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: no known allergies / adverse drug reactions attending: chief complaint: fever, hypoxia major surgical or invasive procedure: none history of present illness: year old male with copd on home o2 (2-3l) and frequent pna who presented yesterday to the er from his nursing home with fever, hypoxia and altered mental status. sats were in the 50s and came up to 90s with nrb by ems. in the ed his rectal temp was 102. a cxr demonstrated a lll pna. labs notable for acute on chronic kidney injury and hyperkalemia. he also had a positive ua. of note, he was recently admitted for hematuria and had bladder fulgeration on . has also been getting po vanc for c. difficile infection. in the er he was given vanc, zosyn, flagyl. ekg without ischemic changes or peaked t-waves, no qrs widening. he received insulin/glucose, calcium and kayexelate. his saturation was up to 92% on 4l, however he was admitted to the icu given the high oxygen requirement. ros positive for cough productive of green phlegm, and chronic chest pain, abdominal (suprapubic), and rectal pain, which are all unchanged. has burning sensation when he urinates. constipated. otherwise negative. past medical history: 1. prostate ca s/p xrt 2. bladder ca, papillary urothelial carcinoma, high grade (dx in ), nonmetastatic (negative cystoscopy ) -most recent cystoscopy and bladder resection in 3. lumbar fracture l5 -- w/multiple steroid injections, previously on chronic opioid therapy 4. copd on l of home o2 (pfts : fvc 89% predicted, fev1 82% predicted and fev1/fvc 93% predicted) 5. pud with gib in 6. hx of rheumatic fever 7. hx of cva 8. s/p appendectomy 9. s/p lap chole in 10. chronic le edema 11. tachy-brady syndrome s/p pacer . afib-aflutter - was on coumadin, however this was stopped given hematuria. 13. parkinsons disease 14. lgib secondary to rectal ulcer: with rectal ulcer s/p sigmoidoscopy and cauterization. 15. stage iii chronic kidney disease 16. melanoma, s/p removal social history: patient is currently at center with the help of a caretaker, . smoked ppd for 30 years, quit 10 years ago. he currently does not drink etoh. family history: non-contributory physical exam: admission physical exam vitals: 98.9, 61, 134/45, 17, 93% on 2-4l. general: elderly male appearing younger than his stated age, breathing comfortably in bed, telling jokes. neck: no jvd. cor: irregularly irregular rhythm. heart sounds are distant. lungs: diffuse rhonchi and coarse upper airway sounds. abd: distended, tympanitic. normoactive bowel sounds and non-tender, without rebound or guarding. extr: heals are wrapped in kerlix. no edema. psych: patient's affect is full. he is cooperative and answering questions appropriately. occasionally loses his train of thought and repeats things he already said. gu: foley catheter in place, urethral meatus without ulceration. pertinent results: chest x-ray findings : patient's condition required examination in sitting semi-upright position using frontal ap and left lateral projection. comparison is made with the next previous chest single ap chest view examination of as well as a more recent single chest view of . moderate cardiac enlargement and elongation of generally widened thoracic aorta as before. unchanged position of previously described left-sided permanent pacer with dual intracavitary electrode system. already on examination of , the patient had bilateral plate atelectasis but no conclusive evidence for pleural effusions. on , the portable single view examination demonstrated an increased density on the left base obscuring the diaphragmatic contour and suggesting the presence of an increased atelectasis. today's ap and lateral chest views again demonstrate the presence of a diffuse density in the left base, most likely representing atelectasis or pneumonic infiltrate. on the lateral view, one can identify an increased density along a major fissure supporting the assumption that pleural effusion has developed. the patient's respiratory effort appears limited as the diaphragmatic contours are relatively high and the basal lung vasculature is markedly crowded. most likely diagnosis is increasing chf probably with superimposed left basal atelectasis or infection. no pneumothorax is present. renal ultrasound impression: mild right pelvicaliectasis and extrarenal pelvis similar to the ct from , but slightly more prominent compared to the us from . video swallow examination: technique: oropharyngeal swallowing videofluoroscopy was performed in conjunction with