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: history of present illness: patient is a 72-year-old gentleman who was transferred from for concern for ttp. patient initially had presented on with a day history of uri symptoms and was found to be hypotensive and admitted with pneumonia and sepsis. patient required intubation and was treated with ceftriaxone, azithromycin, and flagyl with improvement over the next few days. patient was extubated. during that time, patient also had a troponin leak and a catheterization was done that showed one-vessel disease with a rca occlusion of 70-80%. patient also had an abdominal ct at the outside hospital that showed a questionable adrenal mass, however, patient was discharged home on on augmentin and flagyl. a couple of days later the patient began to have copious diarrhea stating about 15-20 bowel movements in a 24-hour period, and also developed altered mental status and fever up to 106 degrees. the patient returned back to , where he was found to have mild elevation of his creatinine to 2.7, and he was intubated for airway protection during the performance of a lumbar puncture since patient was oversedated. the lumbar puncture at the outside hospital showed no evidence of any infection, however, the patient was started on ceftriaxone and p.o. vancomycin. subsequently, the patient developed thrombocytopenia with schistocytes and was transferred to for further evaluation, questionable plasmapheresis. past medical history: 1. tia/cvd. 2. hypertension. 3. hyperlipidemia. 4. cad - catheterization on that showed 70-80% mid rca stenosis and 40-50% lad stenosis. 5. obesity. 6. chronic lower back pain with sciatica. 7. mild chf with an ef of 45%, apical hypokinesis. 8. questionable seizure disorder. medications on admission: 1. atenolol 50 mg p.o. q.d. 2. aspirin 81 mg p.o. q.d. 3. lipitor 10 mg p.o. q.d. 4. protonix 40 mg p.o. q.d. 5. diltiazem 30 mg p.o. q.i.d. 6. phenobarbital 120 mg p.o. q.h.s. allergies: no known drug allergies. social history: the patient lives at home with his wife and was a retired city worker in . patient has two children. denies any tobacco, alcohol, or iv drug use. physical exam on admission: vital signs: temperature 101.4, pulse 96, blood pressure 108/62, respiratory rate 20, and o2 saturation 100% on ac 14 x 650, fio2 of 35%, peep of 5. general: intubated, sedated. heart: s1, s2 regular rate and rhythm, no murmurs, rubs, or gallops heard. lungs: coarse bilateral sounds heard anteriorly. abdomen is soft, obese, positive bowel sounds, nondistended. extremities: + edema, 2+ femoral pulses bilateral. neurologic: was following commands on admission, but was sedated for intubation. laboratories on admission: white count 15.6, hematocrit 26.0, platelets 35. sodium 140, potassium 3.0, chloride 106, bicarb 21, bun 34, creatinine 1.5, glucose 160. ast 1203, alt 1783, alkaline phosphatase 99, total bilirubin 1.3, total protein of 4.5, and albumin 2.1. pt 12.7, inr 1.1, ptt 23. abg: 7.51, 20, 164. hospital course: 1. respiratory - the patient was initially intubated for airway protection after being sedated during the procedure of a lp. patient had a lp done because he presented with an acute mental status change. the lp showed no evidence of infection, however, through the course of the hospital stay, it became difficult to extubate the patient and an attempt was made to wean him off his vent, but patient was not successful, and so patient was eventually trached. on his trach, patient has been on pressure support of 20 with peep of 5, and is slowly being weaned. on the day of this discharge summary, patient is on pressure support of 10 and peep of 5 with a fio2 of 40% and patient seems to be doing well. we will continue to wean his vent settings as tolerated. 2. thrombocytopenia - patient presented with acute thrombocytopenia with the initial thinking of ttp. however, since the patient was exposed to heparin in the outside hospital, a hit antibody was sent, which returned positive. patient also had a right upper extremity ultrasound that was done due to increased swelling of his right upper extremity and he was found to have a right subclavian thrombus. the patient was started on lepirudin drip as per the hematology/oncology team for anticoagulation. patient's platelets slowly rose and at the time of this discharge summary, the patient's platelets were 139. patient was also started on coumadin as patient is going to require about six months of anticoagulation with goal inr of . patient will be on both lepirudin drip and coumadin until his inr hits 4. at that time his lepirudin drip will be stopped and patient will continue coumadin. 