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: penicillins attending: chief complaint: fever major surgical or invasive procedure: central line placement peg tube placement ultrasound guided prostate fluid collection aspiration. history of present illness: 89 year old male with chief complaint of fevers of 104 degrees, agitation, pulling at foley w/ hematuria. pmh bph, afib, htn, recent episode of hemorrhagic prostatitis, primary progressive aphasia. pt was admitted in 1 mo back for hematuria and was found to have hemorrhagic prostatitis. he was cauterized twice. he recd lot of ativan and had to be admitted to the icu for it. didnt get intubated. was xferred to rehab. was doing well. last night was observed to be pulling at his foley. also spiked to 102. was brought to the ed. found febrile to 103 and sbp in 100s. satting well. tachycardic to 120s. lactate up to 5. no wbc count elevation. ua s/o uti. given levoflox x 1. rij placed and recd 4 l ns. lactate down to 2.9. past medical history: bph afib htn recent episode of hemorrhagic prostatitis primary progressive aphasia social history: sh: no etoh, tobacco, illicits family history: nc physical exam: vs: 97 131/86 76 18 94ra gen: friendly male, occasionally singing and humming. heent: mmm, eomi. cor: nl s1s2. rrr pul: poor inspiratory effort, difficult to hear posteriorly. anteriorly cta bilat. abd: soft, thin, nabs, nt/nd extrem: warm, no edema, cyanosis. neuro: cn 2-12 intact. aphasic speech, often speaking in mix of english and yiddish pertinent results: 10:18pm type- 10:18pm lactate-2.1* 09:13pm glucose-97 sodium-144 potassium-3.5 chloride-119* total co2-20* anion gap-9 09:13pm calcium-6.8* phosphate-1.9* magnesium-1.5* 09:13pm wbc-14.8* rbc-2.32* hgb-7.2* hct-21.8* mcv-94 mch-31.2 mchc-33.2 rdw-14.1 09:13pm plt count-99* 05:13pm type- comments-green top 05:13pm lactate-3.2* 04:49pm urine hours-random urea n-821 creat-100 sodium-54 04:49pm urine osmolal-683 04:49pm urine color-yellow appear-cloudy sp -1.019 04:49pm urine -mod nitrite-pos protein-30 glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-lg 04:49pm urine rbc-73* wbc-753* bacteria-mod yeast-mod epi-1 04:49pm urine wbcclump-many mucous-few 04:49pm urine eos-positive 04:45pm glucose-135* urea n-30* creat-1.2 sodium-144 potassium-3.8 chloride-117* total co2-20* anion gap-11 04:45pm calcium-7.1* magnesium-1.6 04:45pm wbc-17.6*# rbc-2.48*# hgb-7.8* hct-23.0* mcv-93 mch-31.5 mchc-33.9 rdw-14.1 04:45pm plt count-103* on admission: 04:45pm pt-14.9* ptt-35.6* inr(pt)-1.3* 09:31am type-mix 09:31am glucose-103 lactate-2.2* 09:31am hgb-8.8* calchct-26 o2 sat-55 05:42am lactate-2.9* 03:40am urine color-red appear-cloudy sp -1.010 03:40am urine -lg nitrite-pos protein->300 glucose-100 ketone-40 bilirubin-lg urobilngn-4* ph-5.5 leuk-lg 03:40am urine rbc->50 wbc->50 bacteria-few yeast-none epi-0 03:15am lactate-5.0* 03:15am hgb-11.0* calchct-33 02:50am glucose-120* urea n-39* creat-1.5* sodium-143 potassium-3.5 chloride-108 total co2-23 anion gap-16 02:50am estgfr-using this 02:50am calcium-8.3* phosphate-1.3* magnesium-1.9 02:50am digoxin-0.6* 02:50am wbc-6.7 rbc-3.38* hgb-10.4*# hct-30.3*# mcv-90 mch-30.8 mchc-34.3 rdw-13.8 02:50am neuts-94.5* bands-0 lymphs-3.7* monos-0.8* eos-0.8 basos-0.2 02:50am plt count-131* 02:50am pt-13.4 ptt-29.7 inr(pt)-1.1 . on discharge: 06:15am wbc-9.0 rbc-3.14* hgb-9.8* hct-28.7* mcv-92 mch-31.2 mchc-34.1 rdw-15.3 plt ct-325 06:15am glucose-121* urean-16 creat-1.0 na-136 k-4.0 cl-100 hco3-31 angap-9 06:57am alt-11 ast-22 alkphos-70 totbili-0.3 06:57am calcium-8.1* phos-1.8* mg-2.0 work -up 07:05am caltibc-212* ferritn-244 trf-163* iron -47 06:40am triglyc-113 hdl-31 chol/hd-3.9 ldlcalc-66 08:06am tsh-4.1 05:30pm vanco-20.3* . cxr: impression: no pneumonia. . ekg: baseline artifact probable atrial fibrillation with rapid ventricular response right bundle branch block rightward axis - is nonspecific but cannot exclude in part right ventricular overload or chronic pulmonary disease st-t wave changes - are in part primary and are nonspecific clinical correlation is suggested no previous tracing available for comparison . prostate ultrasound:conclusion: marked prostatic enlargement with an estimated volume in excess of 150 cc. no evidence of prostate abscess on this limited study. . renal ultrasound: conclusion: normal-appearing kidneys. massive prostate enlargement. . echocardiograms: : impression: moderate left ventricular hypertrophy with overall normal systolic function. mild aortic regurgitation. moderate to severe mitral regurgitation. moderate to severe tricuspid regurgitation. no vegetation identified. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. general comments: a was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. local anesthesia was provided by benzocaine topical spray. the patient was sedated for the . medications and dosages are listed above (see test information section). unsuccessful esophageal intubation. conclusion the probe could not be passed into the esophagus due to patient's inability to cooperate. tte: the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the right ventricular cavity is dilated with normal free wall contractility. the aortic valve leaflets are mildly thickened. the aortic valve is not well seen. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is a trivial/physiologic pericardial effusion. there is a mobile structure in the right atrium consistent with probable eustachian valve (unchanged from prior). no definte vegetation seen (cannot exclude). compared to the prior study of , there is no definite change. cxr: radiology final report chest port. line placement 2:12 pm right picc, 48cm via median vein. right picc tip is in the right atrium, could be pulled back 6 cm to assess its standard position at the cavoatrial junction. compared to prior study from , there is an ill-defined increased opacity in the left lower lobe, could be atelectasis. there is no pneumothorax or sizeable pleural effusion. single left transvenous pacemaker lead terminates in the right ventricle. there is no evidence of overt chf. kub: indication: 89-year-old man with abdominal tenderness, leukocytosis, question free intraperitoneal air. comparison: abdominal radiograph dated and ct abdomen and pelvis dated findings: there is no evidence of free intraperitoneal air. the supine view is markedly limited by motion artifact. gas is seen throughout non-dilated loops of bowel. degenerative changes are noted in the lower lumbar spine. impression: limited study, no evidence of free intraperitoneal air. us retroper abscess drain perc 2:19 pm procedure: after explaining potential risks and benefits of the procedure to the patient's daughter, , verbal consent was obtained over the telephone with a witness. all questions were answered. thereafter, the patient's identity was confirmed with three identifiers. a qualified nurse was present to administer intravenous fentanyl for pain control, with continuous appropriate monitoring. with the patient in the left lateral decubitus position, an endorectal probe was inserted with lidocaine gel, and the prostate gland was scanned. images were limited by scattered coarse prostatic calcifications with associated dense shadowing. however, there was an area of relative decreased echogenicity in the right gland, corresponding to the ct abnormality. this area was more ill defined and not compatible with a discrete fluid collection, but more suggestive of a phlegmon. this area was sampled with an 18-gauge 20- cm needle. however, given the more solid nature of the area, sampling was difficulty. the needle was then removed, and the sample was sent for gram stain and culture. the patient tolerated the procedure without immediate complication. the procedure was performed by dr. with dr. assisting. impression: patient status post ultrasound-guided aspiration of a hypoechoic phlegmon in the right prostate gland. ------------------- brief hospital course: 89 male with benign prostatic hypertrophyu, atrial fibrillation, hypertension, recent episode of hemorrhagic prostatitis, primary progressive aphasia presenting with sepsis, floridly positive urinalysis. . 1) bacteremia / fungemia: patient was admitted hypotensive and tachycardic. ivfs were provided for resuscitation. he was empirically started on vancomycin and levofloxacin. culture and urine culture grew coag + staph and enterococcus. id was consulted. antibiotics were transitioned to daptomycin / levofloxacin, and then daptomycin alone. once final sensitivities revealed a coag + staph and enterococcus which were both sensitive to vancomycin, the patient was started on vancomycin and daptomycin was discontinued. patient was initially in the intensive care unit and upon starting antibiotics the patient stabilized and was able to be transferred to the floor. work- up for a source for the urinary and infections revealed negative, but limited prostate ultrasound. ct scan was performed to eval for abscess, prostate necrosis / abscess. prostate fluid collection was seen. gu was consulted, which recommended us guided fluid extraction and drainage procedure. this was performed, but no abscess was found; small amount of material was extracted and sent for culture. pacemaker pocket was studied via ultrasound and no sign of infection seen. two ttes were perfomed, which showed no vegetations on limited study. a was requested by id, ans was attempted. given his inability to follow commands during the attempt it was deemed safetest not to perform it. discussions with the hcp / daughter re: resulted in the decision to make no further attempts at . source was felt to be most likely prostatic given coag + staph and bacteroides grew out of the fluid drained from the prostate. the patient was started on metronidazole for the bacteroides. cultures showed positive for albicans on . he was started on caspofungin and transitioned to fluconazole. optho evaluation was negative for retinitis. after the prostate drainage, the patient's cultures cleared and remained clear. a picc line was placed for iv antibiotics. --- plan to treat with 6 week course of iv vancomycin for mrsa bacteremia ( day 1 , through ), 2 weeks of iv fluconazole for albicans in the ( through ), and 4 weeks of po flagyl for bacteroides (through ) patient to complete 2 week course of iv fluconazole on discharge. --- patient to follow-up with id for further management medical building 10:30 am --- patient to have repeat prostatic ultrasound as outpatient for further evaluation of prosatic abscess. --- vancomycin levels: plan for trough level to be checked weekly at rehab. patient needs check tomorrow . trough goals 15-20 given severity of patient infection. . 