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 / adhesive tape attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation history of present illness: 64 year old man with esrd from fsgs on hemodialysis, cad w/stent, chf with ef 25-30%, htn and poorly differentiated cancer (likely nsclc) with mets to vertebrae who was recently admitted to /wards in and early for persistent respiratory distress who presents with recurrent respiratory distress. history is taken from records as patient is intubated. per report of his caregiver, the patient had not been doing well at home. he had increasing shortness of breath and fatigue. he had stopped eating and was not taking any of his medications. there was no report of fevers, chills, chest pain. however, his caregiver had noticed occational cough with blood tinged sputum of uncertain amounts. they were in the process of arranging hospice care but had not made any final decisions regarding his overall plan of care. the patient went to dialysis today but was noted to be dyspneic and short of breath. there was also noted to be blood tinged cough. ems called and he was noted to be lethargic. he was put on a nrb and reportedly felt better. he was taken to the ed. in the ed, t 96.6, hr 70, bp 130/82, rr 24, 100%nrb. ekg unchanged from prior. cxr with ? pulm edema/infiltrate. he was given vanco/levo, as well as . he subsequently became more tachypneic and lethargic. he was therefore intubated. a l sublcavian cvl was placed for transient hypotension during intubation. initial lactate 7.3, bnp >70k. past medical history: #. onc hx: pre-renal transplant ct scan chest noted enlarged rml nodule, w/ subcentimeter fdg avid scattered lymph nodes. developed neck pain and found to have c2 pathological fracture, cytology demonstrated poorly differentiated carcinoma. likely non-small cell lung carcinoma, with rml mass and metastasis to the cervical and sacral spine. the only manifestation of his disease currently is cervical neck pain, s/p pathologic fracture and posterior cervical arthrodesis c1-c3 and palliative xrt. #. left common femoral dvt: small non-occlusive, possibly chronic dvt and started on coumadin for a goal inr in #. cad s/p angioplasty d1 and stents to om2/3 in #. esrd secondary to fsgs on hd (mwf) #. hypertension #. lle peroneal nerve palsy gsw to l leg #. thalassemia trait #. h/o substance abuse (heroin/cocaine); reports none since #. chf w/ ef 35% in , ef 25-30% on #. mr - 2+ on in ; now found to be 3+ mr #. pathological c2 fx s/p c1-3 fusion #. parotiditis - (levo/flagyl) #. cdiff - #. hcv - grade 1 inflammation and stage 0 fibrosis on bx social history: lives with wife, has 2 sons, used to work in construction, + smoker 1 ppd for many years quit recently, rare etoh, no drugs. family history: brother with cad, and kidney disease requiring hemodialysis physical exam: vs: t 97.5, bp 120/76, hr 77, rr 16, 100% ac 550/14, peep 5, fi02 0.5 gen: aa male sedated in bed, intubated with neck collar heent: et tube in place, cervical collar in place, unable to assess jvp given collar. chest: brace over portion of back. bronchial bs bilaterally with bibasilar crackles, no wheezes heart: rrr, normal s1/s2, soft hs, no m/r/g abd: soft, non-tender, non-distended + bowel sounds back: unable to assess given intubated ext: no clubbing, cyanosis, edema; 1+ dp pulses bilaterally, l av fistula intact, no peripheral edema. neuro: sedated, pinpoint pupils, could not assess sufficiently pertinent results: 01:30pm pt-45.4* ptt-38.7* inr(pt)-5.1* 01:30pm plt count-252 01:30pm neuts-88.3* lymphs-8.4* monos-2.6 eos-0.6 basos-0.1 01:30pm wbc-12.1*# rbc-3.45* hgb-8.5* hct-27.7* mcv-80* mch-24.5* mchc-30.6* rdw-19.2* 01:30pm calcium-9.9 phosphate-5.5*# magnesium-1.9 01:30pm ck-mb-notdone probnp-greater th 01:30pm ctropnt-0.15* 05:50am blood wbc-19.4* rbc-3.82* hgb-9.4* hct-30.2* mcv-79* mch-24.5* mchc-31.0 rdw-19.9* plt ct-231 06:00am blood wbc-19.9* rbc-4.53* hgb-10.7* hct-35.4* mcv-78* mch-23.6* mchc-30.3* rdw-19.0* plt ct-340 01:30pm blood pt-45.4* ptt-38.7* inr(pt)-5.1* 06:00am blood pt-23.4* ptt-27.7 inr(pt)-2.3* 01:30pm blood glucose-142* urean-39* creat-5.3* na-140 k-5.6* cl-94* hco3-26 angap-26* 06:00am blood glucose-84 urean-27* creat-3.5*# na-135 k-4.4 cl-94* hco3-29 angap-16 01:30pm blood ck(cpk)-27* 03:00am blood ck(cpk)-13* 05:20am blood alt-59* ast-57* ld(ldh)-332* alkphos-92 totbili-0.6 08:50am blood ck(cpk)-8* 05:30pm blood ck(cpk)-18* 01:30pm blood ctropnt-0.15* 03:00am blood ck-mb-notdone ctropnt-0.14* 08:50am blood ck-mb-notdone ctropnt-0.17* 05:30pm blood ck-mb-notdone ctropnt-0.16* 06:00am blood calcium-10.2 phos-3.6 mg-1.6 10:32pm blood type-art po2-219* pco2-44 ph-7.50* caltco2-36* base xs-10 08:18am blood type-art po2-79* pco2-45 ph-7.50* caltco2-36* base xs-9 01:48pm blood glucose-132* lactate-7.3* k-5.5* 02:40pm blood glucose-120* lactate-5.0* 10:32pm blood lactate-1.5 08:18am blood lactate-1.0 blood culture : blood culture, routine (final ): sensitivities requested by dr. # . staphylococcus, coagulase negative. isolated from one set only. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. staphylococcus, coagulase negative. second morphology. isolated from one set only. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | staphylococcus, coagulase negative | | erythromycin---------- =>8 r =>8 r gentamicin------------ <=0.5 s <=0.5 s levofloxacin---------- 0.25 s 0.25 s oxacillin-------------<=0.25 s <=0.25 s penicillin g----------<=0.03 s <=0.03 s repeat blood cultures all negative urine cx escherichia coli. 10,000-100,000 organisms/ml.. presumptive identification. enterococcus sp.. >100,000 organisms/ml.. sensitivity testing performed by sensititre. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | enterococcus sp. | | ampicillin------------ 8 s 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 16 i ciprofloxacin--------- =>4 r gentamicin------------ <=1 s linezolid------------- 1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tetracycline---------- 8 i tobramycin------------ <=1 s trimethoprim/sulfa---- 2 s vancomycin------------ =>128 r c diff negative x 2 cxr : endotracheal tube is in standard position. nasogastric tube has been advanced into the stomach, and left internal jugular catheter has been withdrawn slightly, terminating at the junction of the left brachiocephalic vein and superior vena cava. cardiac silhouette remains enlarged, but there has been improvement in the degree of pulmonary edema. residual airspace opacities remain more prominent in the right lower lobe than the left, and likely represent asymmetric edema although a coexisting pneumonia is also possible in the appropriate clinical setting. radiodensity overlying the upper mediastinum is reportedly related to prior vertebroplasty procedure. av fistula ultrasound : patent left upper arm arteriovenous fistula without thrombus. **tte :** the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 25-30%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. mild (1+) 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. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: no evidence of endocarditis. dilated left ventricle with severe global systolic dysfunction. mild right ventricular systolic dysfunction. mild aortic regurgitation. moderate mitral regurgitation. compared with the prior study (images reviewed) of , the findings are similar, although regionality of lv dysfunction is less apparent on today study - lv systolic dysfunction now looks global. cxr : as compared to the previous examination, the right-sided pulmonary opacities appear less dense but more widespread than on the previous examination. they are no longer confined to the perihilar areas but diffusely distribute in the entire lung. in the interval, the retrocardiac atelectasis has slightly increased in extent. otherwise, the radiographic appearance is unchanged, there is no evidence of pleural effusion. there is unchanged moderate cardiomegaly with subtle signs of overhydration, in unchanged manner, radiopaque material projects over the trachea. brief hospital course: 64 year-old m with esrd on hd, cad, metastatic poorly differentiated cancer (likely nsclc), s/p vertebroplasty presenting with acute respiratory failure. brief micu course: the patient was admitted to the icu for respiratory failure, which appeared to be subacute process over several days. symptoms were thought to be related to fluid overload given that the patient missed dialysis on day of admission and cxr was most consistent with pulmonary edema. (there was a question of a rml infiltrate, but the patient had no f/c or cough with only mild leukocytosis.) pe was not felt to be likely given supratherapeutic inr. acs was not felt to be likely as ekg and cardiac enzymes were stable (althouh ce were elevated renal insufficiency). the patient symptoms resolved after hd, and he was transferred to the floor in stable condition with breathing at baseline (2l o2 for comfort). uti: the patient developed fevers and leukocytosis after his transfer to the floor. he was initially treated with vancomycin for possible coagulase negative staph bacteremia. when his repeat blood cultures failed to grow any bug, the coag negative staph was thought to be a contaminant. he was switched to levofloxacin because of concern for pneumonia, but urine cultures (patient makes a minimal amount of urine daily) ended up growing e coli and vancomycin resistant enterococcus. based on these cultures, his antibiotic was changed to linezolid (ampicillin was not used because he is penicillin allergic). he should be continued on linezolid until . pump/chf: the patient had acute on chronic systolic dysfunction, ef 25-30%. he had signs of fluid overload on cxr, and responded well to hd, as above. he was continued on a bb and acei, as above. cad: the patient has a history of cad s/p mi. as above, the patient was ruled out for acute mi with stable ekg and cardiac enzymes. the patient was continued on , , bb, ace-i, and imdur. htn: the patient was continued on home antihypertensives with no acute issues. given that his bp was well-controlled without nifedipine, his nifedipine was stopped. esrd: the patient was continued on hd on m/w/f schedule with no acute issues. his phoslo (calcium acetate) was stopped because of hypercalcemia, most likely due to his underlying malignancy. a pth related peptide was sent and results were pending at the time of discharge. his phos should be monitored after discharge and phosphate binders such as sevelamer can be started at the discretion of his nephrologist. metastatic nsclc: the patient has metastatic nsclc with metastases to bone. prior plan was to have patient be transitioned to hospice care. the patient was seen by his primary oncology