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: increased seizure frequency. major surgical or invasive procedure: incision and drainage of scalp abscess with likely osteomyelitis history of present illness: the pt is a 57 year-old right-handed man with a history of wilson's disease, seizure disorder (primarily head turning to the left, but does also generalize), s/p left frontal lobectomy, arachnoid cyst drained by stereotatic cyst ventriculostomy in , and insertion of catheter complicated by infection of the catheter, s/p removal and a wound washout on who presents with increased seizure frequency. mr. was last admitted from ~ with increased seizure frequency. during that hospitalization he underwent drainage of his arachnoid cyst, complicated by a catheter infection. his aeds were adjusted, and he was taken off depakote, and eventually discharged on lamictal 400mg and keppra 2250mg . per his family, mr. has been quite stable from a seizure standpoint, only having one/month in the last 2 months (on and ). however, on he woke up complaining of a headache, which he hadn't done in quite some time. he did not have any seizures on that day, but on he did have one of his head-turning seizures. he had none on , but on had a cluster of 'too many to count.' he had his previously scheduled follow-up with dr. on that day, and he had aed levels obtained at that time (results of which are still pending). given his continued clusters, it was recommended that he take an extra 750mg of keppra that night, which broke the clusters. the following day he had no seizures, but again began to cluster on . again on discussion with dr. office, it was recommended that they try giving him additional po ativan. his normal home dose is 4mg/day, but he ended up getting a total of 5.5mg on , which again broke the cluster. on he again got 5.5mg of ativan, and did well. however, in the morning on he called his brother to report that he was again clustering, and this time did have one of his drop attacks, and fell back and hit his head on the stove (no loss of consciousness). they tried giving him additional po ativan, however with little effect, and when he continued to cluster (reported as 'multiple/hour, too many to count'). his family tried to hold out until he had gotten his pm medications at 8pm, however when he was continuing to cluster at 9:30pm they brought him into the ed. by that time he had gotten a total of 5mg of po ativan, and was given an additional 2mg iv on arrival to the ed. while neurology was assessing him at bedside, he proceeded to have a cluster of ~3 head turning episodes w/in 5 minutes, so an additional 1mg of ativan was given x2. his family reports that all of his seizures during this past week have consisted of head turning to the left, with eyelid fluttering and retained consciousness lasting 15-30 seconds. he has not had any bowel or bladder incontinence or post-ictal confusion. per prior notes the patient has at least 4 types of seizures: 1: head turning to the left, occasionally with arm or leg stiffening, lasting 15-30 seconds. maintains consciousness throughout. when well controlled averages ~1/month, but can cluster. 2: eye deviation to the left - unclear frequency. 3: drop attacks - less frequent, though reports last was this morning. 4: gtcs - last was in the context of acute infection, prior to that was ~10 years ago. on neuro ros, the pt denies loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. denies difficulties producing or comprehending speech. denies focal weakness, numbness, parasthesiae. no bowel or bladder incontinence or retention. denies difficulty with gait. on general review of systems, the pt denies recent fever or chills. no night sweats or recent weight loss or gain. denies cough, shortness of breath. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rash. past medical history: -wilson's disease c/b coma and brain injury at about 13 years of age with subsequent seizure disorder s/p left frontal craniotomy with anterior left frontal lobectomy -arachnoid cyst in resection cavity s/p stereotactic cyst ventriculostomy with insertion of rickham catheter c/b infection and rickham catheter removal -pulmonary empyema -hx of pneumothorax social history: currently (as in one day ) lives at house, an facility that has nursing, prior to that the patient lived alone, with help from his brother and sister-in-law. they are hcps, home: , cell: family history: family members have been tested for wilson's, both parents are carriers, and a brother is a carrier. was apparently sequenced by and the patient has two of the wilson's mutations. no family history of seizures physical exam: admission examination: vitals: t: 98.3 p: 82 r: 16 bp:127/58 sao2: 100% on ra general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx. slight 'vacuous smile' of wilson's neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3, though initially states , but corrects to . able to relate history without difficulty. language is fluent with intact repetition and comprehension. normal prosody. there were no paraphasic errors. pt. was able to name both high and low frequency objects, with the exception of cactus, which he calls a porcupine. able to read without difficulty. speech was not dysarthric. able to follow both midline and appendicular commands. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and brisk. vff to confrontation. unable to fully visualize fundi. iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: no deficits to light touch throughout. -dtrs: tri pat ach l 2 2 2 2 1 r 2 2 2 2 1 plantar response was flexor bilaterally. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: deferred. heent: well-healing sutured scar on the scalp with no evidence of drainage. pertinent results: admission labs: 10:30pm blood wbc-5.4 rbc-4.36* hgb-13.9* hct-39.8* mcv-91 mch-31.9 mchc-35.0 rdw-13.2 plt ct-291 10:30pm blood neuts-63.0 lymphs-26.9 monos-6.8 eos-2.5 baso-0.9 10:30pm blood pt-13.1 ptt-30.9 inr(pt)-1.1 10:30pm blood glucose-96 urean-18 creat-1.2 na-141 k-3.8 cl-104 hco3-28 angap-13 10:30pm blood calcium-9.6 phos-2.7 mg-2.4 06:25am blood tsh-3.0 05:45am blood phenyto-13.2 10:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:26am blood ceruloplasmin < 8 10:42pm blood lamotrigine 10.8 (therapeutic) discharge labs: other studies: eeg : findings: abnormality #1: a mildly slowed posterior background with maximal 7.5 hz rhythms was seen in the optimal waking portions of the record. background: the anterior-posterior voltage gradient was preserved. no focal, lateralized, or discharging abnormalities were noted. hyperventilation: not performed. intermittent photic stimulation: no activation of the record. sleep: the patient drowsed but failed to enter stage ii sleep. no new abnormalities were seen in stage i sleep. cardiac monitor: no arrhythmias noted. impression: mildly abnormal eeg with mild posterior background slowing suggestive of a diffuse mild encephalopathy. in particular, no spike discharges were seen. ct head (non-contrast) : impression: 1. no acute intracranial abnormality. 2. stable bifrontal encephalomalacia and post-surgical appearance of the brain. ekg : sinus rhythm. normal tracing. compared to the previous tracing of the rate has slowed. otherwise, no diagnostic interim change. rate pr qrs qt/qtc p qrs t 76 176 88 364/392 71 34 43 mri : technique: t1 sagittal and axial and flair t2 susceptibility and diffusion axial images were obtained before gadolinium. t1 axial and mp-rage sagittal images acquired following gadolinium. comparison was made with the multiple prior examinations including and . findings: again identified are postoperative changes in the left frontal region. since the previous study, the fluid identified in the extra-axial space is no longer visible now. there is dural thickening seen in this region which demonstrates enhancement. there is encephalomalacia in both frontal lobes as before. diffuse hyperintensities in the white matter are also seen. there are patchy areas of hyperintensity in both temporal lobes as before. there is prominence of the ventricles with thinning of the corpus callosum. there are small foci of chronic microhemorrhages in the left temporal region. following gadolinium, no abnormal parenchymal, vascular or meningeal enhancement identified. impression: no acute infarct seen or new enhancing lesions are identified since the previous study. previously noted postoperative changes are again seen with dural thickening in the left frontal region which demonstrate enhancement. bifrontal encephalomalacia and patchy areas of encephalomalacia and temporal lobes are also identified. no evidence of intrinsic signal abnormalities within the hippocampal regions bilaterally. eeg: - left frontotemporal cortex with activity and frequent sharp waves likely from epileptogenic cortex. brief hospital course: seizures mr. presents with increased frequency of seziures from a mean of one event of simple partial seziure each month to clustering to about 20 seziures per day at admission. no evident cause was found for this, with stable neuroimaging, initially with ct and then mri. control was initially gained with dilantin load. this was weaned and vimpat tried, given that the patient had previously been on dilantin for years and the thought that this newer may afford good control without the side effects. vimpat failed to control seizures, was weaned and again replaced with dilantin. dilantin afforded mildly improved control, which was then stopped as the seizures were better after wound debridement and he was having decreased speech, slurring of speech, and