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: sulfa (sulfonamide antibiotics) / nsaids / allopurinol / probenecid / hydrochlorothiazide / claritin / statins: hmg-coa reductase inhibitors attending: chief complaint: unresponsiveness, intracranial thalamic hemorrhage major surgical or invasive procedure: intubation, mechanical ventilation 4/15 peg/tracheostomy history of present illness: 69m experienced right sided weakness, aphasia and headache at home. found to have left thalamic intraparenchymal hemorrhage. from medicine admission note, : in brief, 69 yo m with htn, cad s/p ppm, ckd, osa who presented on to an osh after a sudden fall and found to have a large intraparenchymal hemorrhage thought to be due to a hypertensive bleed. he was at an outside hospital and intubated for airway protection and transferred to the . he was in the neurologic icu and extubated on but had difficulty clearning his secretions and was reintubated. he ultimately needed a trach and peg and was taken off the ventilator a couple of days ago. he was febrile on to 101 and was found to have urine with pseudomonas and enterococcus. he was started on vancomycin and zosyn. a bal was done and shows 3+ gnr but the culture then grew oral flora. c diff was negative x 2, bcx have been negative. <br> his course was also complicated also by acute on chronic renal insufficiency. nephrology was consulted and thinks this is atn and some volume depletion. he may need renal replacement therapy in the future but is stable now. past medical history: osa hypertension gout stage iii-iv ckd (baseline creatinine unclear, 3.3 on admission) vasovagal syncope s/p pcm placement di s/p removal of pituitary adenoma cad social history: pt was residing at home with his wife. family history: non-contributory physical exam: (at time of transfer to medicine) vs: t 96.9 hr 65 bp 144/55 rr 16 sats i/os 2500/1500 (los +12l) gen: mildly agitated, but tracking & responding to most commands heent: ncat. op clear, mmm. face cachectic appearing neck: supple, fresh trach in place cv: rrr, occaisional pvc heard chest: trach in place, mildly tachypnea, though ctab, no rales, wheezes or rhonchi. abd: obese, soft, active bs, g-tube site mildly tender ext: body swollen, especially les neuro: right sided hemiparesis. with flexed rle. squeezes hand to command. perrla, right eye down and inward. spontaneous movement on left limbs. toes up on right. . on day of discharge: vs: tm 100.0f, tc 98.6f, hr 92, range 62-100, bp 134/74, range 134-168/71-80 gen: mildly agitated, but tracking & responding to most commands heent: ncat. op clear, mmm. face cachectic appearing neck: supple, fresh trach in place cv: rrr, occaisional pvc heard chest: trach in place, diffuse rhonchi abd: obese, soft, active bs, g-tube site mildly tender ext: trace edema neuro: right sided hemiparesis. follows commands inconsistently. with flexed rle. squeezes hand to command. perrla, right eye down and inward. spontaneous movement on left limbs. toes up on right. opens eyes to voice. withdraws to pain in all extremities except right upper extremity. pertinent results: ecg: atrial paced rhythm. right bundle-branch block with left anterior fascicular block. non-specific st-t wave changes. no previous tracing available for comparison. . cxr: 1. et tube has its tip approximately 59 mm from the carina. the ng tube has its tip in the distal esophagus and should be advanced further. 2. cardiomegaly with atelectasis in the right mid zone. . ct head: 1. large intraparenchymal hemorrhage centered within the left thalamus with mild surrounding edema and associated mass effect as described above. there is intraventricular extension, with no evidence for development of hydrocephalus. 2. air-fluid levels in the paranasal sinuses, likely secondary to intubation. 3. ng tube is coiled within the posterior nasopharynx. . ecg: atrial fibrillation with occasional ventricular paced beats. left bundle-branch block with left axis deviation. non-specific st-t wave abnormalities. compared to the previous tracing of atrial fibrillation and ventricular pacing appear new. atrial pacing is no longer seen. . ct head: unchanged large left thalamic intraparenchymal hemorrhage with surrounding vasogenic edema and mass effect compressing the mid brain, with significant compression of the left cerebral peduncle. intraventricular extension is unchanged. unchanged coiled appearance of the nasogastric tube in the posterior nasopharynx as previously indicated. however, if there is concern for acute infarction as a cause for the new symptoms, mr is more sensitive and ideal to be performed. . portable cxr: radiograph centered at the thoracoabdominal junction was obtained for assessing nasogastric tube, which has been advanced into the stomach. within the imaged portion of the chest, there has been improved aeration at the lung bases with