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: respiratory distress, hypoxia, tachycardia, fever, chills major surgical or invasive procedure: nasogastric tube left elbow joint aspiration history of present illness: pt. is a 87 y/o with a history of dementia, thrombocytosis on hydroxyurea, tia, seizure, and gout, who presented to ed from nh with hypoxia of 84% ra --> 97% 15l after being noted by nursing staff to be gurgling as well as nasal congestion and drainage early in the morning. pt was given combivent nebs at the nh and at the time was noted to be afebrile with temp of 98f, p 100, rr 20, bp 136/68. later in the afternoon, the patient was noted to have some difficulty breathing, and at that time was found to be 84% on ra. . on arrival to er pt was found to have tmax 102.2, tachy to 120's, sbp 130's, and initially 100% on non-rebreather. pt was able to be weaned down to a 50% fm (98%), and hr improved to 100's after 1l iv fluids. cxr: showed a possible lll pna, and a chest cta was negative for pe, but did show a l sided consolidation. pt recieved levaquin, cefepime, vanco while in the ed and arrived to the micu satting 96% on 5l nc. . of note, the patient had been recieving penicillin vk 250mg po qid since following a recent dental procedure. past medical history: 1.) dementia 2.) essential thrombocytosis 3.) gout 4.) anemia 5.) tia 6.) seizure, previously on trileptal now d/c'd social history: occupation: retired urologist at hosp drugs: unknown tobacco: unknown alcohol: unknown other: nh resident from of family history: reviewed past records and found to be non-contributory physical exam: tmax: 37.6 ??????c (99.6 ??????f) tcurrent: 37.6 ??????c (99.6 ??????f) hr: 111 (111 - 116) bpm bp: 156/85(104) {149/58(81) - 156/85(104)} mmhg rr: 21 (16 - 21) insp/min spo2: 97% heart rhythm: st (sinus tachycardia) height: 51 inch general appearance: no acute distress, thin eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, poor dentition lymphatic: cervical wnl cardiovascular: (s1: normal), (s2: normal), no murmurs, gallops, or rubs peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (percussion: no(t) resonant : ), (breath sounds: no(t) clear : , rhonchorous: bilateral rhonchi throughout all lung fields with no wheezing), significant upper airway secretions and gurgling abdominal: soft, non-tender, bowel sounds present, reducible ventral hernia extremities: right: 1+, left: 1+ musculoskeletal: muscle wasting, thin lower extremeties with decreased bulk skin: warm neurologic: follows simple commands, responds to: verbal stimuli, oriented (to): self, movement: purposeful, tone: not assessed, somnolent but easily arousable, able to follow simple commands and answer questions pertinent results: ultrasound <br> impression: unremarkable right upper quadrant ultrasound. please note, failure to image the gallbladder may be due to prior cholecystectomy or due to collapsed state. no intrahepatic ductal dilatation. <br> cta chest with and without contrast impression: 1. no evidence of pulmonary embolism. 2. left lower lobe consolidation consistent with pneumonia. 3. calcification of the coronary arteries and aorta. 4. 4 mm pulmonary nodule in the right upper lobe. based on risk factors, month follow up is recommended. <br> ct head w/o contrast conclusions: 1. age-related diffuse cerebral atrophy and ventricular enlargement, stable since . 2. bilateral lacunar infarcts in the basal ganglia and small vessel ischemic disease. 3. periodontoid pannus in keeping with possible rheumatoid arthritis or pseudogout. clinical correlation is recommended. 4. overall, if clinical concern is high for acute ischemic disease, an mri evaluation of the brain would be helpful. <br> cxr impression: left retrocardiac alveolar opacity associated with left small pleural effusion is new, consistent with pneumonia or aspiration. less marked right basal alveolar opacity increased, could be due to atelectasis, multifocal aspiration or pneumonia. there is no right pleural effusion. there is no vascular congestion. tortuosity and calcifications of the aorta are unchanged. <br> cxr findings: the enteric tube reaches the stomach. the cardiomediastinal contours are stable. there is no evidence of central lymphadenopathy. bibasilar consolidations have improved. there are small bilateral pleural effusions. pulmonary vascularity is normal. there is no pneumothorax. impression: interval improvement in left lower and right lower lobe consolidations. no radiographic findings to suggest interval aspiration. <br> ct chest impression: 1. persistent consolidation and atelectasis involving the majority of the left lower lobe. the patency of the left lower lobe bronchus is in question, and a small obstructing mass cannot be excluded. correlation with bronchoscopy is recommended. 