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: mental status change, hypoxia major surgical or invasive procedure: none history of present illness: hpi: the patient is a 41 year old male with history of etoh abuse, recently admitted to the from to for treatment of osteomyelitis. the patient had previously beeen discharged from on (may have left ama) for right foot infection requiring debridement and represented to for ongoing foot pain with right foot films revealing for osteomyelitis. the patient is noted to have had a prolonged hospitalization complicated by anemia requiring transfusion, behavioral problems requiring psych intervention, and eventually total ray amputation of the foot. the patient was discharged with plan for follow up with his pcp. . the patient now represents to the ed with initial complaint of foot pain. the patient is reported to have been awake and alert on arrival in no acute distress. when the patient was seen by the evaluating intern, the patient was found to be somnolent. it was thought initially the patient may have ingested something. a dose of narcan with some effect. the patient became somewhat combative between this time and his x-rays. on arrival back from radiology he was found to be sedated with desat from 97-98% on room air to 90% on room air with tongue falling back in throat and failure to protect his airway. the patient was subsequently intubated for airway protection. peri-intubation the patient was witnessed to have copious vomiting with likely aspiration although per ed report suspicion is that he aspirated first contributing to worsening letheragy/hypoxia. a serum tox was negative except for an etoh level of 236. utox not yet collected. given low grade temperature, murmur on exam and history of osteo the patient was additionally treated with vancomycin/gent for possible endocarditis after blood cultures were collected. lactate was noted to be 5.5 in ed. the patient was sent to radiology for cta chest and ct head and sent to micu for ongoing care. . on arrival to the micu the patient is intubated and sedated. patient received 3l ns in the ed. . past medical history: cirrhosis with portal hypertension etoh abuse history of dts and withdrawl seizures history of mssa bacteremia history of mrsa from wound culture social history: the patient is homeless. tobacco: occasional tobacco use etoh: 2 pints of vodka daily illicits: denies any iv drug use currently, has experimented in the past. family history: mother died of mi, pt. unsure age. physical exam: vitals on arrival to floor:t 95.4f, bp 150/88, hr 84, rr 18, sat 96% on 3.5l general: no acute distress, lying in bed, appropriate, conversant, patient alert and oriented times 3 heent: op clear, eomi, perrl neck: supple, no lad. jvd 5cm. chest: occ rhonchi, otherwise clear. + spider angiomata cor: rrr. ii/vi systolic murmur heard at apex abdomen: obese, mildly distended. soft. ascites present. nontender. bs+ extremity: 1+ pitting edema bilaterally r>l, + hyperpigmentation secondary to chronic venous stasis. s/p right large toe amp. no obvious induration or erythema of surrounding area. dp 2+ rectal in ed: light brown stool, trace guaiac positive pertinent results: 07:18am blood wbc-4.3 rbc-2.90* hgb-8.8* hct-26.5* mcv-91 mch-30.3 mchc-33.2 rdw-18.1* plt ct-110* 07:18am blood pt-17.7* ptt-51.7* inr(pt)-1.6* 07:18am blood glucose-79 urean-14 creat-0.8 na-138 k-4.2 cl-111* hco3-21* angap-10 07:18am blood alt-17 ast-33 ld(ldh)-227 alkphos-143* totbili-1.1 dirbili-0.5* indbili-0.6 07:18am blood albumin-2.8* calcium-8.2* phos-4.9* mg-2.0 iron-22* 07:18am blood caltibc-320 hapto-<20* ferritn-42 trf-246 03:17am blood ammonia-49* 07:15am blood wbc-5.9 rbc-3.29* hgb-9.8* hct-30.4* mcv-93 mch-30.0 mchc-32.3 rdw-17.9* plt ct-153 07:40am blood pt-18.7* inr(pt)-1.8* 07:15am blood glucose-75 urean-15 creat-0.9 na-136 k-4.4 cl-106 hco3-23 angap-11 chest (portable ap) 8:09 am reason: eval ngt placement medical condition: 41 year old man with sob, intubated, new ngt reason for this examination: eval ngt placement single ap portable view of the chest reason for exam: fever, tachycardia, shortness of breath. assess et tube and ng tube. comparison is made with prior study performed a day earlier. et tube tip is 5.5 cm above the carina. ng tube tip is out of view below the diaphragm. bibasilar consolidations have improved, mainly in the left side. basilar haziness has also improved secondary to central congestion . there is no pneumothorax or pleural effusion. impression: improved central congestion, fluid overload and bibasilar consolidation/atelectasis. ct chest conclusion: 1. subcentimeter nodular opacities with surrounding ground-glass halo are seen distributed throughout both lungs; the appearances are worrisome for septic emboli. the other possibility would be metastases. 