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: zosyn attending: chief complaint: dyspnea major surgical or invasive procedure: picc placement skin biopsy history of present illness: 72 year-old male with pmh of copd on home oxygen, osa, htn, recent dx of transitional cell carcinoma of his left kidney, and depression who was admitted on under section 12 status for suicidal ideation. he has undergone 2 ect treatments since admission with improvement in his symptoms. he is no longer currently suicidal. . today after his ect treatment he developed abdominal pain across the front of his abdomen, nonradiating, which was and felt like pressure. no n/v, no diarrhea. no fevers or chills. he has also noticed increased dyspnea since the ect treatment. he has doe at baseline, however usually is not dyspneic at rest. he has also dropped his sats from the mid 90's to the low 90's on 3 l nc. admits to associated nonradiating substernal chest pressure. also had an epsidoe of incontinence today. he states he's had incontinece before when he can't make it to the bathroom in time. . he was evaluated on 4 and was continuing to complain of chest pressure. an ekg was unchaged from his admission ekg except that he was slightly tachycardic. he was given asa 325 mg po once and 1 sl nitro with improvement in his chest pressure. labs were drawn, a cxr was preformed, and he was transferred to medicine on . . on he was found to have a temperature of 102. his wbc came back at 20 and his cxr showed a bilateral lt> rt lower lobe pna. he continues to feel poorly and feels dyspneic. he denies current chest pressure. . review of systems: (+) per hpi (-) denies headache, sinus tenderness, rhinorrhea or congestion. no dysuria. denied arthralgias or myalgias. past medical history: - copd, on 2.5l home 02, pfts with fev1/fvc 69%, no significant response to bronchodilators - osa, has not tolerated cpap in past secondary to discomfort - htn - aaa, 4 cm descending aorto on ct - hld - transitional cell carcinoma of left kidney, dx - peripheral neuropathy thought secondary to alcoholism - arthritis, cervical spine - gastro esophageal reflux - gait imbalance - constipation - benign prostatic hypertrophy - vitamin d deficiency - chronic neck and back pain, l-spine mri with degerative disease, l3/l4 disc herniation with involvement of spinal nerves, mild to moderate neural foraminal narrowing multilevel, mild central canal stenosis l3/l4 and l4/l5 - mandibular osteomyelitis in past - anemia social history: hcp . he worked as an electrician until retirement 12 years ago. h/o alcoholism, last drank 15 years ago. denies h/o dts and seizures. has been through detox multiple times. smokes 1ppd for 60 years, has smoked as much as ppd. family history: alcoholism in brother. depression in mother. physical exam: vitals: t: 102.7 bp 200/110 p 144 sat 91% on 3l rr 24 general: elderly male lying in bed, ill-appearing and sweaty. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: increased rr rate, crackles present bilaterally at the bases. gets noticeably dyspneic with any movement. cv: tachycardic and regular. no mrg. abdomen: +bs, soft ntnd ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: alert, confused. knows he's in a hospital, but can't tell me the year. pertinent results: admission labs: 10:12pm blood wbc-20.1*# rbc-4.74 hgb-13.5* hct-41.2 mcv-87 mch-28.4 mchc-32.7 rdw-14.0 plt ct-339 10:12pm blood neuts-86.1* lymphs-8.6* monos-3.9 eos-1.0 baso-0.4 08:49pm blood pt-13.5* ptt-25.3 inr(pt)-1.2* 10:12pm blood glucose-119* urean-16 creat-1.1 na-138 k-4.4 cl-98 hco3-27 angap-17 10:12pm blood alt-24 ast-40 ck(cpk)-606* alkphos-91 totbili-0.5 08:15am blood calcium-9.2 phos-4.3 mg-2.0 08:49pm blood caltibc-276 ferritn-129 trf-212 10:56am blood %hba1c-6.3* eag-134* 08:49pm blood tsh-2.1 . discharge labs: 07:15am blood wbc-10.0 rbc-3.88* hgb-10.7* hct-33.9* mcv-87 mch-27.6 mchc-31.6 rdw-15.1 plt ct-510* 07:15am blood neuts-75.0* lymphs-17.7* monos-4.4 eos-2.3 baso-0.5 07:10am blood pt-12.6 ptt-24.9 inr(pt)-1.1 07:15am blood glucose-89 urean-6 creat-1.1 na-141 k-4.5 cl-103 hco3-29 angap-14 07:15am blood alt-33 ast-14 ld(ldh)-182 alkphos-58 totbili-0.4 07:15am blood calcium-9.0 phos-3.4 mg-2.3 . cardiac enzymes: 04:32am blood ck(cpk)-211 ck-mb-3 ctropnt-<0.01 08:49pm blood ck(cpk)-294 ck-mb-3 ctropnt-<0.01 probnp-* 07:25am blood ck(cpk)-255 ck-mb-2 ctropnt-0.01 probnp-1018* 05:33pm blood ck(cpk)-413* ck-mb-4 ctropnt-<0.01 08:15am blood ck(cpk)-426* ck-mb-4 ctropnt-0.02* 10:12pm blood ck(cpk)-606* ck-mb-5 ctropnt-<0.01 . urinalysis: 09:50pm urine color-yellow appear-clear sp -1.014 09:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg . microbiology: 11:15 pm blood culture staphylococcus, coagulase negative. isolated from one set only. aerobic bottle gram stain: gram positive cocci in pairs and clusters. . 