to be erythematous and pt was febrile. on she underwent exploration in or where 2 jp drains were placed. wound culture grew, pseudomonas, klebsiella and enteroccus. csf analysis done in showed 5950 wbc (71p, 8l, 21m) 3 rbc, glucose 22, (protein not reported). pt was started on ceftaz, amikacin and ampicillin at osh. . earlier day of admission pt was complaining of back pain. she received demerol around 2:15pm and another dose 5:15pm per family. 5 pt noted to be choking followed by jerking motions of upper ext. unknown lower extremities movement. no incontinence. also at this time pt noted to have a wide complex tachycardia. pt soon bacame pulseless and and was shocked x 1 with 200j and became responsive thereafter. episode lasted 5 . after discussion with family pt was transferred to . . on transfer here pt denies any complaints. denies any headache, chest pain, shortness of breath. she is somnolent however easily arousable. denies any photophobia. . micu course: pt was given amikacin, ceftaz iv. ampicillin iv was held given it lowers the seizure threshold, awaiting id input. neuro was curbsided, and stated that there is no benefit to dilantin for meningitis for seizure prophylaxis, so this was discontinued. neuro stated if the sz recurs, to formally consult and give ativan 2mg iv. ortho was consulted. from a cardiac standpoint, we still do not have a clear cause for pulseless vt. the pt was ruled out by 2 sets of negative cardiac enzymes. cardiology was notified upon transfer of the pt to the medical floor, and plan was made to discuss ekgs, antiarrhythmics and obtain tte. the pt underwent le doppler us on to rule out dvt. femoral line was d/c'd. . past medical history: lung cancer resected 15 years ago spinal stenosis pancreatitis hypertension anxiety depression reflux hypothyroid diabetes type 2 s/p appendectomy s/p hysterectomy r hip replacement social history: sh: retired foremrly worked in highschool cafeteria serving food. former smoker, no etoh. family history: fh: unknown. physical exam: t 96.7 bp 122/50 hr 52 rr 19 o2sat 100% 3lnc. gen: elderly female lying in bed in nad. drowsy but easily arousable able to cooperate with exam. heent: perrl, mmm, eomi chest: ctab, no crackles cvr: rrr, nl s1, s2, no r/m/g abdomen: soft, nt, nd, obese ext: no edema, 1+dp/pt pulses. back: incision site with staples intact, some erythema around the site no warmth. 2 jp drains in place. neuro: cn ii-xii intact. ue and le strength. sensation intact to light touch thruout. 2+ patellar reflex. . pe on call out from micu: vitals: tm: 98.6 tc: 98.6 bp: 148/79 p: 80s rr: 16 o2sat: 100% 2l nc i/o: 1480/405 +1.07. general: 78 y/o cf in nad. pleasant, cooperative, joking with staff. aox3. heent: perrl, mmm. op clear. lungs: ctab cv: rrr s1 and s2 audible w/o m/r/g abd: obese, soft, nt, nd. nabs, no masses, no hsm. + intertrigo in skin folds under pannus. 2 jp drains in place in the back ~5 cc serosanguinous drainage in each. incision sites appear clean. peripheral: 2+ edema, ext wwp, moving all extremities, no focal neuro deficits. no clonus. pertinent results: imaging: cxr: impression: 1. cardiomegaly without evidence of pulmonary edema. 2. no evidence of pneumonia. . : rle dopper: negative for dvt . ecg read by micu (unable to find ekg in chart): sinus rhythm, bradycardic, left axis, qt ~500. twave flattening diffusely v2-v6. rhythm strip from osh: demonstrating a wide complex tachycardia, monomorphic vt. . culture data: : blood culture negative : urine culture negative : blood culture negative . abd us impression: likely post operative ileus. tubular foreign bodies over the lumbar spine and right abdomen, as discussed above. clinical correlation with placed drains placed in the or recommended. . echocardiogram measurements: left atrium - long axis dimension: 3.8 cm (nl <= 4.0 cm) left atrium - four chamber length: 4.6 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.7 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.6 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.6 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.2 cm (nl <= 5.6 cm) left ventricle - ejection fraction: >= 55% (nl >=55%) aorta - valve level: 3.6 cm (nl <= 3.6 cm) aortic valve - peak velocity: 1.6 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 0.7 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 0.70 mitral valve - e wave deceleration time: 291 msec tr gradient (+ ra = pasp): *31 mm hg (nl <= 25 mm hg) conclusions: the left atrium is normal in size. there is moderate symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef >55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild pulmonary artery systolic hypertension. mild mitral regurgitation. . ct l spine, done and formal read