3. infectious disease - patient presented febrile with an elevated white count. blood cultures were drawn at the time of arrival to and the patient was 6/6 bottles positive for enterococcal bacteremia. patient was initially started on gentamicin and ampicillin for broad coverage. the source of the infection was unclear, but it was thought to be secondary to nosocomial exposure in the outside hospital and id team was also consulted for concern that patient may have seeded in his right subclavian thrombus and possible cardiac valve. during his hospital course when it was difficult to extubate him, a chest x-ray was obtained that showed possible left lower lobe pneumonia and patient was thought to develop vent-associated pneumonia. patient was started on vancomycin and cefepime for vent-associated pneumonia, and the ampicillin was stopped since the vancomycin would cover for the enterococcal bacteremia. as per discussion with the id team, it was decided that patient will complete a six-week course of gentamicin 120 mg iv b.i.d. and vancomycin 1 gram iv b.i.d. as tolerated. if patient develops renal insufficiency, the gentamicin will be stopped and patient will continue vancomycin. patient also had a transesophageal echocardiogram that was done to rule out endocarditis. no vegetations were seen, however, there was a highly mobile complex atheroma of 3 x 0.7 cm located in the distal aortic arch and proximal descending aorta. after discussing these findings with the id team and the fact the patient had endovascular infection, it was decided that we will still continue the six-week course of antibiotic. patient will get a total of two weeks of cefepime 2 grams iv q.8 for vent-associated pneumonia, which should be stopped on . 4. cardiology - there was some concern that patient may have developed endocarditis given his high degree of bacteremia. patient received a transesophageal echocardiogram that was unremarkable except for this mobile complex atheroma found in the aortic arch and the proximal descending aorta. it was decided that he would anticoagulate for this finding. patient also has a history of hypertension and patient was on lopressor 75 mg p.o. b.i.d. at the time of this discharge summary. 5. neurologic: patient was initially intubated due to oversedation and decreased mental status during the procedure of a lp. however, after intubation, patient's motor function did not improve and patient continued to have decreased mental status with occasional spontaneous movement of the head. patient did not respond to any commands. the neuro team was consulted, who recommended obtaining a mri and an eeg, both of which were unremarkable. the concern came for guillain- syndrome versus icu polyneuropathy. at the time of this discharge summary, ongoing discussions were held with the neuro team regarding performing an emg to rule out guillain- syndrome. in addition, there was some concern about patient having a seizure since the patient was on keppra 500 mg p.o. b.i.d., which the neuro team recommended to continue. 6. renal - patient initially presented with acute renal failure of unclear etiology. however, through the course of the hospital stay, the patient's creatinine improved. at the time of this discharge summary, his creatinine was 0.9 with a bun of 29. patient was making good urine and was self diuresing over a liter per day. 7. hyperglycemia - patient was on an insulin drip initially, but as we stopped the hydrocortisone, patient was switched over to regular sliding scale insulin and patient's blood sugars had been well controlled at this point. 8. adrenal hemorrhage: patient developed some adrenal hemorrhage as per the abdominal ct done at the outside hospital. this is most likely in the setting of hit antibody positive. patient also had a cortrosyn stim test that was done, that did not respond as expected. patient received a seven-day course of hydrocortisone 100 mg iv q.8. patient appeared clinically stable and so no further imaging was done, however, it may be considered as an outpatient to obtain a repeat abdominal ct to assess any changes of the adrenal hemorrhage. 9. gi: patient had decreased mental status and was unable to swallow. patient had a peg tube that was placed and was receiving tube feeds. please note that this discharge summary describes the hospital course events from to . please see additional discharge summary for the rest of the hospital course. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified acute and chronic respiratory failure bacteremia other complications due to other vascular device, implant, and graft acute and subacute bacterial endocarditis cerebral embolism with cerebral infarction acute infective polyneuritis 

Answer: The patient is high likely exposed to