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: cephalosporins / morphine / fentanyl attending: chief complaint: respiratory compromise with hypoxia and hypercarbia. major surgical or invasive procedure: none. history of present illness: 46 year old man with a history of morbid obesity, osa, copd, chronic trach, who was hospitalized in with vap (cultures + for acinetobacter and pseudomonas), who presents with fever, hypoxia and multifocal pneumonia on cxr. he initially traveled to on with oxygen saturations between 78-82% and somnolence. he was started on ceftazidime, vancomycin, flagyl and levofloxacin. a femoral line was placed, cultures drawn, and his trach was changed from a 6.0 shily w/o cuff to a 6.0 portex cuff trach. he was transferred to on with a temp of 101.3, hr 110, and bp 157/83. an abg showed ph7.24 pco2 81 po2 76 on 100% trach collar. he was then ventilated on ps 10/5. repeat abg was ph 7.24 pco2 79 po2 88. in the micu, blood cultures were positive for gpc, with sputum and urine cultures still pending. wide spectrum antibiotics were chnaged to ampicillin, although it remains uncertain if the bacteria are, in fact, ampicillin sensitive, despite clinical improvement. source remains uncertain. he has continued to tolerate the trach mask with high saturations on venous blood gas. he remains on 50% csm with saturations to the high 90's and a respiratory rate in the teens. suction for the trach has remained q3-4hrs. transferred to floor on . past medical history: -dm2 diagnosed with triopathy(retinopathy, nephropathy, neuropathy): cr has been as low as 1 in the past few months, however widely fluctuant when hospitalized 1-2.5. -copd -multiple episodes of respiratory failure requiring intubation in recent years (trach placed in ) -multiple vap with resistent organisms: pseudomonas, mrsa, acinetobacter, citrobacter -acalculous cholecystitis requiring cholecystostomy tube -g-tube -osa on cpap -vre, s/p tracheostomy, as above in -htn -chf -anemia of chronic disease (multiple transfusions in past) -s/p bka for chronic le ulcer -tia in -difficult intubation; fiberoptic guidance in . -urinary retention -osteoarthritis -depression -c. difficile in -hypogonadism -morbid obesity past surgical history bilateral carpal tunnel release in . hydrocele repair in . quadriceps tendon repair in . status post partial resection of transverse colon, end transverse colostomy, mucus fistula, jejunostomy tube percutaneous tracheostomy on . social history: social history: lives in rehabilitation facility. health aide comfortable with suctioning. family history: family history: non contributory. physical exam: t 98.5 hr 68 bp 166/p rr 20 o2sat: 100% on 50%cold steam mask genl: obese male in nad. slightly sleepy but attentive and pleasant. heent: +trach in place. slightly dry mucous membranes. unable to palpate cervical nodes. cv: rrr. normal s1 and s2. no murmur, rubs, or gallops. lungs: on ventral side, cta bilaterally with no wheezes or crackles. abd: active bowel sounds. soft, obese, colostomy bag, midline ovaloid scar. ext: red brawny area on r lower leg, with no edema. 2+ right dorsalis pedis pulse. lines in all ten fingernails. l bka. pertinent results: 03:25am blood wbc-6.1 rbc-2.97* hgb-9.2* hct-26.3* mcv-89 mch-30.9 mchc-34.9 rdw-15.5 plt ct-167 10:30pm blood wbc-11.0# rbc-3.46* hgb-10.5* hct-31.1*# mcv-90 mch-30.4 mchc-33.8 rdw-15.7* plt ct-197 01:27am blood neuts-79.2* bands-0 lymphs-13.3* monos-3.7 eos-3.3 baso-0.5 03:25am blood plt ct-167 10:30pm blood pt-12.9 ptt-27.7 inr(pt)-1.1 03:25am blood glucose-137* urean-25* creat-1.2 na-142 k-4.5 cl-107 hco3-29 angap-11 10:30pm blood glucose-182* urean-34* creat-1.7* na-140 k-5.5* cl-103 hco3-32 angap-11 10:30pm blood alt-14 ast-15 alkphos-44 amylase-35 totbili-0.4 03:25am blood calcium-8.8 phos-4.0 mg-2.0 10:30pm blood albumin-3.8 calcium-9.1 phos-4.4 mg-1.9 03:22pm blood type- po2-33* pco2-59* ph-7.35 calhco3-34* base xs-4 10:32pm blood po2-76* pco2-81* ph-7.24* calhco3-36* base xs-4 07:07am blood type-art temp-37.8 rates-14/ peep-5 fio2-50 po2-105 pco2-45 ph-7.44 calhco3-32* base xs-5 intubat-intubated vent-controlled 12:11pm blood k-4.4 10:32pm blood glucose-185* lactate-1.3 na-139 k-5.6* cl-102 echo - the left atrium is mildly dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. no vegetation seen (cannot exclude). brief hospital course: the patient is a 46 yo m with h/o morbid obesity, osa, copd, chronic trach, recent hospitalization in with vap with cultures + for acinetobacter and pseudomonas who presented to on with o2 sats of 78-82% and somnolence. he was given ceftazidime, vancomycin, flagyl and levofloxacin. cultures were drawn. his trach was changed from a 6.0 shily