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: calcium / penicillins / cephalosporins attending: chief complaint: dyspnea major surgical or invasive procedure: endotracheal tube placement () g-tube exchange by interventional radiology history of present illness: 78 yo male with history of htn, dmii, ckd, cva (, ) with residual deficits, presents from nursing home with respiratory distress. patient had very labored breathing, inhaling and expiring forceably, and gurgling. he was intubated in the emergency department. cxr showed elevated right hemidiaphragm with possible consolidation in the right middle lobe. . patient had received vecuronium during intubation process but for a long time following that, was nonresponsive, not responding to pain. he had an episode of sbp transiently dropping to 70s shortly following intubation, but otherwise has had bp in the 160s. he received vancomycin and zosyn and 2 l of ivf in the ed. patient sent for head ct, cta chest, ct abd/pelvis prior to transfer to the micu. vital signs prior to transfer to the micu were: 97.8, 178/109, 114, 16, 100% on ventilator. . on arrival to the micu, patient is opening his eyes, moving all his extremities weakly. . review of systems: unable to be obtained past medical history: multiple strokes: 1)old remote left frontal stroke in that per nh notes purportedly left him with r-hemi and dysarthria (per son, able to think of words he wants to say and makes grammatically intact sentences, but is often unintelligible) 2)(mri showing acute infarcts in the r medial temporal lobe, r basal ganglia, and high signal in the petrous portion of the r-ica thought to be 2/2stenosis/occlusion started on asa/plavix, thought to be too sig a fall risk for anticoagulation dm2 (last hgba1c was 6.6) cri (baseline cre ~1.6) htn gout gerd social history: prior to recent stroke, lived at home with wife now at rehab. remote history of alcohol and smoking cigarettes (quit 1 year ago.) family history: nc physical exam: general: chronically ill appearing male, intubated, sedated heent: pupils reactive, no jvd, neck supple cv: s1s2, rrr, no m/r/g chest: crackles diffusely, no wheezing abd: peg tube in place, hernia at peg insertion site, soft, nd, nt, +bs ext: no e/c/c, 2+ peripheral pulses neuro: unable to follow commands, but there is a language barrier . pertinent results: admission labs 01:00am blood wbc-20.5*# rbc-3.89* hgb-12.7*# hct-36.5* mcv-94 mch-32.6* mchc-34.7 rdw-12.1 plt ct-430 01:00am blood neuts-92* bands-1 lymphs-2* monos-4 eos-0 baso-0 atyps-1* metas-0 myelos-0 01:00am blood pt-12.2 ptt-27.1 inr(pt)-1.0 01:00am blood glucose-273* urean-31* creat-1.3* na-138 k-4.3 cl-104 hco3-21* angap-17 01:00am blood alt-60* ast-51* alkphos-106 totbili-0.5 01:00am blood ctropnt-0.06* 06:32am blood calcium-8.0* phos-2.8 mg-2.0 01:00am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 12:25am blood glucose-295* lactate-1.2 na-135 k-4.6 cl-105 calhco3-22 . pertinent labs 06:32am blood wbc-15.0* rbc-3.78* hgb-13.5* hct-35.9* mcv-95 mch-35.7* mchc-37.6* rdw-12.3 plt ct-401 04:38am blood neuts-86* bands-8* lymphs-3* monos-1* eos-0 baso-1 atyps-1* metas-0 myelos-0 04:38am blood glucose-219* urean-36* creat-1.8* na-141 k-4.3 cl-106 hco3-25 angap-14 03:33am blood glucose-167* urean-20 creat-0.9 na-142 k-3.6 cl-108 hco3-26 angap-12 04:38am blood alt-35 ast-41* ld(ldh)-395* alkphos-81 totbili-0.3 01:00am blood ctropnt-0.06* 06:32am blood ck-mb-7 ctropnt-0.33* 05:00pm blood ck-mb-3 ctropnt-0.26* 05:41am blood ck-mb-2 ctropnt-0.08* 05:41am blood vanco-17.5 04:38pm blood lactate-1.1 . microbiology blood culture () x 2 - no growth urine culture () - staphylococcus, coagulase negative. 10,000-100,000 organisms/ml.. . gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): pleomorphic gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. 1+ (<1 per 1000x field): gram positive rod(s). respiratory culture (final ): moderate growth commensal respiratory flora. haemophilus influenzae, beta-lactamase negative. heavy growth. beta-lactamse negative: presumptively sensitive to ampicillin. confirmation should be requested in cases of treatment failure in life-threatening infections.. gram negative rod #1. sparse growth. gram negative rod #2. rare growth. . c. diff (, ) -ve x 2 . pertinent reports kub () 1. no evidence of bowel obstruction or ileus 2. stable appearance of previously visualized left kidney inferior pole calculus. . picc () in comparison with the study of , there has been placement of a left subclavian picc line that extends to the lower svc or possibly cavoatrial junction. the opacification at the right base is slightly more prominent. in the appropriate clinical setting, the possibility of developing consolidation should be considered. some indistinctness of pulmonary vessels raises the possibility of some elevation in pulmonary venous pressure. . g-tube placement () successful exchange of an old g tube for a new 20 french mic g-tube, ready for use. . ct head () 1. old left mca infarct and old right aca-mca watershed infarct. 