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: zithromax / neosporin scar solution / latex / pollen extracts / cat hair std extract / bacitracin attending: chief complaint: abdominal aortic aneurysm major surgical or invasive procedure: : resection and repair of abdominal aortic aneurysm with 14-mm dacron tube graft and distal aortic endarterectomy. : exploratory laparotomy, sigmoid resection, and end-colostomy. : right thoracentesis history of present illness: the patient is an 82-year-old gentleman with past medical history significant for hypertension, hypercholesterolemai, and cad s/p cabg , who was recently found to have an abdominal aortic aneurysm 3.5cm which enlarged to 4.6cm. he has previously had a right femoral sarcoma removed and radiation therapy and has a chronically swollen right leg. ct angiogram showed a heavily calcified infrarenal aorta with 3 areas of distinct blowout, almost looking like contained ruptures. the largest one of this just proximal to the renal arteries and approximately 4.6 cm in diameter. the aorta was heavily calcified both proximal and distal to these areas of aneurysmal saccular degeneration and more so at the aortic bifurcation. because of the unusual saccular shape and the appearance that one of these may have actually been an old chronic contained rupture, dr. recommended open repair, as he did not have an endovascular option. past medical history: past medical history: 1. coronary artery disease status post myocardial infarction in , which was treated with angioplasty at the . he then underwent a four-vessel cabg at in by dr. . 2. atrial fibrillation. 3. hypertension. 4. elevated lipids. 5. asthma. past surgical history: status post laparoscopic cholecystectomy and status post right knee arthroscopy. social history: social history: the patient is married he lives in and is a former philosophy professor of education at . he quit smoking a pipe back in and drinks approximately two wine beverages with dinner each evening. family history: no family history of aneurysms. physical exam: physical exam: gen: wdwn, nad vs: afebirle, wnl heent: no neck or supraclavicular lad cv: heart is regular resp: lungs are clear to ascultation bilaterallly. . abd: pos bs, obese, colostomy baf with stool ext:2+ femoral pulses b, no edema neurovascular and sensory exam grossly intact, nl strength there is no suspicious adenopathy in the bilateral groins pertinent results: 04:55am blood wbc-8.8 rbc-3.16* hgb-9.4* hct-28.2* mcv-89 mch-29.8 mchc-33.3 rdw-14.3 plt ct-240 05:08am blood pt-13.4 ptt-30.8 inr(pt)-1.1 04:55am blood glucose-115* urean-36* creat-0.8 na-143 k-4.8 cl-115* hco3-25 angap-8 05:00am blood alt-61* ast-50* ld(ldh)-211 alkphos-70 amylase-153* totbili-0.3 04:55am blood calcium-8.9 phos-2.7 mg-2.1 01:37am urine color-yellow appear-clear sp -1.023 urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-5.5 leuks-tr urine rbc-* wbc- bacteri-few yeast-none epi-0-2 10:57 am bronchoalveolar lavage gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci in clusters. 1+ (<1 per 1000x field): budding yeast. smear reviewed; results confirmed. respiratory culture (final ): 10,000-100,000 organisms/ml. commensal respiratory flora. serratia marcescens. 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. piperacillin/tazobactam sensitivity testing available on request. yeast. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ serratia marcescens | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- 0.5 s gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- 2 s cxr: low lung volumes. small right effusion. increased fullness of the right hilus and prominence of left basilar interstitial markings may refelect mild institial pulmonary edema. increased density at the right base likely a summation of low lung volumes, atelectasis, and mild edema. stable right pleural lipoma. left picc at high svc. ng tip not seen below field of view. echocardiography report results measurements normal range left atrium - four chamber length: *7.0 cm <= 5.2 cm right atrium - four chamber length: *7.0 cm <= 5.0 cm left ventricle - diastolic dimension: 4.1 cm <= 5.6 cm left ventricle - systolic dimension: 2.9 cm left ventricle - fractional shortening: 0.29 >= 0.29 left ventricle - ejection fraction: >= 60% >= 55% left ventricle - stroke volume: 55 ml/beat left ventricle - cardiac output: 4.27 l/min left ventricle - cardiac index: 2.01 >= 2.0 l/min/m2 aortic valve - peak velocity: 1.5 m/sec <= 2.0 m/sec aortic valve - lvot vti: 16 aortic valve - lvot diam: 2.1 cm mitral valve - e wave: 1.1 m/sec mitral valve - e wave deceleration time: *132 ms 140-250 ms tr gradient (+ ra = pasp): *43 to 50 mm hg <= 25 mm hg findings this study was compared to the prior study of . left atrium: dilated la. right atrium/interatrial septum: markedly dilated ra. lipomatous hypertrophy of the interatrial septum. left ventricle: overall normal lvef (>55%). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. paradoxic septal motion consistent with prior cardiac surgery. aortic valve: mildly thickened aortic valve leaflets. no as. no ar. mitral valve: mildly thickened mitral valve leaflets. mild (1+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no pericardial effusion. general comments: suboptimal image quality - bandages, defibrillator pads or electrodes. suboptimal image quality - body habitus. conclusions the left atrium is dilated. the right atrium is markedly dilated. overall left ventricular systolic function is normal (lvef>55%). no regional wall motion abnormalitu seen in suboptimal views.right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: mr. was admitted on for same day elective open aaa repair. he tolerated the procedure well and was transferred to the cvicu for monitoring. overnight, he was hypotensive requiring vasopressors and febrile to 101.7. blood,sputum, and urine cultures were sent and he was started on empiric vancomycin, ciprofloxacin and flagyl. he remained intubated overnight. on pod2, the epidural catheter was removed. he continued to have febrile episodes and remained on broad spectrum antibiotics pending culture results. on exam, his abdomen was mildly tender to palpation and distended. all