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: heparin agents attending: chief complaint: dyspnea major surgical or invasive procedure: n-g tube placement history of present illness: mr. is an 82 yo male s/p prolonged hospital and rehabilitation course following xrt for cell carcinoma who presents with acute onset shortness of breath at rehab earlier today. per report, oxygen saturation dropped to 84-85% on 4l nc from baseline in the mid 90's. he was hypotensive with sbp's in the 80's, which resolved with ivf. per report from rehab, patient was noted to have new thick brown sputum with difficulty swallowing. he was recently started on levofloxacin/flagyl three days ago for treatment of a presumed aspiration pneumonia. . of note, he was admitted to nebh in for ? pneumonia, then discharged to rehab and readmitted for dyspnea and hemoptysis. he was placed on bipap and later intubated with a two-week course complicated by ards, arf requiring temporary hd, acute delirium, and thrombocytopenia. he was treated with a steroid taper for copd exacerbation and broad spectrum antibiotics. he was discharged to rehab on . per his wife, he has made significant gains over the past month while at rehab. . on arrival to the ed, spo2 95% on nrb, rr 32, hr 96, bp 121/47. he received vancomycin 1 g iv, cefepime 2 g iv, solumedrol 125 mg iv, and a combivent neb. past medical history: copd cad anemia of chronic disease chronic dementia chronic renal insuffciency h/o alcohol abuse recent treatment for aspiration pneumonia hypertension hyptothyroidism pancytopenia cell skin cancer of right temple s/p resection + xrt x/p laser turp s/p spine surgeries in the 's social history: until recent fall and spine surgery, patient lived with his wife and was independent with . he smoked until (1.5 ppd) and has a h/o alcohol abuse, quit 5-10 years ago. at baseline he ambulates with a rolling walker. family history: nc physical exam: physical exam: vs: t 98, bp 119/51, hr 88, spo2 93% on 50% shovel mask, rr 30 gen: elderly , resting comfortably, slightly diaphoretic heent: multiple actinic keratoses over scalp, mmm, sclerae anicteric cv: rrr, difficult to auscultate upper airway sounds resp: coarse rhonchi throughout lung fields. no abdominal accessory muscle use, no nasal flaring. abdomen: soft nt/nd, normoactive bs extrem: diffuse muscle wasting, no peripheral edema, calf tenderness, cords pertinent results: 03:15am wbc-17.7*# rbc-3.62* hgb-11.1* hct-34.5* mcv-95# mch-30.5 mchc-32.1 rdw-15.5 03:15am neuts-75* bands-10* lymphs-9* monos-5 eos-0 basos-0 atyps-0 metas-1* myelos-0 03:15am plt smr-normal plt count-373# 03:15am pt-17.4* ptt-31.9 inr(pt)-1.6* 03:23am lactate-1.1 03:31am probnp-2673* 03:31am glucose-128* urea n-48* creat-1.8* sodium-145 potassium-5.2* chloride-112* total co2-22 anion gap-16 04:15am po2-36* pco2-51* ph-7.31* total co2-27 base xs--1 08:41am o2 sat-99 08:41am lactate-0.6 08:41am type-art po2-189* pco2-45 ph-7.32* total co2-24 base xs--3 10:27am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-lg 10:27am urine rbc-1 wbc-74* bacteria-few yeast-many epi-0 10:27am urine hours-random creat-70 sodium-16 potassium-43 03:48pm glucose-168* urea n-46* creat-1.6* sodium-148* potassium-4.3 chloride-116* total co2-23 anion gap-13 03:48pm calcium-7.8* phosphate-3.9 magnesium-2.0 06:05am blood wbc-26.3* rbc-3.32* hgb-10.1* hct-31.4* mcv-95 mch-30.5 mchc-32.2 rdw-16.3* plt ct-330 06:05am blood neuts-93* bands-0 lymphs-4* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-1* 03:06am blood wbc-26.2* rbc-3.56* hgb-10.4* hct-33.9* mcv-95 mch-29.3 mchc-30.7* rdw-16.8* plt ct-376 06:05am blood pt-15.1* ptt-34.7 inr(pt)-1.3* 03:06am blood glucose-139* urean-26* creat-1.6* na-146* k-4.1 cl-114* hco3-25 angap-11 03:06am blood ck(cpk)-15* 03:06am blood ck-mb-notdone ctropnt-0.05* 03:06am blood calcium-7.8* phos-3.7 mg-2.3 06:05am blood calcium-7.2* phos-2.5* mg-1.7 iron-36* 03:20am blood albumin-1.9* calcium-7.5* phos-3.9 mg-2.0 06:05am blood caltibc-73* vitb12-1530* folate-8.6 hapto-321* ferritn-1214* trf-56* 05:30am blood type-art po2-62* pco2-49* ph-7.25* caltco2-23 base xs--5 02:23am blood type-art po2-81* pco2-78* ph-7.11* caltco2-26 base xs--6 04:15am blood type-art po2-76* pco2-53* ph-7.26* caltco2-25 base xs--3 intubat-not intuba comment-bipap 02:23am blood glucose-137* lactate-0.7 na-141 k-3.8 cl-111 08:41am blood o2 sat-99 09:46am urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 09:46am urine rbc-0-2 wbc->50 bacteri-few yeast-mod epi-0 renalep-0-2 . micro: bcx: negative x 4 ucx: yeast x 2 urine negative for legionella stool cx: cdiff positive sputum: mrsa mrsa screen + x 2 . reports: chest (portable ap) 3:20 am ap portable chest: heart size, mediastinal contours are within normal limits. the aorta is mildly tortuous and there are atherosclerotic calcifications of the arch. there is patchy airspace consolidation at the right lung base which partially obscures the hemidiaphragm consistent with right lower lobe pneumonia. there is no pleural effusion on this radiograph that does not fully include the right costophrenic sulcus. left lung is clear. no pneumothorax. the acromioclavicular joints appear narrowed bilaterally. impression: right lower lobe pneumonia. . ecg study date of 3:20:30 am sinus rhythm. atrial ectopy. ventricular ectopy. non-specific inferior st-t wave changes. compared to the previous tracing the rate is faster and ectopy is present. tracing #1 . ecg study date of 8:47:02 am sinus rhythm. atrial ectopy. non-specific inferior st-t wave changes. compared to the previous tracing ventricular ectopy is no longer present. tracing #2 . chest (portable ap) 5:17 am findings: in comparison with the study of , there is poor definition of the left hemidiaphragm with some increased opacification suggesting atelectasis or pneumonia at the left base. the right basilar opacification is again seen and probably is of little change. the upper lung zones are clear. . 