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: vancomycin attending: chief complaint: fever major surgical or invasive procedure: none history of present illness: 84 y/o with h/o recurrent aspiration pna, utis, advanced dementia, s/p peg presents with fever, congestion, lethargy and oxygen desaturation to low 80s today. has had fever to 101.7 at 10 am today. pt has two recented abx course in last month (treated with levofloxacin and cipro) for fever and leukocytosis (up to wbc 15). in the ed vs initially 99.6, 120/68, 100, 30 94% on 10l which improved to 95% on 4l nc. he is a+ox1, which appears to be his baseline. he was noted to be coughing and be rhonchous on exam. cxr without obvious consolidation. ua positive. he received 3l ivf, zosyn, and tylenol 1300mg. vs prior to transfer are 102.6, 127/69, 97, 22, 94% on neb. ekg nl sinus. lactate 3.8 per ed call in pt. was made dnr after his last hospitalization but this did not include dni or dnh. review of systems: stooling regularly, 2 on , once on . transferred to the floor after his icu course. he was oriented x 0 and occasionally answering "yes" to questions. in speaking with his hcp and with his pmd, this is is baseline. past medical history: dementia recurrent aspiration s/p g tube mssa bactermia seizure disorder paroxsymal v tach. depression osteoarthritis ibs vitamin b12 deficiency chronic hypernatremia s/p orif pseduomonas pna small bowel obstruction social history: lives full time at . brother lives on and is poa. family history: unable to obtain given pt with severe dementia physical exam: general:chronically ill appearing elderly white man in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla. unable to follow commands for eom testing. dmm. will not open mouth. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp unable to interperate body habitus lungs: diffusely rhonchus, transmitted upper airway sounds. abdomen: nabs. soft, nt, nd. no hsm. peg in place with mild erthema around insertion site. extremities: no edema or calf pain, 2+ dorsalis pedis/ radial pulses. muscle wasting on ext, thenar. contracted. skin: no rashes/lesions, ecchymoses. neuro: alert. non-verbal. cn 2-12 grossly intact. increased tone in upper ext. toes down going. gait assessment deferred gu: foley in place pertinent results: 02:00pm glucose-184* urea n-56* creat-1.0 sodium-152* potassium-4.8 chloride-116* total co2-23 anion gap-18 12:51pm urine blood-lg nitrite-neg protein-150 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-mod 12:42pm lactate-3.8* 12:51pm urine rbc-0-2 wbc->50 bacteria-few yeast-none epi-0 02:34pm wbc-18.6*# rbc-3.98* hgb-11.8* hct-37.8* mcv-95 mch-29.8 mchc-31.3 rdw-17.1* 08:28pm lactate-3.9* na+-152* 08:28pm type-art po2-65* pco2-42 ph-7.40 total co2-27 base xs-0 08:55pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-lg 05:46am blood wbc-8.6 rbc-2.96* hgb-9.1* hct-28.4* mcv-96 mch-30.8 mchc-32.1 rdw-16.8* plt ct-247 05:46am blood glucose-154* urean-21* creat-0.7 na-139 k-4.4 cl-103 hco3-28 angap-12 05:46am blood calcium-7.9* phos-2.6* mg-1.7 iron-49 05:46am blood caltibc-211* ferritn-109 trf-162* ct cystogram: . no ct cystogram evidence for rectovesicular fistula. 2. probable history of turp given patulous nature of prostatic urethra. note is made of prominent soft tissue at the prostate base which could be further assessed by urology as clinically indicated. if there is a history of turp, this likely represents a bph nodule; however bladder mass including neoplasm cannot be entirely excluded. 3. shaggy-appearing bladder, suggestive of cystitis. 4. bowel-containing ventral hernia without evidence of bowel obstruction. ct pelvis: 1. aborted ct cystogram secondary to presence of rectal tubing. diffuse perivesicular stranding consistent with the patient's history of cystitis without evidence of abscess. two linear foci of increased attentuation between the sigmoid colon and bladder which may reflect chronic inflammation. however, fistula cannot be entirely excluded. othewise preserved colovesicular fat planes. the patient will return to the department for a ct cystogram following removal of the endorectal tube, to repeat atttemt at evaluation for rectovesicular fistula. 2. foley catheter balloon inflated within the prostate, tip of catheter inferior to the prostate as well. 3. partially visualized ventral hernia involving a portion of the sigmoid colon without evidence of obstruction. 4. atypical orientation of the left femur relative to the left acetabulum which may be secondary to known chronic contractures or prior trauma renal us no evidence of abnormal fluid collections within the kidneys, that is concerning for abscess formation. limited examination secondary to patient contractures with poor son windows. bladder not assessed on this renal ultrasound. ultrasound would not be able to detect rectovesicular fistula. brief hospital course: 84 y/o with advanced dementia, recurrent aspiration pna, and recurrent utis admitted to the icu with fever and increasing respiratory distress. #. aspiration pna: the patient has chronic dysphagia and a peg at baseline. he has a history of aspiration pna. he was rhonchorous on exam with witnessed poor secretion clearing with a history of aspiration pna making this the most likely diagnosis. the cxr is fairly benign but there appears to be upper lobe infiltrates which may be underestimated in the setting of dehydration. given history of pseudomonal and mssa pna and chronic nursing home resident he was covered broadly for hap/asp pna with linezolid, zosyn and cipro. dfa for influenza and urine