2. suboptimal examination due to artifact from breathing. within these limitations, there is no central or pe; however, a small subsegmental pulmonary emboli cannot be excluded. 3. atelectasis and small effusions are present at the lung bases. 4. bilaterally gynecomastia is noted. echo conclusions: the left atrium is mildly dilated. the estimated right atrial pressure is 16-20 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. left ventricular systolic function is hyperdynamic (ef>75%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricle is somewhat more dilated. if clinically indicated, a transesophageal echocardiographic examination is recommended. impression: no definite vegetations seen. however, if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. brief hospital course: a/p: 41yom with pmh of homelessness, etoh abuse, hepatitis c, psychiatric disease with possible delerium/personality disorder (not formally diagnosed), presenting with foot pain, with respiratory decompensation in ed requiring intubation, now called out from micu. . # altered mental status - unclear etiology upon admission, the differential included etoh abuse, etoh withdrawal, seizure, toxic ingestion, baseline personality disorder/pscyhosis, toxic/metabolic encephalopathy. serum tox negative on day of admit, significant +etoh only, ammonia 49. concern initially for aspiration, initiated on levo/flagyl, although chest ct without overt signs of aspiration. ct head was negative. initially, lactate was elevated and by clinical hx pt had rapid change in mental status, seizure (from alcohol withdrawal) this was considered given the rapid resolution in lactate. mental status changes, which have since resolved, thought secondary to ethanol use/withdrawal seizure +/- aspiration. patient placed on ciwa scale and was weaned, did not develop any signs of dt's or seizure activity. he was alert and oriented times 3. patient refused to adhere to low sodium diet and refused nasal canula o2, sats remained >90% with no increased work of breathing. was very rude and innapropriate with everyone involved in his care, refused medications, throwing them at the wall. he threatened to leave ama several times and refused to participate in any further workup. . # infectious disease - patient had temp 100.6 in ed and history of osteomyelitis, as above, treated with vancomycin and had been discharged on bactrim. pt remained afebrile throughout stay in unit, and without a leukocytosis. had chest ct with question of septic emboli vs. metastatic disease pattern. no evidence of vegetation or tr,mr thoracic echocardiogram to suggest endocarditis. no blood cultures have been positive during this or last admission. pt did have a murmur on exam that had previously been documented and tee was negative last admission. clinical history with oxygen requirement with intubation concerning for aspiration pneumonia. pt. was extubated without complications, sats>90% and then transferred to the floor where he remained afebrile with a normal white count. all antibiotics were discontinued on and patient was monitored, no signs of infection clinically, normal white blood cell count, blood cultures remained negative. he did not require any supplemental oxygen and vital signs were stable. tee was discussed with cardiology fellow who explained the very low yield of tee in a patient suspected of having right sided endocarditis with negative tte. the patient refused further workup, clinically he did not show worrisome signs concerning for sepsis/bacteremia. given his refusal to undergo further workup, he agreed to outpatient follow up of ct chest and follow up with pcp. appointments have been scheduled for him. he understands he is to return to the ed if any worrisome sign or symptoms develop, this was explained to him in detail. . # etoh abuse- patient with history of etoh abuse, thiamine/folate in ed. was initially on midazolam/versed for sedation, on valium after extubation with concern for withdrawal. placed on ciwa scale, valium 5mg prn ciwa>10; also getting standing valium which was completely