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 / hydralazine attending: chief complaint: vomiting major surgical or invasive procedure: 1. intraosseous access obtained. 2. right internal jugular central venous catheter placed. 3. left picc placed. 4. endotracheal intubation history of present illness: 69 year old male with h/o cva and baseline non-communicative, aspiration pna, hydrocephalus s/p vp shunt who was brought in from nh by son for nausea and vomiting. also noted to have increased yellow secretions. per sone, his father has been pulling at his g-tube for past few days; unable to communicate though so son unclear whether it was painful. did not know whether tube feeds have been a problem. pt reports ms e; unchanged. on arrival to , pt non-communicative (but at baseline), fever 102. hr 120s, sbp 120. cxr was done which was wnl. wbc 22. lactate 1.9. ct head was done given h/o hydrocephalus and new onset vomiting. ct was concerning for enlarged 3rd ventricle thus neurosurgery evaluated pt and felt unlikely to represent signficant change. ct abd/pelvis done which showed bibasilar opacities c/w aspiration pneumonia. pt given vanc/levo/flagyl for aspiration pna. in addition, central access was attempted x3; unsuccess femoral line attempts on both r/l and subclavian secondary to return of arterial blood; thus intraosseous access obtained. also of note, during the multiple line attemps, pt became increasing tachycardic, hypotensive, vomiting with ?aspiration. ngt placed with coffee-ground return. pt hydrated with 4l ns. bp remained stable however was tachycardic to 120s persistantly despite fluids. 2 pivs subsequently obtained. of note, pt was admitted with fever,cough and intially tx for aspiration pna but subsequently found to have c.diff and proteus uti; d/c'd with 10d meropenem and 14d flagyl. he was then readmitted for recurrent c.diff, vre uti and yeast uti and d/c'd on flagyl, fluconazole and tetracycline. of note, all c.diff toxin cultures from were negative. past medical history: alzheimer's dementia bipolar disorder pvd dm type ii hydrocephalus s/p vp shunt (son says it was placed 3-5 years ago at with no revisions, unknown cause of hydrocephalus) h/o subdural hemorrhages (unknown if before or after shunt placed) hearing loss with hearing aids cataracts hypertension hypercholesterolemia h/o siadh with fluid restriction of 1l per day h/o aspiration pnas s/p recent cva () recent c. diff infection h/o vre uti social history: resides in nh. used to work as an accountant, 100 pack year smoking history, he is nonverbal at baseline with a peg tube. he is dependent on others for adls. family history: type 2 diabetes mellitus, alzheimer's and bipolar disease. physical exam: t:98 bp: 123/61 hr: 129 r 20 o2sats 98% on vent support gen: intubated, sedated, ng tube with some coffee-grounds. vp shunt - scalp site easily compressible heent: pupils: 6-4 mm b/l neck: supple. lungs: coarse crackles b/l. cardiac: heart sounds are irregularly irregular, with a pansystolic murmur radiating to the axilla. abd: peg site clean. foley in situ. hypoactive bowel sounds extrem: cold peripheries. neuro: intubated and sedated, therefore could not be assessed, therefore, mental status could not be assessed. pupils equally round and reactive to light. pertinent results: 04:15pm glucose-178* urea n-82* creat-0.7 sodium-142 potassium-5.4* chloride-100 total co2-26 anion gap-21* 06:15am glucose-216* urean-10 creat-0.3* na-139 k-5.0 cl-107 hco3-22 angap-15 04:15pm calcium-11.4* phosphate-4.9* magnesium-2.8* 04:15pm wbc-22.8*# rbc-5.03# hgb-13.9*# hct-41.9 mcv-83# mch-27.7 mchc-33.3 rdw-16.0* plts: 422 04:15pm neuts-80.4* lymphs-13.9* monos-4.9 eos-0.3 basos-0.5 wbc: 22.8 -> 11.0 hct: 41.9 () -> 23.1 () -> 31.9 (, after 2 units rbcs) lactate: 1.9 inr: 1.3 -> 1.7 -> 1.3 imaging: ct abdomen/pelvis (): impression: 1. extensive tree-in- opacities at the lung bases are suggestive of aspiration. 2. poorly defined areas of hypodensity in the left kidney are new from a prior study from and raise concern for infectious or ischemic process. 3. no evidence of acute bowel process. 