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: keflex attending: chief complaint: s/p cardiopulmonary arrest major surgical or invasive procedure: mechanical ventilation (previously trached) central venous catheter r sc placed -> d/c'd and changed to picc line left femoral a-line placed chest tube removal history of present illness: this is a 76 y/o male with with history of large right mca and mca/pca watershed infarct in , likely cardioembolic due to his history of atrial fibrillation; cardiomyopathy with ef 15%; s/p mrsa pneumonia, now with e.coli pleural effusion; c.diff infection; and s/p recent trach and peg on for inability to wean vent from recurrent aspirations; found unresponsive at the facility this morning. patient is interactive but non-verbal ( trach) at baseline, but it is not clear from records when he was last seen normal. . this morning at rehab, at approximately 7:20 am he was found to be unresponsive and pulseless, but had a blood pressure of at least 100/60. he was given cpr for 8 minutes, although the records document a pulse at one minute, and he received epinephrine, after which he had vtach at 192, for which pt was loaded with amiodarone and started on amiodarone gtt. per patient's sister, he has been having increased secretions from trach +/- bloody secretions, requiring increased suctioning. this is not documented in nh records. . he was then transferred to the ed, with stable bp in 120's/70's and hr in 70's. initial vs in ed were tc 98.4, bp 124/70, hr 80's, rr 18, sao2 100%/vent. he was continued on amiodarone and given levofloxacin for abx coverage. he had blood and urine cx sent, cxr, ct head (negative), and ct torso done. upon initial exam, he was noted to flex his limbs to noxious stimuli, but his eyes were deviated up and to the left, and he had a "resting tremor" of the left arm, which was described as intermittent twitches of the arm that were not sustained or rhythmic. he was then transferred to the micu for further management. just before he was transported his nurse in the ed noticed more pronounced left arm twitching. the ed resident evaluated him and then called neurology for a consult re:?seizure, while the patient was being taken to the icu. . upon arrival to the micu, pt's vs were stable, however he was noticed to have left arm twitching and blood at the corner of his mouth. upon opening his mouth, the tongue was found to be bitten and macerated, with tongue fasiculations. an oral airway was placed. patient was given 4 mg iv ativan total and loaded with 1 gm dilantin. past medical history: - hypertension - hypercholesterolemia - disc bulge l4-5 w/o herniation - hx of osteomyelitis t12-11 - screening carotid study ': bilateral mild to moderate carotid stenosis - s/p laminectomy thoracic spine - cardiomyopathy with lvef 10-15% - ischemic mca cva - paroxsymal afib - history of gi bleed - aspiration pna (patient failed speech and swallow in past) - cri with baseline cr 1.8-2.2 - s/p trach/peg social history: from rehab. no history of tobacco, history of heavy alcohol use (2 pint/day) but has been less recently. retired biochemist. family history: nc physical exam: vs: tc 95.6, bp 129/79 ->80's/40/s with dilantin, hr 83-100, rr 19, sao2 100%/ac 450 x 14, fio2 50%, peep 5. general: unresponsive male with rightward eye gaze, biting down on tongue heent: pupils pinpoint and non-reactive. no doll's eye reflex. +tongue biting and fasiculations. oral airway in place. trached. neck: supple, unable to assess jvd chest: diffue coarse rhonchi, right chest tubes in place cv: rrr s1 s2 distant, no murmurs appreciated abdomen: obese, soft, active bowel sounds, peg c/d/i ext: +2 edema in le and ue b/l; heel ulcer neuro: unresponsive except to noxius stimuli, pupils pinpoint and nr, trace corneal reflex. +tongue fasiculations. +hyperactive dtr's, +clonus, +upgoing toes. pertinent results: 11:45am blood wbc-15.6* rbc-2.92* hgb-8.1* hct-24.8* mcv-85 mch-27.5 mchc-32.5 rdw-20.4* plt ct-336 11:45am blood neuts-84* bands-0 lymphs-3* monos-11 eos-1 baso-0 atyps-0 metas-0 myelos-1* nrbc-1* 11:45am blood hypochr-3+ anisocy-2+ poiklo-1+ macrocy-normal microcy-2+ polychr-occasional target-1+ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ 11:45am blood glucose-128* urean-70* creat-1.6* na-147* k-3.6 cl-106 hco3-32 angap-13 04:24am blood glucose-140* urean-84* creat-2.3* na-144 k-4.1 cl-106 hco3-26 angap-16 03:21am blood glucose-124* urean-92* creat-2.7* na-145 k-3.5 cl-108 hco3-26 angap-15 _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ 07:56pm blood phenyto-13.8 04:04am blood phenyto-12.5 phenyfr-2.7* %phenyf-22* 03:21am blood phenyto-12.1 phenyfr-2.6* %phenyf-21* _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ ct torsow/contrast ct chest w/contrast; ct abdomen w/contrast ct chest with iv contrast: the patient has a tracheostomy tube with tip that terminates at the thoracic inlet. there