11:16 am sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. sparse growth. yeast. sparse growth. _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . 2:15 pm sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): yeast(s). respiratory culture: commensal respiratory flora absent. yeast. sparse growth. of two colonial morphologies. staph aureus coag +. rare growth. legionella culture: no legionella isolated. fungal culture: yeast. of two colonial morphologies. . 2:51 pm blood culture ( myco/f lytic bottle) source: venipuncture. blood/fungal culture (preliminary): no fungus isolated. blood/afb culture (preliminary): no mycobacteria isolated. . -urine legionella antigen : negative -c. diff toxin: negative x 5 -blood cultures , , , , : no growth -urine cultures , , , : no growth 09:25am blood aspergillus galactomannan antigen-negative 09:25am blood b-glucan-negative . imaging: . cxr (portable ap) : increased vague densities at the bases, which could be atelectasis or pneumonia. study degraded by subtle patient motion. . cxr (pa and lateral) : on the current study there is evidence of a patchy density at the left lower lobe posteriorly, consistent with pneumonia in the appropriate clinical setting. there is also some obscuration of the right heart border and increased density overlying the cardiac silhouette in the lateral view consistent with right middle lobe consolidation again likely pneumonia in the appropriate clinical setting. upper lungs remain clear. there are no features of chf and the heart size is normal. impression: bilateral pneumonias as described above. . echocardiogram (tte) : the left atrium is normal in size. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. mild pulmonary artery systolic hypertension. . bilateral lower extremity venous ultrasound : there is normal compressibility, augmentation and spontaneous phasic flow with no evidence of intraluminal filling defect. there is an anechoic structure in the left popliteal fossa measuring 1.7 x 1.2 x 1.2 cm, most consistent with cyst. impression: no evidence of dvt. left cyst. . abdomen (supine and erect) : nonspecific bowel gas pattern. unclear etiology of the gas-filled loops of bowel in the upper abdomen. this will be better assessed with ct if clinically indicated. . ct head w/o contrast : 1. no acute intracranial process. if there is clinical concern for subtle metastasis, or acute ischemia, mri is more sensitive, if not contraindicated. 2. markedly prominent ventricles and sulci, stable, representing global atrophy. 3. stable chronic small vessel ischemic changes. 4. left maxillary mucosal thickening on limited views of the paranasal sinuses. . ct abdomen/pelvis : 1. no evidence of distention of colon. 2. prominent loops od jejunum, could be due to enteritis of infectiuos, ischemic, or inflammatory etiology. short term kub to follow- if clinical concern. 3. mass at the lower pole of the left renal pelvis. 4. questionable lytic lesion in the right femoral neck, incompletely characterized. further evaluation with a dedicated radiograph is recommended. . ct right lower extremity : 1. no femoral osseous lesion detected. in particular no lesion is identified in the right femoral neck. the lucency quesitoned in this area on the abdominal ct likely represents partial imaging of a prominent area of more diffuse osteopenia ( triangle), but is not thought to represent a focal lytic lesion. 2. incompletely imaged left intrarenal soft tissue mass with delayed clearance of contrast from an inferior left renal calix, concerning for a transitional cell carcinoma, similar in appearance to the study performed on . 