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 / metoprolol / levaquin attending: chief complaint: resp failure/hypotension major surgical or invasive procedure: intubation. left subclavian line placement. history of present illness: 89 yo m with multiple admission, with a h/o chf, af, pd, hypothyroidism, and right leg ulcer, who presents with decreased urine output and fever. pt was treated emperically with bactrim x 1 day for dysuria. he was brought to the ed today for low uo, fever, and rigors. . in the ed, vs were notable for temp to 105, bp initially sable and satting on ra. exam was unremarkable except for his ms. p was unrevealing for a source of infection. given vancomycin, flagyl, ctx. he was given 6 lns for presumed sepsis with renal failure thought dehydration. with this, he became tachypneic with rr 33, using accessory muscle for breathing. he was intubated. a left subclavian was attempted but not able to be passed. a left ij was placed with some difficulty of feeding the wire. he was briefly on levofed for a low mixed venous sat. his inital lactate was elevated to 6.3 which has decreased to 3.3. elevated k initially treated with kayexalate, d50, insulin with improvement to 3.9. a repeat abg however showed an increasing k to 5.9. pt has another episode of bradycardia to 40's, improved with 1 amp bicarb; now on d5w w/ bicarb gtt. a ct scan of chest and abd showed no intrabd process but a possible pneumonia. . the patient has been admitted twice to within the last six months. he was admitted to the on for chf and sepsis to aspiration pneumonia, requiring intubation and tube placement. his second admission occurred from for rul pna, to which he was treated with aztreonam/vanco/flagyl empirically for a 10 day course with a picc line placed. he was also transfused 2 units prbcs at that time. past medical history: 1) parkinson's disease 2) bph 3) large left hernia 4) s/p appy 5) s/p hernia repair 20 yrs ago 6) atrial fib: dx , not on coumadin, rate 80-100 7) h/o chf: tte: ra mod dil, mild symm lvh, ef 45-55%, rv fxn depression, abnl diastolic septal motion c/w rv vol overload. + ar, + mr, 3+ tr, mild pa sys htn 8) fe def anemia: baseline 28-30 9) hypothyroidism: tsh 4.6 10) cri: baseline cr 0.9-1.0 11) left leg wound: followed by dr. and dr. . last seen . exposed extensor hallicus . treated with vac dressing. 12) pna: serratia in sputum , pansensitive social history: pt lives at home with his wife and daughter. is retired construction/ engineer/ realestate man. no etoh, tobacco, or drugs. did occasionally smoke a pipe but quit greater than 20 years ago. family history: father had dm. mother died of heart disease /rythm problems. she was over 90 at her death. daughter (alive at 47) had hodgkins many years ago. physical exam: admission exam gen: awake, intubated, able to nod heent: intubated neck: left ij, flat jvp lungs: crackles bilaterally, rhonchi in upper lobes heart: rrr, l s1/s2, 3/6 sem at lsb abdomen: distneded, + bs, nontender, semireducible hernia in left inguinal area ext: r leg with wound vac, no edema skin: no rashes neuro: moves all extremities, contracted in left hand pertinent results: admission labs: 10:35pm type-mix po2-29* pco2-39 ph-7.38 total co2-24 base xs--2 10:35pm lactate-2.5* 10:35pm o2 sat-62 08:15pm type-mix po2-40* pco2-41 ph-7.34* total co2-23 base xs--3 08:15pm lactate-2.7* 08:15pm hgb-8.8* calchct-26 o2 sat-79 08:15pm freeca-1.03* 08:00pm glucose-145* urea n-103* creat-3.1* sodium-136 potassium-5.6* chloride-101 total co2-22 anion gap-19 08:00pm ck(cpk)-140 08:00pm ck-mb-6 ctropnt-0.19* 08:00pm calcium-7.7* phosphate-4.6* magnesium-2.5 08:00pm wbc-13.0* rbc-2.89* hgb-7.7* hct-24.4* mcv-84 mch-26.8* mchc-31.7 rdw-18.2* 08:00pm neuts-92.7* bands-0 lymphs-3.0* monos-4.3 eos-0.1 basos-0 08:00pm hypochrom-1+ anisocyt-2+ poikilocy-normal macrocyt-normal microcyt-1+ polychrom-normal 08:00pm plt smr-normal plt count-234 05:46pm type-art po2-101 pco2-42 ph-7.19* total co2-17* base xs--11 05:46pm lactate-3.9* k+-5.9* 04:55pm type-art po2-236* pco2-56* ph-7.13* total co2-20* base xs--11 04:55pm glucose-255* lactate-3.3* k+-5.9* 04:55pm hgb-7.6* calchct-23 02:46pm lactate-4.0* 02:37pm creat-3.3* potassium-6.1* 02:37pm wbc-18.7* rbc-2.85* hgb-7.6* hct-23.8* mcv-83 mch-26.8* mchc-32.2 rdw-18.1* 02:37pm plt count-252 11:41am lactate-6.7* k+-6.6* 11:00am pt-12.7 ptt-23.2 inr(pt)-1.1 10:20am glucose-161* urea n-118* creat-3.6*# sodium-127* potassium-8.6* chloride-93* total co2-18* anion gap-25* 10:20am alt(sgpt)-20 ast(sgot)-105* alk phos-196* amylase-42 tot bili-0.4 10:20am albumin-3.4 calcium-9.1 phosphate-4.5 magnesium-3.1* 10:20am cortisol-83.0* 10:20am crp-270.2* 10:20am wbc-20.1*# rbc-3.36* hgb-9.2* hct-28.0* mcv-83 mch-27.3 mchc-32.7 rdw-18.4* 10:20am neuts-95* bands-1 lymphs-3* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 10:20am hypochrom-normal anisocyt-1+ poikilocy-occasional macrocyt-1+ microcyt-occasional polychrom-occasional teardrop-occasional 10:20am plt smr-normal plt count-315 10:20am urine color-yellow appear-clear sp -1.013 10:20am urine blood-lg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:20am urine rbc-* wbc-0-2 bacteria-rare yeast-few epi-0-2 10:17am lactate-6.3* . discahrge labs: . microbiology: : urine culture: 10k-100000k yeast : blood culture: 2/4 bottles albicans : >25pmns <10epis, 1+ gpc, yeast . imaging: ap cxr: findings: the ett tube was pulled back with its tip now projecting 4 cm above the carina. the position of the left subclavian catheter is unchanged. the heart size is mildly enlarged, but stable. there is bibasilar consolidations most probably represent atelectasis. there is worsening of left upper lobe consolidation which could represent aspiration or developing pneumonia. there is no further pleural effusion or pneumothorax. . : ct abdomen/pelvis: impression: 1. interval development of diffuse thickening of the distal sigmoid colon and rectum with mild surrounding inflammatory fat stranding and intrapelvic fee fluid consistent with proctitis/distal colitis. these findings are most likely infectious versus inflammatory in etiology, although given the extensive atherosclerosis within the major arterial vessels, ischemia is also a consideration. 2. large left inguinal hernia containing a large segment of sigmoid colon without evidence for hernia incarceration or bowel obstruction. 3. extensive atherosclerotic disease throughout the visualized aorta and its branches. 4. extensive sigmoid-colonic diverticulosis. 5. small pleural effusions with unchanged airspace opacification at the bilateral lung bases, right greater than left, which may represent atelectasis, however, infection/infiltrate is also a consideration. . echo: the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is probably mildly depressed with inferior hypokinesis. the right ventricular cavity is mildly dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets are moderately thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is no pericardial effusion. . compared with the prior study (images reviewed) of , the degree of tricuspid regurgitation and rv dysfunction is less. brief hospital course: sepsis: the patient initially presented with severe sepsis, with lymphocytosis, hypoptension fevers, lactate of 6.3 with an anion gap acidosis, respiratory distress, and acute renal failure. the patient was given aggressive fluid resusitation (6l ns), vancomycin, ctx, and flagyl. in the ed, he was started on a levophed drip, which stabilized his bp. after 24 hours on antibiotics and fluids, his levophed drip was discontinued with good effect. moreover, his lactate returned to levels with resolution of his acidosis. he became afebrile, and his wbc returned to . blood and urine cultures grew out yeast, specifically albicans. id was consulted. he was started on voriconazole, which was switched to fluconazole on . a cxr showed a question of pneumonia, so the patient was maintained on ceftriaxone. vancomycin was d/c'd. moreover, an abdominal ct showed wall thickening in the procto-sigmoid colon. however, c. diff toxin was negative. gi was consulted, and they thought the wall thickening was consistent with proctitis secondary to watershed ischemia from his hypotension. we maintained him on flagyl, however, given a previous history of diarrhea and ? of c. diff. a prostate exam was normal, and ophthalmology ruled out optic endophthalmitis. an echo showed changes consistent with age, but no definitive vegetations or endocarditis. his exam did not demonstrate stigmata of endocarditis. on transfer to the floor, his signs of sepsis had vanished; while on the floor he remained afebrile, without leukocytosis, and clinically continued to improve. he had no signs or symptoms of infection at discharge. at discharge, the patient is on oral flucaonazole to complete a 14 day course after being on voriconazole, started on for his fungemia. he has completed a 10 day course of ceftriaxone, which was switched to po cefpodoxime on (started , completed ) for his lul pneumonia. he will complete a 14 day course of flagyl for proctitis, to be finished on . he will follow up with opthalmology in weeks. he will follow up with his pcp 1 week. . respiratory failure: the patient was found to be in respiratory failure in the ed, with a respiratory rate of 33 using accessory muscles. his failure was thought to be due to a question of pneumonia vs. chf. his respiratory status improved over 24 hours, and he was extubated on after passing a spontaneous breathing trial. he was maintained on 2-4l nc with good sats, and eventually tolerated room air well with sats in the mid to upper 90's. once his bp was stabilized, he was given intermittent lasix with good uop and improvement with his respiratory exam. on transfer to the floor, he was breathing well on room air. while on the floor he had no further significant respiratory issues, but did have some respiratory secretions. he received chest pt, nebs prn, and suctioning with good results. he was restarted on his home regimen of furosemide 20 mg qod. he maintained o2 sats >95% on room air. . acute renal failure: his admission creatinine was 3.3, well above his baseline. he also demonstrated decreased uop. after aggressive fluid resusitation, his cr improved steadily over the first 72 hours. his fena was about 1%. moreover, his admission anion gap metabolic acidosis resolved with fluids. upon transfer to the floor, his cr was at his baseline at 1.2 and he was making good uop at 50-100ml/hr. his medications were renally dosed. . bradycardia/lbbb: on admission, an ekg demonstrated a lbbb with severe bradycardia of a junctional/escape origin. this pattern resolved upon arrival to the icu. he ruled out by cardiac enzymes and did not experience