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: penicillins / sulfonamides / diltiazem / codeine / iodine-iodine containing / ativan / fish product derivatives attending: chief complaint: shortness of breath major surgical or invasive procedure: picc line placement history of present illness: the patient is an 80 year old male with a history of severe copd, hypertension, hyperlipidemia, diabetes, spinal stenosis, afib/flutter, and chf with ef 59%. he had a recent hospitalization for cap/aspiration pneumonia, and a recent levofloxacin course for bronchitis. he presents with a worsening rhonchorous cough, sob, and fatigue. . he was recently admitted from with a 9 day icu stay for lll pneumonia treated with levofloxacin. he was also diuresed during his stay, as some component of his symptoms were thought to be due to chf in the setting of aggressive volume resuscitation for hypotension. his course was complicated by afib with rvr and hypotension. he is not sure when he came home from rehab but he thinks it has been several weeks. he is currently at home with his wife and has home . . dr. reports that he came to the ed today for worsening sob and fatigue. he reports a cough that worsened over the last day or so. he presented on to his pcp with complaints of a cough and was treated for possible new bronchitis with levofloxacin 250 mg qd x 7 days. the patient reports improvement in his cough after the antibiotics but his symptoms have since recurred (he cannot say the exact date of when this recurred). he feels chest congestion but has a hard time mobilizing his secretions. he denies fevers, sore throat, runny nose. . of note, the patient reports frequent falls with spinal stenosis causing left leg weakness. his last fall was a witnessed fall three days ago when he fell onto his back. he also reports periodic abdominal pain and diarrhea with a history of uc. his last bout of abdominal pain was when he fell. he currently denies abdominal pain, bloody stools, diarrhea, melena and n/v. . in the ed, vs were initially t 96.7, bp 159/89, hr 90, rr 22, spo2 100% on 2l nc. repeat bp measurements showed a dropping sbp from 90 to 70. he was bolused with 1l ns and had improvement in his sbp to 100. he was given a dose of levofloxacin as well as vancomycin for pus draining from his left antecubital fossa distal to an area of thrombophlebitis (noted in out-pateint records). he was also given combivent nebulizer with improvement in his symptoms. . past medical history: # recent complicated hospitalization with pneumonia, respiratory insufficiency, chf, hypotension, and arrhythmia # hypertension # type 2 diabetes mellitus: on ssi + levemir # hypercholesterolemia # ulcerative colitis- controlled on asacol alone # cervical spinal stenosis with lle weakness and frequent falls # status post total left hip replacement on , postoperative atrial fibrillation/flutter with eleven second pauses # macular degeneration # schatzki's ring # copd # left knee arthroscopy in . # normal stress mibi in , with an ejection fraction of 59% # atrial fibrillation with rvr # s/p pacemaker # reduced dlco, likely due to emphysema. social history: retired internist. prior smoker, quit 15 years ago. married with three children and six grandchildren. family history: his father died of myocardial infarction at age 70. mother died of myocardial infarction at age 80. sister died of complications of surgery at age 60. physical exam: vs in the ed: 96.7, 159/89, 90, 22, 100% on 2lnc vs on arrival to the icu: 96.6, 71 apaced, 133/54, 16, 96% 2lnc general: comfortable, elderly, hard of hearing heent: poor dentition, dry mm, op clear w/o exudates lungs: diffuse ins + exp wheeze but good air movement; crackles at bases b/l, no egophony cardio: rate regular, no murmurs appreciated but hard to hear heart sounds over breath sounds abd: + bs, soft, obese, ntnd, ext: 1+ , right slightly greater than left; wearing pneumoboots skin: scattered ecchymoses; small punctate skin break on left antecubital fossa draining thick yellow pus when expressed; has minimal erythema overlying site of hardened thrombophlebitis in distal left forearm neuro: awake and alert (per ed, was sleepier on presentation), ox3, conversant, cn ii - xii intact; strength 3/5 in lower extremities, in upper pertinent results: admission labs: na 120, cr 1.8 (baseline hard to tell from omr, ckd; best cr recently was 1.2), bun 54, wbc 16.3 with 4% bands, hct 29.1 (recent baseline in low 30's); urine lytes with na 15, osm 368 . admission ekg: apaced, regular, hr 79, qrs 126, no st changes . admission cxr: patchy opacities at left heart border with loss of left hemidiaphragm, though not significantly worse than film from . ue ultrasound: 1) thrombosed basilic vein with surrounding peripheral inflammatory change consistent with thrombophlebitis. 