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: patient recorded as having no known allergies to drugs attending: chief complaint: increased somnolence major surgical or invasive procedure: bronchoscopy, central line placement, picc placement history of present illness: 53 year old male with severe copd, remote l cva (residual r sided weakness), dm, hypercarbic respiratory failure, chronically vented was sent to ed because of worsening somnolence and hypotension. pt usually gets his care at /bu but was just recently at for vap. he has been intubated at the beginning of , reportedly at for hypercarbic respiratory failure in setting of severe copd. before that he has been o2 dependent due to severe copd, living at a nh. at the osh, he was found to have a rml and rll collapse and paratracaheal lad as well as chronic right pleural effusions. he also has questionable old granulomatous lung disease with calcified hilar lad. he eventually required trach/peg because of difficulties weaning from the vent. he reportedly had a bronchoscopy done ruling out malignancy. he was at rehab (radius hospital) since . he has been doing better until the middle of , when he was on cpap transiently. however, since the end of , his respiratory status worsened again and he remained on ac. he was treated for vap in here due to pseudomonas esbl. since then he was back at rehab and was weaned successfully. the day of admission, he underwent a t-piece trial and then was found to be unresponsive on the floor. the circumstances are unclear and oral report from the included tonic-clonic movements, while another report does not confirm that. the patient was transfered to for further evaluation. in the ed, his vs were 97.9, 110, 80/46, rr 20, 98% on unclear settings. a ct head and spine were unremarkable. a cxr showed chronich rll collapse but then subsequently after a r subclavian line placement showed almost complete r sided white-out with a off at the r mainstem bronchus. the patient was given abx, vanco, levo, cefepime and he received a total 5l ns. he persisted to be hypotensive and was started on levophed. on arrival to the icu, his bp was 96/70 and hr 117. he was only complaining of mild r foot pain but did not recall and injury to the foot. he reports that he had a seizure, but denies any complete loc. he denies any cp, abd pain, ha, vision changes, f,c,ns, dysuria, problems breathing or worsening secretions. past medical history: past medical history: - chronic vent/trach/peg for hypercarbic respiratory failure at the beginning of , ?reportedly due to copd exacerbation - severe copd, home o2 dependent in the past - per rehab admission note, questionable old granulomatous lung disease with calcified hilar lad - remote l cva with residual right sided weakness - new onset generalized tc seizures on per rehab neuro note, thought to be post-cva and metabolic abnormalities (on transfer from rehab on keppra, depakote) - diabetes mellitus, on 16u lantus at rehab and riss - depression - schizophrenia, on effexor and risperdal - past h/o etoh abuse - gerd psh: - trach - peg social history: social history: divorced. former smoking. has been at a nh prior to recent admission and vent facility. has been on home o2 before that for severe copd. family history: family history: non-contributory physical exam: vs: temp: 97.9 bp: 109/54 hr: 88 regular rr: 13 o2sat 96% trach mask gen: comfortable, nad heent: perrl, eomi, anicteric neck: large neck, difficult to assess jvd, trach in place resp: coarse b/l breath sounds with increased crackles at bases posteriorly cv: rrr, s1 and s2 wnl, no m/r/g abd: obese, nd, nl b/s, soft, mildly tender to palpation in rlq, no masses, peg tube in place ext: no c/c/e, warm, 1+ dp pulses skin: no rash neuro: opening eyes. handgrip intact, unable to lift off feet from bed or dorsiflex of palmarflex feet r > l. eomi. pertinent results: 10:15pm blood wbc-14.3*# rbc-4.17*# hgb-12.9*# hct-37.7*# mcv-91 mch-31.1 mchc-34.3 rdw-15.9* plt ct-576* 06:29am blood wbc-7.5 rbc-2.86* hgb-8.6* hct-25.7* mcv-90 mch-29.9 mchc-33.3 rdw-15.2 plt ct-488* 10:15pm blood pt-15.9* ptt-27.6 inr(pt)-1.4* 10:15pm blood glucose-212* urean-23* creat-0.7 na-139 k-5.2* cl-91* hco3-36* angap-17 06:29am blood glucose-106* urean-3* creat-0.2* na-140 k-4.1 cl-100 hco3-35* angap-9 02:33am blood alt-9 ast-9 ld(ldh)-90* alkphos-32* totbili-0.1 10:15pm blood calcium-9.9 phos-4.4 mg-2.6 06:29am blood calcium-8.6 phos-3.9 mg-1.9 10:15pm blood valproate-61 10:28pm blood po2-68* pco2-51* ph-7.46* caltco2-37* base xs-10 intubat-intubated vent-controlled 04:25pm blood type-art po2-85 pco2-55* ph-7.42 caltco2-37* base xs-8 10:18pm blood lactate-2.4* 09:00pm blood lactate-1.4 5:55 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs. smear reviewed; results confirmed. respiratory culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. sparse growth oropharyngeal flora. pseudomonas aeruginosa. moderate growth. of two colonial morphologies. gram negative rod(s). sparse growth of two colonial morphologies. proteus species. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem------------- 1 s piperacillin---------- 16 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s 1:00 pm stool consistency: loose source: stool. **final report ** fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. fecal culture - r/o vibrio (final ): no vibrio found. fecal culture - r/o yersinia (final ): no yersinia found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. (reference range-negative). chest (portable ap) 10:14 pm impression: persistent volume loss of the right hemithorax. right lung base opacity could be a combination of pleural fluid and atelectasis. underlying pneumonia cannot be excluded. ct head w/o contrast 12:17 am 1. no evidence of intracranial hemorrhage, acute major vascular territorial infarction, cerebral edema or fracture. 2. study limited by oblique positioning. probable remote left cerebellar infarction. ct abdomen w/contrast; ct pelvis w/contrast 3:51 am impression: 1. short segment uncomplicated sigmoid colitis, which is non-specific and may be infectious/inflammatory in etiology. 2. incompletely imaged bilateral pleural effusions, with partial collapse of the right lower lobe which may be post-obstructive, given the presence of fuid in the right lower lobe bronchus. brief hospital course: a/p: 53m on chronic trach-mask for copd/rll collapse/r pleural effusions, l cva (residual r sided weakness), dm, admitted for unresponsiveness likely sepsis. # hypoxia secondary to chronic r pleural effusions, r lung collapse, severe copd and tracheostomy: initial abg revealed chronic hypercarbia and compensated respiratory acidosis. initially suspected mucuous plug and subsequent lung collapse as possibly contributoring to hypoxia, or aspiration pneumonia given that patient was found down. cxr demonstrated rapidly evolving r lung opacification. was continued on ipratropium, fluticasone and albuterol nebs prn. sputum culture revealed pseudomonas sensitive all antibiotics except ciprofloxacin. thus, for nosocomial pneumonia, he was started on tobramycin inhalation soln 300 mg ih and meropenem 1000 mg iv q8h. successfully transitioned to trach-mask. initially had bronchoscopy on given persistent r lung collapse with resultant suctioning and sample sent to microbiology lab that revealed pseudomonas aeruginosa ~/ml with the same sensitivities. bronchoscopy was again peformed on , the day of discharge, for persistent r lower lobe collapse despite clinical improvement. an additional bal was obtained and culture data should be followed up in 48 hours. the microbiology lab can be contact at ( for final results. additionally, given his bronchoscopy the day of discharge, it would not be unusual for him to have a post-bronch fever 12-hours post-procedure. this would not represent a new infection. #diverticulitis: new rlq pain overnight. ct-demonstrated diverticulitis without abscess or collection. no wbc count, no fever. given that he was already on meropenem, and no evidence of new infection, no further antibiotics were added. recommended brief bowel rest with resolution of tubefeeding once pain resolved slightly. pain control with iv dilaudid. will continue these treatements as an outpatient. # dm: glargine (lantus) 16units as home regimen. initially started on insulin sliding scaled with 1/2 dose lantus given npo status. once diet was advanced, this was increased to 16. discharged with insulin sliding scale and scheduled insulin. # seizures: stable. per rehab neurology note, one gtc seizure in , thought to be due to post-cva and metabolic abnormalities. per discussion with nursing home staff, no sign of seizure at time of unresponsiveness. had slight fall out of chair without injury about 2-3 days prior to admission. on day of admission was simply found lying in bed with unresponsiveness, no signs of any trauma. therapeutic on valproic acid on admission. continued home regimen of levetiracetam 250 mg po bid and divalproex sprinkles 875 mg tid. # unresponsiveness: resolved. initially suspeced seizure with postictal state v. hypoxia v. sepsis. unlikely hypoxia as is chronic at baseline, and abgs did not show marked change. no evidence of seizure. based on clinical picture, likely sepsis, which is now