4. vp shunt catheter tip in the right hemiabdomen appearing unremarkable. ct head (): continued evolution of blood products of left mca territory infarction. no midline shift. enlarged 3rd ventricle. persistent dilatation of the lateral ventricles. these findings may be chronic but correlation with signs of increased cranial pressure recommended. renal u/s (): impression: no definite son correlates identified for bilateral renal hypodensities seen on previous ct, with no solid masses identified. the nephrographic abnormalities on recent ct are suspicious for infectious or ischemic process and their lack of visualization may relate to limitations of this study. cxr (): findings: comparison with study of , there are lower lung volumes. there is still some right infrahilar and left suprahilar opacification consistent with aspiration. however, some of this may also reflect crowding of vessels due to poor inspiration. right ue u/s (): impression: no dvt in the right upper extremity. right cephalic vein was not definitely identified. brief hospital course: # aspiration pneumonia initially febrile with leukocytosis. patient was intubated in the ed for concerns regarding airway protection and continued vomiting. he also received vanc/levo/ flagyl in the ed. vent settings were gradually weaned and he was easily extubated on . he had sputum cultures sent, which grew mrsa and klebsiella pneumonia. he was on aspiration precautions and treated with a regimen of vanco and ceftriaxone. however, the ceftriaxone was switched to meropenem given esbl klebsiella in the urine. he will complete a 10d course of vanco and a 14d course of meropenem. at time of discharge, his fevers and leukocytosis have resolved, he continues to have spo2 in the upper 90s on room air, and his secretions have improved. # hypovolemia labs initially suggestive of significant volume depletion with hypotension, increased calcium, bun, hematocrit. he is unable to independently take pos, and had been vomiting. he received 4l iv ns in the ed via intraosseous line as no peripherals or central lines could be placed. also, he was tachycardic, likely both from volume depletion and holding his antihypertensives due to hypotension. once in the micu, a r ij tlc was placed. his blood pressure and heart rate normalized with volume resuscitation, and his tlc was d/c'd once picc access was obtained with ir assistance. # hypertension occurred a few days after his hypovolemia and hypotension were corrected. likely due to a rebound effect from being off his home antihypertensives, especially clonidine. the hypertension resolved after these medications were resumed, albeit at lower doses and with clonidine given po. his ekg showed stable lvh and new twi in the anteroseptal leads. this is nonspecific, but due to the possibility of ischemia, cardiac markers were checked and were not elevated when compared to his baseline. he was also continued on his home aspirin. - please note that he does not currently have a clonidine patch. this was written in the discharge medications, but can be placed at the ecf. - also, his other antihypertensives are at lower doses - please titrate to his prior regimen as tolerated. # n/v ct showed no acute abdominal pathology. lfts wnl. neurosurgery was consulted initially for concern of worsening icp in a patient with a vp shunt, but felt his head ct was not suggestive of this. son felt that his mental status was at baseline. following extubation, tfs were restarted gradually with high residuals, so he was started on reglan for presumed diabetic gastroparesis as the cause of his vomiting. there may have also been contribution by his uti, as this has caused these symptoms in him previously. # uti. urine growing proteus, esbl klebsiella, both sensitive to meropenem. his inital ceftriaxone and bactrim were switched to meropenem 500mg q6h and will be continued to complete a 14 day course. his foley was d/c'd and replaced by a condom cath. # anemia hematocrit initially 41.9 due to hemoconcentration from dehydration. it gradually trended down to a nadir of 23.1. he received 2 units prbcs, and it remained stable around 32 subsequently. no coffee grounds were noted since the ed, and his stool was guaiac negative x2. he was started on lansoprazole. # fen initially had to hold tf for high residuals, but after reglan was started, we were able to advance him to a goal of 45ml/hr, which was well tolerated. he received 35 units glargine qhs due to initial decreased enteral intake, but this was increased to 60 units glargine qhs at discharge as he is at goal with tfs and having glucose levels upper 200s, lower 300s. - please uptitrate the glargine to his prior regimen (listed as 78 units qhs) as tolerated. # r ue swelling doppler u/s performed and showed no evidence of dvt. # dispo his other chronic