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: vancomycin / unasyn attending: chief complaint: s/p arrest major surgical or invasive procedure: endotracheal intubation picc line placement history of present illness: 53m with recent intoxication who presented s/p fall with 30 minutes of pea arrest of unclear etiology. . reportedly, patient fell down 4 stairs and his neck became wedged face down between iron raling and fence pole. he was lifted over this. on arrival patient was noted to be weithout pulse and in pea arrest. piv access was obtained, ett tube was inserted with visualization of cords. pupils were noted to be pinpoint and 2mg narcan was admistered. pt was without pulse for 30 minutes before spontaneous regain of circulation (without acls medications). cpr was discontinued. en route, patient continued to be unresponsive. he was given 2 piv,narcan withotu improvement of ms. on arrival to osh, patient was in sr, bp 139/85, hr 87, 96% ventilator. on arrival to the osh, patient was intubated, completely unresponsive and flaccid with no reflexes in lower extremities. he was started on sedation with versed and fentanyl,which were the only medications he received prior to transfer to the micu. he was started on hypothermic protocol. he was med flighted here but was unable to continue therapeutic hypothermia on transfer. on arrival to , patient was evaluated with ct head,neck and torso. trauma evaluation included imaging of head, neck, and torso. imaging of his head neck and torso were unrevealing. have broken his nose a bit. upon return from ct resumed on hypothermic protocol, t 33.5c. etoh level of 292. pt was bolused fentanyl and vecuronium. in the ed he was biting down on the tube, but rest of his body was paralyzed. was started on propofol which relaxed pt. hr and bp have been within normal limits. fast echocardiography showed globably working heart but not a great pump. c collar is stll on, unable to remove given lack of mental status. . on arrival to the micu, pt was intubated, unarousable. family unable to be contact. review of systems: unable to obtain. past medical history: alcohol abuse prior tracheostomy in for a retropharyngeal abscess asthma social history: per family does abuse alcohol, with worsening recent intake due to his mother's death. has three daughters and is from . prior landscaper but hasn't worked in years due to back pain and alcohol family history: brother with bipolar, alcoholism in many family members, schizophrenia in sister who committed suicide (~2 years ago) and also mental health problems in mother (paranoia, aggression but no diagnosis made) who died 2 weeks prior to admission physical exam: admission physical exam: vitals unknown (not previously recorded) general: intubated, sedated, pinpoint pupils, nonresponsive heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, distended, nontender. act bowel sounds present, no organomegaly gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: not responsive, no withdrawl to pain, pupils non responsive, babinski equivocal, no twitchings, no clonus. . discharge physical exam: tmax 99.7, bp 120-135/76-85, hr 88-106, rr 8, saturation >95% ra general - alert and interactive though easily distractible heent - sclerae anicteric, mmm neck - supple, no thyromegaly, jvp difficult to assess heart - rrr, nl s1-s2, no mrg lungs - ctab, no wheezes/rales/ronchi, with upper airway lung sounds abdomen - nabs, soft/nt/nd, no masses or hsm extremities - wwp, no c/c/e, 2+ peripheral pulses, picc line on right c/d/i skin - no rashes or lesions neuro: affect, arousable, oriented to person, uses objects in the room to try to figure out the date and location, muscle strength 5/5 in bilateral upper extremities, unable to ambulate/very ataxic gait, cerebellar exam impaired, cranial nerve exam nonfocal although patient was so distractible that it was difficult to assess fully pertinent results: admission labs: 10:36pm blood wbc-8.0 rbc-4.62 hgb-14.2 hct-42.7 mcv-92 mch-30.7 mchc-33.2 rdw-14.1 plt ct-176 03:07am blood neuts-82.0* bands-0 lymphs-14.7* monos-2.6 eos-0.1 baso-0.5 10:36pm blood pt-11.4 ptt-27.3 inr(pt)-1.1 03:07am blood glucose-133* urean-12 creat-0.8 na-135 k-3.7 cl-99 hco3-17* angap-23* 03:07am blood alt-64* ast-91* ck(cpk)-257 alkphos-48 totbili-0.4 03:07am blood calcium-7.9* phos-3.3 mg-1.8 10:47pm blood ph-7.25* comment-green top 10:47pm blood freeca-1.02* 10:47pm blood glucose-137* lactate-3.3* na-138 k-3.5 cl-103 calhco3-19* . ct head neck : findings: the patient is intubated with the tip of the ventilation tube above the carina. the orogastric tube is coiled within the oropharynx and does not reach to the stomach. . ct head: the cerebral sulci, ventricles, and extra-axial csf-containing spaces have normal size and configuration. there is no shift of the midline structures. the -white matter differentiation of the brain parenchyma is well preserved, and there is no ct evidence of intracranial hemorrhage or acute ischemic infarct. no fractures are identified. mucosal thickening is involving the bilateral ethmoid and right maxillary sinus. . cta head: the intracranial internal carotid, vertebrobasilar and anterior, middle and posterior cerebral arteries are patent with normal contrast enhancement and branching pattern. there is no evidence of stenosis, occlusion, aneurysm, or arteriovenous malformation. . cta of the neck: the origins of the common carotid and vertebral arteries are patent without significant stenosis. the common, internal and external carotid arteries are normal in appearance. there is no evidence of hemodynamically significant stenosis or dissection. the cervical portions of the vertebral arteries likewise demonstrate normal contrast opacification. note is made of atelectasis involving the bilateral lung apices. impression: 1. normal ct of the head, specifically without evidence of post-traumatic hemorrhage or skull fracture. 