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: vancomycin hcl/d5w attending: chief complaint: sob/doe major surgical or invasive procedure: evacuation of retroperitoneal hematoma excision of periaortic lymph nodes ligation of repair of iatrogenic splenic lac history of present illness: 84 yo man w/ h/o as, copd, pvd who p/w sob/dyspnea. pt is a poor historian, but per pt, describes decreased functional status over sub-acute time course, with decrease mobility/increased sedentary lifestyle over at least past 1 month due to increased sob/doe. pt states has had "more difficulty" with his breathing over this past month, describes sob at rest and with exertion, to point where he became too uncomfortable so came to ed. otherwise denies cp/pressure, orthopnea, pnd, lower extremity edema, f/c, cough. he presented to with these complaints and was found to have t 99.4, hr 100 (sinus), rr 40-50, bp 165/56, o2 84-86% on ra, 100% on nrb. labs notable for trop (trop 0.218). pt given 80mg iv lasix with good uop, combivent neb x 1, asa 325mg x 1, nitropaste 1 inch, and started on hep gtt and was transferred to for further care. on arrival to 6 , patient was noted to be tachypnic to 40's, visibly using accessory respiratory muscles to breath. he was given another 80mg iv lasix x 1 with good uop, but continued resp distress. abg was 7.34/67/70 on nrb and therefore was transferred to ccu. pt intubated. has had been kept on vent--thought to have copd exacerbation, as well as chf & possible pna. question of pe also raised as d-dimer elevated. lenis (-), though no cta given renal dysfunction, nor v/q given underlying lung disease. also, pt has been in and out of afib (no record of it in past); started on dilt & heparin gtt for this. past medical history: 1.aortic stenosis (moderate aortic valve stenosis by echo; aortic valve area 1 cm squared. maximal gradient of 42, with a mean gradient of 26) 2.pvd s/p r fem- bypass 3.carotid artery disease 4.copd 5.htn social history: past history of tobacco use, none in past 25 years, no alcohol, no drug use family history: nc physical exam: vs: t afebrile bp 125/58 hr 83 rr 32 o2 95% on vent gen: elderly man lying in bed, intubated & sedated neck: supple with jvp of to angle of jaw cv: distant heart sound, s1, s2, with 2-3/6 sem chest: vent sound abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. no femoral bruits. pertinent results: on admission: 12:26am blood wbc-14.5* rbc-4.29*# hgb-13.1*# hct-38.3*# mcv-89 mch-30.5 mchc-34.1 rdw-13.5 plt ct-307# 12:26am blood pt-13.6* ptt-26.5 inr(pt)-1.2* 05:10am blood d-dimer-2592* 12:26am blood glucose-185* urean-36* creat-1.5* na-140 k-4.5 cl-97 hco3-34* angap-14 06:00am blood alt-46* ast-68* ld(ldh)-478* ck(cpk)-128 alkphos-76 totbili-0.6 09:37am blood lipase-128* 12:26am blood calcium-8.9 phos-4.8* mg-2.3 11:23pm blood type-art po2-70* pco2-67* ph-7.34* caltco2-38* base xs-6 chest (portable ap) the heart size is mildly enlarged but grossly unchanged. the aorta is tortuous and calcified. the lungs are hyperinflated. this most likely represent unlike emphysema. perihilar opacities involving the lower lobes are demonstrated, right slightly worse than left and might represent pulmonary edema with asymmetric appearance due to underlying emphysema. small right pleural effusion cannot be excluded. the slight asymmetry between the lungs might represent underlying right lower lobe infectious process which can be better characterized after resolving of pulmonary edema. on day# 7: when pt. developed acute renal failure/: 05:02am blood glucose-266* urean-105* creat-3.0* na-138 k-7.1* cl-102 hco3-19* angap-24* 11:43pm blood wbc-18.2* rbc-2.38* hgb-7.4* hct-20.5* mcv-86 mch-31.0 mchc-36.0* rdw-14.8 plt ct-86* 11:08am blood wbc-34.1* rbc-2.17* hgb-6.7* hct-19.6* mcv-90 mch-30.7 mchc-34.1 rdw-14.0 plt ct-241 02:08pm blood alt-7470* ast-9415* ld(ldh)-* alkphos-46 amylase-700* totbili-1.0 12:30pm blood type-art po2-389* pco2-65* ph-7.24* caltco2-29 base xs--1 intubat-intubated vent-controlled 05:43am blood lactate-9.3* 08:06pm blood freeca-0.95* abdomen (supine & erect) port impression: no evidence of free air or pneumatosis, however, plain radiograph is insensitive in the evaluation of bowel ischemia and if there remains clinical concern, ct is recommended to further evaluate. further pertinent evaluation: ct abdomen w/o contrast 11:37 am 1. findings are consistent with hemorrhagic ascites; no fresh hemorrhage or definitive source is evident on these images. the hemorrhagic ascites does extend to the aorta and paraaortic region, which were evacuated on the patient's recent surgery. a splenic laceration is felt to be less likely. a mass within the abdomen or underlying lesion cannot be distinguished on this examination; a followup ct examination is recommended. if the patient is stable, mri may also be helpful. 2. thickening of small bowel loops may be incident to ischemia, edema, or hemorrhage. 