resolved. continue antibiotics as an outpatient. # h/o cva: right sided weakness. seizure ppx post-cva and gtc seizure. # psychological issues: stable. schizophrenia and depression. continued on effexor, risperdal and trazodone. medications on admission: medications at rehab: heparin sc tid lansoprazole 30 mg po daily senna 8.6 mg po bid prn acetaminophen 325 mg q6h as needed for pain, fever. levetiracetam 250 mg po bid trazodone 50 mg po tid folic acid 1 mg po daily venlafaxine 75 mg po bid risperidone 2 mg po hs divalproex 875 mg tid ipratropium bromide inhalation q6h as needed for wheezing, sob docusate sodium ten ml po bid chlorhexidine gluconate 0.12 % mouthwash miconazole nitrate 2 % powder topical albuterol 4-6 puffs inhalation q4h beclomethasone dipropionate 2-4 puffs bisacodyl 5 mg tablet, delayed release daily as needed. diltiazem hcl 30 mg 0.5 tablet po tid furosemide 60 mg po bid lactulose thirty ml po q8h as needed. insulin scale as printed and attached. discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 4. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 5. levetiracetam 250 mg tablet : one (1) tablet po bid (2 times a day). 6. folic acid 1 mg tablet : one (1) tablet po daily (daily). 7. venlafaxine 75 mg tablet : one (1) tablet po bid (2 times a day). 8. risperidone 2 mg tablet : one (1) tablet po hs (at bedtime). 9. beclomethasone dipropionate 80 mcg/actuation aerosol : one (1) inhalation inhalation (2 times a day). 10. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day) as needed. 11. divalproex 125 mg capsule, sprinkle : seven (7) capsule, sprinkle po tid (3 times a day). 12. acetaminophen 160 mg/5 ml solution : ten (10) ml po q6h (every 6 hours) as needed for fever or pain. 13. ipratropium bromide 17 mcg/actuation aerosol : four (4) puff inhalation q6h (every 6 hours). 14. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed. 15. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours). 16. tobramycin 300 mg/5 ml solution for nebulization : five (5) ml inhalation (2 times a day) for 10 days: tobramycin inhalation soln 300 mg ih . please use perinebs to deliver. . 17. pantoprazole 40 mg iv q24h 18. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 19. meropenem 1000 mg iv q8h d1=, total 8 days 20. hydromorphone (dilaudid) 0.5 mg iv q6h:prn pain 21. outpatient physical therapy to be evaluated & treated in longterm care facility 22. outpatient occupational therapy to be evaluated & treated in longterm care facility 23. insulin sliding scale , insulin sc - sliding scale & fixed dose fingerstick q6h ---insulin sc fixed dose orders: bedtime, glargine 16 units ---insulin sc sliding scale q6h humalog glucose insulin dose 0-50 mg/dl amp d50 51-150 mg/dl 0 0 units 151-200 mg/dl 3 units 201-250 mg/dl 5 units 251-300 mg/dl 7 units 301-350 mg/dl 9 units 351-400 mg/dl 11 units > 400 mg/dl notify m.d. 24. nutrition tubefeeding: start upon arrival; probalance full strength; starting rate: 30 ml/hr; advance rate by 10 ml q4h to goal rate: 70 ml/hr. residual check: q4h. hold feeding for residual >= : 200 ml. flush w/ 50 ml water q6h 25. trazodone 50 mg tablet : one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: hospital discharge diagnosis: primary: pneumonia, diverticulitis secondary: hypotension, diabetes, history of stroke discharge condition: hemodynamically stable & afebrile discharge instructions: you were admitted with worsening somnolence and poor respiratory status. you were found to have pneumonia. you have been started on antibiotics and will continue these at your longterm care facility. please take all medications as prescribed. your facility will be provided with a list of your current medications that you will continue taking. please return to the ed or seek medical care if you notice increased work of breathing, shortness of breath, fever, chills, nausea, vomiting, diarrhea or for any other symptom which is concerning for you. followup instructions: to be followed by longterm care facility physicians while in residence. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: esophageal reflux unspecified pleural effusion diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified depressive disorder, not elsewhere classified unspecified schizophrenia, unspecified pneumonia due to pseudomonas other late effects of cerebrovascular disease septic shock epilepsy, unspecified, without mention of intractable epilepsy gastrostomy status chronic respiratory failure tracheostomy status other disorders of muscle, ligament, and fascia diverticulitis of colon (without mention of hemorrhage) 

Answer: The patient is high likely exposed to