team and the palliative care team inhouse, and despite multiple conversations about hospice, the patient did not feel ready to change his code status to dnr/dni. he understands that his best option to go home is to change his code status and transition to hospice care. for the present, he is choosing to continue full care and dialysis, and is therefore being discharged to rehab. vertebral fractures: the patient has a history of c2 fracture s/p c1-c3 fusion and t4 compression fracture s/p vertebroplasty. j collar was continued, though he is often non-compliant with his collar. orthotics was , and they confirmed that his collar is appropriately fitted. the patient was encouraged to wear his collar as much as possible. gluteal ulcers: wound care was consulted for recommendations to care for the patient's ulcers. he was provided care per their recommendations. pain: mostly in his neck secondary to the pathologic fractures. the patient's oxycontin and oxycodone were increased to improve his pain control. he was also started on standing tylenol, and his need for the standing dose should be reevaluated over the upcoming weeks. dvt: the patient was continued on coumadin, which was briefly held on admission for supratherapeutic inr. at the time of discharge, his inr was therapeutic on his present dose. his inr should be monitored closely. anemia: the patient has a history of anemia, most likely renal disease. hct remained at baseline of 28-30 with no evidence of bleeding. he continued to receive epo with dialysis. code: full for now. had extensive discussion with patient's spouse and hcp regarding goals of care. the patient and his spouse understand that he has the option to pursue care with hospice if he changes his code status. medications on admission: calcium acetate 667 mg po tid w/meals b complex-vitamin c-folic acid 1 mg daily ipratropium bromide 1 inh qid guaifenesin (15) ml po q6h albuterol 90 mcg/actuation aerosol sig: two (2) inh q4-6 metoprolol tartrate 50 mg po bid isosorbide mononitrate 30 mg po daily docusate sodium 100 mg po bid senna 8.6 mg po bid pantoprazole 40 mg po q24h (every 24 hours). lisinopril 10 mg po daily nifedipine 30 mg po daily acetaminophen 500 mg po q6h epoetin alfa 10,000 unit/ml hd gabapentin 300 mg po daily warfarin 2 mg po 75 mg po daily lidocaine 5 % daily to neck oxycodone 5 mg po q 3 hours prn simvastatin 20 mg po once a day. oxycontin 10 mg q8 discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 5. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for neck pain: leave on for 12 hours, then take off for 12 hours. 9. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 10. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 11. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation every 4-6 hours as needed for shortness of breath or wheezing. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. warfarin 2 mg tablet sig: one (1) tablet po daily16 (once daily at 16). 15. gabapentin 300 mg capsule sig: one (1) capsule po please give once daily on dialysis days only. do not give on days the patient does not have dialysis. 16. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day) for 2 weeks. 17. epoetin alfa 10,000 unit/ml solution sig: 10,000 units injection at hemodialysis. 18. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 13 days: last dose due on . 19. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours): hold if sedated or rr < 10. 20. oxycodone 20 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain: hold if patient is sedated or rr < 10. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: respiratory failure secondary diagoses: end stage renal disease, urinary tract infection, metastatic lung cancer, acute on chronic systolic heart failure, coronary artery disease, history of dvt on anticoagulation discharge condition: breathing improved with sat's in 90s on room air to 2l by nasal cannula. discharge instructions: you were admitted with respiratory failure, most likely due to too much fluid in your lungs. you were given dialysis and the extra fluid was removed. you also were found to have a urinary tract infection. you were given antibiotics and your fevers improved. 1. please take all medications as prescribed. 2. please attend all follow-up appointments listed below. 3. please call your doctor or return to the hospital if you develop fevers greater than 101f, difficulty breathing, chest pain, shaking chills, or any other concerning symptom. 4. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet ***medication changes*** started: aspirin 81mg daily tylenol at 1000mg three times a day linezolid 600mg every twelve hours (until ) stopped: nifedipine calcium acetate (phoslo) guaifenesin increased dose of: oxycontin to 20mg every twelve hours oxycodone to 20mg every 4 hours as needed for pain. followup instructions: you have an appointment with your primary doctor: provider: , md phone: date/time: 9:50 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure bacteremia long-term (current) use of anticoagulants pressure ulcer, buttock personal history of venous thrombosis and embolism staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus acute on chronic systolic heart failure secondary malignant neoplasm of bone and bone marrow malignant neoplasm of middle lobe, bronchus or lung 

Answer: The patient is high likely exposed to