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: biaxin attending: chief complaint: ataxia, confusion, emesis major surgical or invasive procedure: : vp shunt revision with new programmabel valve at 100 : removal of entrie right vp shunt and placement of new evd : placement of new left vp shunt history of present illness: this is a physician who is known to service for previous placement of r vps for treatment of hydrocephalus following a ruptured avm. it was initially placed in but more recently revised on and by dr. . he presented to the ed with increased lethargy, ataxia, confusion and one episode of emesis. he is scheduled for a r vps revision. past medical history: right frontal spongioform avm s/p bleed in and s/p vp shunt(treated at bw). static frontal lobe syndrome following avm bleed. has had problems with short term memory since the bleed. (followed in cognitive neurology clinic at and as a cognitive therapist at .) revision of distal part of ventriculoperitoneal shunt and replacement of peritoneal catheter by dr , laparoscopic guidance of distal ventriculoperitoneal catheter by ,interrogation and revision of programmable ventriculoperitoneal shunt; removal and revision of proximal catheter; removal and revision of valve of ventriculoperitoneal shunt and replacement with programmable valve, strata/24/11 history of alcohol abuse hyperlipidemia ivc filter placement social history: retired physician, with wife, known short term memory loss, was receiving continuous cognitive therapy family history: congential avms physical exam: on discharge: awake, upgaze palsy, perrl, mae to command. verbal intermittently, more with family and at times, responds more readily to spanish. sutures clean dry and intact. pertinent results: 07:25am urine color-straw appear-clear sp -1.009 07:25am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.5 leuk-neg 06:48am glucose-140* lactate-1.2 na+-140 k+-4.0 cl--101 tco2-26 06:43am urea n-13 creat-1.0 06:43am calcium-8.7 phosphate-2.6* magnesium-2.1 06:43am wbc-8.2 rbc-4.62 hgb-14.0 hct-40.4 mcv-87 mch-30.4 mchc-34.8 rdw-12.7 06:43am neuts-72.5* lymphs-17.0* monos-6.3 eos-4.0 basos-0.3 06:43am plt count-289 06:43am pt-12.9 ptt-22.3 inr(pt)-1.1 ekg : sinus tachycardia. borderline low precordial voltage in the precordial leads. since the previous tracing of the rate is faster. clinical correlation is suggested. intervals axes rate pr qrs qt/qtc p qrs t 107 162 96 308/390 50 11 32 ct head pre-op : 1. right transfrontal ventricular catheter in place, with interval enlargement of the ventricles, most pronounced increase in the size of the third ventricle. 2. stable appearance of known cavernomas involving the midbrain, as described on the recent mri. ct head post-op: 1. following revision of the intraventricular shunt, there has been a decrease in the ventricular size as measured both across the frontal horns at the level of the caudate heads and at the level of the third ventricle. 2. unchanged appearance of transependymal migration of csf. 3. no evidence of intracranial hemorrhage. ct head w/o contrast significantly increased ventriculomegaly since the prior scan three days ago. ct head w/o contrast decrease in the size of the ventricles - post-placement of a new evd. however, correlate clinically and follow up as clinically indicated for any complications. mri brain - increased hydrocephalus since the previous study 18 hours previously. there are no new infarctions. otherwise, unchanged appearance of numerous susceptibility artifacts throughout the cerebrum, cerebellum and brainstem consistent with micro-hemorrhages or cavernomas ct head - small focus of intraventricular blood in the right lateral ventricle unchanged since . ventricles are normal in size, no change to explain the patient's somnolence. ct head - normal ventricular size. interval resolution of bilateral occipital intraventricular hemorrhages. small amount of right frontal pneumocephalus, decreased ct head w/ & w/o contrast small hyperdense focus within the left temporal most likely represents intraventricular hemorrhage which is new since , . lenis neg ue nonvasive - upper extremity venous thrombosis involving the picc containing right basilic and right axillary vein. ct head - ventricular size and resolution of intraventricular hemorrhage since prior study three days ago. ct head - s/p l vps placement. new left frontal tract ich. bilat lower ext veins -no dvt in either lower extremity bilat up ext veins us - 1. interval resolution of previously noted right axillary dvt. 2. the right basilic clot is intervally diminished in size. 3. no new dvt. : clostridium difficile. feces positive for c. difficile toxin by eia. :clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. dc date labs: 10:21am cerebrospinal fluid (csf) protein-<6* glucose-91 10:21am cerebrospinal fluid (csf) wbc-1 rbc-1* polys-0 lymphs-36 monos-8 eos-3 other-53 07:25am urine color-straw appear-clear sp -1.009 07:25am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.5 leuk-neg 06:48am glucose-140* lactate-1.2 na+-140 k+-4.0 cl--101 tco2-26 06:43am urea n-13 creat-1.0 06:43am