are multiple mediastinal and axillary lymph nodes, none of which are pathologically enlarged. the aorta is moderately calcified along with coronary artery calcifications. there is a right-sided pleural effusion that is small in size and decreased compared to prior study. two chest tubes are seen within the effusion. there is a small amount of associated pneumothorax. there is also atelectasis of the right lower lobe; the possbility of superimposed airspace disease cannot be excluded. both air and fluid are decreased compared to prior study. there is a tiny left pleural effusion. within the lung parenchyma, there is ground glass opacity diffusely thoughout the left lung, nonspecific, although the possibility of infection cannot be excluded. subcutaneous emphysema is seen along the chest tube tracts. ct abdomen with iv contrast: within the liver, there is a focal hypodense hepatic cyst within the left lobe measuring 19 mm. within the caudate lobe of the liver, there is an additional 8 x 14 mm hypodensity also likely representing hepatic cyst. the gallbladder contains a small amount of fluid. there is a small amount of perihepatic fluid. there is thickening of the aderenal glands bilaterally without evidence of focal lesion. the pancreas, spleen, and kidneys are unremarkable. the small and large bowel are within normal limits. there is no evidence of obstruction. there is a small- to- moderate amount of fluid within the pelvis. calcifications extend along the course of the aorta into the iliac and common femoral arteries. ct pelvis with iv contrast: the urinary bladder, prostate, and rectum are unremarkable. there is a rectal tube in place. there is a moderate amount of soft tissue edema throughout the entire torso, most notable within the pelvis and proximal thighs. there is a lipoma in the distal psoas muscle, incidentally noted. bone windows: there are no suspicious lytic or sclerotic bony lesions. there is fusion of t10/t11 with an angular kyphosis, unchanged and either postinfectious, postraumatic, or congenital in etiology. multilevel degenerative change of the thoracolumbar spine are seen. _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ ct head w/o contrast 12:58 pm findings: again demonstrated is a large low-density area within the right mca distribution consistent with a subacute/chronic infarction which is not significantly changed compared to prior study from . there are also linear hyperdense foci near the vertex of the posterior temporal region likely representing cortical mineralization secondary to the infarct. there is no evidence of acute intracranial hemorrhage. the ventricles are similar in size. there is no shift of the midline. impression: stable head ct with no evidence of new intracranial hemorrhage. stable right mca territorial chronic/subacute infarction. _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ neurophysiology report eeg study date of findings: pushbuttons: five events were identified for periods of rhythmic eye-blinking. apart from eye-blink artifact, no other changes in the eeg were seen. the eye-blinking lasts for many seconds at a time, and in short periods between the eye-blinking, the eeg does not show signs of epileptiform activity. when the eye-blinking stops, no epileptiform changes are seen. automated interictal epileptiform activity: background activity consists of very low amplitude hz mixed delta and theta frequency slowing. throughout, ekg artifact is seen as a rhythmic change in the eeg. automated spike detection: this algorithm captured 141 events, all for eye-blink artifact. automated seizure detection: this algorithm captured no events. sleep: no normal sleep or wake transitions were seen. cardiac monitor: revealed a generally regular rhythm with average rate of 120 bpm. impression: this is an abnormal 24 hour bedside telemetry due to the presence of extremely suppressed background activity. the episodes of eye-blinking do not appear to be ictal, but clinical correlation is suggested. automated algorithms have failed to identify any epileptiform activity. . 146 105 73 179 agap=15 3.5 30 1.8 ck: 62 mb: notdone trop-t: 0.20 comments: ctropnt: ctropnt > 0.10 ng/ml suggests acute mi ca: 9.0 mg: 2.8 p: 3.5 alt: ap: tbili: alb: 2.9 ast: ldh: dbili: tprot: : lip: phenytoin: 13.8 source: line-art 85 14.4 8.5 406 26.5 source: pt: 18.1 ptt: 34.2 inr: 1.7 source: catheter color yellow appear clear specgr 1.023 ph 5.0 urobil neg bili neg leuk neg bld sm nitr neg prot 30 glu neg ket neg rbc 0 wbc 0 bact none yeast none epi <1 6:08p ph 7.42 pco2 48 po2 98 hco3 32 basexs 5 type:art; temp:35.8 11:55a na:147 k:3.6 cl:106 tco2:32 glu:124 lactate:1.1 11:45a 147 106 70 128 agap=13 3.6 32 1.6 estgfr: 42/51 (click for details) ck: 46 mb: notdone trop-t: 0.18 comments: ctropnt: notified whitehead,e ew 5.26 at 1.30p ctropnt: ctropnt > 0.10 ng/ml suggests acute mi ca: 9.0 mg: 3.0 p: 3.4 