3. descending colon and sigmoid colon diverticulosis. 4. scrotal skin thickening and trace subcutaneous fat stranding in the proximal left thigh, nonspecific in appearance. this could represent edema or inflammatory changes. however, no associated subcutaneous emphysema to indicate a necrotizing infection is identified. . scrotal ultrasound : 1. no intratesticular mass. 2. no signs of fournier's gangrene or epididymitis. 3. small bilateral hydrocele. 4. small indeterminate nodule adjacent to the left epididymis may represent a granuloma, but cannot be further characterized by ultrasound. . femur (ap and lateral) : this exam is wnl with no bone destruction, fracture, or other osseous abnormality. no overt abnormality in the partially visualized hip and knee and no knee effusion. . cxr (portable ap) : interval placement of a picc line is seen with right arm entry and tip in the expected location of the superior vena cava. there is left basilar opacity most compatible with atelectasis given the linear appearance. there is lucent appearance of the upper lungs suggestive of underlying emphysema. cardiomediastinal silhouette is stable. there is no pneumothorax. bones appear intact. adequate position of right arm picc line with tip in the expected location of the svc. . bone scan (wet read): negative . pathology: . skin biopsy right thigh : marked superficial dermal edema and perivascular and interstitial mixed cell infiltrate with lymphocytes, neutrophils, and rare eosinophils. . note: the marked dermal edema is suggestive of erysipelas. the number of neutrophils is less than usually observed, however, inflammation may be decreased in resolving lesions of erysipelas. the decreased inflammation may, in part, be due to partial treatment from prior antibiotics. the histologic differential diagnosis includes a bullous hypersensitivity reaction including a drug eruption. pas and gram stains are negative for fungi and bacteria respectively. clinical-pathologic correlation is recommended. brief hospital course: 72 year-old male copd on home oxygen, osa, htn, recent diagnosis of transitional cell carcinoma of his left kidney, and depression admitted initially to psychiatry for suicidal ideation s/p 2 ect treatments with pneumonia. he was transferred to the micu for bibasilar pneumonia and back to the floor . he was readmitted to the micu on for somnolence and increased oxygen requirement. . # health-care associated pneumonia: on , the patient developed fever to 102 and tachycardia to 140s. he treated for health-care associated pneumonia with vancomycin, cefepime, and ciprofloxacin, later changed to vancomycin, zosyn with improvement in his respiratory status. sputum grew methicillin-sensitive staph aureus. . # copd: the patient's shortness of breath was thought to be multifactorial, related not only to pneumonia but also to copd and acute on chronic diastolic heart failure. he was treated with methylprednisolone, followed by prednisone taper. the prednisone taper was completed prior to discharge. the patient was discharged on albuterol and spiriva. . # acute on chronic diastolic congestive heart failure: the patient's shortness of breath was thought to be multifactorial, related not only to pneumonia but also to copd and acute on chronic diastolic heart failure. bnp was . the patient was diuresed with iv lasix, putting out as much as 6 liters of urine to a single dose of lasix 20 mg iv. an echocardiogram was performed and showed mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). the patient was euvolemic at the time of discharge. . # paroxysmal atrial fibrillation: the patient had two episodes of paroxysmal atrial fibrillation. the first episode occurred in the intensive care unit in the setting of pneumonia and responded to iv diltiazem. the second occurred on the medical floor in the setting of profuse diarrhea and dehydration and responded to iv fluids alone. with chads-2 score of 1 (htn), patient was started on full dose asa for anticoagulation. tsh was normal and echo showed normal global systolic function (lvef>55%). mi was ruled out with serial cardiac enzymes. . # benign prostatic hypertrophy: continued