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: this is a 51-year-old male admitted on , who has severe crohn's disease status post multiple surgical revisions leaving the patient with short-gut syndrome requiring chronic home tpn, from which the patient has been subject to multiple line infections, sepsis, and ards in the past, who was admitted to the micu from the emergency room with fever of 103?????? and hypotension. this patient was in his usual state of health until when he was noted by his 24-hour nurse to be febrile with a temperature of 103.1?????? and systolic blood pressures in the upper 70s. he was brought to where he was started on dopamine for his low blood pressure and received supplemental oxygen and was transferred to for further management. in the emergency department, the patient was noted to have two picc lines, all of which were occluded. a right subclavian triple lumen was placed after which the left picc was removed. with fluid resuscitation, the patient's blood pressure was brought up to 170, and the dopamine was discontinued. he was given iv solu-medrol for chronic steroid use, as well as an amp of d50 for hypoglycemia. past medical history: 1. crohn's disease status post multiple surgical revisions including total colectomy, and partial ileal resection for which he is on home tpn. 2. multiple picc line infections. 3. chronic renal insufficiency with a previously billed baseline creatinine of 2.0-2.5. 4. severe osteoporosis status post cervical stabilization in after spontaneous vertebral body collapse. 5. chronic coag-negative staphylococcus osteomyelitis of these cervical vertebrae near the area of the surgical stabilization in for which the patient is on chronic suppressive vancomycin. 6. hypertension. 7. depression. 8. anemia for which he is on epogen for a baseline hematocrit between 23-30. 9. dementia, mild. 10. chronic nausea. 11. mitral regurgitation, 4+ by tee in with an ejection fraction of 55%. 12. ards in . medications on admission: niferex 15 mg p.o. b.i.d., prednisone 2 mg p.o. q.d., imodium 4 mg q.6 hours, tums, vitamin c, rocaltrol 0.25 mg q.d., vitamin d, wellbutrin sr 150 mg b.i.d., zantac 50 mg iv q.d., vancomycin 1 g iv q.o.d., sandostatin 20 mg im q.month, fentanyl patch 50 mcg q.72 hours, ambien 10 mg p.o. q.h.s. p.r.n., tylenol p.r.n., benadryl 50 mg p.o. q.6 hours p.r.n., vistaril 25 mg p.o. q.6 hours p.r.n., xanax 0.5 mg p.o. q.6 hours p.r.n., marinol 25 mg p.o. b.i.d. p.r.n., ativan 1 mg p.o. q.h.s. p.r.n., remeron 30 mg p.o. q.h.s., trazodone 50 mg p.o. q.h.s. p.r.n., clonazepam 0.5 mg p.o. q.h.s. p.r.n., amtriptiline 50 mg p.o. q.h.s., atenolol 50 mg p.o. q.d., zofran 4 mg iv q.8 hours p.r.n., epogen 4000 u subcutaneous q.week. allergies: methotrexate, compazine. social history: significant for a 60 pack-year tobacco history which is ongoing. no alcohol or other drugs. there is a history of past narcotic abuse and pain medications in the past. he lives alone with 24 nursing care. his family is intermittently involved in his care. his brother is the primary spokesman for the patient's numerous siblings; however, his brothers and are also healthcare proxies for him. physical examination: vital signs: upon arrival in the emergency department, his temperature was 103??????, heart rate 110-120, blood pressure 120/60, respirations 30, oxygen saturation 97% on 8 l face mask. general: the patient was a middle-aged male in moderate distress. heent: anicteric. dry mucous membranes. he had jugular venous distention approximately 5-6 cm. no lymphadenopathy. cardiovascular: he was tachycardiac with regular s1 and s2 sounds and without any murmurs or gallops. chest: minimal expiratory wheezes were heard scattered bilaterally. crackles were heard at the bases. abdomen: soft and nontender. there were multiple old scars and a suture protruding from the periumbilical area. the ostomy was pink on the right midabdomen that was prolapsed however was viable with good capillary refill, and it was functioning. extremities: warm. he had 2+ pulses. he was able to move all four extremities on command. he was without any skin breakdown noted on back or extremities. neurological: he was alert and oriented times two. he had a grossly nonfocal exam. skin: there were no rashes noted on his body. laboratory data: initial studies were significant for a hematocrit of 37, white count 5.5, platelet count 119; bicarb 15, bun 40, creatinine 2.3; he had a therapeutic vancomycin level on ; urinalysis was with dilute urine but otherwise negative; blood cultures were drawn, as was a random cortisol level. electrocardiogram was normal sinus rhythm with isolated significant