alt: 17 ap: 63 tbili: 0.5 alb: 2.6 ast: 19 ldh: dbili: tprot: : 70 lip: 18 85 15.6 8.1 336 24.8 n:84 band:0 l:3 m:11 e:1 bas:0 myelos: 1 nrbc: 1 comments: hct: notified 12:19pm plt-ct: verified by smear plt-ct: occ large plt present hypochr: 3+ anisocy: 2+ poiklo: 1+ microcy: 2+ polychr: occasional target: 1+ plt-est: normal pt: 17.9 ptt: 40.0 inr: 1.7 11:20a color yellow appear clear specgr 1.016 ph 5.0 urobil neg bili neg leuk tr bld neg nitr neg prot 30 glu neg ket neg rbc wbc bact few yeast none epi 0-2 brief hospital course: 76 y/o male with pmh significant for mca stroke, s/p recent trach/peg, s/p chest tubes for recent empyema, now presenting from rehab s/p cardiac arrest and in status epilepticus. . # s/p cardiac arrest - pea primary rhythm, thought to be secondary to hypoxia from mucous plugging or blood clots in trachea. he had no signs of sepsis and blood cultures were all negative. troponin was elevated in the setting of renal failure but had no ecg changes. the patient was initially was dobutamine and dopamine for pressor support and then later to levophed which was discontinued after 2nd hospital day. he was continued on hydrocortisone and fludrocortisone for 7 days for presumed adrenal insufficiency which was started prior to arrival to the micu. he was initially amiodarone but was stopped after 24 hours. the patient had no further cardiac arrhthymia during his micu stay. . # seizure/anoxic brain injury/stroke - most likely anoxic brain injury in setting of cardiac arrest and hypoperfusion to brain as well as later repeat mri brain on showed a new right posterior temporal/superior parietal/occipital regions, posterior to the chronic infarct, which was the culprit for seizure/twitching. he was loaded with 1gm of dilantin initially and was continued on 100mg iv q8h which achieved a good therapeutic dilantin level. his twitching improved with dilantin but still continued to have intermittent eye twitching. after 5 days of not showing any evidence of meaninful and/or purposeful responsiveness over the course of the micu stay, neuro consultant felt that his prognosis for recovery was poor. pt was continued on asa. pt was switched to po dilantin on and repeat dilantin level after 2 days of po dilantin was 12.4. continue current dilantin dosing. - free dilantin level goal of .3 to correlate with a total of 13-15. . # respiratory failure - in setting of recurrent aspiration cva, now trached and pegged. continued ventilation and aggressive chest pt and pulmonary toilet. chest tube to suction, and ip injected tpa x 4 days break up to loculation and further facilitate drainage. - pt was continue on aztreonam 1 gm q8 for e.coli pna c/b empyema during last admission, course until . sputum was also growing mrsa and started vancomycin on , last day at least . vancomycin was held on with plans for dosing by level given renal insufficiency. hold dose for level >15. - chest tube # 2 was removed on after confirming no air leak and no further drainage. repeat cxr after #2 removed showed no changes in hemopneumothorax. however, chest tube #1 continued to have air leak and drainage. the right sided chest tube was placed to water seal on with a chest xray that showed a stable pneumothorax and no significant change or worsening with re-expansion of the right lung. please continue to keep chest tube in place until there is no longer an air leak present. the chest tube may be removed at that time. please continue iv vanco and iv aztreonam for 2 additional weeks (end date ) to complete a total of a 6 wk course of abx for his empyema. please monitor daily vanco levels and give an vancomycin 1g prn for vanco trough <15. his vanco trough on day of discharge () was 22.4. . # h/o chf - ef 15%, was on afterload agents including bb, isordil, digoxin, hydralazine. initially, all were held given pressor-dependent hypotension.the patient was restarted on bb and was aggressively diuresed with iv lasix and lasix gtt. the lasix gtt was discontinued on and the patient was transitioned to lasix 100 mg iv tid and diuril 500 mg iv bid with goal -500 to 1 liter each day. in the future, this high dose of lasix may not be beneficial and consideration should be made for bumex + diuril. . # anemia- the patient required intermittent blood transfusion for drifting down hct which was partially attributed to phlebotomy. however, he had bleeding from trach site for which he underwent bronch on and showed suction trauma with granulation tissues at the carina without any active bleeding. he was given vitamin k. ip repeated bronch on which only showed slight trach displacement with was repositioned and only saw granuation tissues. he did have guaiac positive stool on but lavage from peg was negative for any coffee ground materials or blood. the patient may have swallowed blood resulting in melena. however, h2 blocker was switched to iv ppi. - his hematocrit remained