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: sulfa (sulfonamides) attending: chief complaint: respiratory failure major surgical or invasive procedure: intubation history of present illness: hpi: pt is a 79 year old man with multiple medical problems cad s/p cabg, pvd, type 2 dm, cri, who was admitted to podaitry on for evaluation of ulcer/cellulitis transfered to medicine on because of change in mental status and worsening renal function in the setting of drop in hct. hospital course was remarkable for occasional fevers, hypoxia thought to be chf, anemia with guaiac positive stools, delerium, leukocytosis. pt developed sudden onset sob on am; cxr showed bilateral infiltrates, thought to be most likely bilateral pulm edema w/ underlying pna. he was given 40 mg iv lasix w/ imp in symptoms. abg was 7.46/35/89. cardiac enzymes were negative x 3. ekg did not show any changes. pt was started on heparin sc. pulm was consulted and thought that he could now have bilateral pna. pt already on broad abx coverage with levo, zosyn and 1 dose of vancomycin. since this initial sob, he has been desating, and was recently switched from 4l o2 to 7l on face mask. pt was still fluctuating from mid 80s to high 90s at time of transfer, with rises in respiratory rate also. pt is also exceptionally lethargic, and was able to open his eyes for only a few seconds at a time before falling back asleep, after sternal rub and wet face cloths. subsequent abgs today were 7.46/33/76 and 7.44/35/146. he was transferred for observation to the micu in the afternoon of . urine, blood and sputum cultures are pending at time of transfer. past medical history: cad s/p cabg in 99 pvd s/p r cea bph cri (1.7-1.9 baseline cr) dm type 2 cva' 80's dementia r plantar ulcer hyperlipidemia cellullitis/osteo 2 r toe s/p r femoral bypass anemia (baseline 31) right femoral-peroneal bypass with composite arm and saphenous vein graft bilateral carotid endarterectomies. history of right iliac stent. , femoral-popliteal bypass graft with jump graft to anterior tibialis; approximately ten years ago had failed and occluded. physical exam: pe: 98.1 (axillary) 64 132/47 26 general elderly , somnolent but arousable, open eyes to command heent: dry mucose, no jvp cv: s1, s2 2/6 sem at lsb pulm: limited exam 2 effor, bibasilar crackles with diminiched bs to midlung abd: normal abdominal sounds, soft, nt, nd extremities: no edema, dressing over r heel, neuro moves all 4 extremities, lethargic but responds to questions. not alert or oriented. cn ii-xii intact pertinent results: 08:50pm pt-13.8* ptt-36.6* inr(pt)-1.3 08:50pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 08:50pm wbc-11.6*# rbc-2.69*# hgb-8.9*# hct-26.4*# mcv-98 mch-33.2* mchc-33.8 rdw-12.8 08:50pm calcium-8.7 phosphate-2.8 magnesium-1.7 08:50pm glucose-199* urea n-49* creat-2.1* sodium-136 potassium-4.5 chloride-104 total co2-20* anion gap-17 cxr findings: the patient is status post median sternotomy and cabg. pulmonary vascular congestion and increased interstitial opacities consistent with congestive failure, slightly progressed. small right pleural effusion and no pneumothorax. heart size is upper limits of normal. impression: chf with small right pleural effusion. no focal consolidation seen. . cxr there is cardiomegaly with pulmonary vascular engorgement consistent with chf. there is a focal area of opacity in the left upper zone, new since the prior study of , which could represent an area of pneumonia in the left upper lobe, as the the appearance is atypical for asymmetric leftsided pulmonary edema. . cxr indication: low oxygen saturations. pulmonary edema and pneumonia. the heart is enlarged. there remains an asymmetrical bilateral pattern of alveolar opacification, most prominent centrally in the perihilar regions, left greater than right. allowing for positional differences, this is probably not changed significantly in the interval since the recent chest radiograph. left-sided pleural effusion and/or pleural thickening is also stable. . wound dulture (ankle) from = coag + and coag - staph and enterococcus: sensitive to ox, amp, gent, levo, vanco. . bx cultures ngtd with 2 pending urine cultures pending incl. legionella ag. . echo : 55% ef, moderate pulmonary hypertension, mr 1 brief hospital course: assessment: 79 y/o male with h/o cad, pvd, type 2 dm cri admitted for rle cellulitis transfered to medicine for ms change, fevers, renal insuficiency and hypoxia and now transferred to the micu with increased o2 requirement in the setting of ms changes. . plan: 1) hypoxia: ongoing hypoxemia since admission. differential was originally aspiration pna in setting of gastroparesis (seen on cxr) vs. trali (less likely due to delayed onset since first transfusion and slow progression). with potential progression to ards. pt was intubated on day of admission. weaning trials failed and his respiratory status remained poor. no known source of his infiltrative lung disease was found despite multiple studies for fungal, bacterial sources. pt was followed by id and all recommended tests and studies were ordered and followed. no known source was determined based on multiple blood, sputum and urine cultures. ultimately, due to gastric distension upon admission evident on cxr, it was thought that the cause of his respiratory failure was probably aspiration pneumonitis. . 