2. new small region of consolidation in the right lower lobe. this may be due to aspiration or atelectasis. 3. mild right lower lobe bronchiectasis. 4. stable small right upper lobe nodule. 5. a few borderline mediastinal lymph nodes. 6. small calcified granuloma in the spleen. 7. bilateral non-obstructing nephrolithiasis. 8. bilateral glenohumeral degenerative changes. 9. central venous catheter tip in the superior vena cava. 10. small fat containing anterior abdominal wall hernia. <br> bilat upper extremity venous ultrasound impression: thrombosis involving the left cephalic and basilic veins. no evidence of deep vein thrombosis of the right or left upper extremity. <br> cxr (pa and lat) findings: as compared to the previous examination, the right-sided picc line is in unchanged position. the retrocardiac opacity shows subtotal resolution, in the left basal lung. very subtle remnant peribronchial opacitie are seen. there is no evidence of newly appeared parenchymal opacities, and no evidence of pleural effusion. the size of the cardiac silhouette is at the upper range of normal, there is no evidence of overhydration. <br> microbiology stool clostridium difficile toxin a & b test-final (negative) stool clostridium difficile toxin a & b test-final (negative) urine urine culture-final {> 10^5 } blood culture blood culture, routine-final (no growth) blood culture blood culture, routine-final (no growth) joint fluid gram stain-final; fluid culture-final (no growth) stool clostridium difficile toxin a & b test-final (negative) urine urine culture-final {> 10^5 } sputum gram stain-final (two morphologies of gnrs); respiratory culture-final (no growth) blood culture blood culture, routine-final (no growth) blood culture blood culture, routine-final (no growth) urine urine culture-final (no growth) urine urine culture-final (no growth) urine legionella urinary antigen -final (negative) sputum gram stain-final (no microorganisms); respiratory culture-final (no growth) blood culture blood culture, routine-final (no growth) blood culture blood culture, routine-final (no growth) brief hospital course: 87 y/o m with a history of dementia, thrombocytosis previously on hydroxyurea, tia, seizure, and gout who presented from his nursing home in respiratory distres with acute hypoxia, tachycardia, fevers, and leukocytosis. <br> pneumonia: likely related to a respiratory infection in the setting of possible aspiration event given copious upper airway secretions and notable cough, fever, and leukocytosis. cta with l lower lobe consolidation correlates with cxr at presentation. patient never experienced hypotension related to pneumonia. initial sputum gram staining showed two morphologies of gram negative rods; however, there were never postive sputum cultures or blood cultures. patient was transiently on levofloxacin due to concern for legionella; however, a negative urine legionella antigen prompted the discontinuation of levofloxacin on . the pneumonia was treated with a full 14 day course of cefepime starting on . metronidazole and vancomycin were also part of the patient's antibiotic regimen; however, the cefepime was the only antibiotic used for the full 14 days of treatment. all iv antibiotics were stopped on . the patient's initial copius and thick secretions improved day by day throughout the patient's hospitalization. he required less and less suctioning and was able to mount a good cough in response to chest physiotherapy. he should continue to receive chest pt at his long term care facility. <br> hypoxia: pt initially 84% on ra at and weaned from 100% nrb to 50% fm to 3l nc with o2 sats in mid 90's. he remained on supplemental oxygen for several days after transfer from the micu; however, with suctioning, and good chest pt, the patient was liberated from supplemental oxygen and had acceptable o2 sats (> 92%) for greater than a week prior to discharge. <br> gout / pseudogout: the patient presented to the hosptial with allopurinol listed as a home medication; however, this was discontinued in the micu due to concerns that it would exacerbate patient's constipation. the medication was restarted upon transfer to the floor team. after being on the medical floor for two days, that patient was noted to grimace when arms were passively moved. there was bilateral swelling, warmth, and