2) atrial fibrillation with rapid ventricular rate: patient has a history of atrial fibrillation and off his betablocker in the setting of infection developed atrial fibrillation with rapid ventricular response. the patient was continued on his digoxin and metoprolol was uptitrated for effect. patient remains off coumadin since first episode of hemorrhagic prostatitis in , medical center. --- patient will follow-up with his primary care physician regarding restarting coumadin. . 3) nutrition poor po intake since admission. pt was encouraged to eat with multiple foods and family, but patient's pos were minimal. the family decided it would be best to place a feeding tube to improve his health and nutritional status in the short term, fully aware the long term outcomes are unchanged via feeding tubes. patient was started on tube feeds. 4) acute renal failure creatinine elevated at presentation, thought to be pre-renal. declined wwith ivfs. elevated again after dye load from ct scan on . trended back to normal prior to discharge. . 5) bph: continued finasteride. foley catheter remained in place initially. patient initially failed a void trial. plan to attempt a second void trial as an outpatient. if fails, plan to replace foley and follow-up with urology as previously planned. . 6) primary progressive aphasia: family for orientation, communication. . 7) dementia unknown etiology. cont home aricept, modafinil . the patient was full code during this admission. contact was with daughter , md (cell), (home). medications on admission: aricept digoxin brimonidine latanoprost finasteride modafinil trazodone discharge medications: 1. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 2. modafinil 100 mg tablet sig: one (1) tablet po qdaily (). 3. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day). 4. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 5. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 6. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 7. latanoprost 0.005 % drops sig: one (1) drop ophthalmic at bedtime: left eye. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 11. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 14. diltiazem hcl 60 mg tablet sig: one (1) tablet po qid (4 times a day). 15. fluconazole in saline(iso-osm) 200 mg/100 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 6 days: last day = . 16. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 5 weeks. 17. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: 1) sepsis 2) prostate fluid collection 3) atrial fibrillation . secondary 1) primary progressive aphasia 2) htn discharge condition: not tolerating pos. afebrile. following simple commands. speaking in mix of yiddish and english. discharge instructions: you were admitted with a severe infection. this was most likely in your prostate but did spread to the . you were also found to have a fungal infection of the . you are being treated with intravenous antibiotics for both bacterial and fungal infections. . you were started on tube feeding as well given your poor diet. . you will require to have labs drawn 1 x / week to ensure tolerance to the intravenous medications and tube feeding. . you will also have to follow up with urology and infectious disease. you will require re-imaging of your prostate with a ct scan to ensure that the infection has resolved. . please take the following antibiotics: 1. vancomycin 1g iv daily through . (total 6 weeks) 2. flagyl 500mg orally every 8 hours through (total 4 weeks) 3. fluconazole 200mg iv daily through (total 2 weeks) 4. please draw weekly cbc, chem 7, lft's, vancomycin level, esr, and crp and adjust vancomycin level as indicated. results can be sent to dr. at the number below. followup instructions: please follow up with the following appts: . urology provider: , md phone: date/time: 1:50 . infectious diseases provider: . phone: date/time: 10:30 in . . prostate ultrasound you must also have a repeat ultrasound of your prostate. please discuss with your urologist and infectious disease doctor regarding the scheduling of this study. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] percutaneous aspiration of prostate diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified severe sepsis atrial fibrillation infection with microorganisms resistant to penicillins hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other persistent mental disorders due to conditions classified elsewhere intestinal infection due to clostridium difficile aphasia other staphylococcal septicemia abscess of prostate 

Answer: The patient is high likely exposed to