w/o cuff to a 6.0 portex cuff trach. he was transferred to where he was febrile to 101 and his abg was notable for ph 7.24 pco2 81 po2 76 on 100% trach collar. he was then ventilated on ps 10/5. repeat abg was ph 7.24 pco2 79 po2 88. he was started on vanco/gent. while in the micu, his respiratory status improved and his blood cultures were notable for enterococcus so his abx were changed to ampicillin and he defervesced (he will need to complete a 14 day course of amp - to be completed on ). he was transferred to the floor on . he did well until pm of when he became tachypneic. the tachypnea improved with suctioning. on , he again became tachypneic to rr 40s and o2 sats decreased to 79% on 40% trach mask. respiratory therapy got little mucus return with suctioning so they bagged him with improvement in o2 sats to 99%. he was changed to 100% trach mask with o2 sats 97-99% but continued tachpnea in 30s so he was transferred to the icu team for ps o/n. the patient was supported on pressure support ventilation and his setting were weaned down. he did well with a trach mask on . his blood pressure continued to be elevated. he was restarted on his home labetalol and clonidine. he was started on captopril which was titrated up during the course of admission. if his bp remains elevated at rehab, his clonidine dose can be increased. regarding the patients chronic back pain, he was given po dilaudid prn which was sufficient for pain control. increasing his pain medication should be avoided. the patient was hypoglycemic at times during his micu course. his home insulin regimen was insulin glargine 50 units and humalog ss. his glargine was cut in half to 25 units . if his sugars are elevated while at rehab, his lantus can be increased back to his home regimen. discharge medications: 1. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed. 2. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 3. aspirin 325 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily). 4. atorvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. paroxetine hcl 20 mg tablet : one (1) tablet po daily (daily). 6. trazodone 100 mg tablet : one (1) tablet po hs (at bedtime) as needed. 7. olanzapine 5 mg tablet : one (1) tablet po tid (3 times a day) as needed. 8. clonidine 0.1 mg tablet : two (2) tablet po bid (2 times a day). 9. gabapentin 300 mg capsule : one (1) capsule po tid (3 times a day). 10. clonazepam 1 mg tablet : two (2) tablet po tid (3 times a day). 11. hydrocodone-acetaminophen 5-500 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 12. docusate sodium 100 mg capsule : two (2) capsule po bid (2 times a day). 13. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 14. ampicillin sodium 2 g recon soln : two (2) g injection q6h (every 6 hours) for 7 days: last day should be . 15. tramadol 50 mg tablet : two (2) tablet po qid (4 times a day). 16. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily): apply to left shoulder. 17. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 18. albuterol-ipratropium 103-18 mcg/actuation aerosol : puffs inhalation q4h (every 4 hours). 19. fluticasone 110 mcg/actuation aerosol : four (4) puff inhalation (2 times a day). 20. lorazepam 0.5 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for anxiety. 21. labetalol 200 mg tablet : one (1) tablet po tid (3 times a day). 22. captopril 25 mg tablet : two (2) tablet po tid (3 times a day). discharge disposition: extended care facility: northeast - discharge diagnosis: congestive heart failure edema enterococcus bacteremia discharge condition: good. blood pressure slightly elevated. will need to continue to titrate up medications at rehab. discharge instructions: if you develop any shortness of breath, difficulty breathing, heart palpitations, worsening leg edema, or any other concerning symptoms, please call your doctor or go to an emergency department. continue on a low sodium diet (2 gm sodium diet). followup instructions: --please make as appointment to see dr. () within the next 1 week for blood work and a follow up appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of other (naso-)gastric tube diagnoses: pneumonia, organism unspecified hyperpotassemia anemia of other chronic disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified acute respiratory failure bacteremia personal history of other diseases of circulatory system morbid obesity osteoarthrosis, unspecified whether generalized or localized, site unspecified hypoxemia streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy tracheostomy status bronchitis, not specified as acute or chronic other testicular hypofunction attention to colostomy 

Answer: The patient is high likely exposed to