erythema of the elbow joints noted on exam. this was thought to be a gout flare in response to illness and re-initiation of allopurinol therapy. allopurinol was again discontinued and remained discontinued for the rest of the hospitalization. patient received two days of colchicine at a low dose and had no notable response to this medication. rheumatology was consulted and they aspirated fluid from the left elbow on . the joint aspirate had ~ wbcs and many positively birefringent rhomboid crytals. this was thought to be consistent with a cppd pseudogout inflammatory arthritis. as the patient's peripheral wbc count was rising at this time, this was postulated as a contributor. the patient received naproxen 250 mg twice a day for 7 days. at end of naproxen course on , the patient had full passive and active rom of both elbows without any pain. <br> tachycardia: on presentation, pt initially tachy to 120's, which improved somewhat with 1l ns. on exam, mucous membranes dry and clinical patient appears somewhat volume down. cta negative for pe, and tachycardia could be related to fevers, leukocytosis and underlying infection. ekg consistent with sinus tachycardia in the micu. added low dose metroprolol (12.5mg po tid) and continued that dose through the hospitalization. the patient's tachycardia eventually improved as his overall presentation improved with decreasing wbc count, treatment of pneumonia, treatment of pseudogout, and treatment of fungal uti. <br> dementia / altered mental status: pt with known dementia; however, his sister reported that at baseline he was quite conversant and would frequently read medical journals and the globe. he often clipped newspaper articles to send to his sister in . at presentation he was oriented to person only, but was able to answer simple questions and follow commands. b12, folic acid, and tsh were all measured upon admission and found to be within normal limites. a head ct on showed multiple lacunar infarcts and diffuse cerebral atrophy. the patient became agitated and confused while in the micu and this was controlled with zyprexa initially. upon transfer to the floor the patient was extremely somnolent. zyprexa was discontinued and the patient gradually became more awake and aware. at time of discharge he was oriented to himself, the name of the hospital, the date, and his reason for admission. <br> diarrhea / c diff testing: patient developed soft liquid stools shortly after the initiation of colchicine and continued to have soft stools up to the day of discharge. he also struggled with fecal incontinence and although this was most likely a function of the patient being unable to use the bathroom without help. a rectal exam was performed on to check for evidence of fecal impaction and the exam bore out that the patient had adequate rectal tone and there was only liquid stool in the rectal vault. he was ruled out for c. diff by three negative fecal c. diff toxin studies on , and . he was on oral vancomycin for 4 days for empiric treatment of c. diff in setting of persistent leukocytosis; however, this medication was discontinued on day of discharge. upon discharge, the patient's stool consistency was still loose; however, he was requesting a toilet to examining physicians, so he seemed capable of sensing his bowel movement in his rectal vault and was capable of holding it in. this issue should be followed and bowel regimen should be adjusted as needed by outpatient physicians. <br> urinary incontinence / uti: patient was incontinent of urine during the hospitalization and has an unknown baseline of urinary continence. this, like fecal incontinence was thought to be a function of the patient's inability to request help appropriately so that he could use a urinal in bed. he deconditioned state left him unable to urinate on his own. he did have a urine dipstick positive for wbcs as well as a urine culture positive for greater than 10^5 colonies of , he was treated with a three-day course of fluconazole prior to discharge. his urinary incontinence should be followed to see if it resolves following discharge. <br> elevated lfts: elevated transaminases, alk phos and ldh on admission of unclear etiology given normal u/s with no evidence of cholecystitis. could possibly be related to underlying infection, fever, and sirs syndrome. ast > alt, though patient with no known history of heaty etoh use. d2 of admission alt>ast. this condition resolved shortly after departure from the micu and was not further worked-up while the patient was on the floor. <br> thrombocytosis: platelet count 310 on admission, consistent with previous platelet counts. known history essential thrombocytosis; however, platelets were as high as 962 on presumably due to systemic inflammatory status in setting of ongoing cppd psuedogout flare. at discharge the platelet count was and had been trending down for three days. this level should be checked a week after discharge to make sure that it doesn't begin to rise again. <br> nutrition: in the micu, the patient initially failed two speech and swallow evaluations in the setting of altered mental status and poor respiratory function. he was npo with tube feeds through ng tube as sole nutrition upon transfer from the micu. as his mental status improved, he was initiated on a liquid diet and tolerated that and was quickly advanced to a regular diet which he handled with ease aside from needing assistance to feed himself due to decreased arm strength from muscular deconditioning. <br> ppx: while in hospital, the patient received sq heparin, pneumoboots, and a bowel regimen <br> code status: full code (this was confirmed when health care proxy (hcp) visited him from <br> communication: sister: is health care proxy and came to visit the patient and was involved in discussion of his care as well as his code status. medications on admission: triamcinolone 0.1% cream topically prn itching tylenol 500mg po bid, atc allopurinol 100mg po daily asa 325mg po daily cacarbonate 500 mg po tid docusate 100 mg po bid lasix 20 mg po daily on m, w, f hydrea 500 mg po every other day nasacort nasal spray to nostrils daily artificial tears, 3 drops to eyes daily multivitamin daily protonix 40 mg po daily simvasatatin 40 mg po daily vitamin d 800u po daily fleets, dulcolax, mom prn constipation penicillin vk 250 mg 4x/day s/p dental procedure discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. calcium carbonate 1,250 mg/5 ml(500 mg) suspension sig: one (1) po tid (3 times a day). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. therapeutic multivitamin liquid sig: one (1) tablet po daily (daily). 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic daily (daily). 6. hydroxyurea 500 mg capsule sig: one (1) capsule po every other day (every other day). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po daily (daily). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. outpatient lab work please check hematocrit on and forward result to facility physician. discharge disposition: extended care facility: of discharge diagnosis: pneumonia calcium pryophosphate deposition disease altered mental status urinary tract infection dementia essential thrombocytosis hypertension hypercholesterolemia discharge condition: stable, pneumonia resolving discharge instructions: dear dr. , you were admitted to the hospital to treat a pneumonia. you were given supplemental oxygen and treated with antibiotics. your pneumonia appears improved on a repeat cxr. you were evaluated and noted to be at risk for aspiration and were fed through a nasogastric tube. the nasogastric tube was eventually taken out and you were fed a regular diet. you developed calcium pyrophosphate deposition (cppd) disease while in the hospital. you were treated with an anti-inflammatory and antibiotics, and your disease appears improved. you developed a urinary tract infection and were treated with an anti-fungal. you were tested for c. diff and it was negative. . please make sure you take all of the medications we have listed. . we have made changes to your medications, we have stopped lasix and allopurinol. . . please discuss with your pcp regarding starting colchicine 0.6mg po bid for maintenance of cppd remission. . please keep the appointment listed below with your pulmonologist to follow up on your pneumonia. . please come back to the emergency room if you have fever, chills, joint pain, shortness of breath, markedly altered mental status, or chest pain. followup instructions: provider: /dr phone: date/time: 3:00 procedure: venous catheterization, not elsewhere classified insertion of other (naso-)gastric tube arthrocentesis diagnoses: pneumonia, organism unspecified unspecified pleural effusion candidiasis of other urogenital sites gout, unspecified other persistent mental disorders due to conditions classified elsewhere pulmonary collapse pneumonitis due to inhalation of food or vomitus hypoxemia other disorders of calcium metabolism urinary incontinence, unspecified essential thrombocythemia chondrocalcinosis, due to pyrophosphate crystals, upper arm 

Answer: The patient is high likely exposed to