q-wave in lead iii and flattened ts in the same lead. chest x-ray revealed cardiomegaly, unchanged from prior exams. cephalization of the vessels suggested congestive heart failure but without effusions or focal infiltrates, and a right-sided rib fracture. assessment/plan: the patient was admitted to the micu service for sepsis of unclear etiology, although the past history of picc line infection and sepsis was suggested, as no other obvious source was identifiable. he was given stress dose steroids. he was started on linezolid and zosyn empirically, in addition to continuing his vancomycin. hospital course: despite aggressive fluid rehydration, the patient continued to develop hypotension. he was started on pressors, and a swan was placed to better guage hemodynamic parameters, keep the patient euvolemic and monitor mitral regurgitation. the swan-ganz catheter revealed data consistent with a septic physiology unresponsive to fluid bolus. the patient had bilateral patchy infiltrates, as well as increasing respiratory distress, consistent with ards. he was started on xigris and was attempted to be ventilated by an ards strategy; however, he was persistently hypoxic with a conventional strategy. he was therefore switched to aprv ventilation for several days which maintained his oxygenation. on hospital day #4, fecal-like material was noted to be on the ng tube, and his ostium was disimpacted with large amounts of viscus material from the stoma. ct of the abdomen was performed which did not show an obstruction. at the same time, his random cortisol level was found to be normal, and his stress-dose steroids were discontinued. his picc line eventually grew klebsiella which was sensitive to zosyn. linezolid was discontinued, and the patient became afebrile. his bicarbonate levels were persistently low, and the patient was diagnosed with a renal tubular acidosis, and bicarbonate was supplemented in his tpn. by hospital day #8, the patient was weaned from the levophed, although he was still with fever. a tee was performed due to concern of possible endocarditis, giving the patient's severe murmur and his history of bacteremia. vegetation was seen on the anterior leaflet of the mitral valve, but this was unchanged in size as compared to prior exams. also unchanged was the patient's 4+ mitral regurgitation. by hospital day #11, the patient was having improved pulmonary function, requiring less oxygenation but still highly peep dependent. he still had persistently low-grade fevers. repeat ct of the abdomen and chest was performed looking for bacterial seeding and abscess, but none was found. several days after the levophed was discontinued, afterload reduction was started to encourage diuresis of the fluid that he had retained during his resuscitation. with afterload reduction, the patient's creatinine improved to better than his previously known baseline, where he was as low as 1.6 at times. all of the patient's lines were changed in an attempt to ascertain the cause of the continued low-grade temperatures. despite being unable to find the source, his condition continued to improve. he continued to diurese and faced numerous electrolyte imbalances for which a renal consult was obtained. the patient also suffered an episode of a sinus pause versus high-grade av block seen on the monitor. a cardiology consult was obtained, and no further specific diagnosis could be obtained; however, the recommendation was made at that point to stop the patient's beta-blocker. the patient's condition continued to improve. he suffered no further arrhythmic events, and due to several successful spontaneous breathing trials with good rsbi and abg results, he was extubated for approximately ten hours. at that time, the patient became hypotensive resulting in increasingly hypertensive anxiety and hypertension. he was felt to be suffering from pulmonary edema, as his hypertension was uncontrolled, blowing through his wide open mitral regurgitation causing pulmonary edema which resulted in worsening agitation and worsening hypertension. he was therefore reintubated for tachypnea and respiratory distress. at that time, the decision was made to perform a tracheostomy which would facilitate the patient's weaning, as he could be brought off the ventilator in a more controlled fashion with less rapid cessation of sedation. tracheostomy was performed by . mri of the cervical spine was attempted to be obtained; however, the patient reverted from drips to p.o. he was far too anxious to endorse sitting inside the mri machine. on hospital day #23, the patient was interacting and responding appropriately with only mild sedation requirements, awaiting only a speech and swallow evaluation prior to his discharge to the weaning facility in , . discharge diagnosis: 1. klebsiella picc line sepsis, status post xigrus and zosyn therapy. 