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: amoxicillin attending: chief complaint: sepsis major surgical or invasive procedure: a-line femoral triple lumen line history of present illness: year old male with warm hemolytic anemia on chronic prednisone 10mg, gi bleeds, af with , chf with ef 45%, listeria endocarditis, mechanical avr on coumadin, ckd stage iii, presenting from nursing facility with complaints of tachycardia, fever, abdominal pain. the onset was 3 days prior; due to the patient's poor baseline mental status and intubation, limited history was obtained from the patient. . it was noted per ems notes that the patient was found in rehab with evidence of svt in 160s, sbp in 120s, got 6 of adenosine responded with 10 sec pulse (90-100 bp) intermittent hypotension, otherwise no localizing symptoms despite the patient's subjective complaints of abdominal pain. on arrival to the ed, he was noted to be febrile to 105, on a non-rebreather. ct of torsal showed bil infiltrates, consistent with aspiration pna. ekg: svt, 160, no appreciable ischemic changes. he was intubation with etomidate and succinylcholine, first pass with bougie, 7.5 tube that is at 22 at the lips. phenylephrine used in the peri-intubation for goal systolic blood pressure greater than 120, given fentanyl, versed. abx were targetting hcap: cefepime, vancomycin, levofloxacin. recieved 2l of ivf. has a 20-gauge peripheral, right-sided picc central access - r groin. after these intervention, pt's hr down to 90 (regular, sinus) and sbp approx 100-120. admitted to micu for sepsis/pna complicated by svt that has currently resolved. of note, micu was asked to need to pull picc and culture tip as a potential additional source of infection. ed was unable to pass the foley despite 3 attempts. urology consult as an inpatient was recommanded by the ed. . on review of transfer notes, picc line was last changed on (changed weekly), zinc oxide to butt, lotrisone to foot. he was last transfused on with prbc hct of 24.6 on . he has been complaining of abdominal pain for the past week treated with maalox and simethicone. he had vs: temp of 102 axillary; hr 164; bp 115/81; rr 26; 86% ra 92% 2l. . past medical history: # anemia, multifactorial as below, baseline hct 28 # autoimmune hemolytic anemia (coomb's +, warm autoantibody), on prednisone 10mg po daily # listeria endocarditis s/p avr, suppressive amoxicillin stopped due to hemolytic anemia # aortic mechanical valve, recently coumadin resistant so intermittently on lovenox bridge, followed by dr. # hx recent gi bleeds: colonoscopy : noted normal colon with melanotic stool in terminal ileum # gerd: egd polyp in the area of the papilla; found on the wall opposite the ampulla. small hiatal hernia. otherwise normal egd to third part of the duodenum. # h/o presyncope # ckd cr 1.6-2.0 stage iii # cad s/p nstemi # chronic chf, likely diastolic, ( ef=50%) # hyperlipidemia # hypertension # depression vs adjustment disorder after death of brother # prostate cancer- s/p radiation # bladder/bowel incontinence # right lateral malleolus stage 1 pressure ulcer # dementia # hypothyroidism social history: never smoked, no etoh or other drugs. currently living at rehab. uses wheelchair typically. requires assistance in all his adls and iadls. has 2 sons and 4 grandchildren family history: no bleeding diatheses or heart disease. father had stomach cancer. no other cancers including colon. physical exam: vitals: t:98.5 bp:93/47 p:76 r: 18 o2: 98% vent general: intubated heent: sclera anicteric, mmm, oropharynx clear neck: supple lungs: ctab, no w/r/c anteriorly. cv: regular rate and rhythm, normal s1, pronounced s2, no murmurs, rubs, gallops. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding. gu: no foley, blood around the scrotum. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: at admission: 10:19pm urine hours-random urea n-329 creat-97 sodium-20 potassium-43 chloride-17 10:19pm urine osmolal-378 10:19pm urine color-red appear-cloudy sp -<1.005 10:19pm urine blood-lg nitrite-pos protein->300 glucose-neg ketone-tr bilirubin-sm urobilngn-0.2 ph-5.0 leuk-neg 10:19pm urine rbc->182* wbc->182* bacteria-none yeast-none epi-0 10:19pm urine eos-negative 09:15pm glucose-121* urea n-35* creat-1.8* sodium-136 potassium-4.4 chloride-103 total co2-21* anion gap-16 09:15pm alt(sgpt)-41* ast(sgot)-50* alk phos-79 tot bili-0.5 09:15pm albumin-2.9* calcium-7.6* phosphate-2.6* magnesium-2.2 09:15pm wbc-15.3* rbc-3.75* hgb-12.0* hct-35.0* mcv-93 mch-32.0 mchc-34.3 rdw-20.8* 09:15pm plt count-106* 09:15pm pt-24.2* ptt-41.5* inr(pt)-2.3* 09:14pm type- po2-34* pco2-47* ph-7.31* total co2-25 base xs--2 09:14pm lactate-2.9* 05:55pm type- po2-40* pco2-43 ph-7.39 total co2-27 base xs-0 05:55pm lactate-1.8 05:30pm