resolution of atelectatic changes. . : atrial fibrillation with ventricular premature beats or beats. intraventricular conduction delay. diffuse non-specific st-t wave abnormalities. compared to the previous tracing ventricular pacing is no longer noted. clinical correlation and repeat tracing are suggested. . : portable cxr: lungs are grossly clear. mild cardiomegaly is unchanged. dual-lead left chest wall cardiac pacemaker wires follow expected course. nasogastric tube tip is in the stomach. interval removal of the endotracheal tube. . ct c-spine: there is no malalignment or loss of vertebral body height. degenerative changes are seen from c3 through c6, but no significant stenosis is identified. there is no definite fracture seen. there is a possible hypodense nodule in the left thyroid lobe measuring approximately 13 mm. this can be assessed with ultrasound when the patient is stable. . ct head: relatively stable left thalamic hematoma. . cxr: 1. no evidence of acute pneumonia. unchanged cardiomegaly. 2. tip of ng tube likely in the distal esophagus. recommend advancing 10 cm for optimal placement. . carotid dopplers :no evidence of hematoma along the right aspect of the neck. no evidence of arteriovenous fistula or pseudoaneurysm of the right carotid artery. . cxr portable: in comparison with the study of , there is a huge amount of subdiaphragmatic air consistent with the recent peg placement. continued moderate cardiomegaly in patient with dual-channel pacer device in place. tracheostomy tube is in good position. mild suggestion of some air bronchogram in the retrocardiac region. this could be a manifestation of an early developing consolidation. . renal ultrasound: echogenic kidneys consistent with medical renal disease. large simple cyst on the right. no hydronephrosis or evidence of obstruction. bladder not well evaluated. . cxr portable: in comparison with the study of , there has been some decrease in the free intraperitoneal gas, though somewhat less than would be expected. has the patient had any interval abdominal surgery or a continued air leak? there is increased opacification at the left base with silhouetting of the hemidiaphragm and poor visualization of the descending aorta. in view of the clinical appearance, the possibility of pneumonia at the left base must be seriously considered. the costophrenic angles are poorly seen and small pleural effusions may be present bilaterally. tracheostomy tube remains in place, as does the dual-channel pacemaker. . right upper extremity ultrasound: negative for right upper extremity clot. . laboratories: please see attached. . microbiology: 10:25 am blood culture a-line. (thought to be contaminant) **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. isolated from one set only sensitivities performed on request.. aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. reported by phone to dr heard @ 10:04 am. 10:56 am urine source: catheter. order changed p/ ,md 2106 . **final report ** urine culture (final ): pseudomonas aeruginosa. >100,000 organisms/ml.. enterococcus sp.. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | enterococcus sp. | | ampicillin------------ <=2 s cefepime-------------- 4 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- 8 s piperacillin/tazo----- <=4 s tetracycline---------- =>16 r tobramycin------------ <=1 s vancomycin------------ <=1 s 3:18 pm bronchoalveolar lavage gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci in pairs. respiratory culture (final ): heavy growth oropharyngeal flora. enterobacter aerogenes. 10,000-100,000 organisms/ml.. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter aerogenes | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 3:18 pm bronchoalveolar lavage right lung. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and chains. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): heavy growth oropharyngeal flora. enterobacter aerogenes. 10,000-100,000 organisms/ml.. identification and sensitivities performed on culture # (). fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 12:31 pm urine source: catheter. **final report ** urine culture (final ): yeast. ~7000/ml. probable enterococcus. ~1000/ml. 4:54 am urine source: catheter. **final report ** urine culture (final ): yeast. >100,000 organisms/ml.. all other cultures were negative brief hospital course: mr. is a 69 year old right handed male with hypertension, chronic renal insufficiency (baseline creat 3.0-3.3), diabetes, atrial fibrillation s/p pacemaker, presenting with acute onset of right sided weakness and decreased responsiveness, found to have left thalamic hemorrhage. . brief hospital course (neurology/sicu): - admitted from ed, intubated and sedated. over night had pupillary asymmetry that resolved. head ct showed no acute change. - extubated, unable to obtain mri to clear c-spine due to pacemaker, ngt placed and po antihypertensive meds started - remained in icu for bp control, frequent pvcs / 4-6 beat runs of ventricular tachycardia, replaced a-line, started tube feeds - requires nicardipine drip intermittently, hypernatremia worsened, urine osmol sent, increased free water bolus via ngt. - hypernatremia evaluated by endocrine, ruled out di based on elevated urine osmolality. increased free water enteral and iv. no acute events. - failed speech and swallow evaluation, metoprolol and clonidine increased, off nicardipine drip .