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: shellfish / topamax / augmentin attending: chief complaint: abdominal pain major or invasive procedure: tracheostomy history of present illness: this is a 37 y/o m with pmhx of alcoholic pancreatitis s/p splenectomy and distal pancreatectomy (') who presents after 4 wk etoh binge with abdominal pain, nausea, vomiting and pancreatitis. pt denied any hematemesis or dark stools. in the , pt received approx 5l ivf, levofloxacin/flagyl and was transferred to floor with a diagnosis of alcoholic pancreatitis. on the floor, the pt has received another 2.5l boluses and has been notably tachycardic, hypertensive, requiring valium q2hrs on ciwa and developed a new oxygen requirement. the patient was transferred to the icu for further care. past medical history: 1. alcoholic pancreatitis; history of ards requiring intubation in the setting of severe pancreatitis in 2. splenic hematoma s/p splenectomy. tail of pancreas was densely adherent to spleen hilum, had distal pancreatectomy 3. gerd 4. htn 5. sleep apnea tried on cpap, bipap but hasn't tolerated 6. hypercholesterolemia. 7. chronic pain in left side of abdomen and left shoulder, followed in pain clinic. pt has declined trigger point injections due to fear of needles 8. alcohol withdrawal; long history of alcohol abuse; several admissions for dts and intubations 9. right upper quadrant abscess, status post percutaneous catheter drainage in . 10. hx elevated lfts, fatty liver and hepatomegaly on us 11. hypertriglyceridemia, has been on gemfibrozil off and on (self-d/c'd due to abdominal bloating, loose stools) 12. migraine ha/cluster has - since age 15, has been on multiple abortive and prophylactic meds, none have been successful, currently on fioricet prn. pain back of neck, behind eyes, sometimes has several ha in a day, has can last several days. worse in rainy weather. 13. asthma 14. depression - slit wrists age 17, has been in counselling off and on, first time was at age 11 when his parents went through a divorce. 15. psychiatric hospitalization for 24 hrs at for detox (age 19) 16. false positive rpr social history: tobacco: quit smoking over a year ago, used to smoke 1 ppd etoh: started drinking 7th grade, drank 30 beers a night plus few shots of alcohol in his 20's, abstinent since , attended aa but found it boring. started drinking vodka daily 2 weeks ago. drugs: remote hx mj, cocaine. denies ivda. denies recent drug use. living: lives with mother who takes care of his medications. on disability for chronic pain. family history: father cad (1st mi in 40's), etoh mother type 2 dm, 3 sisters: 1 with seizure d/o, 1 with migraines, + family hx alcoholism (father, 2 sisters) physical exam: on admission: appearance: uncomfortable eyes: eomi, perrl, conjunctiva clear, noninjected, anicteric, no exudate ent: mm dry neck: no jvd cardiovascular: rrr, nl s1/s2, no m/r/g respiratory: cta bilaterally, comfortable, no wheezing, no ronchi, no rales gastrointestinal: soft, diffusely tender to palpation, obese, non-distended, normal bowel sounds musculoskeletal/extremities: no clubbing, no cyanosis, no joint swelling, no edema in the bilateral extremities neurological: alert and oriented x3, fluent speech, no asterixis, sensation wnl, cnii-xii intact integument: warm, no rash, no ulcer pertinent results: wbc 11.8 rbc 2.52 hgb 7.3 hct 22.8 mcv 91 mch 28.8 mchc 31.8 rdw 13.6 plt 900 electrolytes glucose 137* bun 10 creat 0.6 na 135 4.4 cl 96 hco3 31 urine culture (final ): no growth. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. 11:01 am bronchoalveolar lavage **final report ** gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. in pairs. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. staph aureus coag +. >100,000 organisms/ml.. sulfa x trimeth sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- =>16 r trimethoprim/sulfa---- =>16 r vancomycin------------ <=1 s 6:49 am blood culture source: venipuncture. **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s aerobic bottle gram stain (final ): reported by phone to @ 1827 on - cc6c. gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). speech and swallow evaluation mr. pmv well. he was able to participate in swallow evaluation, however he was very lethargic after being washed up by rn this am. he continues to present with signs of aspiration on thin liquids as evidenced by throat clearing, wet volitional cough and sensation of a tickle in his throat. he did appear to tolerate alternating bites and sips of nectar thick liquids and puree. however, based on patient's increased fatigue, suggest he begin pleasure feeds of nectar thick liquids and puree in small amounts when he is awake and alert during the day. continue use of dobhoff as primary nutrition, hydration and medications at this time. if patient noted with any s/sx of aspiration (i.e. coughing, po noted in or around trach site), please refrain from giving po. pmv must be in place for all pos. this swallowing pattern correlates to a dysphagia outcome severity scale (doss) rating of level 3, moderate dysphagia. recommendations: 1. pmv in place for all pos. 2. initiate small amounts of nectar thick liquids and puree consistencies as pleasure feeds when patient is awake and alert and requesting throughout the day. 3. continue use of tube feeds as primary means of nutrition, hydration and medications. 