mood was more depressed. he was seizure-free for several days prior to discharge and the thought was that his seizure were most likely exacerbated by his infection. headache and scalp abscess he had some headache on presentation which was worsened post-ictally. given stability of imaging and likely post-ictal headache, it was not until there was some discharge from his previous scalp incision that we noted abscess. cultures were send and vancomycin, gram stain revealed gram positive cocci in pairs and clusters and culture grew staphalococcus aureus which was sensitive to methacillin, however given coag-negative staph seen from culture id felt that a course of vancomycin for a likely osteomyelitis was the best treatment. he was started on a course for 4 weeks (end date ) and id will follow-up on that date and determine whether additional treatment is required. scalp abscess wash-out mr. was taken to the or by dr. , neurosurgery, for washout of former operative site. procedure went well, with mr. staying the icu overnight. he woke soon afterward was successfully extubated the following morning. on that morning his examination had returned to baseline, but for removal of frontal bone and slightly sagging scalp. per dr. , there was little debri left at the time of wash-out and the wound looked clean. cultures were sent which grew s. aureus. patholgy from bone sample was pending on discharge. he was instructed to wear a helmet whenever he is up becuase of the craniectomy. wilson's disease no evident scleral copper deposits. penicillamine and pyridoxine were continued. medications on admission: - lamictal 400mg - keppra 2250mg - ativan 1mg qid (though has been averaging 5.5mg/day this past week) - pyridoxine 50mg daily - cuprimine 500mg - calcium and vitamin d discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. lamictal 200 mg tablet sig: two (2) tablet po bid (). 5. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. lorazepam 1 mg tablet sig: one (1) tablet po q6h (every 6 hours). 9. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for sore throat. 10. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 11. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for until days. 12. levetiracetam 750 mg tablet sig: three (3) tablet po bid (2 times a day). 13. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for prn pain. discharge disposition: extended care facility: - discharge diagnosis: scalp abscess increased seizures likely due to infection exacerbating underlying seizure disorder. secondary wilson's disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you came to hospital with increased seizure frequency. these events were not seen well on eeg monitoring. you had frequent partial seizures, better controlled well with dilantin. this medication was stopped on as there was some concern that you were having side effects including dimished spontaneous speech and nausea. while you were here, you had some headache and developed red skin over your forehead, which later began to produce some discharge. this was found to be infected. neurosurgery removed part of teh skull, and samples in the or which grew stap aureus. your wound dressing will need to be changed on a daily basis. you were started on vancomycin and id was consulted. you will need to complete a course of vancomycin until for a likely osteomyelitis. continuation of this antibiotic will then be discussed with the infectious disease doctors at your .you should also wear the helmet per neurosurgery. followup instructions: continue vancomycin until when id will determine whether additional time is required and final cultures from bone biopsy have returned. get vancomycin trough weekly to with goal 15-20. change wound dressing on a daily basis until neurosurgery on . continue anti-epileptic drugs: keppra 2250mg po bid, lamictal 400mg po bid, and ativan 1 mg po every 6 hours. additional ativan can be given if patient has a seizure longer than 5 minutes or a cluster > 10 seizures. 1. provider: , md phone: date/time: 11:00 2. infectious disease appointments: a) at 10:00a with dr. lm , basement id west (sb) b) 10:00a id, lm , basement id west (sb) 3. neurosurgery: at 2:45 pm w/ dr. lm bldg (), neurosurgery west procedure: excision of lesion or tissue of cerebral meninges other craniectomy diagnoses: other postoperative infection unspecified osteomyelitis, other specified sites methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site bell's palsy staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus cellulitis and abscess of other specified sites cerebral cysts ptosis of eyelid, unspecified localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy late effects of cerebrovascular disease, dysarthria disorders of copper metabolism 

Answer: The patient is high likely exposed to