the speech and swallow division. multiple consistencies of barium were administered. findings: barium passes freely through the oropharynx and esophagus without evidence of obstruction. there is trace penetration of thin liquids, but no gross aspiration. for full details, please refer to speech and swallow division note in the omr. impression: trace penetration of thin liquids with no evidence of aspiration. labs: 12:25pm wbc-8.5 rbc-2.90* hgb-8.5* hct-26.3* mcv-90 mch-29.2 mchc-32.3 rdw-14.9 12:25pm neuts-83.9* lymphs-9.3* monos-5.7 eos-0.9 basos-0.2 12:25pm glucose-117* urea n-56* creat-3.2* sodium-138 potassium-6.3* chloride-103 total co2-26 anion gap-15 01:00pm urine blood-lg nitrite-neg protein-150 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 01:00pm urine hours-random creat-108 sodium-64 potassium-54 chloride-49 12:25pm ctropnt-0.09* 08:10pm ck-mb-4 ctropnt-0.08* 08:10pm ck(cpk)-303 06:30am blood wbc-7.8 rbc-2.74* hgb-7.9* hct-26.7* mcv-98 mch-28.9 mchc-29.6* rdw-14.7 plt ct-287 12:25pm blood wbc-8.5 rbc-2.90* hgb-8.5* hct-26.3* mcv-90 mch-29.2 mchc-32.3 rdw-14.9 plt ct-292 12:25pm blood neuts-83.9* lymphs-9.3* monos-5.7 eos-0.9 baso-0.2 07:10am blood pt-14.8* ptt-32.1 inr(pt)-1.3* 12:25pm blood pt-14.2* ptt-30.1 inr(pt)-1.2* 06:30am blood urean-35* creat-2.2* na-142 k-4.5 cl-108 hco3-29 angap-10 12:25pm blood glucose-117* urean-56* creat-3.2* na-138 k-6.3* cl-103 hco3-26 angap-15 12:25pm blood alt-17 ast-36 ld(ldh)-292* alkphos-67 totbili-0.2 12:25pm blood ctropnt-0.09* 08:10pm blood ck-mb-4 ctropnt-0.08* 08:10pm blood ck(cpk)-303 05:21am blood calcium-7.4* phos-4.3 mg-1.9 12:25pm blood albumin-3.1* 05:21am blood vitb12-474 05:21am blood tsh-0.90 12:35pm blood lactate-1.0 12:25 pm blood culture x 2 blood culture, routine (pending): 1:29 pm urine site: catheter **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. 6:21 pm rapid respiratory viral screen & culture source: nasopharyngeal swab. **final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. 2:23 pm urine source: cvs. **final report ** urine culture (final ): <10,000 organisms/ml. brief hospital course: healthcare associated pneumonia: we found an infiltrate on cxr and fever to 102 f. he had several hospitalizations for the same diagnosis and was treated during last admission with vancomycin and zosyn x 12 days. there was concern for ongoing aspiration. however on a bedside and video swallow examination there was no clear evidence of aspiration. the patient was treated with iv vancomycin and cefepime for pneumonia and picc line placed in interventional radiology on . however, despite treatment his symptoms did not improve. he remained with significant wheezing and hypoxia. the antibiotics were discontinued after we had several discussions with patient, his care giver and hcp who agreed regarding hospice care. this is because of very frequent admissions back to back during the last several months without improvement in the quality of life and the presence of several advanced diseases including recurrent bladder cancer, advanced ckd and copd, dementia and parkinsons that limit life expectancy (see below). acute on chronic kidney disease: his baseline creatinine is about 2.3. he had on admission (up to 3.2) but improved with rehydration. his lasix was discontinued. bladder and prostate cancer: has had ongoing hematuria which cleared to dark yellow urine upon discharge. foley was placed on admission and this was discontinued when he was transferred to the medical floor. he was followed by his urologist dr. as an outpatient. c diff colitis: he had no active diarrhea and his treatment dose of oral vancomycin was continued while on other antibiotics but should be tapered by 1 dose per day on a weekly basis (3 week taper) following his completion of vanc/cefepime on . however, during this admission, he developed progressive abdominal distention and tympany. kub showed lots og gas. a ct was not done per hcp as he requested hospice care and no more diagnostic tests. paroxysmal atrial fibrillation: we continued amiodarone and beta blocker. coumadin was previously discontinued because of bleeding complications (the most recent being transfusion dependent severe hematuria with resulting r kidney obstruction likely from hematoma and blood clots). hypertension, benign: he was continued on his toprol but we stopped amlodipine. hyperlipidemia: we stopped simvastatin because of comfort measures. copd: standing albuterol/ipratropium nebs while inpatient. parkinson's disease: continued home sinimet. depression: continued