2) track extending from the skin surface at the more inferior punctate focus into the subcutaneous tissues. no drainable collection. ct chest w/o contrast: bilateral lower lobe consolidation, worse on the left. moderately large left pleural effusion. no endobronchial obstructive lesion shown. the patient should be followed up with a chest radiograph in 4 weeks, to ensure resolution. esophageal distension with food debris in the lower esophagus indicating risk of aspiration. incidental finding of new superior endplate collapse of t10 and t12, healed right rib fractures and non-healed left tenth rib fracture. . . esophagus study date of 1:25 pm comparison: ct chest, . findings: barium passes into the esophagus without obstruction. there is a stagnant column of barium within the distal esophagus. barium does traverse into the stomach; however, passage is delayed without evidence of a physical obstruction. there are poor peristaltic contractions with significant tertiary contractions noted. due to the high residue remaining in the esophagus and risk of aspiration, full esophagram was not completed; however, there was no evidence of significant hiatal hernia or schatzki's ring on this examination. the high residual content within the esophagus could put the patient at risk for aspiration during reflux episodes when recumbent or with coughing. impression: poor peristaltic contractions with significant tertiary contractions representing esophageal dysmotility with significant residue remaining in the esophagus that would put the patient at risk for aspiration events. . . video oropharyngeal swallow study date of 1:29 pm technique: oropharyngeal video fluoroscopy was conducted in conjunction with the speech and swallow division. multiple consistencies of barium were administered with the patient in the right lateral position. findings: barium passes through the oropharynx without evidence of obstruction. there is slow oral phase with frequent spillover and high residue in the valleculae. there was aspiration and penetration with thin liquid barium. there was penetration with nectar-thickened barium and no gross aspiration or penetration with thick barium or barium-coated solids. on glands down into the esophagus, there was still significant residue from the patient's recent barium esophagram. for further details, please see the speech and swallow division note in the online medical record. impression: gross aspiration and penetration with thin liquids. penetration with nectar-thickened liquids. no aspiration or penetration with thick barium or barium-coated solids. significant residue noted in the esophagus that has a tendency to reflux when the patient coughs. . . chest port. line placement study date of 8:50 pm findings: in comparison with study of , there has been placement of a right subclavian picc line that extends to the lower portion of the svc near the cavoatrial junction. this information was discussed by the resident on call with the iv nurse. otherwise, little change with bibasilar atelectatic change, much more prominent on the left, and pleural effusions, also more prominent on the left. there also appears to be some engorgement of the pulmonary vessels consistent with elevated pulmonary venous pressure in this patient with cardiomegaly and a dual-channel pacemaker device in place. . . unilat up ext veins us study date of 2:46 pm technique: upper extremity venous ultrasound findings: a superficial vein within the antecubital fossa is again seen to be noncompressible and expanded by internal thrombus without demonstrable flow, consistent with thrombus. on today's examination which includes complete examination of the upper extremity veins it is found that the thrombosed vessel represents the cephalic vein rather than the basilic vein as previously suspected. doppler interrogation of the left brachial basilic, axillary, subclavian and internal jugular veins show demonstrates normal flow and compressibility without evidence of thrombus. in the region of the antecubital fossa, there is less edema of the subcutaneous tissues, when compared with prior us and there is again no drainable collection identified. impression: stable echogenic thrombus within the left cephalic vein at the level of the antecubital fossa with no proximal thrombus identified. less induration of the subcutaneous tissues when compared with prior imaging with no drainable collection identified. . . brief hospital course: the patient is an 80 year old male with a history of severe copd, recent hospitalization for cap/aspiration pna, and levofloxacin course for bronchitis, who presented with a rhonchorous cough, sob, and fatigue. he was admitted to the micu after a hypotensive episode in the ed which resolved with iv fluids, and is now being transferred to the floor. . # pneumonia: evaluated for cap versus aspiration pna. ct showed lll consolidation and pleural effusion. no mass was seen that would suggest a post-obstructive cause for his pneumonia. video swallow studies showed frank aspiration and esophageal dysmotility. he was treated with an antibiotic regimen of vancomycin/aztreonam/flagyl for presumed aspiration pneumonia. he was continued on his home fluticasone-salmeterol diskus (250/50) and given albuterol and ipratropium nebulizer treatments as needed. he remained afebrile after transfer from the icu, except for a low grade temperature of 100.2 on the evening of . his pulmonary exam and coughing improved over the course of his stay, and the patient reported less shortness of breath and more comfortable breathing. he is planned for a 10 day course of antibiotics, which should finish on . . # aspiration: his initial chest ct was concerning for food debris retained in the esophagus. frank aspiration and esophageal dysmotility with regurgitation were seen on a later video swallow study. it had been noted that the patient would cough much more after eating and after lying flat. the findings were discussed in detail with the patient and his family. he declined alternative means of nutrition such as a peg tube, and wished to continue eating despite the risk of aspiration. he was kept on strict