2. normal cta of the head and neck. 3. incidental note of coiled orogastric tube in the oro- and hypopharynx. repositioning is recommended . tte : the left atrium and right atrium are normal in cavity size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is borderline pulmonary artery systolic hypertension. there is a prominent anterior fat pad with a very small pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. . ct head : 1. no acute intracranial pathology. a small hypodense focus in the right internal capsule- uncertain chronicity. if there is concern for acute infarction, an mri can be performed if not ci. 2. pansinus opacification ?(likely relates to the endotracheal intubation). the study and the report were reviewed by the staff radiologist. . cxr : 1. change in position of picc line, which may be accentuated by lordotic positioning. the tip now overlies the upper right atrium. 2. left lower lobe collapse and/or consolidation, unchanged. 3. prominence of the cardiomediastinal silhouette and vascular markings, also grossly unchanged. . cxr pa/lat: findings: as compared to the previous radiograph, there is no relevant change. no endotracheal tube. borderline size of the cardiac silhouette without pulmonary edema. no pleural effusions. no evidence of pneumonia. right-sided picc line in constant position. . mri head: findings: there is no acute intracranial hemorrhage, infarction, edema, mass or mass effect seen. the ventricles and sulci appear age appropriate. no diffusion abnormalities are seen. there is no signal abnormality on the gradient echo images. a small focus of t2 flair hyperintensity seen in the right internal capsule extending into the corona radiata likely represents an old infarct. major intracranial flow voids are preserved. there is mild mucosal thickening in the maxillary, ethmoid and sphenoid sinuses as seen on the earlier ct studies. impression: no acute intracranial abnormality. brief hospital course: mr. is a 53 year old male with alcohol abuse who was admitted after a reported pulseless arrest for 30 minutes in the field before return of circulation. he was originally transferred from outside hospital with an endotracheal tube to undergo the arctic sun cooling protocol. he completed this but the only cause for his arrest that could be found was intoxication and possible resultant hypoxia (cardiac work-up negative). he was treated for aspiration pneumonia with levofloxacin x 8 days when he developed a fever and cough with mssa in the sputum. unfortunately, he continued to have altered mental status after completion of antibiotics and resolution of acute cardiopulmonary issues. the altered mental status was determined to be anoxic brain injury. . # status post pea arrest: per the ems report, his pea arrest was in the setting of being intoxicated and falling from his porch, with his head and neck becoming stuck in the fence of his front yard. his friends and family who witnessed this said that he had already turned blue before ems arrived and that everyone had a very difficult time extracting him from the fence/porch. based on history, report of 30 minutes of cpr, no strips from the event were sent with the patient and he never received any acls medications per the documentation. on arrival he was started on the therapeutic hypothermia protocol for neurologic protection. he was cooled to 32 degrees celsius for about 16 hours and rewarmed early, as he had no evidence of renal or hepatic dysfunction, negative cardiac enzymes and his echocardiogram did not have any evidence of systolic or diastolic dysfunction, which made a primary arrest event unlikely. he was monitored on continuous eeg monitoring for over 24 hours with no evidence of seizure after rewarming and decreasing his sedation. he was started on aspirin 81 mg daily and continued on his home simvastatin 40 mg daily for ongoing cad and stroke risk modification. . # respiratory failure: patient was initially intubated by ems in the setting of a possible arrest, and initially had a p:f ratio that suggested acute lung injury, thought to be due to an aspiration event. his oxygenation improved over the next few days, but he spiked a fever and his sputum production increased along with a worsening left basilar consolidation concerning for pneumonia. his sputum culture grew out staph aureus which speciated out to mssa. he completed an 8 day course of levofloxacin for pneumonia. his mental status remained the biggest barrier to extubation, as he would become very agitated off sedation, so he was tried on precedex and prn haldol for agititation and his mental status became less agitated. he was eventually extubated and performed well off the vent. he does have significant neck thickness and snores when sleeping, has never had sleep apnea work-up. . # anoxic brain injury: when he was finally weaned off sedation and mechanical ventilation, he had altered mental status. he was manifesting symptoms of impaired attention/concentration and was hyperarousable on exam. per his family, this was a very big change from baseline mental status. his normal personality is a "big jokester," "flirt," and very lighthearted with a good memory. he underwent an mri which was negative for acute focal damage and his labs did not show evidence of electrolyte abnormalities, toxicities (besides alcohol), or infection. his tsh and b12 were normal. neurology was consulted and they felt that his symptoms were most consistent with axonal injury due to the fall and anoxic brain injury. it was too early during this hospitalization to determine how much recovery he may have. his family was given the contact information for dr. who is a traumatic