3. bilateral pleural effusions and pulmonary findings as described above. ct abdomen w/contrast 1:29 pm 1. retroperitoneal hematoma extending along the left posterior pararenal space inferiorly as far as the left groin and has decreased in size when compared with the previous ct from two weeks prior. 2. ascites, which has increased in size when compared to the previous ct. 3. bilateral pleural effusions with associated atelectasis, pleural calcification. 4. splenic cysts. 5. sigmoid diverticulosis without evidence of diverticulitis. 6. anasarca. 2:52 pm bronchoalveolar lavage gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs. respiratory culture (final ): oropharyngeal flora absent. klebsiella oxytoca. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella oxytoca | ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- 16 i cefuroxime------------ =>64 r ciprofloxacin--------- 1 s gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- =>128 r brief hospital course: this patient had a very protracted and complicated hospital course. below is a review of hospital course by system. in general, mr. arrived at with increasing sob/doe, tx for acute exacerbation of chf, and t/f to for further care. in icu, con't resp failure, intubated and tx for copd, chf, pna, afib, glycemic control, htn and renal issues. on day 7, mr. developed arf, a lactic acidosis, increased ventilatory needs and worsening hemodynamic status. an abdominal us was neg and kub gave no evidence. he developed increased abdominal girth, and it was decided to take him for ex-lap for sepsis, increased abdominal girth, arf and lactic acidosis for possible gut ischemia/infarct. upon exploration, a retroperitoneal hematoma was discovered and evacuated, a large adhesed periaortic ln was excised and sent to path (found to be paraganglioma) along with the the ligated and a iatrogenic slenic lac controlled. post operatively, the patient remained in icu setting on the vent. renal function slowly resumed. he developed a klebsiella pneumonia which was treated w/ appropriate abx. he had difficulty weening from vent and was thus trached. nutrition was maintained w/ tf's and a peg placed. lastly access via picc was established. post op his neuro status improved and on d/c is a/o and following commands. his hospital course included ed eval and tx at , ccu, micu and ultimately the tsicu b/f d/c. neuro: throughout hospital stay, pt was sedated appropriately for ventilation and analgesia was maintained as appropriate. throughout his stay, neuro checks proved a waxing and type picture with propofol for sedation, and haldol for agitation as per the micu team. overall, his neuro status improved throughout with improvement of other medical issues. cv: pt had new issue of atrial fibrillation. during micu stay needed pressors of da and levophed to maintain bp on at same time became olguric and septic as described. this recovered post-operatively. he experienced a bump in tni, likely due to demand ischemia. he was properly anticoagulated and rate controlled with dilt. around day 13-14, per chart review, he reverted back to nsr and was continued on b-, , bp meds, asa and statin. he has runs of htn which responded well to bp meds including metop, hydralazine and clonidine. postoperatively he remained stable on his rx and had no further issues. pulm: with the initiating cc of sob/doe pt was treated for chf exacerbation with lasix, nitro, nebs and t/f to . here he was intubated for increased resp distress, given iv steroids and nebs for copd, diuresed for chf, and started emperically on vanco/zosyn for pna after pan cx. he continued to remain on the vent throughout his stay, with varying vent support. a klebsiella pna was discovered on bal, and tx w/ 2 week course of meropenam. a trach was performed on due to continued vent needs. on d/c he remains on cpap + ps(12) with tv 550, rate 30, fio2 40%, and peep 5. the last week of admission, the patient developed a pleural effusion and 2.5l of fluid that did not grow organisms. this improved resp status and did not recur. gi/fen: pt's fluid and electrolytes were replaced/maintained throughout his hospital stay. early diuresis for chf was aggressive and preceeded arf. pt was given a peg on and continues to receive tf at goal of 65. the question of possible bowel ischemia proved untrue with the ex-lap, but findings as described above. prior to the or he received a abd us, only showing cholelithiasis w/o cholecystitis and nl portal flow. heme/id: pt was treated emperically early in the course for pna with vancomycin and zosyn. he was afebrile but had increased wbc count of 47.9, 29% pmns. throughout his stay, abx included flagyl, linezolid and fluconazole. yeast grew in the urine, blood cx were neg, the pt remained mrsa and c.diff neg, but did grow klebsiella found on sputum and bal, treated with 2 weeks of meropenam ending on the day of d/c. pt had bouts w/ fever, though has been stable and afebrile on d/c. gu/renal: as described, on day 7, pt experienced arf and was evaluated by renal. arf was from atn secondary to decreased renal perfusion from hypotension and retroperitoneal bleed. over the hospital stay this improved and remains at a baseline of bun/cr of 50/1. endocrine: pt has been treated w ssi throughout hospital stay. early in hospital course, glucose rose to 180-200's likely secondary to steroids. has been well controlled and is 80-120 x 7-10 days. prophylaxis: the pt. was maintained on dvt/gi prophylaxis w/ h2 , sqh and scd's throughout. le us was neg for dvt. pt maintained full code. medications on admission: lasix 40 mg p.o. daily advair 50/250 doxazosin 4 mg p.o. daily folic acid 1 mg p.o. daily 81 mg of aspirin p.o. daily lipitor 10mg daily albuterol prn discharge medications: 1. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 2. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 6. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 7. doxazosin 4 mg tablet sig: one (1) tablet po hs (at bedtime). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 9. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day). 10. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. metolazone 5 mg tablet sig: one (1) tablet po daily (daily). 13. ipratropium bromide 17 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours). 14. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 15. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). discharge disposition: extended care facility: northeast - discharge diagnosis: congestive heart failure chronic obstructive pulmunary disease acute renal failure extra-adrenal paraganglioma retroperitoneal hematoma discharge condition: good discharge instructions: during your hospital stay, you were treated for acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. during your stay you suffered acute renal failure and had to go to surgery for a retroperitoneal hematoma. in the surgery, a large lymph node surrounding your aorta was removed, an artery called the inferior mesenteric artery was tied off in the process, and a small laceration to your spleen occurred and was repaired without complication. the lymph node was described by pathology as a paraganglioma, a type of extra-adrenal tumor. the endocrinologists were unable to definitively diagnose this mass in the setting of your acute illness, and it is suggested that you follow up with this as an outpatient after you rehabilitiation. in your recovery, you have had a pneumonia that has been treated with antibiotics. in addition, it has been difficult to ween your breathing off of the ventilator. consequently, you will be going to a vent rehabilitation center to help you recover and breath without the ventilator. following completion of vent rehab, you will follow up with both the trauma surgery service and with the vascular surgery service as listed below. please continue all medications that you are discharged on as listed below, and continue any home medications that you were on prior to hospital admission once you return home. if you experience any worrisome symptoms including increased shortness of breath or trouble breathing, chest pain, fever, chills, severe abdominal or back pain, or anything else that worries you please seek medical attention. followup instructions: 1. trauma surgery: please call and arrange an appointment for 1-2 weeks. 2. vascular surgery: please call and arrange an appointment with dr. in 2 weeks. 3. endocrinology: please call and arrange an appointment in weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube thoracentesis percutaneous [endoscopic] gastrostomy [peg] incision of abdominal wall arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus other surgical occlusion of vessels, abdominal arteries other sympathectomy and ganglionectomy excision of lesion of adrenal gland low forceps operation with episiotomy excision of lesion of tendon sheath excision of lesion or tissue of spleen diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation hematoma complicating a procedure aortic valve disorders accidental puncture or laceration during a procedure, not elsewhere classified diaphragmatic hernia without mention of obstruction or gangrene occlusion and stenosis of carotid artery without mention of cerebral infarction acute respiratory failure septic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation calculus of gallbladder without mention of cholecystitis, without mention of obstruction accidents occurring in residential institution acute vascular insufficiency of intestine atherosclerosis of native arteries of the extremities, unspecified surgical or other procedure not carried out because of contraindication diastolic heart failure, unspecified chronic vascular insufficiency of intestine diverticulosis of colon (without mention of hemorrhage) diabetes with unspecified complication, type ii or unspecified type, uncontrolled neoplasm of uncertain behavior of paraganglia accidental cut, puncture, perforation or hemorrhage during surgical operation 

Answer: The patient is high likely exposed to