4. strict 1:1 supervision if patient takes pos. 5. if patient noted with coughing, desaturation, or po in or around trach please refrain from giving pos. 6. we will continue to follow to see how he is and if his diet may safely be advanced at a later time. ct abd with iv and po contrast minimal periportal edema is unchanged. otherwise the liver, gallbladder, adrenal glands, right kidney, and both ureters appear normal. posterior cortical defects in the left kidney are unchanged, consistent with old insult. atherosclerotic calcifications are again noted in the aorta and the iliac arteries. the prior ng tube has been replaced with a dobbhoff tube, which terminates in the proximal stomach. oral contrast opacifies part of the stomach and the distal small bowel, without opacifying much of the duodenum. otherwise the stomach and small bowel appear normal. moderate-to-large amount of stool is noted throughout the colon. the patient is again noted to be status post distal pancreatectomy and splenectomy. a large rim-enhancing fluid collection measuring approximately 9.4 (trv) x 7.8 (ap) x 12.1 (cc) cm is little changed from the prior study of . a small fluid collection seen anterior to the gastric body and also a small amount of fluid tracking along the transverse mesocolon are also unchanged. lymph nodes measuring up to 12 mm in short axis are again noted, particularly at the gastrohepatic and cardiophrenic regions. again small amount of pancreatic tissue is noted remaining proximal to the clips from distal pancreatectomy. the current single phase study is suboptimal for evaluating the vascular structures, however the portal vein appears attenuated as it crosses over the pseudocyst, and the smv and the confluence of the portal veins are not well opacified. collateral veins are noted along the left margin of the pseudocyst. the sma remains patent. no free air is seen within the abdomen. ct pelvis with iv contrast: the urinary bladder is mildly distended. the balloon of the foley catheter is noted to be inflated possibly within the upper portion of the prostate. the seminal vesicles appear normal. again a moderate-to-large amount of stool is noted throughout the rectosigmoid colon. no free air or free fluid is noted in the pelvis. small inguinal lymph nodes do not meet ct size criteria for adenopathy. osseous structures: no region of bony destruction is seen concerning for malignancy. impression: 1. large pseudocyst is unchanged from , with fluid extending anterior to the stomach and in the transverse mesocolon. smv and confluence of the portal vein are not well opacified on this single phase study but are likely involved. 2. moderate-to-large amount of stool. brief hospital course: the patient was admitted to the hospitalist service on for acute-on-chronic pancreatitis. due to tachypnea and tachycardia, the patient was admitted the and subsequently to the icu. neuro: the patient takes methadone 40mg daily (he self-divides into smaller doses) and oxycodone 5mg q6h prn, which was confirmed with his pharmacy; also takes zanaflex. at the time of discharge, pain was well controlled with methadone 85 mg po q4h and tizanidine. at the time of discharge, the patient was also maintained on clonazapam and lorazapam. cardiac: during the hospital course, the patient had elevated blood pressures, likely related to the systemic inflammatory response and also to pain. also, the patient takes propranolol as outpatient and likely has underlying hypertension. at the time of discharge, the patient was normotensive and stabilized on blood pressure medications. pulmonary: the patient was intubated on for an increased co2. bronchoscopy was performed on . the patient was thought to be in ards. the patient was treated for an mrsa pneumonia during his hospital stay. treatment course with vancomycin was completed on . a stat tracheotomy was performed at bedside for a endotracheaal cuff herniation that became supraglottic on . the patient was weaned from ventilation and was transferred to trach mask on . the tracheostomy tube was changed from a portex 8.0 to 6.0 for improved patient tolerance on . the patient was unable to tolerate a passameur valve on 3 separate occassions. etoh withdrawl: on admission, the patient was treated with a ciwa scale. at time of discharge, no ciwa scale dosing was required but the patient was maintained on standing benzodiazapines. id: the patient was emperically started on vancomycin and zosyn. vancomycin was continued for mrsa pneumonia. gram negative rods were identified in the blood and which was treated by both meropenum and cipro. meropenum should should discontinued on . vancomycin was discontinued on (21 day course) per id. fen: tube feedings were used to maintain nutrition. dobhoff tube was placed on . due to resuscitation, the patient was slowly diuresed with lasix during his icu stay. at discharge, he was thought to be still somewhat volume overloaded. speech and swallow saw the patient on . recommendations are as follows: 1. pmv in place for all pos. 2. initiate small amounts of nectar thick liquids and puree consistencies as pleasure feeds when patient is awake and alert and requesting throughout the day. 3. continue use of tube feeds as primary means of nutrition, hydration and medications. 