issues remained stable and were treated as previously. he will be discharged back to the extended care facility from which he was admitted. medications on admission: heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). clonidine 0.3 mg/24 hr patch weekly : one (1) patch weekly transdermal qthur (every thursday). metoprolol tartrate 75 mg tablet : one (1) tablet po bid (2 times a day). lisinopril 40 mg tablet : one (1) tablet po daily (daily). aspirin 325 mg tablet : one (1) tablet po daily (daily). simvastatin 40 mg tablet : one (1) tablet po daily (daily). levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation: give if no bowel movement within the last 24 hours. lantus 100 unit/ml solution : seventy-eight (78) units subcutaneous at bedtime. insulin regular human 100 unit/ml solution : as directed injection every six (6) hours: insulin sliding scale. acetaminophen 650mg q4h prn furosemide 40mg po daily mvi 1 tab daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 3. aspirin 325 mg tablet : one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed. 6. acetaminophen 325 mg tablet : two (2) tablet po every four (4) hours as needed for fever or pain: max 4g/day. 7. levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). 8. metoprolol tartrate 25 mg tablet : one (1) tablet po three times a day: hold for sbp < 100, hr < 60. 9. metoclopramide 10 mg tablet : one (1) tablet po qid (4 times a day). 10. insulin glargine 100 unit/ml solution : sixty (60) units subcutaneous at bedtime: plus sliding scale, see attached. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for wheezing on exam. 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 13. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 12h (every 12 hours) for 4 days: 10 day course to finish on . 14. clonidine 0.3 mg/24 hr patch weekly : one (1) patch weekly transdermal q wednesday. 15. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 16. meropenem 500 mg recon soln : one (1) recon soln intravenous q6h (every 6 hours) for 13 days: 14 day course to complete on . 17. ondansetron 4 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 18. lisinopril 10 mg tablet : one (1) tablet po once a day: hold for sbp < 95. 19. insulin see attached sliding scale for regular insulin discharge disposition: extended care facility: roscommon discharge diagnosis: primary: aspiration pneumonia complicated cystitis. secondary diagnoses: diabetes mellitus type 2, controlled, with complications peripheral vascular disease hypertension prior cerebrovascular accident chronic anemia hydrocephalus with ventriculoperitoneal shunt discharge condition: stable. discharge instructions: you were admitted to with vomiting. this was likely because the tube feeds were passing through your bowels very slowly, perhaps due to diabetes. some of the vomit entered your lungs and lead to a pneumonia. we also found a bladder infection, and treated both infections with iv antibiotics. your blood pressure was initially low, which improved with fluids. it became high later, but improved when we restarted your outpatient medications. we also gave you 2 units of blood because your red blood cell level was low. we will discharge you back to your extended care facility. please take all medications as prescribed and go to all follow up appointments. we started another medication, reglan, to help prevent your stomach from slowing down. we also started lansoprazole due to concern about stomach irritation. if you experience any nausea, vomiting, difficulty breathing, fevers, chills, increased sputum, blood in the vomit or stool, or any other concerning symptoms, please seek medical attention or come to the emergency room immediately. followup instructions: please follow up with your primary care provider at within 1-2 weeks. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of other (naso-)gastric tube transfusion of packed cells diagnoses: abnormal coagulation profile anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled pneumonitis due to inhalation of food or vomitus pressure ulcer, lower back alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance pressure ulcer, heel hypovolemia atherosclerosis of native arteries of the extremities, unspecified tachycardia, unspecified proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site gastrostomy status gastroparesis presence of cerebrospinal fluid drainage device diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to