terazosin. the patient's foley catheter was removed on the day of discharge, and the patient voided a small amount of urine. he was bladder scanned for 350 cc prior to discharge and refused a foley . he should have a voiding trial on arrival to rehab and consideration should be given to foley placement if he is retaining urine. . # diarrhea: the patient developed profuse diarrhea while on the medical floor. c. diff was negative x 5. his diarrhea was presumed to be due to antibiotics. he was treated with immodium. the patient's fluid status will need to be monitored closely at rehab due to ongoing. . # erysipelas: on the medical floor, the patient developed a worsening groin rash that was initially thought to be fungal but worsened on nystatin. dermatology was consulted and thought the rash to be likely cellulitis/erysiphelis. skin biopsy was consistent with this. the patient was initially treated with iv fluconazole and nafcillin, subsequently narrowed to just nafcillin. ct and ultrasound were done to rule out fournier's gangrene. the patient's rash was improving and sutures were removed prior to disharge. # drug rash: patient developed a maculopapular rash during his icu stay. dermatology thought likely drug reaction secondary to zosyn that he had received a week prior. the rash improved despite ongoing treatment with nafcillin. the patient was monitored for signs of dress syndrome. he should have cbc with diff and lfts checked weekly while on nafcillin. . # question of lytic lesion in right femur: a possible lytic bone lesion was noted in the patient's right femoral neck during abdomen/pelvis ct. this finding was not confirmed by plain films or by ct of the patient's right lower extremity. after discussion with radiology, the decision was made to proceed with bone scan given the patient's known transitional cell carcinoma and the high-risk location of the lesion. the preliminary read of this scan was negative, but the final read will need to be followed after discharge. . # depression: the patient was initially admitted to the psychiatry service for depression under section 12. during his psychiatric admission, the patient received two electroconvulsive therapy treatments, which were complicated by aspiration and pneumonia. in the icu and on the medical floor, the patient was followed by the psychiatry consult service. he continued his regimen of aripiprazole 5 mg po hs, fluoxetine 80 mg po daily. at rehab, the patient will need ongoing psychiatric care. the psychiatry service should be consulted on admission to rehab. dr. at recommended consulting dr. at rehab. . # transitional cell carcinoma: the patient was recently diagnosed with transitional cell carcinoma. he has urology follow-up for this on per patient, he will be undergoing nephrectomy after depression treatment. . # hypertension: increased lisinopril to 10 mg daily and decreased diltiazem extended-release to 240 mg daily. . # hyperlipidemia: continued simvastatin 10 mg po daily . # chronic neck and back pain: stopped gabapentin and oxycontin. discharged patient on only oxycodone 5 mg q6h prn pain. . # gerd: continued omeprazole 20 mg po daily . # obstructive sleep apnea: continued autoset cpap at night. . # tobacco abuse: initially treated with nicotine patch and gum but discontinued this prior to discharge. . # communication: healthcare proxy is . medications on admission: current inpatient mediations: aripiprazole 5 mg po/ng hs nicotine patch 14 mg td daily ipratropium bromide neb 1 neb ih q6h:prn wheeze/sob oxycodone (immediate release) 5 mg po/ng q4h:prn pain multivitamins 1 tab po/ng daily oxycodone sr (oxycontin) 30 mg po q12h gabapentin 200 mg po/ng hs diltiazem extended-release 360 mg po daily fluoxetine 80 mg po/ng daily fluticasone propionate nasal 2 spry nu daily fluticasone-salmeterol diskus (250/50) 1 inh ih tiotropium bromide 1 cap ih daily albuterol inhaler 1 puff ih q4h:prn sob/wheeze omeprazole 20 mg po daily aspirin 81 mg po/ng daily simvastatin 10 mg po/ng daily terazosin 5 mg po hs lisinopril 5 mg po/ng daily aluminum-magnesium hydrox.