2) gastric distension seen on cxr. could be gastroparesis in setting of dm. this could be the precipitant of aspiration pna. could be s/p obstruction as well due to ca or other etiologies. - ng tube placement on the first 3 days to decompress stomach yielded improvement per cxr. - reglan (renally dosed)was used for motility. eventually an ng was placed for feeding with high residuals that resolved with time. . 3) ms change prior to intubation: etiology could include - med induced, underlying infection given fever, uremia, or cns process less likely given non focal but mild coagulopathy with increase ptt and trhrombocytopenia - patient was alert, in non aparent distress, per pcp at his normal baseline. ct scan showed no acute changes. . 4) cellulitis/osteo?? r heel podiatry & vascular following, drain and cleaned the wound. wound closed on . swab sent for culture. no osteomyelitis. did not find involvement of underlying planar fascia or bone. underwent wound care for duration of his admission. . 5) fevers: could be cellulitis/bacteremia/pneumonia; no spike in temo on . cont vanco and zosyn. zosyn continued until and vancomycin was dosed by level for a week. occasional fevers persisted to 101 but no known source was found. multiple cultures from sputum, blood and urine were negative. . 6) anemia: iron: 11 caltibc: 224 ferritn: 203 trf: 172 likely anemia of chronic disease - patient with guaiac + stools on presentation, transfused 1 unit and hematocrit check 24.4 from 23.9. not good response in the setting of epigastrial pain and + guiaic stools concerning for gi bleeding. gi was consulted. hemolysis labs ldh 182, hapt 182, fibrinogen 622, d dimer , fdp 10-40 platelets 130.000, not clear picture of dic, platelets low but stable. persistent guiac positive stools. discussed with gi fellow, they feel that given the pulmonary status of the patient and since his hct is stable, he would not be a good candidate at this point for an egd given that cedation would be used during the procedure. felt that the risk outweights the benefits at this point. - ppi - hold aspirin and cilostazol . 7) cad: statin, bb, held asa . 8) dm: well controlled throughout, continued ssi . 9) pvd: statin, - held asa and cilostazol . 10) dementia: patient, according to pcp, at his baseline prior to intubation . 11) bph: continued doxazosin . 12) prophylaxis: aspiration precautions, hep sqq, ppi . 13) comm: with family throughout. . on , a family meeting was held where all 3 health care proxys (his 3 daughters) were present. a decision to render the pt was made based on his prior wished never to be in a long term state of chronic disability. on , with all proxys present along with other family members, a decision to extubate and titrate to comfort with morphine was made. the patient expired within 1.5 hours of extubation. medications on admission: allergies nkda social widowed, smoked tobaco, lives alone with assistance from daughter . meds on transfer: 1000 ml d5 1/2ns continuous at 50 ml/hr acetaminophen 325-650 mg po q4-6h:prn lidocaine jelly 2% 1 appl tp once albuterol 0.083% neb soln 1 neb ih q6h:prn metoprolol xl 50 mg po daily atorvastatin 40 mg po daily milk of magnesia 30 ml po q6h:prn bisacodyl 10 mg po/pr daily:prn morphine sulfate 1 mg iv q4-6h:prn pain calcium carbonate 500 mg po qid:prn olanzapine 5 mg po q12h:prn agitation cetylpyridinium chl (cepacol) 1 loz po prn pantoprazole 40 mg iv q12h dextrose 50% 12.5 gm iv prn piperacillin-tazobactam na 2.25 gm iv q6h order date: doxazosin 4 mg po hs povidone iodine 1/4 strength 1 appl tp asdir docusate sodium 100 mg po bid sertraline hcl 100 mg po daily folic acid 3 mg po bid senna 1 tab po bid:prn guaifenesin ml po q6h:prn cough sodium chloride 0.9% flush 3 ml iv daily:prn heparin 5000 unit sc tid levofloxacin 250 mg po q24h order date: insulin sc (per insulin flowsheet) sliding scale & fixed dose order date: @ 0844 also: pt received vancomycin hcl 1000 mg iv once duration: 1 doses order date: discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances insertion of other (naso-)gastric tube closed [endoscopic] biopsy of bronchus excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue closure of skin and subcutaneous tissue of other sites diagnoses: thrombocytopenia, unspecified unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin other and unspecified coagulation defects atherosclerosis of unspecified bypass graft of the extremities cellulitis and abscess of foot, except toes ulcer of heel and midfoot gastroparesis cellulitis and abscess of toe, unspecified peripheral autonomic neuropathy in disorders classified elsewhere 

Answer: The patient is high likely exposed to