glucose-112* urea n-34* creat-1.5* sodium-138 potassium-4.0 chloride-106 total co2-24 anion gap-12 05:30pm alt(sgpt)-40 ast(sgot)-41* ck(cpk)-61 alk phos-75 tot bili-0.4 05:30pm ck-mb-6 ctropnt-0.21* 05:30pm albumin-2.9* calcium-7.4* phosphate-2.2* magnesium-2.2 05:30pm wbc-15.2* rbc-3.70* hgb-12.0* hct-34.4* mcv-93 mch-32.4* mchc-34.8 rdw-19.9* 05:30pm neuts-78* bands-1 lymphs-10* monos-7 eos-1 basos-0 atyps-1* metas-2* myelos-0 05:30pm hypochrom-normal anisocyt-2+ poikilocy-occasional macrocyt-2+ microcyt-normal polychrom-normal ovalocyt-occasional 05:30pm plt smr-low plt count-119* 05:30pm pt-24.8* ptt-37.9* inr(pt)-2.3* 03:15pm type-art rates-16/ tidal vol-500 o2-100 po2-353* pco2-36 ph-7.43 total co2-25 base xs-0 aado2-323 req o2-59 -assist/con intubated-intubated 12:16pm lactate-1.7 12:00pm glucose-106* urea n-32* creat-1.4* sodium-137 potassium-4.1 chloride-105 total co2-25 anion gap-11 12:00pm estgfr-using this 12:00pm alt(sgpt)-11 ast(sgot)-16 alk phos-69 tot bili-0.6 12:00pm ctropnt-0.07* 12:00pm calcium-7.5* phosphate-2.1* magnesium-2.3 12:00pm wbc-11.7*# rbc-3.74* hgb-12.1* hct-34.6* mcv-93 mch-32.4* mchc-35.0 rdw-20.8* 12:00pm neuts-82* bands-0 lymphs-5* monos-12* eos-0 basos-0 atyps-1* metas-0 myelos-0 12:00pm hypochrom-normal anisocyt-2+ poikilocy-occasional macrocyt-2+ microcyt-normal polychrom-occasional ovalocyt-occasional stippled-occasional 12:00pm plt smr-low plt count-89* 12:00pm pt-28.0* ptt-34.6 inr(pt)-2.7* micro: blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient sputum gram stain-final; respiratory culture-final inpatient urine legionella urinary antigen -final inpatient urine urine culture-final inpatient catheter tip-iv wound culture-final inpatient blood culture blood culture, routine-preliminary {enterococcus faecalis}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final inpatient blood culture blood culture, routine-preliminary {enterococcus faecalis, enterococcus faecalis}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final emergency blood culture blood culture, routine-final {enterococcus faecalis}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final emergency 12:20 pm blood culture right picc #2. blood culture, routine (preliminary): enterococcus faecalis. final sensitivities. high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: susceptible to 1000mcg/ml of streptomycin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details.. sensitive to daptomycin mic = 1.0 mcg/ml, sensitivity testing performed by etest. enterococcus faecalis. second morphology. sensitive to daptomycin @ 0.5 mcg/ml, sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecalis | enterococcus faecalis | | ampicillin------------ <=2 s daptomycin------------ s s linezolid------------- 1 s penicillin g---------- 1 s vancomycin------------ =>32 r anaerobic bottle gram stain (final ): reported to and read back by @ 1030pm . gram positive cocci in pairs and chains. aerobic bottle gram stain (final ): gram positive cocci. in pairs and chains. tte the ge junction was not crossed. propofol sedation. left atrium: no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. good (>20 cm/s) laa ejection velocity. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: depressed raa ejection velocity (<0.2m/s). no asd by 2d or color doppler. aorta: simple atheroma in aortic arch. simple atheroma in descending aorta. aortic valve: mechanical aortic valve prosthesis (avr). no masses or vegetations on aortic valve. no aortic valve abscess. trace ar. mitral valve: mildly thickened mitral valve leaflets. no mass or vegetation on mitral valve. moderate to severe (3+) mr. tricuspid valve: no mass or vegetation on tricuspid valve. physiologic tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. the patient was monitored by a nurse in throughout the procedure. local anesthesia was provided by benzocaine topical spray. the patient was sedated for the tee. medications and dosages are listed above (see test information section). no glycopyrrolate was administered. no tee related complications. the rhythm appears to be atrial fibrillation. results were personally reviewed with the md caring for the patient. conclusions no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. the right atrial appendage ejection velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. simple atheroma are seen in the aortic arch and descending thoracic aorta to 35 cm. a well-seated mechanical aortic valve prosthesis is present.trace aortic regurgitation is seen (normal for this prosthesis). no masses, vegetations or abscess are seen on the aortic valve. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. moderate to severe (3+) mitral regurgitation is seen. impression: well-seated mechanical aortic valve prosthesis trace aortic regurgitation and no discrete vegetation or abscess. no evidence for valvular mass or vegetations. moderate to severe mitral regurgitation. le ultrasound technique and findings: there is a diminutive right internal jugular vein which does demonstrate some flow on spectral imaging. the right subclavian vein is patent along its course. there is thrombosis of the right axillary vein with a distended hypoechoic lumen, which does not compress. the right brachial vein is also filled with hypoechoic thrombus, but some flow is seen through this. the right basilic and cephalic veins are normal without evidence of thrombus. normal flow is seen in the left subclavian vein. impression: occlusive thrombus in the right axillary vein, with non-occlusive thrombus in the right brachial vein. the finding of right upper extremity dvt was discussed with dr. by phone at 10 a.m. cta chest, abd, pelvis findings: chest cta: opacification of the pulmonary vasculature demonstrates no filling defects to suggest a pulmonary embolus. the aorta is without evidence of dissection. atherosclerotic calcifications are visualized throughout the aortic arch. otherwise, the aorta is within normal limits. great vessels are within normal limits. coronary artery calcifications along with mitral and aortic annulus calcifications are noted. there are bibasilar opacities, greater on the left than the right, suggestive of aspiration. otherwise, the airways are patent to the subsegmental levels and the lungs are without evidence of other consolidations, effusions, or pneumothorax. no hilar, mediastinal, or axillary lymphadenopathy by ct size criteria. ct of the abdomen with iv contrast: hypodensities are visualized throughout the spleen and may be representative of contusions or infarctions. otherwise, the liver, stomach, visualized loops of small and large bowel, pancreas, and bilateral adrenal glands are within normal limits. the kidneys appear atrophic with surrounding stranding suggestive of medical renal disease. no free fluid or free air throughout the abdomen. atherosclerotic calcifications are visualized throughout the abdominal aorta, but the aorta is of normal caliber and contour. ct of the pelvis with iv contrast: large amount of stool is visualized in the sigmoid colon and rectum. otherwise, the visualized loops of sigmoid colon are within normal limits. the bladder is normal. brachytherapy seeds are again visualized within the prostate. there is no pelvic or inguinal lymphadenopathy. no free fluid or free air throughout the pelvis. surgical clips are visualized along bilateral external iliac arteries. osseous structures: no suspicious lytic or sclerotic osseous lesions. degenerative changes are visualized throughout the thoracolumbar spine. old compression deformities are again visualized involving l1 and l4. there are compression fracture involving l3 and l5, which are new in comparison to prior study from , but likely not acute. additionally, there is a left 10th posterior rib fracture which is also new from , but of unknown chronicity. impression: 1. no evidence of pulmonary embolism or dissection. 2. hypodensities are visualized throughout the spleen and may be representative of contusions or infarctions. no evidence of free fluid or air in the abdomen. 3. there is a left 10th posterior rib fracture, adjacent to the spleen, which is also new from but of unknown chronicity. 4. old compression deformities are again visualized involving l1 and l4. there are compression fracture involving l3 and l5, which are new in comparison to prior study from . 5. bibasilar lung opacities, raising the possibility of aspiration pneumonia. ekg sinus rhythm. slight left axis deviation. right bundle-branch block. non-specific st-t wave abnormalities. compared to the previous tracing right bundle-branch block is once again present. the other findings are similar. tracing #1 cxr final report indication: sepsis, evaluate tube placement. comparison: . findings: a single portable supine view of the chest was obtained. low lung volumes result in bronchovascular crowding. the endotracheal tube ends 4.0 cm above the carina. an orogastric tube follows the expected course, although the tip is not seen. a right picc ends in the lower svc. there is no focal consolidation, pleural effusion, or pneumothorax. cardiac and mediastinal silhouettes are stable with aortic knob calcifications. impression: endotracheal tube ends 4 cm above the carina. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sat 3:49 pm final report indication: -year-old man with worsening renal function. please assess for obstruction or vascular disease. technique: grayscale and color doppler ultrasound images of both kidneys were obtained. comparison: ct of the torso from . findings: the right kidney measures 11.8 cm, the left kidney measures 11.1 cm without evidence of hydronephrosis, obstructing stones or masses. the resistive indices of the right kidney range from 0.73 to 0.84 and the left kidney from 0.72 to 0.80. no parvus tardus . the main renal artery and main renal vein are patent. impression: 1. no hydronephrosis. 2. patent vasculature without signs of renal artery stenosis. the study and the report were reviewed by the staff radiologist. indication: -year-old man with warm hemolytic anemia on chronic prednisone with gi bleed, atrial fibrillation with , status post traumatic foley placement with stool coming out of the foley catheter. technique: mdct images were acquired through the pelvis without iv contrast. after an initial non-contrast examination, 300 cc of iodinated contrast was injected into the foley catheter. the partially imaged abdomen shows an unremarkable lower pole of both kidneys and unremarkable small and large bowel loops. no abdominal free fluid or free air is present. ct of the pelvis with iv contrast: contrast fills the bladder completely as well as numerous mural trabeculations consistent with a " tree" appearance related to a neurogenic bladder. air within the bladder is likely related to foley insertion. small amount of extraluminal contrast is noted in the prostatic urethra with increased contrast also noted inferiorly at the anal verge. no evidence of a frank leak is noted, although evaluation of the rectal lumen is limited due to a large amount of stool within it. no pelvic or inguinal lymphadenopathy or pelvic free fluid is present. the sigmoid colon is unremarkable. osseous structures: the visible osseous structures show no suspicious lytic or blastic lesions or fractures, although compression fractures of the l5 and l4 vertebral bodies are unchanged compared to the previous examination. also noted is mildly increased sclerosis of the femoral heads of uncertain significance. impression: extraluminal contrast surrounds the prostatic urethra suggesting a leak at that location. the study and the report were reviewed by the staff radiologist. dr. dr. approved: 11:58 pm ct head noncontrast findings: exam is severely limited by motion artifact. however, no gross evidence of intracerebral hemorrhage is seen. the ventricles are slightly dilated out of proportion to the sulci which may suggest normal pressure hydrocephalus or could be compatible with central aprenchymal volume loss and more conspicuous from prior. no edema or shift of normally midline structures is noted. no suspicious osseous lesions are noted. the mastoid air cells are normal. there is mild mucosal thickening within the maxillary, ethmoidal and sphenoidal sinuses. this may relate to recent endotracheal intubation. impression: the examination is limited by motion; however, no gross intracerebral hemorrhage is seen. prominence of the ventricles could represent normal pressure hydrocephalus or central parenchymal volume loss. correlate clinically and followup. the study and the report were reviewed by the staff radiologist. brief hospital course: year old male with warm hemolytic anemia on chronic prednisone 10mg, gi bleeds, af with , chf with ef 45%, listeria endocarditis, mechanical avr on coumadin, ckd stage iii, presenting from nursing facility with complaints of tachycardia, fever, abdominal pain found to have aspiration pna c/b svt. he was treated for enterococcal bacteremia and pneumonia, but eventually died on from shock of unclear etiology. see below for details of his hospitalization: # pulmonary: patient was initially intubated as below, then reintubated on for difficult to manage secretions. conversation was had with son on and decision was made that patient would likely want to proceed to tracheostomy/peg tube. ip was consulted though he destabilized prior to evaluation and intervention. # septic shock: he was initially intubated and required vasopressors for septic shock and atrial fibrillation. on intake, he was found to have aspiration pneumonia and gram positive bacteremia which speciated to enteroccocus. he was initially placed on linezolid/cefepime, this was switched to daptomycin for a planned 6 weeks course from through . he completed a course of levaquin for pneumonia. he had a tee which did not show endocarditis. picc line was placed on . his urine output began to decrease during the early morning of , though he remained normotensive until mid-morning, when he developed hypotension followed by profound bradycardia culminating in asystole/pea. he was subsequently coded and developed a vt which was defibrillation responsive. suspecting an acidosis or hyperkalemic-induced wide-complex tachycardia, she was given aggressive bicarbonate and