calcium-8.7 phosphate-2.6* magnesium-2.1 06:43am wbc-8.2 rbc-4.62 hgb-14.0 hct-40.4 mcv-87 mch-30.4 mchc-34.8 rdw-12.7 06:43am neuts-72.5* lymphs-17.0* monos-6.3 eos-4.0 basos-0.3 06:43am plt count-289 06:43am pt-12.9 ptt-22.3 inr(pt)-1.1 brief hospital course: this is a 70 year old physician who came to the er the morning of a previously scheduled vp shunt revision. he was lethargic and nauseas with worsening ataxia and he underwent a revision of the distal portion of the vp shunt. post-operatively, he remained intubated and was then extubated in the pacu. his mental status continued to improve. he had a clear dinner without issue on and on he had bowel sounds and flatus. his diet was advanced. he later developed some increasing abdominal distention but his he had flatus and his belly was soft. abdominal xray showed ileus and he was made npo. his mental status continued to improve. however, he had an episode of emesis that evening and then again overnight requiring ng tube placement by general surgery. on , he had a loose bm in am and was advanced to sips- vomited x2, was switched back to npo, and had an unremarkable ua for symptoms of urinary urgency. on he had a repeat kub which continued to show dilated small bowel and was transferred to the general surgery service for management of his ileus. on mr. had episodes of respiratory distress with an increased oxygen requirement. cxr appeared wet and he was given lasix per the medicine team request. his ngt output was replaced on a 1:1 basis. repeat head ct was stable from prior episode, without hydrocephalus. ct abdomen showed dilated small bowel with decompression in terminal ileum. he was taken to the or on by dr. for abdominal exploration for obstruction vs. infection. on he was found to be obtunded and was taken to radiology for a ct scan and was escorted by anesthesia. ct showed significant increase in ventricular size. he shunt was accessed at the bedside in the icu and opening pressure was found to be 19 but the shunt was functioning well. an external drainage device was set attached to the shunt to drain csf. his mental status improved but 1-2 hrs later he was again lethargic. only 5 cc could safely be withdrawn from the shunt and he only minimally improved. he was taken to the or emergently for removal of vp shunt and placement of a new antibiotic impregnated external ventricular drain. csf was sampled from the valve in the or and set for a csf panel per id. the entire vp shunt system was sent to microbiology per dr. . he was taken to the sicu intubated. his evd was open at 5cm h20 shortly afterwards, he was extubated in the sicu and was following commands. his post-op ct showed significant decrease in ventricular size and his drain was raised to 10cm h2o. overnight, patient developed a limited r lateral gaze and was seen to be staring. eeg was ordered and to rule out seizure activity. on , patient was examined and he continued to have limited r lateral and upward gaze, he was also aphasic and not following commands as well as he has been in the past. he was seen to have a r ue tremor. his drain was dropped back to 0cm h20 to drain for 20cc and then evd was raised to 5cm h2o. an mri w/o contrast was ordered to rule out stroke and stroke neurology was consulted. eeg showed complex partial seizures and epilepsy team was consulted for appropriate management. he was to drain 400cc/day or 100cc/6hr, if goal is not met,the orders were to drop the drain to 0cc h2o and drain until goal is achieved, then raise back to 5cc h2o. his neuro checks were changed to q2h. on , patient's exam remained stable, he was placed on dilantin for his complex partial seizures and his level was 11.1. on , his evd output was lower than the desired goal, his drain was dropped to 0 to drain 20cc then raised back to 5. a repeat head ct showed improvement of hydrocephalus and csf was sent for vancomycin trough. patient had lateral and upward gaze limitation, but was following complex commands. on , patient's exam much improved, alert and oriented to self and place with prompting, full strength, slight l drift. he passed a speech and swallow and could have a regular diet. his drain is periodically dropped to -5 to drain csf to obtain goal of 400cc/day. csf cultures remain negative to date. he improved neurologically. on his daily goal of csf drainage was dropped to 320cc/day. he continued to remain stable and his diet was advanced. he tolerated die without nausea or vomiting. on , he was transferred back to neurosurgery service, dr. for planned internalization of vp shunt. id consult recommended a repeat csf culture to completely ensure that he has no evidence of meningitis. csf as of showed no evidence of growth. additionally, his diet was advanced and he was on a regular diet without issues. on he was lethargic throughout the day. he had a fever of 101.6f in the afternoon and a fever work up was initiated. csf was sent from evd. on , ct head showed slightly larger ventricles and small amount of ivh in l lateral . his daily goal from evd drainage was increased to 360cc/day. eeg was also re-ordered to re-evaluate for seizure