legionella antigen was negative. he initially required a facemask o2, however was weaned to room air with decreased secretions by when he was called out to the floor. his sputum cultures grew both mssa and pseudomonas, so he was continued on a 8 day course of zosyn and a 3 week course of nafcillin for mssa. he will need weekly cbc and chemistry panel drawn at for monitoring. # uti: the patient had a mildly positive ua on admission, however ua was repeated on on as urine appeared cloudy and showed >1000 wbcs, with many bacteria, moderate blood, large leuks; repeat on was similar except no bacteria were seen. foley was changed on admission. urine culture from grew >100,000 gnr with mixed fecal flora; repeat cultures later in his admission (on zosyn/cipro/linezolid) grew only yeast. he was noted to have irritation/ulceration in his urethral meatus. due to concern for abscess or rectovesicular fistulagiven extreme pyuria, ctu was performed which again did not reveal a rectovesicular fistula. on evening, the rn staff noted white discharge from the urethral meatus. urology was consulted in the setting of his history and felt that this could be consistent with sloughing of cells in the urethra, but unlikely to be a new infection or abscess. his ucx were positive for yeast and in the setting of ct finding of cystitis and positive ua, he was treated with fluconazole for fungal uri x 7 days (to be completed on saturday ). he will need urology follow up as an outpatient given his prostatic nodule that was found on the ct cystogram. he has no history of bph or having a turp and will need this to be addressed as an outaptient. # bacteremia: of his admission blood cultures grew coag negative staph. this was thought to be a contaminent; subsequent cultures negative, treated with broad spectrum abx (including linezolid) as above. #. diarrhea: the patient has a history of constipation, but had liquid stools throughout his admission. c diff was negative x 3 and he had a flexiseal in place to prevent pressure ulcers and skin contamination during his hospital stay. the etiology of his diarrhea is most likely antibiotic related. his stool softeners were held in the hospital. he was started on loperamide prn for diarrhea and should be continued as an outpatient. #. hypernatremia: treated with increased free water via peg with improvement. #. seizure disorder, since age 15. chronically on phenobarbital. his serum levels were therapeutic. #. end stage dementia: minimally verbal at baseline, a&ox0 at at baseline. was initially non verbal in icu; began to interact minimally upon transfer to medical floor. dysphagia, has peg. #. h/o paroxsymal v-tach: monitor on tele access: picc code status: dnr/ intubation, pressors ok; this was confirmed with hcp emergency contact: hcp brother. medications on admission: s/p levoquin 500mg po x 7 days finished s/p cipro 500mg po daily x 7 days - albuterol- ipratropium nebs q4h bottle mag citrate prn scopolamine patch 1.5mg q72hrs lansoprazole 30mg daily penobarbital 60mg via g tube scopolamine patch 1.5mg q72hrs acetaminopthen 160mg/5ml elixir 20ml po q6h via g-tube bisacodyl 10mg suppository pr tid mwf docusate 50mg/5ml liquid 10mg mom prn 8.8mg / 5ml syrup 5ml fleet enema prn discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. phenobarbital 20 mg/5 ml elixir : three (3) po bid (2 times a day). 3. fluconazole 200 mg tablet : two (2) tablet po q24h (every 24 hours) for 4 days. 4. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 6. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback : one (1) intravenous q8h (every 8 hours) for 1 days. 7. nafcillin in d2.4w 2 gram/100 ml piggyback : one (1) intravenous q4h (every 4 hours) as needed for mssa pneumonia for 2 weeks. 8. scopolamine base 1.5 mg patch 72 hr : one (1) transdermal every seventy-two (72) hours. discharge disposition: extended care facility: - discharge diagnosis: aspiration pneumonia fungal uti dementia urinary retention diarrhea discharge condition: stable, on room air. discharge instructions: you were admitted to the hospital with shortness of breath and fevers. you were sent to the icu and started on antibiotics. your oxygen levels were improved and were transferred to the floor. your urine also looked like it was infected and there was concern for an infection. you had a ct scan to look for abscess and a connection between your bowel and your bladder, which was negative. you were started on antibiotics and and these will be continued. the following medications were started: 1. nafcillin - last dose on pm 2. zosyn last dose on pm 3. fluconazole 4. immodium followup instructions: have already discussed his case with who will see the patient tomorrow at . procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances injection or infusion of oxazolidinone class of antibiotics diagnoses: acidosis anemia, unspecified unspecified septicemia candidiasis of other urogenital sites sepsis other persistent mental disorders due to conditions classified elsewhere paroxysmal ventricular tachycardia pneumonitis due to inhalation of food or vomitus methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site retention of urine, unspecified epilepsy, unspecified, without mention of intractable epilepsy diarrhea hyperosmolality and/or hypernatremia pseudomonas infection in conditions classified elsewhere and of unspecified site other gastrostomy complications unspecified antibiotic causing adverse effects in therapeutic use dysphagia, unspecified nodular prostate with urinary obstruction 

Answer: The patient is high likely exposed to