2:07 pm chest (portable ap) chest, supine portable: comparison is made to earlier on the same day. a new nasogastric tube terminates in the stomach. however, the sidehole lies only immediately beyond the expected site of the gastroesophageal junction. the mediastinal and hilar contours are unchanged. bibasilar parenchymal opacities are also unchanged. impression: new nasogastric tube terminating in the stomach. however, the tube could be advanced further in order to gain greater purchase, as the side hole lies near the gastroesophageal junction. . 4:26 pm chest (portable ap) findings: in comparison with earlier study of this date, there is little change in the position of the nasogastric tube. the side port remains in the region of the ge junction, and the tube should be advanced 6-10 cm for optimal positioning. little change in the appearance of the heart and lungs. . echo : conclusions the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. there is mild global left ventricular hypokinesis (lvef = 50%), which may be partially due to rhythm (appears to be atrial fibrillation based on the transmitral doppler profile). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild global left ventricular systolic dysfunction. mild mitral regurgitation. . chest (portable ap) 10:34 am nasogastric tube terminates below the diaphragm within the stomach. cardiomediastinal contours are unchanged. right perihilar and bibasilar opacities appear similar to the previous examination. bilateral small-to- moderate pleural effusions are partially layering on this semi-upright radiograph, and there are possible calcified pleural plaques. pa and lateral radiograph prior to discharge may be helpful to confirm this impression. . 7:20 pm ct abdomen w/o contrast; ct pelvis w/o contrast ct of the abdomen without iv contrast: incompletely visualized are small-to- moderate sized bilateral pleural effusions with associated atelectasis of the dependent lower lobes. coronary artery calcifications are present. evaluation of the solid organs is limited by the non- contrast technique. numerous punctate calcifications are noted scattered throughout the liver and spleen consistent with old granulomatous disease. there is a small splenule adjacent to the spleen. there are extensive abdominal arterial vascular calcifications due to atherosclerosis. there are cysts of the left kidney and other small hypodensities too small to characterize. the right kidney is abnormally small, cystic, and atrophic with coarse calcification along its medial aspect from old insult. there is no hydronephrosis. the pancreas is atrophic. the gallbladder is unremarkable. extensive soft tissue and mesenteric edema and a small amount of ascites is noted. oral contrast has passed through to the splenic flexure of colon. there are no dilated loops of small or large bowel. there is no evidence of obstruction or pneumoperitoneum. there are numerous colonic diverticula. the descending and sigmoid colon are not well evaluated due to lack of oral contrast opacification and distention. extensive mesenteric edema and small amount of ascites also complicates assessment for wall thickening; however, there is apparent wall thickening of the sigmoid and lower descending colon, as well as the cecum. there is no loculated fluid collection or abscess. ct of the pelvis without iv contrast: the right hip arthroplasty causes streak artifact which somewhat obscures the pelvis. small amount of ascites layers into the pelvis. stool is present in the rectum. foley catheter is in the bladder. bone windows: there are extensive degenerative changes of the visualized spine. patient is status post laminectomy. impression: 1. wall thickening involving the sigmoid colon and possibly cecum consistent with colitis, more likely infectious. no evidence of megacolon or pneumoperitoneum. no abscess identified, within the limits of noncontrast examination. 2. diverticulosis. 3. extensive atherosclerosis of the abdominal aorta and arteries. 4. atrophic right kidney. 5. anasarca. 