brain injury and frontal lobe disinhibition specialist. his mental status on discharge was lethargic but arousable, easily distractible, only oriented to person. he was working with occupational and physical therapy to help adapt to his new baseline. . # rash: pt noted to have diffuse morbilliform rash on trunk, extremities, and face. this occured in the setting of receiving cefepime empirically for fevers (see below) and having a past history of penicillin allergy. the cefepime was changed in favor of levofloxacin which mssa was susceptible to. his rash resolved after about 3-4 days. . # aspiration pneumonia: pt spiked fevers to 101 over the day of . blood, urine, sputum all sent for culture and sputum grew out staph aureus (mssa) as well as gnr. concern for ventilator-associated pneumonia vs. sinusitis given the opacifications of his sinuses on ct. he was started on vanc/cefepime empirically until the mssa speciated. it was susceptible to levofloxacin so he was changed to monocoverage to complete an 8 day course. also continued his albuterol hfa and fluticasone inhaler for reactive airway disease. . # alcohol intoxication: he had a high level on admission (> 200) and per the family has a significant history of alcohol abuse. he was initially on propofol which would help treat withdrawal, then was managed with ativan for agitation due to concern about alcohol withdrawal. after he had been in the hospital for 4 days the benzodiazepines were discontinued, and he was transitioned to prn haldol for agitation. he did not require any medications for agitation for several days before discharge. . # cervical spine trauma: cta of his neck on admission had no evidence of fracture but he was maintained in a cervical collar until he was able to wake up to confirm whether or not he had any pain on examination. his cervical spine was cleared after extubation. . # transaminitis: very mild on admission and trended down over the next 24-48 hours, hepatitis b and c serologies were negative and it thought to be due to his alcohol abuse. . transitional issues: - please assist with alcohol/substance abuse counseling and detox - consider work-up for obstructive sleep apnea and setting up cpap. this might help with his lethargy during the day time and his asthma symptoms - please assist with physical therapy and occupational therapy medications on admission: albuterol hfa furosemide 20 mg daily tramadol 50 mg prn loratidine 10 mg daily fluticasone 110mcg ih simvastatin 40 mg daily metoprolol succinate 25 mg daily aspirin prn? discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q4h (every 4 hours) as needed for wheezing. 2. loratadine 10 mg tablet : one (1) tablet po once a day. 3. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 4. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. metoprolol succinate 25 mg tablet extended release 24 hr : one (1) tablet extended release 24 hr po daily (daily). 6. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 7. folic acid 1 mg tablet : one (1) tablet po daily (daily). 8. multivitamin tablet : one (1) tablet po daily (daily). 9. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain/fever. tablet(s) 10. polyethylene glycol 3350 17 gram powder in packet : one (1) powder in packet po daily (daily) as needed for constipation. 11. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*0* discharge disposition: extended care facility: rehab discharge diagnosis: primary diagnosis cardiac arrest due to pulseless electrical activity/hypoxia anoxic brain injury alcohol intoxication and fall aspiration pneumonia discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to the hospital because the ems team found you unresponsive and only barely breathing. there was concern that your heart had stopped or you had stopped breathing so a tube was inserted into your lungs to help breathe for you and your body was cooled to try to preserve your brain function. unfortunately, when you woke up, you were still confused and showed signs of brain injury. this is most likely because your brain was not getting enough oxygen while you were getting cpr. this is also affecting your ability to walk independently so you were sent to rehab to work on your balance again. the following changes were made to your medications: - please start taking thiamine and folate supplements. - please take a multivitamin daily - please take acetaminophen for pain - you may use miralax as needed for constipation. - please start taking aspirin 81 mg daily for stroke prevention - stop taking furosemide it is very important that you keep all of the follow-up appointments listed below. you should bring all of your medications to each appointment so your doctors update their records and adjust doses as needed. also, your family members should call dr. who is a neurologist that specializes in traumatic brain injuries. it was a pleasure taking care of you in the hospital! followup instructions: please call dr. at ( to make an appointment in the next 2 weeks. he specializes in traumatic brain injuries. while you are at rehab, the doctors at the facility will care for you. when you are ready to leave, they will help make appointments with your primary care doctor for outpatient follow-up. primary care doctor: name: , location: primary medicine, llc address: , , phone: fax: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnoses: acidosis hyposmolality and/or hyponatremia asthma, unspecified type, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus anoxic brain damage dermatitis due to drugs and medicines taken internally metabolic encephalopathy other specified antibiotics causing adverse effects in therapeutic use alcohol withdrawal acute alcoholic intoxication in alcoholism, unspecified 

Answer: The patient is high likely exposed to