this phenomenon during admission. it was thought related to his sepsis/acidosis, which resolved over the first 24 hours. an echo did demonstrate mildly depressed ef, mr , as well as changes consistent with age. . vancomycin extravasation: on , his vancomycin extravasated into his left forearm prior to being d/c'd. a welt developed around the site, and attempts at draining were unsuccessful. cool packs and elevation were administered after consultation with pharmacy. his welt showed no change over 48 hours. upon transfer to the floor, his welt was stable with no signs of necrosis. while on the floor the welt slowly improved and there were no signs of necrosis at discharge. he will follow up with his pcp for this lesion. . left leg ulcer: his ulcer was vac dressed by plastics. they changed his dressing on m-w-f without complications. he will follow up with plastic surgery after discharge. . parkinson's/hypothyroidism: controlled well with his outpatient regimen. . fen: the patient was initially hyperkalemic in the ed, likely related to his arf. his potassium responded well to kayelxalate, and returned to limits with 24 hours. he remained asymptomatic. on , he was shown to be mildly hypernatremic. it was thought to be caused by free water depletion. his free water deficit was calculated to be between 1.5l and 2l. upon arrival to the floor, he was started on 500ml free water boluses throug his q 6 hours. he remained asymptomatic and his hypernatremia resolved. he also received tube feeds through his tube without incident. he will continue on tube feeds at home to meet his nutrition needs. he was evaluated by speech and swallow. he may have pureed solids and nectar thick liquids, however, he will not be able to take enough po to meet his metabolic needs, therefore, he will take po only for pleasure. he will benefit from continued speech therapy as an outpatient. . bph: his proscar was held until when his family requested its continuation. it was restarted on . he failed a voiding trial on and again on . flomax 0.4 mg daily was started on . he will be d/c'd with a foley in place and will follow up with urology as an outpatient. . code status: the patient was full code during admission. medications on admission: bactrim ds po qday started carbidopa/levo 25/100 1 tab po tid comtan 200mg po tid mirapex 3mg po tid proscar 5mg po qam levothyroxine 12.5mcg po qam asa 81mg po qday lasix 20mg po qod prevacid 30mg po qam dss 100mg po tid alphagan 0.15% opth 1 drop os qam/pm discharge medications: 1. entacapone 200 mg tablet sig: one (1) tablet po tid (3 times a day). 2. carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po tid (3 times a day). 3. pramipexole 1 mg tablet sig: three (3) tablet po tid (3 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day). disp:*qs 1 bottle* refills:*0* 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. levothyroxine 25 mcg tablet sig: 0.5 tablet po daily (daily). 8. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 9. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 2 days: last dose 8/17. disp:*6 tablet(s)* refills:*0* 10. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 3 days: last dose 8/18. disp:*6 tablet(s)* refills:*0* 11. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day). 12. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 13. furosemide 20 mg tablet sig: one (1) tablet po qod (). 14. docusate sodium 150 mg/15 ml liquid sig: 30 ml po tid (3 times a day) as needed for constipation. disp:*qs 1 bottle* refills:*2* 15. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). disp:*30 capsule, sust. release 24hr(s)* refills:*0* 16. pantoprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 17. bedside suctioning unit bedside suction unit including yankauer, suction catheter, and suction handle. 18. albuterol-ipratropium 2.5-0.5 mg/3 ml solution sig: puffs inhalation every six (6) hours. disp:*qs 1 inhaler* refills:*2* discharge disposition: home with service facility: family & services discharge diagnosis: fungemia. pneumonia. proctitis. discharge condition: stable. discharge instructions: during this admission you have been treated for fungemia, pneumonia and proctitis. please continue to take all medications as prescribed. if you develop fever >101, worsening cough, feeling lightheaded, abdominal pain, or any other symptom that is concerning to you, please seek medical attention. followup instructions: plastic surgery clinic phone: date/time: 1:00 urology unit phone: date/time: 8:00 building, provider: ball,o.d. phone: date/time: 2:00 follow up with your pcp weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances transfusion of packed cells application of other wound dressing diagnoses: pneumonia, organism unspecified acidosis hyperpotassemia congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis unspecified acquired hypothyroidism atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease paralysis agitans acute respiratory failure septic shock other left bundle branch block iron deficiency anemia, unspecified disseminated candidiasis dehydration hyperosmolality and/or hypernatremia other specified disorders of rectum and anus venous (peripheral) insufficiency, unspecified inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) ulcer of ankle candidiasis of unspecified site 

Answer: The patient is high likely exposed to