- no acute events - c-spine cleared by ct. trach and peg performed at bedside. - goal tfs via peg, trach --> secretions, chest pt. bp labile (120 - 180s), neuro q4hrs - transferred to medical service . brief hospital course by problem (neuro/sicu): . #) neurology: ct with left thalamic hemorrhage and surrounding edema, trace amount of blood layering in the posterior of the left lateral. etiology of stroke was likely hemorrhagic. he was admitted to neuro-icu; bp was initially controlled on nicardipine drip; sbp:120-160. repeated ct head showed stable hemorrhage. cholesterol profile: 151/ ldl 100, trig 123. he was started on aspirin 1 week after the stroke . #) cardiology: atrial fibrillation; off coumadin (not on coumadin on presentation); rate controlled. s/p pacer. . #) resp: s/p trach on because of excessive secretions. chronic aspiration. . #) gi: s/p peg on . on tube feeds with free water boluses. id: started zosyn and vancomycin renally dosed on for fever, empirically as pt spiked fever; now off fever for the past 24h; aspiration pneumonia, uti. . #) renal: patient was hypernatremic initially in icu; corrected slowly with d5w; sodium level is normal at the time of transfer to medicine. he had acute on chronic renal failure on (baseline 3.2 and now 4.8) in the setting of infection. iv fluids were increased to ns @ 100ml/h. off lisinopril since . fena: 0.8. nephrology was consulted. . #) heme: slow and continous drop h/h; multifactorial (slowly dropping ht 34 initially; now 25). guaiac negative. see assessment below. . #) infectious disease. bal performed after trach, grew pan-sensitive enterobacter. started on vanco/zosyn . urine grew pseudomonas and enterococcus. hospital course by problem (from , by medicine service): assessment: mr. is a 69 year old man with hypertension, cad s/p pacemaker, chronic kidney disease (creatinine 3.0), and obstructive sleep apnea admitted after left thalamic hemorrhage (stable) secondary to hypertension, with icu and floor admission thus far complicated by uti, ?pneumonia (bal growing enterobacter), acute on chronic renal failure (now resolving), and hypertension. called out from neuro icu. <br> #) low-grade fever: had enterobacter pneumonia (from bal) and enterococcus and pseudomonas uti (treated with zosyn). fever persists, but less frequent and lower grade. source likely pneumonia (given increased secretions and findings on chest x-ray with low-grade fevers) vs. chronic aspiration. currently on zosyn, course to finish on . white blood cell count stable. right upper extremity ultrasound showed no clot. urine culture grew yeast, likely colonization. please monitor fever curve, wbc count; culture if spikes. please use condom catheter instead of indwelling foley to minimize infection risk. course (14-days) of zosyn to complete on . <br> #) anemia. hematocrit has been slowly trending down since admission. received a total of two units of prbc's ( and ). likely multifactorial: acute blood loss (from recent peg placement or other ugi source), poor production given acute illness, chronic renal insufficiency, loss from frequent blood draws. guaiac negative, but with gastroccult positive residual on , now resolved. continue to guaiac stools, on ppi, started epo 20,000 units per week, transfuse to keep hematocrit over 21%. <br> #) acute on chronic renal failure: baseline cri and creatinine of ~3. bun/creatinine steadily rose in house with peak uremia of 123/4.8. likely prerenal etiology +/- atn, continues to have excellent urine output. renal is following. currently creatinine trending down (93/3.9) today. renal ultrasound showed no evidence of hydronephrosis or obstruction. unclear if creatinine today (3.8) represents new baseline or if will continue to downtrend. continue sodium bicarbonate for acidosis and monitor sodium levels (hypernatremic). monitor lytes closely; renally dose medications; avoid nephroxin. on epoietin. will need renal follow up (has nephrologist at ) in weeks after discharge. <br> #) eye discharge. continue erythromycin ointment x 5 days, last day is . <br> #) hypernatremia. resolved. continue free water boluses with tube feeds, at 300cc q3h. <br> #) hemorrhagic stroke: left thalamic hemorrhage with surrounding edema likely secondary to hypertension. appreciate neurology recommendations. goal sbp is between 