2. ards, resolved at this time. the patient requires minimal ventilatory support needing at this time only a pressure support of 5 and 5 with 40%. he will likely be able to use a trach mask, as well as a pessary valve to speak after he has a swallow evaluation. his wean will be greatly facilitated by the optimal management of his mitral regurgitation. 3. mitral regurgitation of 4+ on most recent transesophageal echocardiogram. the patient has good result with ace inhibitor afterload reduction with systolic blood pressures of a goal running between 100-120. he is not on a beta-blocker at this time due to an incident of sinus pause versus high-grade av block per cardiology's recommendation. 4. sedation. the patient is currently being mildly sedated and has anxiety treated with a fentanyl patch, as well as p.o. ativan patch. 5. chronic renal failure. the patient's current creatinine is 1.8, which has been as low as 1.6. this is much lower than his previously believed baseline. this is likely secondary to the ace inhibitor treatment and aggressive afterload reduction to improve his cardiac output. 6. renal tubular acidosis. the patient will continue to require bicarb replenishment in his tpn to prevent him from being dyspneic. 7. chronic obstructive pulmonary disease. the patient is a long-time smoker up until the day of admission. his baseline co2 at this point upon discharge ranges between 48 to the low 50s, and his tpn bicarbonate requirements have been titrated to achieve a neutral ph based upon these pco2 levels. 8. anemia. stable at this time on epogen and iron. 9. conjunctivitis. the patient is finishing a gentamicin drop treatment for the left eye. 10. chronic osteomyelitis. he will be on vancomycin indefinitely for coag-negative staphylococcus in the cervical spine. because he has orthopedic hardware in the same area and was bacteremic during this hospitalization, he will need an mri as an outpatient when he is less anxious to see if the area has been seeded or colonized. if his orthopedic hardware is infected, it may have to be removed in the future. 11. crohn's disease with short-gut syndrome. the patient will be on chronic tpn. picc lines were inserted prior to his discharge. bicarb should be monitored and titrated to his native pco2 of 50. 12. sinus pause versus high-grade av block: no reoccurrence, as the beta-blocker has been held per cardiology's recommendation, but this possibly may be able to be restarted in the future upon cardiology follow-up. discharge medications: captopril 50 mg p.o. t.i.d., ativan 2 mg p.o. q.8 hours, gentamicin ophthalmic solution 2 drops o.u. q.4 hours x 2 days, fentanyl patch at 50 mcg/hr to be changed q.72 hours, albuterol nebulizer solution q.4 hours, aspirin 325 mg p.o. q.d., vancomycin 1000 mg iv q.24 hours for which the patient should have levels followed, as his renal function improves, heparin 5000 u subcutaneous q.12 hours to be continued until the patient is ambulating, artificial tears 2 drops o.u. q.i.d., erythropoietin 40,000 u subcutaneously once a week, zofran 2 mg iv q.6 hours p.r.n., polysaccharide iron complex 150 mg p.o. b.i.d., tpn for which the most recent formulary is a volume of 1.7 l/day, 65 g amino acids per day, 350 g dextrose per day, 50 g of fat per day with trace elements added daily, multivitamin added daily, with the amount of acetate and chloride to be determined based on the chloride and bicarb levels. the patient will require acetate each day, as he has renal tubular acidosis and has ongoing .................. in his urine. most recently he was on 50 sodium chloride, 80 sodium acetate, 15 sodium phosphate, 20 potassium acetate, 10 magnesium sulfate, 14 u insulin. this formula should be reviewed on a regular basis. follow-up: the patient should follow-up with his gasstroenterologist dr. within the next week. dr., 12-697 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube fiber-optic bronchoscopy arterial catheterization temporary tracheostomy injection or infusion of oxazolidinone class of antibiotics infusion of drotrecogin alfa (activated) diagnoses: mitral valve disorders chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure infection and inflammatory reaction due to other vascular device, implant, and graft other and unspecified postsurgical nonabsorption regional enteritis of small intestine with large intestine chronic osteomyelitis, other specified sites 

Answer: The patient is high likely exposed to