4. strict 1:1 supervision if patient takes pos.5. if patient noted with coughing, desaturation, or po in or around trach please refrain from giving pos. at the time of discharge, diet was as follows: regular; consistency: pureed; nectar prethickened liquids 1:1 supervision with all meals. tubefeeding: replete w/fiber full strength; goal rate: 75 ml/hr residual check: q4h hold feeding for residual >= : 250 flush w/ 30 ml water q4h. at the time of discharge, the patient was afebrile, vital signs were stable, and the patient was his diet. medications on admission: (per ) acamprosate 666mg tid bupropion 100mg fioricet 1 tab prn klonopin 2mg tid plus 4mg qhs gemfibrozil 600mg methadone 10mg q6h prn oxycodone 5-10mg q6h prn protonix 40mg qd propranolol 40mg seroquel 100mg qhs zanaflex 8mg , 12mg qhs patient also on a variety of inhalers in the past, but none filled at cvs recently: albuterol 2 puffs q4-6h prn flovent 2 puffs advair 250-50 1 puff serevent 1 puff azmacort 2 puffs discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. artificial tear with lanolin ointment sig: one (1) appl ophthalmic prn (as needed). 3. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscellaneous q6h (every 6 hours) as needed for tk secr/ consolidation. 4. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 5. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 6. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: one (1) cap po qid (4 times a day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. quetiapine 100 mg tablet sig: one (1) tablet po q 24h (every 24 hours). 9. tizanidine 2 mg tablet sig: four (4) tablet po bid (2 times a day). 10. tizanidine 2 mg tablet sig: six (6) tablet po qhs (once a day (at bedtime)). 11. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 12. bupropion 100 mg tablet sig: one (1) tablet po tid (3 times a day). 13. clonidine 0.3 mg/24 hr patch weekly sig: two (2) patch weekly transdermal q week (). 14. medication papain 2.5 % solution 30 ml ngt prn 15. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 16. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) for 5 days. 17. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 18. metoclopramide 10 mg tablet sig: two (2) tablet po qidachs (4 times a day (before meals and at bedtime)). 19. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 20. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed. 21. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 22. methadone 10 mg tablet sig: six (6) tablet po q4h (every 4 hours). 23. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed. 24. insulin nph human recomb 100 unit/ml cartridge sig: one (1) 15 subcutaneous twice a day. 25. insulin regular human 100 unit/ml cartridge sig: one (1) injection four times a day: sliding scale. 26. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 27. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 28. meropenem 500 mg recon soln sig: one (1) intravenous every six (6) hours: end date . discharge disposition: extended care facility: discharge diagnosis: acute on chronic pancreatitis respiratory distress acute respiratory obstruction due to endotracheal tube displacement with inability to re-intubate discharge condition: stable followup instructions: provider: , specialties cc-3 (nhb) phone: date/time: 12:45. . you will have a ct scan in the am prior to your appointment. your ct will be at 10 am. please arrive at 9am. , . you will need to be npo for 3 hours prior to the exam. you will get you po contrast when you arrive at 9am. you may take your medications by motuh prior to the exam. provider: , md phone: date/time: 11:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances arterial catheterization temporary tracheostomy replacement of tracheostomy tube diagnoses: esophageal reflux pure hypercholesterolemia unspecified essential hypertension infection with microorganisms resistant to penicillins asthma, unspecified type, unspecified personal history of tobacco use depressive disorder, not elsewhere classified hypopotassemia acute respiratory failure bacteremia unspecified sleep apnea methicillin susceptible pneumonia due to staphylococcus aureus diarrhea chronic pancreatitis tachycardia, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus acute pancreatitis alcohol withdrawal delirium inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation foreign body in trachea dysphagia, unspecified other and unspecified alcohol dependence, episodic 

Answer: The patient is high likely exposed to