pending. brief hospital course: impression: pt is a 78 yo female with h/o lung cancer, type ii diabetes mellitus and spinal stenosis s/p recent laminectomy/foraminectomy surgery complicated by nosocomial meningitis who is transferred to after seizure, pulseless vt arrest. . # pulseless ventricular tachycardia at outside hospital, in normal sinus rhythm status post shock with 200 joules - unclear etiology of pulseless vt, precipitant. no ekgs from osh prior to or immediately after pulseless vt. one strip from osh with code blue note demonstrated monomorphic vt. the pt was ruled out for myocardial infarction by cardiac enzymes here. a 12 lead ekg obtained here was significant for prolonged qtc at 450-470 msec, however this was felt to be acquired long qt syndrome, unrelated to her pulseless vt episode. her fluoxetine and amitryptline was discontinued, however, given the pt has severe depression, added fluoxetine back and followed qtc with ekgs. cardiology, electrophysiology was consulted and recommened pt undergo electophysiology study/t wave alternans/possible vt ablation, however, given her infectious issues, it was decided by the primary medicine team to hold off until her antibiotic course was continued. her electrolytes were repleted aggresively to keep k>4.0, mg>2.0. tte completed showing ef>55%, 1+ mr, otherwise preserved biventricular systolic function, no evid of structural heart disease playing a role in vt. the patient will continue a beta blocker, metoprolol upon discharge to rehab. she is to follow up with ep as an outpatient for eps/tw alternans/vt ablation. an appointment has been set up for her. . # meningitis - bacterial meningitis with pseudomonas and klebsiella per report, growing out of wound cx with enterococcus growing out of broth only. id was consulted here, and there was communication between the osh id attending, dr. , and our id team. the pt was treated with ceftazidime 2g iv q8 and amikacin 500mg iv q12h for now, planned 21 day course (day ). we obtained amikacin peak and trough labs: (directions on how to obtain accurate troughs and peaks: 30 min prior to giving dose, and 1 hour after infusing dose with goal peak 20-30, goal trough <8). of note, there was a question here on whether there was hardware in the back after her laminectomy, as the pt underwent kub, and curvilinear densities were seen l2-l4, which were discussed w/ dr. and felt to be the jp drains. these were removed . there was also an ongoing academic discussion on the true efficacy of the ceftaz. per dr. , the pseudomonas (which is to only amikacin and ceftaz) tested positive on extended spectrum beta lactamase test at osh, and furthermore, the pseudomonas was aztreonam resistant, which are both indications the ceftazidime is not really having much effect on the pseudomonas. it was felt the amikacin was responsible for her improvement, however, aminoglycosides do not penetrate csf as well, and w/ signficant side effects, therefore not an ideal choice, however, the pt does not have many other options given the resistant pseudomonas. the pt did not undergo repeat lp given she was doing clinically very well, with no ha, nuchal rigidity, afebrile. to obtain idea of baseline lumbar fluid collection/surgical site-- id requesting ct lumbar spine. pt agreed and will order (pt refused mri). will d/c after c-spine mri with id follow up in 3 weeks w/ dr. . of note, after the jp drains were removed, there was minimal drainage from the jp sites seen on her bandages. her surgical site is with minimal erythema, no drainage, sutures intact and appears to be healing well. since the pt is on amikacin iv, which causes hearing loss, she was set for audiology eval, however, b/c of back and hip pain, was not able to tolerate being transported in wheelchair. she will need to have an audiology eval as an outpatient. she has a picc line in the left arm for iv antibiotics, and will complete 15 more days. she continues to look clinically well, with no headache, neck stiffness, weakness, or pain. . # seizure - unclear if patient has a primary seizure disorder. no previous history per family. continue management of meningitis as above. pt could also have become hypoxic after pulseless vt/arrest and thus seized hypoxia/decreased cerebral blood flow. also in ddx: pt received demerol, which can lower seizure threshold. she was loaded with dilantin at osh. we consulted neurology about continuing dilantin however consult stated that dilantin has not been shown to prevent seizures in meningitides, so we discontinued it. . # post op spine surgery - ortho spine at with dr. was following the patient throughout her course. the surgical site appears clean, with minimal drainage, and healing well. . # type 2 dm - her