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: headache and neck pain that goes down my spine major surgical or invasive procedure: : vps removal : lumbar puncture : bedside i&d of chest wound history of present illness: this is a 40 year old white male who presented from an osh with a vps in place that was placed at in after brain biopsy for benign tumors that were obstructing csf flow. hereports that they are like "tuberous sclerosis" but that is not what it is. he reports that he had low grade temps to 99 at home with neck pain that goes down his spine. he did not have nausea or vomiting until friday overnight. he also had slightly blurred vision. he went to the osh when the pain had gotten to be enough. they did an lp and started abx after the lp had an elevated wbc. past medical history: benign brain tumors obstructive hydrocephalus social history: he lives with his 2 children in a 3 bedroom apt. he is divorced. the nurse reports that his exwife died this past of a drug overdose. he states he has some support with the children. he works as a xray tech. he travels regularly to nursing homes and prisons for his job. he smokes 1ppd and has cut back on this since being in the new apt. he drinks rarely. he denies drug use. family history: non-contributory physical exam: on admission: physical exam: o: t: 97 bp: 111/64 hr: 72 r 18 o2sats100 gen: wd/wn, comfortable, nad. heent: pupils: no photophobia / ncat / shunt palpable in the right occipital region. compresses easily and is slow to refill eomis neck: slight limit of passive rom to discomfort. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ /scar from vps noted extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. recall: objects at 5 minutes. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light,4 to 2 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. no abnormal movements, tremors. strength full power throughout. no pronator drift sensation: intact to light touch toes downgoing bilaterally at discharge: he is neurologically intact. he had a right chest wall wound with two openings and iodoform packing. the margins are arthematous. pertinent results: head ct : findings: the patient is status post recent ventricular shunt removal, with skin staples and a small amount of fluid and subcutaneous emphysema in the right parietal scalp subcutaneous soft tissues. there is no evidence of intracranial hemorrhage, edema, masses or mass effect. there is no pneumocephalus. the -white matter differentiation is normal. the ventricles and sulci are normal in caliber. the basal cisterns are normal. the imaged paranasal sinuses and mastoid air cells are clear. impression: 1. no acute intracranial pathology. 2. a small amount of fluid and air in the subcutaneous tissues of the right frontoparietal scalp, related to the recent shunt removal. ekg : sinus rhythm. non-specific anterior t wave flattening. no previous tracing available for comparison. head ct : findings: a small amount of layering hemorrhage in the atrium of the left lateral ventricle (2:14) and some hyperdensity within an asymmetrically enlarged choroid plexus within the left lateral ventricular body, indicating hemorrhage, have not significantly changed since the recent study. no new intracranial hemorrhage is detected. the -white matter differentiation is preserved. the ventricular size is unchanged since the prior study, without evidence of interval onset of hydrocephalus. the basal cisterns are normal. no extra-axial fluid collection is seen. a small amount of subcutaneous emphysema and fluid in the right frontoparietal scalp has improved since the prior study. the paranasal sinuses and mastoid air cells are clear. the orbits are unremarkable. impression: 1. stable small intraventricular hemorrhage layering in the atrium of the left lateral ventricle with small hemorrhage in the choroid plexus within the left lateral ventricular body, also unchanged. 2. no new hemorrhage or hydrocephalus. mri brain : impression: 1. status post removal of left ventricular shunt catheter, with a small amount of hemorrhage in the left lateral ventricle. 2. mild enhancement within both lateral ventricles and along the track of the left frontal shunt catheter, can be secondary to reactive inflammation or infection. 3. subtle isointense mass in the right periventricular region causing mild compression of the foramen of . the previously described left lateral ventricular mass is difficult to delineate given the asymmetric enlargement and hemorrhage within the left lateral ventricle choroid plexus. followup both lesions (nature uncertain) to assess stability/ progression. us right chest wall 1cm fluid collection at vp shunt removal site with extensive surrounding induration. super-infection cannot be determined by ultrasound. ct head : impression: 1. stable ventricular size without evidence of interval onset hydrocephalus. 2. no residual evidence of intraventricular hemorrhage. no new intracranial hemorrhage is detected. 3. stable lesion right foramen of ( possible subependymal giant cell astrocytoma in the setting of underyling tuberous sclerosis) unchanged from mri of . brief hospital course: this is a 40 year old man who was admitted to with meningitis. he was taken to the or for removal of the entire vp shunt system with dr. . an external drain was not place as it was felt that the patient did not require another vp shunt. id was consulted and csf cultures were still pending from hospital. he was started on vancomycin, cefepime, and ampicillin. on , the ampacillin was d/c'd and vanc was increased to 1250mg. ajh was called for csf results and no growth has been seen. id requested a lumbar tap to reassess csf. on a lp was performed and csf was sent for evaluation. csf continued to show elevated wbc however it was improved from prior. he had an evolving collection underneath his right chest wall at the area of his chest incision. it was monitored and a ultrasound was ordered to evalaute which was consistent with post-op seroma. he remained stable on the floor while awaiting id recs and and culture results on , on the remainder of his staples were removed and the collection at his right chest wall looked to be improving. later in the day he noted exudate from his chest incision and subsequently approximately 30cc of drainage was expressed by our team. as a result of this general surgery was consulted who performed an i and d of the wound at the bedside. id continued to follow and gram stain from this chest collection showed gram negative rods. he remained stable while awaiting further culture results in order to better target treatment. nursing performed daily dressing changes of chest wounds and a wound care consult was requested. ct head was done to ensure that he does not have enlarging venricles prior to discharge. home services were established and coordinated and he was discharged on . medications on admission: advil prn discharge medications: 1. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) gm intravenous q 12h (every 12 hours) for 14 days: 14 days from . disp:*20 bags* refills:*0* 2. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gm intravenous q6h (every 6 hours) for 14 days: 14 days from . disp:*40 bags* refills:*0* 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain fever. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 5. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 6. senna 8.6 mg tablet sig: two (2) tablet po at bedtime as needed for constipation. tablet(s) 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*7 patch 24 hr(s)* refills:*0* 9. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: home with service facility: amedisys home care discharge diagnosis: meningitis vp shunt infection cellulitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge 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. ?????? 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. followup instructions: ??????please call ( to schedule an appointment with dr. , to be seen in four weeks. ??????you will need a ct scan of the brain without contrast. infectious disease - 11:45a id, lm bldg (), basement id west (sb) tel: - vanco trough. cbc w/diff, lfts, bmp once weekly and fax results to * you need to follow up with acs for your chest wound. they recommend an appointment in wks. this can be made by calling . procedure: spinal tap incision of lung other incision with drainage of skin and subcutaneous tissue removal of ventricular shunt diagnoses: tobacco use disorder cellulitis and abscess of trunk other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation seroma complicating a procedure other and unspecified escherichia coli [e. coli] infection and inflammatory reaction due to nervous system device, implant, and graft meningitis due to unspecified bacterium personal history of benign neoplasm of the brain 

Answer: The patient is high likely exposed to