6. small-to-moderate bilateral pleural effusions. . chest (portable ap) 5:08 am impression: ap chest compared to and 30: moderate bilateral pleural effusion right greater than left has increased more substantially on the right than the left since . mild cardiomegaly and mediastinal vascular engorgement have worsened. right lower lung is obscured by effusion, left shows increasing atelectasis. upper lungs are clear aside from mild vascular engorgement. nasogastric tube ends in the stomach. no pneumothorax. sequence of changes suggests earlier left heart failure has progressed to biventricular or predominantly right-sided decompensation. . ecg study date of 5:14:32 am sinus rhythm and occasional atrial ectopy. diffuse non-specific st-t wave changes. compared to the previous tracing of no diagnostic interim change. . chest port. line placement 2:40 pm findings: there is a new right picc line with tip in the right atrium. there is an ng tube coiled in the stomach. there are moderate bilateral pleural effusions with bilateral lower lobe volume loss. an underlying infectious infiltrate cannot be excluded. the appearance of the lungs is not significantly changed compared to the film from the prior day. . chest (portable ap) 12:45 pm findings: the ng tube tip is in the stomach. there is moderate bilateral pleural effusions and bilateral lower lobe volume loss. an underlying infiltrate cannot be excluded. there is pulmonary vascular redistribution and perihilar haze, suggesting chf. the right picc line is unchanged. . chest (portable ap) 11:27 am findings: in comparison to the previous examination, the size of the cardiac silhouette is slightly decreased. the extent of the bilateral pleural effusions is stable. moderate bibasilar atelectasis, no secure evidence of pneumonia. the nasogastric tube is in unchanged position. impression: otherwise, no relevant changes. . ecg study date of 11:30:46 am sinus rhythm. p-r interval is 110 milliseconds. poor r wave progression across the anterior precordial leads, probably a normal variant. non-specifc inferior and lateral st-t wave changes. compared to the previous tracing of no atrial ectopy is seen. the other findings are similar. . chest (portable ap) 2:17 am single view, chest: moderate bilateral pleural effusion unchanged. no focal consolidation. lung fields are clear. no pneumothorax. unchanged aortic knob calcification. hilar contour, cardiomediastinal silhouettes are within normal limits. the heart size is upper limit of normal. ng tube with tip in the stomach is noted. impression: unchanged moderate layering bilateral pleural effusion. no acute cardiopulmonary process or significant changes since prior radiograph. brief hospital course: the patient was admitted to the medical icu with a diagnosis of pnemonia, likely aspiration. he was given broad spectrum antibiotics including vancomycin and zosyn. his course was notable for decreased urine output, which responded well to fluid boluses. also, he developed atrial fibrillation on the evening of the 28th. this was managed with digoxin and metoprolol. he had difficulty swallowing and an ng tube was placed. a stool culture was positive for c-difficile and he was started on metronidazole. he has a baseline dementia and he did become agitated with placement of the ng tube necessitating restraints. he was transferred to the floor, where he remained on vanc/zosyn. he continued to have intermittent desats thought to be to mucous plugging, and his floor course was notable for significant pulmonary congestion. sputum grew out mrsa, urine grew out yeast. ct abdomen was suspicious for colitis. his flagyl was changed to po vancomycin. he was maintained on metoprolol 12.5 for rate control of his afib. he then experienced acute hypoxia, and was transferred to the micu on . this was likely another aspiration event. there, his wife requested status, his non-comfort medications were discontinued, and he subsequently expired on . . problem list: . #) chronic renal insufficiency: he had low urine output during his stay, responsive to ivf. per report, baseline creatine s/p prolonged icu course in is ~1.8. his cr ranged from 1.5 to 1.8 during his stay. . #) anemia: consistent with anemia of chronic inflammation . #) cad: unknown anatomy. continued on asa 81 mg daily. echo as above. . #) hypothyroidism: continued on synthroid. . #) ppx: pneumoboots, ppi. per report, patient has a history of thrombocytopenia, presumed secondary to heparin products, but no documented hit-antibody. wife reports heparin as an allergy. per lab, hit antibody is low yield when platelets are not low. . #) fen: failed speech and swallow with recommendations for npo. possible peg tube, though peg tube not likely to stop aspiration. family did not seem to be interested in peg tube, so one was never placed. he received tube feeds though ngt during his stay. . #) contact: . medications on admission: metronidazole 500 mg iv q8 hours levofloxacin 750 mg qod colace 250 mg daily ferrous sulfate 325 mg daily advair 250/50 diskus synthroid 50 mcg daily senna 2 tabs qhs tiotropium 18 mcg daily acetaminophen 650 mg q4 hours prn robitussin 10 ml tid discharge disposition: expired discharge diagnosis: aspiration pneumonia mrsa pneumonia discharge condition: expired md procedure: venous catheterization, not elsewhere classified insertion of other (naso-)gastric tube diagnoses: acidosis anemia in chronic kidney disease coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile chronic systolic heart failure pressure ulcer, lower back pressure ulcer, heel hyperosmolality and/or hypernatremia malnutrition of moderate degree 

Answer: The patient is high likely exposed to