aspiration precautions during his stay. he was also started on reglan 5 mg po with meals and at bedtime. he was seen by gi consult, but declined endoscopy or further procedures to evaluate his gi motility issues while an inpatient and wants to follow-up with his gastroenterologist after leaving the hospital. . # left antecubital thrombophlebitis: on admission he was noted to have an area of induration on his left arm. the lesion was not red and inflamed, but was firm and draining thick yellow pus. ultrasound of the arm veins on was consistent with thrombophlebitis, with no drainable fluid collection identified. repeat us on showed less induration but otherwise similar findings. wound cultures from grew mrsa. blood cultures from grew coag negative staphylococcus in bottles, which likely represents a contaminant rather than bacteremia given that a different organism was seen than the one in the wound culture. surveillance cultures were sent daily, and no growth was seen in any of them at the time of discharge. vascular surgery was following and did not think any further antibiotic treatment was needed and recommended follow-up with dr. several weeks following discharge. . # atrial fibrillation: his home meds include amiodarone and metoprolol for a history of atrial fibrillation. he has not been anticoagulated with coumadin since after having a series of falls. he had several episodes of afib while admitted, with rates reaching the 110-130s. he was generally asymptomatic during these episodes. when not in afib, he was atrially paced at 70 bpm. on several occasions, the episodes responded to receiving his scheduled metoprolol dose early. his home dose of metoprolol was 100 mg . this was adjusted in the icu to 75 mg tid and increased on the floor to 100 mg tid on . his recent episodes of afib are likely related to his recent illness and may decrease in frequency as his condition improves. his cardiologist, dr. , was consulted and recommended that if he requires further rate control, he should start diltiazem q6h, titrating it up as needed, and decrease his metoprolol dose to 50 mg po bid. . # hyponatremia: his hyponatremia on admission was likely from elevated adh given his uosm > 300. possible etiologies considered included siadh from a lung process, though he did not have such low hyponatremia on prior admission. elevated adh in setting of chf was considered, but he was not in florid failure. tsh was 1.5 and cortisol was within normal limits. his los fluid balance was negative in the icu. his na improved over the last few days before discharge, with na 125 on and 128 on . he was kept on a fluid restriction of 1500 ml during his stay and excess free water was avoided if possible in his antibiotic infusions. . # hypotension: he had transient hypotension on admission likely due to volume depletion. he did meet criteria for sirs/sepsis initially, but his bp remained fairly stable and even hypertensive afterwards. he was continued on a beta blocker, but his home enalapril and hctz were held during most of his stay. he was restarted on a lower dose of enalapril prior to discharge, with plans to titrate back up as tolerated. . # abdominal pain and diarrhea: the patient has a history of uc and intermittent abdominal pain. he was relatively asymptomatic during his hospital stay, reporting only very mild tenderness to palpation diffusely across the abdomen. he was continued on his home regimen of asacol. he was mildly constipated at the time of transfer from the icu, but resumed regular bowel movements with a gentle bowel regimen. . # diabetes: during his hospitalization, his blood glucose levels were running high using his home dose of long-acting insulin 17 units qhs (levemir at home substituted with lantus while admitted). his sliding scale humalog usage was 40 units over 24 hours on . his evening lantus dose was increased from 17 units to 30 units and his sliding scale was adjusted. his fbg was 168 the next morning, but his insulin dosing will likely need further adjustment after discharge. . medications on admission: amiodarone 200 mg tablet qd atorvastatin 10 gm qd budesonide 1 to 2 sprays in each nostril once a day enalapril 10 mg fluticasone-salmeterol 250 mcg-50 mcg one puff folic acid 1 mg qd hydrochlorothiazide 12.5 mg qd insulin detemir 17 units every night ipratropium-albuterol 1-2 puffs(s) 2-4 times daily prn levothyroxine 100 mcg tablet qd mesalamine 1200 mg tid metoprolol tartrate 100 mg tablet montelukast 10 mg tablet pantoprazole 40 mg primidone 50 mg tablet qd sertraline 50 mg tablet qd solifenacin 10 mg qd terazosin 6 mg qd tramadol 50-100 mg tablet q6 hours prn acetaminophen 1000 mg tid prn pain aspirin 325 mg qd calcium carbonate 650 mg (1,625 mg) tablet - 2 (two) tablet(s) calcium citrate-vitamin d3 200 mg (calcium)-250 unit tablet - 2 tablet(s) by mouth once a day at lunch cholecalciferol (vitamin d3) 1,000 unit capsule 1 (one) capsule(s) by mouth once a day docusate sodium 100 mg qd glucosamine sulfate 1500 mg qd guaifenesin 600 mg tablet sustained release - 2 (two) tablet(s) magnesium 250 mg qd multivitamin-minerals-lutein qd discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po tid (3 times a day). 7. montelukast 10 mg tablet sig: one (1) tablet po at bedtime. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 9. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 10. vesicare 10 mg tablet sig: one (1) tablet po once a day. 11. terazosin 2 mg capsule sig: three (3) capsule po once a day. 12. tramadol 50 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 13. acetaminophen 500 mg tablet sig: two (2) tablet po three times a day as needed for pain. 14. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 15. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day) as needed for cough. 16. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 17. budesonide 32 mcg/actuation spray, non-aerosol sig: nasal once a day. 18. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 19. magnesium 250 mg tablet sig: one (1) tablet po once a day. 20. centrum silver tablet sig: one (1) tablet po once a day. 21. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: inhalation four times a day as needed for shortness of breath or wheezing. 22. primidone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 23. aztreonam in dextrose(iso-osm) 2 gram/50 ml piggyback sig: one (1) intravenous q8h (every 8 hours): continue through . 24. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours): continue through . 25. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): continue through . 26. metoclopramide 5 mg tablet sig: one (1) tablet po qachs: please give 30 min before meals. 27. metoprolol tartrate 100 mg tablet sig: one (1) tablet po three times a day. 28. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 29. enalapril maleate 2.5 mg tablet sig: one (1) tablet po twice a day. 30. calcium carbonate 650 mg (1,625 mg) tablet sig: two (2) tablet po twice a day. 31. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime: please adjust as necessary based on blood sugars. 32. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous qidachs: please adjust as necessary based on blood sugars and to avoid hypoglycemia. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary diagnoses: aspiration pneumonia pharyngeal dysphagia esophageal dysmotility thrombophlebitis atrial fibrillation secondary diagnoses: chronic obstructive pulmonary disease diabetes mellitus ulcerative colitis cervical spinal stenosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital for worsening cough and shortness of breath. in the hospital, a chest ct scan showed pneumonia in the lower lobes of the lungs and a distended esophagus with food debris. further evaluation showed esophageal dysmotility with poor function during swallowing and a high risk for aspiration. recommendations were given to help reduce this risk when eating. we increased the frequency of your medication metoclopramide (reglan), which should help your stomach empty and may reduce the risk of regurgitating food. your pneumonia is being treated with several antibiotics including aztreonam, vancomycin, and metronidazole. the aztreonam and vancomycin must be given intravenously. a picc line was placed in order to deliver these medications more easily. you will need to continue taking these antibiotics through to complete the course. the picc line can be removed after the antibiotics are completed. the antibiotics are also being used to treat thrombophlebitis, an infected blood clot in one of the veins of your arm. your arm veins were evaluated by ultrasound, showing that the clot was limited to a single vein. you were seen by vascular surgery, who recommended no further antibiotics after your pneumonia is treated. blood cultures during your stay did not show spread of the infection into your blood. several times during your stay in the hospital, your heart went into atrial fibrillation with a rapid heart rate. you were kept on your home dose of amiodarone and your rapid heart rate would improve after receiving metoprolol. the stress of an infection can lead to worse episodes of atrial fibrillation. as your pneumonia resolves, your episodes of atrial fibrillation will hopefully decrease as well. you should follow up with your cardiologist, dr , after discharge for further recommendations and possible medication adjustments. serious infections can lead to increased blood glucose levels. your nightly insulin dose was increased from 17 units to 30 units while in the hospital. you should continue to check your blood glucose levels regularly and adjust your insulin dose as appropriate. you may need less after leaving the hospital. several of your medications have been changed and several medications have been added or stopped. you should refer to your discharge medication sheet for further details. followup instructions: you have the following appointments scheduled over the next few weeks. you should call your pcp, , to set up a followup appointment after discharge from rehab. his clinic can be reached at . department: otolaryngology-audiology when: tuesday at 1 pm with: , md building: lm bldg () campus: west best parking: garage department: west clinic when: wednesday at 1:30 pm with: , md building: de building ( complex) campus: west best parking: garage department: vascular surgery when: friday at 10:00 am with: , md building: lm campus: west best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified atrial fibrillation atrial flutter other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonitis due to inhalation of food or vomitus other complications due to other vascular device, implant, and graft cardiac pacemaker in situ ulcerative colitis, unspecified phlebitis and thrombophlebitis of superficial veins of upper extremities spinal stenosis in cervical region ulcer of other part of lower limb dyskinesia of esophagus 

Answer: The patient is high likely exposed to