130-160. continue current antichypertensive regimen: clonidine, doxazosin, diltiazem (90mg q6h), metoprolol; holding lisinopril because of renal failure. started amlodipine on with good results on blood pressure. continue aspirin. monitor blood pressure; can go up on amlodipine if need additional blood pressure control. needs neurology follow up in weeks after discharge (number of neurology clinic in discharge paperwork). <br> #) atrial fibrillation: no warfarin given bleed. rate controlled currently. continue telemetry, metoprolol, diltiazem (ppm in place), aspirin. <br> #) cad: continue metoprolol, aspirin. allergy to statins. holding acei given renal failure. <br> #) respiratory: trach to humidified oxygen currently. continue aspiration precautions, pulmonary toilet. aspiration precautions. <br> #) f/e/n: tube feeds. monitor lytes, continue free water boluses, at 300ml q3h.<br> <br> #) ppx: heparin sq for dvt ppx, no bowel reg given diarrhea (but give as needed). ppi. <br> #) code: dnr, but okay to intubate (given trach), confirmed with wife on . hcp is wife (form in chart). <br> #) communication. wife : (home), (work) <br> #) dispo. needs aggressive pt/ot. confirm pneumovax status: received pneumovax. will need renal, neuro, and pcp follow up upon discharge. medications on admission: nephrocaps, vit d 50,000 weekly, aspirin 325mg daily, colcicin 0.6 prn gout, methylphenidate 60mg po tid, zoloft 25mg daily, lisinopril 40mg daily, atenolol 100mg, cardura 16mg daily, cardizem cd 240mg, catapress=ttx3 clonidine transdermal patch weekly mvi, kentoconazonle cream, androgel daily discharge medications: 1. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 2. piperacillin-tazobactam 2.25 gram recon soln : one (1) recon soln intravenous q8h (every 8 hours) for 6 days. 3. erythromycin 5 mg/g ointment : one (1) application (0.5 inch) ophthalmic qid (4 times a day) for 2 days. 4. diltiazem hcl 90 mg tablet : one (1) tablet po q6h (every 6 hours). 5. amlodipine 5 mg tablet : one (1) tablet po hs (at bedtime). 6. clonidine 0.3 mg tablet : one (1) tablet po three times a day. 7. hydralazine 25 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for sbp > 160. 8. doxazosin 4 mg tablet : four (4) tablet po hs (at bedtime). 9. metoprolol tartrate 50 mg tablet : three (3) tablet po tid (3 times a day). 10. epoetin alfa 20,000 unit/2 ml solution : one (1) injection injection once a week. 11. sodium bicarbonate 650 mg tablet : one (1) tablet po bid (2 times a day). 12. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. 13. colace 50 mg/5 ml liquid : five (5) ml po twice a day as needed for constipation. 14. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 15. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 16. aspirin 325 mg tablet : one (1) tablet po daily (daily). 17. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed. 18. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 19. insulin lispro 100 unit/ml solution : one (1) sub q injection subcutaneous asdir (as directed): per sliding scale (attached). discharge disposition: extended care facility: - discharge diagnosis: primary: - left thalamic intra-parenchymal hemorrhage - hypertension - acute on chronic kidney disease secondary: - atrial fibrillation s/p pacemaker placement - coronary artery disease discharge condition: stable, with low-grade temperatures. satting 100% on trach mask. intermittently follows commands. blood pressures have been ranging 120-160 systolic. discharge instructions: you were admitted after an intracranial hemorrhage in an area of the brain called the thalamus, which resulted in a stroke. your hospital course was complicated by worsening kidney function, which has partially resolved, a urinary tract infection, and pneumonia, both of which are being treated with an antibiotic. you are being discharged to for further occupational and physical therapy to rehabilitate from the stroke. . please take all of your medication as prescribed. your doctors at rehab arrange follow up with your nephrologist at , a neurologist (dr. at , and your primary care doctor as needed. followup instructions: - follow up with pcp (dr. ) as appropriate - follow up with neurology (dr. , ph ) as appropriate, ? 4-6 weeks after discharge from - follow up with nephrology (patient has a nephrologist at hospital who has known him for a long time), as appropriate procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: obstructive sleep apnea (adult)(pediatric) pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation intracerebral hemorrhage compression of brain pneumonitis due to inhalation of food or vomitus cerebral edema hyperosmolality and/or hypernatremia pseudomonas infection in conditions classified elsewhere and of unspecified site right bundle branch block and left anterior fascicular block 

Answer: The patient is high likely exposed to