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: precedex attending: chief complaint: found unresponsive. major surgical or invasive procedure: -endotracheal intubation -picc line -arterial line history of present illness: this is a 57 year old homeless male with pmh of chf, a. fib, dm, psoriasis, osa; found unresponsive at the hotel where he lives. he was found between the bed and the wall, unclear how long the pt was unresponsive. he was initially taken to , but was transferred here because he was too large to fit in the scanner. at the osh ed he was intermittently lucid, tachy to 140s and 88% on ra. he was given iv narcan for acute ams w/o improvement. nothing else revealing on workup (unrevealing cardiac enzymes, ua, glucose, utox and etoh neg). abg 7.36/60/60/34 on 4l/nc. wbc 12.6. ceftriaxone/flagyl for possible aspiration pneumonia and transferred to . in the ed, vitals were t 98, hr 108, bp 136/72, rr 24, 98% on ra. he was intubated for unclear reasons. received ceftriaxone, vancomycin, and acyclovir as empiric coverage for meningitis. given flagyl for unclear reasons. lp could not be performed (?attempted). a cxr showed ?rul infiltrate. a ct head, abd/pelvis could not be performed due to size. he was continued on a dilt drip. patient admitted to the on . continued on the above antibiotic regimen. had ct head, which was negative for acute bleed. attempt at lp was unsuccessful (could only hit bone). tte performed and uninterpretable due to body habitus. tee fellow for possible tee, on hold currently. weaned off dilt gtt. neuro consulted. eeg performed. woke up and was apparently violent so placed on propofol. patient was recently hospitalized at the va w/ nonexertional cp and tx for chf exacerbation. pt's coumadin was stopped at that time because of being extremely noncompliant and f/u meds. past medical history: congestive heart failure atrial fibrillation diabetes psoriasis obstructive sleep apnea morbid obesity social history: patient lives in a hotel. previously living in his car. otherwise unknown. family history: unknown. physical exam: on arrival: general: intubated, sedated, morbidly obese heent: sclera anicteric, nc/at, ett in place neck: supple, jvp difficult to assess due to body habitus lungs: clear to auscultation anteriorly cv: irregularly irregular, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, soft, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, chronic venous stasis changes skin: diffuse psoriatic plaques covering >50% bsa, areas of excoriation and dried blood pertinent results: labs on admission: 06:35pm blood wbc-15.2* rbc-4.73 hgb-12.8* hct-40.9 mcv-86 mch-27.1 mchc-31.4 rdw-16.7* plt ct-328 06:35pm blood neuts-84.1* lymphs-9.3* monos-5.7 eos-0.5 baso-0.3 10:10pm blood pt-16.3* ptt-26.5 inr(pt)-1.5* 06:35pm blood glucose-194* urean-13 creat-0.8 na-148* k-4.6 cl-108 hco3-30 angap-15 06:35pm blood alt-29 ast-44* ld(ldh)-275* ck(cpk)-896* alkphos-124* totbili-0.8 06:35pm blood lipase-19 06:35pm blood ck-mb-9 ctropnt-0.01 probnp-1402* 06:35pm blood calcium-8.6 phos-4.1 mg-2.4 07:49pm blood ammonia-86* 06:35pm blood tsh-2.3 06:35pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:49pm blood glucose-190* lactate-1.9 . chest x-ray : ap supine chest radiograph is obtained portably. the patient is quite rotated to his right and motion artifact significantly limits evaluation. due to the extreme limitations of the study, evaluation is deemed non-diagnostic and repeat study is recommended. . ct head : no evidence of intracranial hemorrhage, edema, mass effect, or infarction. the ventricles and sulci are normal in size and configuration. there are no fractures. visualized paranasal structures are notable for mucosal thickening at the sphenoid and ethmoidal air cells, more prominently on the right. . eeg : this is an abnormal routine eeg in the waking and sleeping states due to the presence of delta frequency slowing intermixed with a normal background. this finding can be seen with mild encephalopathy, medication effect, or extreme drowsiness. there were no focal abnormalities or epileptiform features noted. note is also made of an irregular cardiac rhythm with a tachycardia. . ct head : no hemorrhage or mass effect. . cxr : reason for exam: acute desaturation. . comparison is made with prior study . still mild pulmonary edema has markedly improved. there are linear atelectasis in the left base. there is mild to moderate cardiomegaly. there are no enlarging pleural effusions. . brief hospital course: this is a 57 year old male with morbid obesity, osa, dm, afib, chf, here with altered mental status leading to intubation, now extubated with improving mental status. # altered mental status: patient was initially found to be obtunded. this was of unclear etiology. hypercarbia would not be wholly unexpected in this patient given his body habitus and his cpap requirement. eeg results from showed abnormal in waking and sleeping states, with findings which can be seen with mild encephalopathy, medication effect, or extreme drowsiness. no focal abnormalities or epileptiform features. mri was unable to be performed as patient was too large for scanner. patient was treated empirically for meningitis but lp was attempted multiple times and unsuccessful due to patient's body habitus. repeat ct scan to look for cerebral edema or evidence of anoxic brain injury was negative. extubated on , mental status assessed and patient initially alert and able to follow commands but non-verbal. did not appear appropriate after extubation from mental status perspective, and was reintubated shortly thereafter. repeat head ct from was negative. the patient self extubated on in the morning with stable respiratory function post-extubation. at that time he was able to follow complex commands post-extubation, talking and responsive. on he had a new delirium with increased wbc, diarrhea, and was treated empirically for c. diff (initially with flagyl, switched to po vanco due to increased diarrhea and increased wbc count). after being transferred to the floor the patient was alert and oriented x2 initially. he was found to be somnolent on the morning after arrival to the floor after not wearing his cpap at night. his abg was not particularly concerning (7.43/76/47), but his ms improved with 30 minutes of cpap, and no other abnormalities were found. his mental status continued to improve and he remained alert and oriented x3 for the week prior to discharge. . # respiratory failure: the patient was intubated in order to protect airway in setting of altered mental status. it was a difficult intubation using fiberoptic scope