blood sugars were well controlled on glipizide er 20mg po qam, and an iss. she is tolerating po well. . # htn - well controlled: - incr metoprolol to 37.5 mg po tid, dilt 90mg po qid, triam/hctz 37.5/25 po qd. - all w/ hold parameters. . # anxiety/depression - stable. - added back fluoxetine 40mg po qd. # intertrigo: the pt demonstrated marked improvement on ketoconazole 2% topically under her pannus and groin area. she can be transitioned to nystatin powder at rehab. . #fen: diabetic/cardiac diet. . #prophy: sc heparin, protonix at home . #access: picc line placed in left arm . #comm: daughter (hcp) h ; cell . . #code: full medications on admission: levothyroixine glipizide digoxin cartia pravachol propranolol colace amitriptyline senokot. discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*100 tablet(s)* refills:*3* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal tid (3 times a day). disp:*qs 1 tube* refills:*2* 5. diltiazem hcl 30 mg tablet sig: three (3) tablet po qid (4 times a day). disp:*360 tablet(s)* refills:*2* 6. trazodone 50 mg tablet sig: 0.25 tablet po hs (at bedtime) as needed. disp:*15 tablet(s)* refills:*2* 7. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). disp:*135 tablet(s)* refills:*2* 8. amikacin 500 mg iv q12h 9. ceftazidime 2 gm iv q8h 10. fluoxetine 20 mg capsule sig: two (2) capsule po daily (daily). disp:*60 capsule(s)* refills:*2* 11. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h until bm daily (). disp:*qs ml(s)* refills:*2* 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 13. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). disp:*1 disk w/ device* refills:*2* 14. glipizide 10 mg tab, sust release osmotic push sig: one (1) tab, sust release osmotic push po daily (daily). disp:*30 tab, sust release osmotic push(s)* refills:*2* 15. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 16. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. disp:*qs ml(s)* refills:*2* 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 18. ketoconazole 2 % cream sig: one (1) appl topical (2 times a day) for 7 days. disp:*1 largest stock tube* refills:*0* 19. morphine 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain for 14 days. disp:*100 tablet(s)* refills:*0* 20. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 21. outpatient lab work please check cbc with differential, chem 10, lfts q week. also check amikacin peak and trough qweek (30 minutes prior to giving amikacin dose, draw level for trough, and 1 hour after infusing amikacin, draw level for peak). fax these results to dr. at infectious disease clinic. her fax number is: . 22. antibiotic instructions you will have a minimum of 21 days on amikacin iv and ceftazidime iv, you are on day 6 of therapy. you will need to see dr. (see appointment) in follow up for re-evaluation of how long you need to take your antibiotic. discharge disposition: extended care facility: - discharge diagnosis: 1. nosocomial meningitis status post laminectomy, foraminectomy, possible dural tear 2. pulseless ventricular tachycardia 3. history of seizure at outside hospital prior to transfer 4. type ii diabetes mellitus 5. hypertension 6. anxiety disorder 7. major depressive disorder 8. history of spinal stenosis discharge condition: good, stable discharge instructions: if you experience any worsening of your symptoms, including headache, weakness in your legs, numbness, urinary or bowel incontinence, decreased sensation in your extremities, neck stiffness, chest pain, palpititations, please report to the emergency dept. immediately. please take all of your medications as directed. please follow up with your physicians, information below. followup instructions: 1. you have a follow up appointment with your primary care physician . on friday, , at 1:45pm. his office number is: . 2. you have a follow up appointment with infectious disease with dr. . your appointment is set for at 10:00am at the , basement, suite j, . her office number is: if you have any questions. 3. you will need to follow up with cardiology/electrophysiology for possible procedure on your heart for your abnormal rhythm. your appointment is for wednesday, at 12:30pm, in 7, , with dr. . his office number is: . 4. repeat ct l-spine w/ contrast on monday, at 8:00 am. go to 3. no solid foods 3 hours prior. please call if questions. md, procedure: venous catheterization, not elsewhere classified diagnoses: other postoperative infection urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of bronchus and lung other convulsions anxiety state, unspecified long qt syndrome candidiasis of skin and nails meningitis due to gram-negative bacteria, not elsewhere classified 

Answer: The patient is high likely exposed to