low at 24 but stable with no active issues. . # h/o c diff colitis - flagyl was discontinued on arrival to the icu given its ability to lower the seizure threshold. he had no more recurrence of diarrhea and negative c. diff cultures from . . # a fib - the patient was in normal sinus rhythm on transfer. anticoagulation was held given the low hematocrit and concern for gi bleed in addition to acute stroke, ? hemorrhagic. the patient is on asa 325 mg. . # cri - cr now stable at 1.5-1.6. continue to monitor with diuresis. # f/e/n - with g tube on tube feeds, monitor lytes . # ppx - heparin sc, famotidine . # access - r sc placed -> d/c'd and changed to picc line, left femoral a-line d/c'd . # code - full . # communication - sister , ) . medications on admission: 1. digoxin 125 mcg qod 2. lansoprazole 30 mg qd 3. ascorbic acid 90 mg/ml drops 4. therapeutic multivitamin liquid qd 5. heparin sc tid 6. ferrous sulfate 300 mg/5 ml liquid qd 7. isosorbide dinitrate 10 mg tid 8. senna 8.8 mg/5 ml 9. docusate sodium 50 mg 10. hydralazine 50 mg q8 hrs 11. albuterol nebs prn 12. ipratropium nebs prn 13. metoprolol 100 mg tid 14. aspirin 325 mg qd 15. aztreonam mg iv q8h 16. flagyl 500 mg tid discharge medications: 1. senna 8.8 mg/5 ml syrup : one (1) tablet po bid (2 times a day) as needed. tablet(s) 2. mineral oil-hydrophil petrolat ointment : one (1) appl topical tid (3 times a day) as needed. 3. artificial tear with lanolin 0.1-0.1 % ointment : one (1) appl ophthalmic prn (as needed). 4. aspirin 325 mg tablet : one (1) tablet po daily (daily). 5. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 6. phenytoin 100 mg/4 ml suspension : one (1) po q8h (every 8 hours). 7. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 8. ipratropium bromide 17 mcg/actuation aerosol : 4-6 puffs inhalation q4h (every 4 hours) as needed. 9. albuterol 90 mcg/actuation aerosol : 4-6 puffs inhalation q4h (every 4 hours) as needed. 10. insulin lispro (human) 100 unit/ml solution : one (1) subcutaneous asdir (as directed). 11. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day). 12. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily). 13. famotidine 20 mg tablet : one (1) tablet po q24h (every 24 hours). 14. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 15. lorazepam 2-4 mg iv q1-2h:prn seizure 16. heparin flush midline (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 17. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 18. chlorothiazide 500 mg iv bid 19. furosemide 100 mg iv tid 20. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 21. zinc sulfate 220 mg tablet : one (1) tablet po daily (daily) for 14 days. 22. ascorbic acid 500 mg tablet : one (1) tablet po daily (daily). 23. chlorothiazide 500 mg iv bid please give 30 mins prior to lasix. 24. aztreonam in dextrose(isoosm) 1 g/50 ml piggyback : one (1) gram intravenous every eight (8) hours for 2 weeks: end date . 25. vancocin 1,000 mg recon soln : one (1) gram intravenous once a day for 2 weeks: end date . dose by levels as patient has renal failure. discharge disposition: extended care facility: - discharge diagnosis: anoxic brain injury cerebrovascular accident congestive heart failure, ef 15% empyema s/p chest tube air leak in chest tube from likely bronchopleural fistula discharge condition: poor prognosis for neurologic recovery, non-purposeful movement of eyes. does not follow commands. discharge instructions: please check dilantin level in 5 days and dose accordingly. please monitor electrolytes and creatinine with iv diuresis. please have chest tube removed once there is no air leak present. please continue iv vancomycin/iv aztreonam for 2 more additional weeks to treat his empyema. his vancomycin has been dosed by daily levels as his renal failure has required q48 hour dosing. followup instructions: please follow up with your neurologist, dr. , in 4 weeks. please follow up with your pulmonogist in 4 weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent other intubation of respiratory tract bronchoscopy through artificial stoma transfusion of packed cells infusion of vasopressor agent diagnoses: other primary cardiomyopathies acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified atrial fibrillation infection with microorganisms resistant to penicillins chronic kidney disease, unspecified paroxysmal ventricular tachycardia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure anoxic brain damage personal history of other diseases of circulatory system long-term (current) use of anticoagulants methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back pressure ulcer, heel cerebral artery occlusion, unspecified with cerebral infarction chronic respiratory failure empyema with fistula other accidents other tracheostomy complications open wound of tongue and floor of mouth, without mention of complication 

Answer: The patient is high likely exposed to