for intubation. he was diuresed aggressively with lasix due to pulmonary edema (approx 30l over los). he was initially extubated on , however required reintubation with awake fiberoptic by anesthesia later in the pm on due to worsening tachypnea despite bipap. mini-bal performed with no growth on final culture. he was continued with ongoing diuresis. he had infiltrates on chest x-ray concerning for ventilator assocaited pneumonia (vap) given tan colored sputum and he was started on vanco/zosyn. he self extubated on in the morning, with stable respiratory status post-extubation. he is placed nightly on bipap prophylactically, and his abg/vbg??????s remained stable. he completed a 7 day course of vancomycin/zosyn and had no further respiratory symptoms on the floor. . # leukocytosis: his wbc count fluctuated. elevated wbc at presentation raised the possibility of infection as cause of ams. urine studies were negative. possible rul infiltrate on cxr, however chest x-rays were poor studies given his body habitus and difficult to interpret. sputum culture only with growth of oropharyngeal flora. unable to assess for history of meningismus; therefore he was started on empiric treatment for meningitis. bal from was negative at final culture result. all urine cultures negative. blood cultures also negative. perisistently elevated wbc counts still have had unclear cause, so he was started on empiric flagyl as well on . on patient was changed to po vanco when his wbc went up to 20 and his diarrhea worsened. his wbc count trended down, and his diarrhea resolved. wbc on discharge was 10.7. he will continue a 14 day course of oral vancomycin on 4/31/. . # atrial fibrillation: patient had a-fib with history of rvr. this controlled on oral diltiazem and this was uptitrated as his bp allowed. he was not placed on coumadin due to poor compliance (per review of his va records). . # chf: the patient has a reported history of congestive heart failure. it was difficult to assess volume status in this patient due to obesity. he was diuresed aggressively due to his positive fluid balance and for benefit of his repiratory status. tte was attempted but was not readable given his overlying tissue. the patient was seen by pt and did not require oxygen for ambulation. later during his hospitalization he seemed to have been over-diuresed, so lasix was decreased to 40 mg daily, and he remained euvolemic on this regimen. also, lisinopril 5 mg daily was added to his medications. # psoriasis: the patient has extensive psoriasis. he was started on topical creams as recommended in his recent va discharge summary (calcipotriene .005% cream and triamcinolone acetonide .1% cream ), and his psoriasis improved. . # diabetes: this was controlled on iss. he was started on metformin 500 and uptitrated to metformin 850 . fingerstick blood glucose was mostly in the 150-200 range prior to discharge. further managment may include an increase in metformin or additional of a sulfonylurea and was deferred to the outpatient setting. . #osa: patient required bipap at night to prevent hypoxia and hypercarbia. when he did not wear this his mental status was altered or he had episodic desaturation. prior to discharge he was provided with a bipap machine by medical company. request was mailed to va for records from his sleep study to be sent to this company. . # disposition: social work and case management worked with the patient extensively to arrange disposition that was both satisfactory to him and medically appropriate. he was concerned that his belongings had been lost in the course of his hospitalization and transfer. the outside hospital and hotel where he had previously been were , and some of his belongings were found at . he was discharged with the phone number to that hospital and plans to go pick up his things there. he was also given clothes, shoes, a cab voucher, and $43. he will go to a 17 court shelter, which has agreed to accomodate him. his medications will be provided by the va. his bipap was taken with him. his vital signs and mental status were stable and, although he was quite reluctant to leave, he has no further medical indication for hospitalization at this time. medications on admission: from recent discharge (va): - lasix 60mg - toprol xl 200mg - ocuvite presvervision tab qd - hydrocortisone 1% cream, - calcipotriene 0.005% top cream - triamcinilone 0.1% ointment - combivent 90/18 - 2puffs q6 prn - mom 220mg- 2 puffs qhs - asa 81 qd - chlorhexidine 4% qd after showering - fluoxetine 40mg qd discharge disposition: home discharge diagnosis: -altered mental status -hypercapnic respiratory failure -hospital acquired pneumonia -psoriasis -diabetes type 2 -hypertension -morbid obesity -c. difficile infection discharge condition: hemodynamically stable, afebrile, alert and oriented to person and place. discharge instructions: you were admitted for altered mental status and were treated for possible meningitis (brain infection). it is unclear whether you had meningitis, and also you had two ct scans of the head which did not show any cause of altered mental status. you required intubation to protect your airways and you were treated for pneumonia while you were on the ventilator. after you came off the ventilator you did very well. you developed diarrhea and we treated you for an antibiotic-associated infection. we also noticed that you became difficult to around when you did not wear your cpap at night. . we started your application for medical insurance. you should follow up with ... . we made the following changes to your medications: added vancomycin take by mouth four times a day until ... you should also continue your topical psoriasis creams as written in your medication list. please take all your medications as described on your medication list. . it is very important that you wear your cpap at night. when you do not wear this, your levels of carbon dioxide rise and this causes you to have altered mental status which is very dangerous. if you have any problems with your cpap machine please call your doctor immediately. . please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, or any other symptoms that you are concerned about. followup instructions: please call the hospital and follow up with your pcp weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure acute respiratory failure intestinal infection due to clostridium difficile morbid obesity encephalopathy, unspecified hyperosmolality and/or hypernatremia ventilator associated pneumonia other psoriasis lack of housing meningitis, unspecified 

Answer: The patient is high likely exposed to