2. no evidence of an acute intracranial abnormality. . cxr () 1. et tube 5 cm above carina; endogastric tube side port below ge junction. 2. elevated right hemidiaphragm with underlying atelectasis and/or pleural effusion. . cxr (): interval improvement in right middle and right lower lobe atelectasis has been demonstrated with focal consolidations currently better appreciated in the right lower lobe. there is new consolidation in the right upper lobe that given its rapid development is most likely representing a focus of aspiration. neoplastic origin would be significantly less likely given its rapid development. the left lung is clear. . echo () the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with basal and mid-inferolateral akinesis. the remaining segments contract normally (lvef = 45%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. impression: mild regional left ventricular systolic dysfunction, c/w cad. mild mitral regurgitation. compared with the prior study (images reviewed) of , regional wall motion abnormalities are new. mitral regurgitation is slightly more prominent. . ct head () 1. no acute intracranial process. 2. remote left mca infarct. 3. right cerebral watershed infarct, secondary to ica occlusion. 4. chronic involutional changes. . cta chest/abd () 1. collapse of the apical segment of the right upper lobe, the right middle lobe, and the basilar segments of the right lower lobe. endobronchial soft tissue density is appreciated, which does not appear to be enhancing and may represent mucus plugging. correlate with bronchoscopy as obstructive mass is not excluded. 2. 1-cm nonobstructive stone in the left kidney. 3. no acute intra-abdominal process. 4. there is a 9 mm nodule within the right lobe of the thyroid, requires no followup. . ekg: sinus tachy at 109 bpm, nl axis, nl intervals, inferior q waves, nonspecific lateral st changes . tte (): the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with basal and mid-inferolateral akinesis. the remaining segments contract normally (lvef = 45%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. impression: mild regional left ventricular systolic dysfunction, c/w cad. mild mitral regurgitation. . ct head without contrast (): 1. old left mca infarct and old right aca-mca watershed infarct. 2. no evidence of an acute intracranial abnormality. brief hospital course: 78 year old male with hypertension, type 2 diabetes mellitus, chronic kidney disease, cerebrovascular disease with residual deficits admitted from nursing home with respirator distress. . #. respiratory failure - given persistent fever and leukocytosis, likely bacterial pneumonia with hemophilus influenza noted on sputum culture. treated with four days of vancomycin/cefepime/levaquin which was switched to unasyn on day 5, 6 and 7 and then switched to augmentin for three more days. blood and urine cultures were negative (coag negative staph in urine culture is likely contaminant). legionella was negative. urine toxicology was negative. ct abdomen/pelvis/head with no pathology. extubated on and weaned to nasal canula over the next day. . after transfer to the medicine floor, the patient became again febrile with repeat leukocytosis. concern was that augmentin was not being properly absorbed, and given that the pt was unable to get medications through the g-tube given the need for ir guided replacement, we restarted the pt on unasyn. unasyn was continued for a period of 11 days total. of note, also on ddx of fever was c-diff, especially with recent antibiotic usage. a c-diff assay was sent which was positive (see below). over time, the pt was able to be weaned to ra. after ~ 2 weeks, the pt again began to spike fevers with a leukocytosis. a repeat cxr showed possible infiltrate in lllf. thought was that aspiration pneumonitis vs. pneumonia could have been contributing. iv flagyl (which had been started for c-diff) was kept on for possible aspiration pna. iv flagyl was stopped on as pt was then afebrile without leukocytosis. pt did not have any new o2 requirement or increase secretions. . # c-diff: pt noted to spike a fever upon transfer to the medicine floor with a new leukocytosis of 23. notably had been on unasyn, so c-diff sent which was positive. iv flagyl was started at first, however once pt spiked a fever again after 1 week (with mild leukocytosis), and distended abdomen, po vanc was started and kub showed nondistended loops of bowel. he was to continue this medication for 2 weeks since last abx dose other than po vanc (stating ), ending . #. sinus tachycardia: pt noted to be tachycardic upon arrival to the medical floor to the 110s. as he was febrile, this was treated with apap and his tachycardia improved to the 