tapered off appropriately with no change in vital signs or concern of seizure activity. continue thiamine and folate. continued spironolactone, added furosemide to his regimen. . #. anemia - chronically low. received multiple transfusions during last admission, with normal ferritin and low iron suggestive of blood loss (given recent surgeries). checked iron studies which were not consistent with iron deficiency. continued folate, his hematocrit was stable throughout the admission, no signs of active bleeding. #. thrombocytopenia- related to cirrhosis, splenic sequestration . #. psych - continued seroquel . #. fen/ppx - continued subq heparin and ppi. . #. code - full . #. dispo: with the help of social work and case mgmt, were able to find a shelter and he was scheduled appointments with pcp, , repeat ct scan. medications on admission: medications: (at time of transfer) metronidazole 500mg po tid acetaminophen 325-650mg q6h: prn (not to exceed 2g daily) quetiapine 100mg po qpm diazepam 10mg po q4h per ciwa scale folic acid 1mg po daily thiamine 100mg po daily vancomycin 1g iv q12h levofloxacin 500mg po q24h discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily): hold for k>5.5. disp:*30 tablet(s)* refills:*0* 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day) for 1 months. disp:*2700 ml(s)* refills:*0* 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 8. seroquel 100 mg tablet sig: one (1) tablet po at bedtime. discharge disposition: extended care facility: pilgrim shelter discharge diagnosis: primary altered mental status secondary to etoh withdrawal pulmonary nodules secondary cirrhosis related to etoh abuse and hep c h/o dt's and withdrawal seizures h/o osteomyelitis s/p right ray amputation discharge condition: stable, ambulating, alert and oriented times times 3 discharge instructions: you were admitted to the hospital with change in mental status. there was concern for the protection of your airway and you were intubated and sent to the intensive care unit. there was a ct scan done with concern for septic emboli. you were placed on empiric antibiotics for >48 hours. a transthoracic echocardiogram was done which showed no evidence of vegetations, tricuspid regurgitation, or mitral regurgitation. you remained afebrile and had a normal white blood cell count in the days following, blood cultures remained negative throughout your stay. clinically there were no signs of active infection. you refused a low sodium diet and refused to take your medications and cooperate with nursing staff. further workup with a transesophageal echocardiogram was deemed to be low yield in this setting. you were monitored for any fevers which did not develop, your oxygen saturation were >90% on room air. you will be discharged with a follow up appointment to see a primary care physician. are also being made to provide shelter for you. you have an appointment to have a follow up ct scan of your chest done, please follow up with this appointment. you were also monitored for alcohol withdrawal and placed on a valium protocol per ciwa. the valium was tapered off completely prior to discharge. on discharge you did not have any signs of delirium tremens, seizures, or withdrawal and your vital signs were stable. return to the emergency room if: **chest pain, shortness of breath, palpitations, loss of consciousness, fevers, chills, high sweats, or any other concerning symptoms. please adhere to your medication regimen: furosemide 20mg daily spironolactone 50mg daily metoprolol 25mg twice daily quetiapine 100mg at nighttime folic acid 1mg daily thiamine 100mg daily lactulose 30 ml three times per day (titrate to 3 bowel movements per day) followup instructions: provider: scan phone: date/time: 2:45 please be there at 2:30pm, do not eat or drink for 3 hours prior to the procedure. location is on the of the building. provider: , md phone: date/time: 2:00. this is your new primary care doctor please keep this appointment. provider: , dpm phone: date/time: 10:50 procedure: insertion of endotracheal tube diagnoses: thrombocytopenia, unspecified anemia, unspecified unspecified pleural effusion chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver portal hypertension pulmonary collapse other diseases of lung, not elsewhere classified hypoxemia lack of housing alcohol withdrawal acute alcoholic intoxication in alcoholism, continuous hypertrophy of breast 

Answer: The patient is high likely exposed to