-simethicone 30 ml po q4h:prn milk of magnesia 30 ml po q8h:prn constipation acetaminophen 650 mg po q4h:prn nicotine polacrilex 1 stck po q2h:prn cravings . medications: lisinopril 5mg po qday diltiazem 360mg po qday terazosin 5mg po qday simvastatin 10mg po qday asa 81mg po qday prilosec 20mg po qday albuterol 2puffs qid prn sob spiriva advair 250-50 one puff flonase 50mcg 2puffs qday prozac 80mg qday abilify 5mg po qdaily neurontin 200mg po qhs colace 100mg po qdaily ambien 10mg po qhs oxycodone 5-10 mg po q4-6hrs prn pain discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: depression aspiration pneumonia copd erisipelas paroxysmal atrial fibrillation . secondary: hypertension transitional cell carcinoma obstructive sleep apnea gerd benign prostatic hypertrophy tobacco use discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you came to the hospital with depression. you were transferred to the intensive care unit due to shortness of breath. your found to have pneumonia and an exacerbation of your copd. you were treated with antibiotics for pneumonia and with steroids for copd. with this treated, your breathing improved. subsequently, you developed a groin rash, diarrhea, confusion, and an increased oxygen requirement, requiring transfer back to the intensive care unit. your antibiotics were changed. as your condition improved, so you were transferred back to the medical floor. just prior to discharge, you were given a special type of iv called a picc that will allow you to receive antibiotics at rehab. . in addition to the groin rash, you developed a second, more generalized rash, which was thought to be due to an antibiotic called zosyn (pipercillin/tazobactam). you are currently on a related antibiotic called nafcillin, which you are tolerating well. however, you should avoid zosyn and related antibiotics in the future. . you had two episodes of an abnormal heart rhythm called atrial fibrillation. due to this, your aspirin dose was increased to 325 mg daily. . you developed severe diarrhea. you were treated with a medication called loperamide, with improvement in you diarrhea. . you will need further psychiatric treatment after your medical condition improves. the psychiatrist at rehab should be consulted and will arrange for appropriate follow-up, which may include transfer back to the psychiatry service at . . you foley catheter was removed on the day of discharge. you had a bladder scan which showed that there was still 350 ml of urine in your bladder. you will need to have a voiding trial as soon as you arrive at rehab and may need a foley catheter placed if you are found to be retaining urine. . there have been some changes to your medications: start nafcillin for skin rash until start loperamide for diarrhea start multivitamin increase aspirin to 325 mg daily due to atrial fibrillation increase lisinopril to 10 mg daily decrease diltiazem to 240 mg daily stop neurontin (gabapentin) stop colace (docusate) due to diarrhea stop ambien decrease oxycodone to 5 mg every 6 hours as needed for pain stop oxycontin continue nystatin for thrush for another 5 day . follow up as indicated below. followup instructions: for your transitional cell carcinoma, please follow-up with your urologist, dr. , at on at 2:30 p.m. address is at on the . phone #. . as above, patient may need transfer for inpatient psychiatric treatment after medically cleared. per dr. (), will need to be evaluated by psychiatrist (dr. at rehab. procedure: venous catheterization, not elsewhere classified closed biopsy of skin and subcutaneous tissue diagnoses: obstructive sleep apnea (adult)(pediatric) other chronic pain anemia, unspecified esophageal reflux cellulitis and abscess of trunk congestive heart failure, unspecified toxic encephalopathy unspecified essential hypertension atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) malignant neoplasm of kidney, except pelvis abnormality of gait other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot dermatitis due to drugs and medicines taken internally diarrhea hyperosmolality and/or hypernatremia unspecified hereditary and idiopathic peripheral neuropathy backache, unspecified urinary incontinence, unspecified other dependence on machines, supplemental oxygen cervicalgia erysipelas penicillins causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to