100s. as the pt was wet on exam, we held off on ivf boluses, and the thought was that the tachycardia was more likely responsive to the fever the pt was having, or possibly anemia (see below). of note, the pt's bps were stable throughout the episodes of tachycardia. an ekg was done which confirmed sinus tach. the pt denied pain throughout these episodes. once the fever was adequately treated, the tachycardia improved. . # anemia/hct drop: in the setting of aggressive ivf boluses in the micu, the hct drop seen during mr. hospital stay was thought most likely dilution. that said, we sent labs to test for the pt's iron indices which were c/w acd. the patient was also guaiac'ed which was positive. thought was that anemia may also be contributing to sinus tach, and in the setting of demand ischemia, may also benefit from transfusion in that regard. hct continued to drop to 22, so transfusion of 1 unit prbc was done. a gi c/s was called out of concern that there was an upper gi bleed (melena noted). endoscopy was done which showed that the site of g-tube switch had some stigmata of recent bleed, but no active bleeding. aside from the pantoprazole iv 40 bid that was started (and then transitioned lansoprazole po), we also started 1 gram sucralfate as per gi c/s recommendations. he will continue this for 7 days post-discharge. he will continue lasoprazole 30 indefinitely. after this episode, hct was trended daily and stayed stable ~ 30. . #. elevated troponin: likely demand ischemia in the setting of hypotension upon presentation. no ekg changes noted. cardiac enzymes peaked at 0.33. continued on aspirin, plavix, statin and metoprolol. transthoracic echocardiogram showed lvef of 45% and no regional wall motion abnormality. . #. cerebrovascular disease - status post two strokes in and . he has residual right hemiplegia and dysarthria. not on warfarin given history of gi bleed and fall risk. only on plavix at nursing home which was held on day 1 but restarted on day 2. plavix was again held in the setting of gi bleed, however restarted after stable hct. ct head did not show any acute intracranial process. at baseline, has 3+ motor rue, 1+ motor lue, can wiggle toes on r foot, not on left. . #. hypertension: held on admission due to hypotenion in the setting of his pneumonia. restarted hydrochlorothiazide-triamterene on while continuing metoprolol 50 mg po tid. . # eosinophilia: pt noted to have eosinophilia after 2 weeks. thought was that unasyn likely cause of eosinophilia (abs eosinophil count remained <1000). . #. diabetes mellitus: last hba1c on was 6.6%. sugars well controlled on insulin sliding scale. . # gerd: continued on pantoprazole iv qdaily while intubated and changed to po once extubated. unfortunately, pt had episode of ugi bleed. as such, pantoprazole was started iv bid. this was changed to po at the time of discharge. . # depression: continued on citalopram. . # nutrition - his peg was leaking with tube feeds. interventional radiology was consulted on to replace his peg tube so his tube feeds can be restarted. this was completed on in the ir suite. a nutrition c/s was called for assistance with tf recommendations. . # goals of care: multiple discussion with his son and wife, hcp were held over the course of his icu stay. he will be dnr but ok to intubate for respiratory distress. a family meeting was then held on , and they again decided for dnr ok to intubate, but further conversations will be held as they also understand the poor prognosis. hospice services were offered and the family said they would speak with us once they had made a firm decision. medications on admission: citalopram 20 mg daily (liquid) mvi 1 tab daily (elixir) triamterene-hctz 37.5/25 mg daily simvastatin 40 mg daily tamsulosin 0.4 mg daily omeprazole 40 mg ferrous sulfate 300 mg (elixir) trazodone 25 mg daily prn agitation regular insulin sliding scale glyburide 1.5 mg vitamin c 500 mg acetaminophen 1000 mg q8h metoprolol 50 mg tid pureed, nectar thick liquids discharge disposition: extended care facility: healthcare center - discharge diagnosis: pneumonia and respiratory failure discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances replacement of gastrostomy tube diagnoses: anemia, unspecified esophageal reflux acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure blood in stool intestinal infection due to clostridium difficile late effects of cerebrovascular disease, hemiplegia affecting unspecified side tachycardia, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage pneumonia due to hemophilus influenzae [h. influenzae] mechanical complication of gastrostomy foreign body in larynx other acute and subacute forms of ischemic heart disease, other inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation eosinophilia late effects of cerebrovascular disease, dysarthria 

Answer: The patient is high likely exposed to