calcium boluses. his pulse returned. laboratories revealed profound lactic acidosis. the difficult prognosis was discussed with his son, who elected to not further escalate care and changed code status to dnr. the patient was sustained on pressors and bicarbonate gtt until another son arrived from . he later passed away with his family at the bedside. the cause of his decompensation remains unclear, but may be related to worsening septic shock or possible cardiogenic shock from sudden mi. # atrial fibrillation: initially in the icu went into afib with to the rate of 170s, given adenosine 6mg, then given amio load, then amio gtt, on levophed and vasopressin for hypotension which were quickly weaned to off. an ng tube was placed on and his beta-blocker was restarted # dvt: axillary/brachial vein dvt on the right was found, likely due to prior picc which had been initially pulled. he was maintained on heparin/coumadin as below. # uretheral perforation: due foley placement in ed. urology was consulted and recommended to have a voiding trial in 10 days from (on ) and if does not void, to call urology back. regarding urethro-rectal fistula cystogram as outpatient with possible colorectal surgery outpt f/u. # chronic anemia: required frequent outpatient transfusions. he was transfused 1u on and bumped appropriately. he was transfused 1u on . # mechanical avr - goal inr 1.8 to 2.2. he was supratherapeutic on admission and coumadin was initially held. he was restarted on coumadin when inr was 1.8 on at 3mg daily. heparin gtt was also started at that time then turned off once inr therapeutic. # hypothyroidism - continued levothyroxine. # chronic systolic chf - ef of 45%. he was diuresed with lasix 40mg at a time. # warm hemolytic anemia - continued prednisone (decreased dose to 10mg during admission) per dr. with bactrim prophylaxis. # hyperlipidemia - stopped pravastatin given possibility of interaction with daptomycin. this should be restarted at the conclusion of daptomycin course. # altered mental status: after extubation, patient sleepy but arousable and could not carry conversation. this was thought to be secondary to sedation which was slowly clearing. if does not improve, further work-up should be dont as an outpatient and nutritional goals will need to be addressed. medications on admission: - levothyroxine 75 mcg po daily - omeprazole 40 mg capsule po bid - pravastatin 20 mg tablet po daily - sulfamethoxazole-trimethoprim 400-80 mg tablet po daily - zinc oxide 40 % ointment one app topical - senna 8.6 mg tablet two tab po hs - lotrisone cream 1 app - maalox/magoh/simeth 30ml po q4h prn - oxycodone 5 mg tablet 0.5 po q8h prn pain. - smithethicone 80 mg po bid prn - smithethicone 160 mg po tid - prednisone 20 mg tablet po daily - calcium carbonate 650 mg po tid prn - warfarin 3 mg tablet po suntuwethfrsa at 1800. - acetaminophen 1000mg - acetaminophen 650mg q4 prn - carvedilol 3.125 mg po daily - cyanocobalamin mcg tablet po daily - folic acid 4 mg tablet po daily - sucralfate 1 gram po qid - bisacodyl 10 mg po daily prn constipation. - docusate sodium 100 mg po bid discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus injection or infusion of oxazolidinone class of antibiotics central venous catheter placement with guidance transurethral balloon dilation of the prostatic urethra diagnoses: acidosis thrombocytopenia, unspecified abnormal coagulation profile subendocardial infarction, initial episode of care acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified long-term (current) use of steroids severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate other persistent mental disorders due to conditions classified elsewhere accidental puncture or laceration during a procedure, not elsewhere classified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia heart valve replaced by other means chronic kidney disease, stage iii (moderate) acute respiratory failure pneumonitis due to inhalation of food or vomitus septic shock intestinal infection due to clostridium difficile infection with microorganisms without mention of resistance to multiple drugs other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants bladder neck obstruction do not resuscitate status anticoagulants causing adverse effects in therapeutic use urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other and unspecified infection due to central venous catheter streptococcal septicemia chronic diastolic heart failure autoimmune hemolytic anemias late effect of radiation urethral fistula phlebitis and thrombophlebitis of other sites phlebitis and thrombophlebitis of deep veins of upper extremities urethral stricture, unspecified other specified disorders of prostate 

Answer: The patient is high likely exposed to