cultures were negative on pod4 but he continued to have fevers. transplant surgery was consulted for a potential abdominal pathology, and a ct scan was obtained demonstrating pneumatosis of the sigmoid colon. he was taken to the operating for suspicion of bowel ischemia. he underwent exploratory laparotomy that demonstrated necrotic sigmoid colon, which was resected with creation of an end-colostomy. he required intermittent pressors during the case, and was taken intubated to cvicu on neo-synephrine drip. on pod 6 and 1 from the aaa repair and ex-lap, respectively, he was intubated on one pressor in the icu, continuing to have low grade fevers and a mildly elevated white count. he was volume overloaded and was maintained on a lasix drip for adequate diuresis. he was extubated on pod3 from the ex-lap, and maintained oxygen saturation on nasal cannula. he had return of bowel function through the ostomy on pod5 from the ex-lap. he was continued on broad spectrum antibiotics pending culture results, and remained afebrile. he was maintained on lasix drip for further diuresis. on pod 11(from aaa repair)/6(from ex-lap) he experienced increasing respiratory distress and required re-intubation. chest xray demonstrated a large pleural effusion. he underwent right thoracentesis to drain 550cc pleural fluid on . diuresis was continued with lasix drip. cultures from bronchoalveolar lavage were growing serratia, and he was started on cefepime. on sedation was weaned off to assess mental status; he was interactive and following commands, tolerating tube feeds at goal, with functioning ostomy. he was successfully extubated and remained stable on nasal cannula. while on the lasix drip, pt experienced an increase in his creatinine to 2.0, once off the lasix drip pt, creatinine has normalized. - , pt remained in the cvicu. during this time frame the lasix drip was stopped, because of his creatinine. again this has normalized, pt also had increase in sodium from around 147 - 154. he was treated with free water. on dc sodium has normalized. pt received tf during this period of time. when bowel function returned, he was slowly started on sips. it was noticed that he had difficulty swallowing. pt did receive speech and swallow, recommended ground foods; thin liquids supplement for dysphagia; calorie counts were done pt po intake was minimal. they recommended tf, these are now cycled from 6am to 6 pm. these are to continue until po intake is improved. pt then transferred to the floor. - , pt and case management was then consulted for rehab placement. during this time frame was nutritional support, with tf, pt worked . pt stable for rehab on . foley remains in place, this can be taken out at your discretion. pt is taking po. medications on admission: finasteride 5mg po daily furosemide 40mg po daily combivent 18mcg-103mcg 1-2 puffs daily lisinopril 10mg po daily toprol xl 12.5mg po daily nasonex 2 sprays as needed for nasal congestion procardia xl 15mg po daily aspirin 325mg po daily benadryl 50mg qhs prn insomnia mvi 1 tab daily singulair 10mg po daily viagra prn discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): until ambulatory. 2. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 6. travatan z 0.004 % drops sig: one (1) ophthalmic hs (). 7. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic q4h (every 4 hours). 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. rosuvastatin 5 mg tablet sig: one (1) tablet po daily (daily). 10. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for wheeze. 13. picc heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. pleasse pull after last dose of cefepine 14. cefepime 2 gram recon soln sig: one (1) recon soln injection q12h (every 12 hours) for 2 days: please stop on , then pull picc line. 15. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day). 16. ciprofloxacin 0.3 % drops sig: 1-2 drops ophthalmic q4h (every 4 hours). 17. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed for wheezing. 18. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for rash. 19. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 20. lasix 20 mg tablet sig: one (1) tablet po once a day. 21. lisinopril 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: abdominal aortic aneurysm ischemic bowel right pleural effusion discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: division of vascular and endovascular surgery abdominal aortic aneurysm (aaa) surgery discharge instructions what to expect when you go home: 1. it is normal to feel weak and tired, this will last for weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have incisional and leg swelling: ?????? wear loose fitting pants/clothing (this will be less irritating to incision) ?????? elevate your legs above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? you should get up every day, get dressed and walk, gradually increasing your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (let the soapy water run over incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 101.5f for 24 hours ?????? bleeding from incision ?????? new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: scan phone: date/time: 11:00 provider: , m.d. phone: date/time: 11:30 provider: mri phone: date/time: 1:40 dr hrs. lmob 7 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances thoracentesis colostomy, not otherwise specified closed [endoscopic] biopsy of bronchus open and other sigmoidectomy resection of vessel with replacement, aorta, abdominal endarterectomy, aorta procedure on single vessel diagnoses: thrombocytopenia, unspecified pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis unspecified pleural effusion unspecified essential hypertension unspecified protein-calorie malnutrition atherosclerosis of aorta atrial fibrillation aortocoronary bypass status percutaneous transluminal coronary angioplasty status pulmonary collapse other and unspecified hyperlipidemia old myocardial infarction other respiratory complications other ascites chronic obstructive asthma, unspecified hyperosmolality and/or hypernatremia acute vascular insufficiency of intestine abdominal aneurysm, ruptured surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to