activity. lens and cultures were sent to workup fever. lens showed rue blood clots in axillary and basilic veins. no heparin was started. picc line for tpn administration located near clots and was removed. on . patient was difficult to arouse during morning rounds. although, 1 hours later he was much better given his neurological change in exam a head ct was obtained which demonstrated resolved ivh and small ventricles. on , patient under a left vps. he tolerated the procedure well and was intubated without incident. please review dictated operative report for details. he was transferred back to sicu for further management. post-op ct showed placement of vps. new left frontal catheter tract ich without significant mass effect. he was extubated without incident, pt remained stable. subsequently, r evd was removed in routine fashion on and post pull ct showed stable ich and decrease in ventricle size. on , his exam was more lethargic in am, eo to voice and commands with bue and wiggles toes. he was experiencing narrow complex tachycardia, cardiology was consulted and beta blocker was started. patient also spiked fever to 102.5. he was pan cultured and lens ordered. he was seen to have lue rhythmic tremors, he was restarted on dilantin. over the weekend, patient was found to have positive c.diff culture and fevers were thought to be from a combination of iv vancomycin and c.diff. he was started on flagyl and vancomycin changed to oral medication. cardiology recommendations were to start him on metoprolol 12.5 po bid for tachycardia. on , patient was more alert, eo spontaneously, alert to self and following commands in all 4 extremities. he was transferred to step down unit. lens were negative for new dvt and showed some resolution of the axillary and basilic clots in the rue. on he was stable and transferred to the floor. flagyl was made po per id. it was decided that he should have a full two week course of these antibiotics. tucks ointment was ordered for hemorrhoids. his dobbhoff was found coiled din his mouth overnight and it was removed. on , he was following commands and moving his four extremities spontaneously. calorie counts were continued and his calcium was repleted. he was tolerating a regular diet. he was medically cleared for rehab. medications on admission: lipitor 40mg daily, lexapro 10mgdaily, wellbutrin 100mg qam, 150qpm discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: max 4 g/24 hrs. 2. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 3. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal tid (3 times a day) as needed for hemorrhoids. 4. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 5. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day): hold for sbp<110,hr<55 . 8. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qam (once a day (in the morning)). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 10. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 weeks: duration: 2 weeks started . 11. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 12. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 13. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 2 weeks: duration: 2 weeks started . 14. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: hydrocephalus ileus urinary retention failed vp shunt post-op fever aspiration pneumonia right ue dvt basillic and cephalic veins lethargy left frontal intracerebral hemorrhage c diff discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). 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. ?????? you may wash your hair only after sutures have been removed. !!sutures should be removed on !! ?????? you may shower before this time using a shower cap to cover your head. ?????? 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 rehab, 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. !!if you need any antibiotic treatment in the next 12 months for any reason, you should take oral vancomycin and flagyl during this treatment and one week after to prevent c diff!!! followup instructions: please follow-up with dr. in one month with a head ct. please call paresa at for this appointment md procedure: parenteral infusion of concentrated nutritional substances ventricular shunt to abdominal cavity and organs intravascular imaging of intrathoracic vessels incision of peritoneum laparoscopic lysis of peritoneal adhesions removal of ventricular shunt central venous catheter placement with guidance diagnoses: obstructive hydrocephalus intracerebral hemorrhage other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonitis due to inhalation of food or vomitus peritoneal adhesions (postoperative) (postinfection) intestinal infection due to clostridium difficile other complications due to other vascular device, implant, and graft paralytic ileus retention of urine, unspecified other ascites encephalopathy, unspecified localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy mechanical complication of nervous system device, implant, and graft dysphagia, unspecified frontal lobe syndrome postprocedural fever 

Answer: The patient is high likely exposed to