quetiapine and stopped mirtazapine gerd: stopped omeprazole. bilateral heel ulcerations: wound care recs pressure ulcer care per guidelines: turn and reposition off back q 2 hours and prn limit sit time to 1 hour at a time using a pressure redistribution cushion for both heels : cleanse with wound cleanser then pat dry moisturize periwound tissue with aloe vesta for right heel : apply wound gel to adaptic dressing then follow with dry gauze and abd pad, wrap with kerlix for left heel : dry abd pad, wrap with kerlix change daily gout: stopped allopurinol. delirium/dementia: with waxing and weaning mental status health care proxy/goals of care: we had several discussions with his (phone: cell: as he was his hcp) regarding goal of care and hospice. initially, the patient wished to be full code. the patient's pcp was involved in his care while inpatient and discussed with the patient his medical care. the patient was not clear enough to make this decision (to change his code status to dnr/dni) so he remained full code (initially). however, he later had some lucid times were he agreed to be dnr/dni with comfort measures after discussion with his hcp. i discussed the goal of care and prognosis again with his his and his care giver. both strongly agreed regarding hospice care, comfort measures and no rehospitalizations. his code status was changed and most of his medications were discontinued. he was placed on oral morphine. medications on admission: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. furosemide 20 mg tablet sig: one (1) tablet po mon, wed, fri. 3. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): 4x per day for 7 days then taper by 1 capsule per week until off. 4. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 5. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 7. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 8. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 9. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation twice a day. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 11. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 12. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 13. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 16. oxycodone 5 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. 17. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 18. quetiapine 25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)). 19. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 20. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 21. multivitamin tablet sig: one (1) tablet po daily (daily). 22. florastor 250 mg capsule sig: one (1) capsule po once a day: start after po vancomycin is finished. discharge medications: 1. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for continuing treatment of c.diff: take 4 times daily until , then taper by 1 capsule / day every week. 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. furosemide 20 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 4. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 5. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours). 9. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 11. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 12. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 13. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 16. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 17. quetiapine 25 mg tablet sig: 0.5 tablet po hs (at bedtime). 18. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 19. multivitamin tablet sig: one (1) tablet po daily (daily). 20. cefepime 1 gram recon soln sig: one (1) recon soln injection q24h (every 24 hours): last day . 21. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q48h (every 48 hours): last day . 22. vitamin d 400 unit capsule sig: one (1) capsule po twice a day. 23. florastor 250 mg capsule sig: one (1) capsule po once a day: start taking after oral vancomycin is finished. discharge disposition: extended care facility: - heathwood/ discharge diagnosis: primary diagnosis: health care associated pneumonia c diff colitis discharge condition: mental status: confused - sometimes. 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 with pneumonia and treated with antibiotics. please take your medications as prescribed and make your follow up appointments. followup instructions: department: surgical specialties when: thursday at 3:00 pm with: , md building: campus: east best parking: garage procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified hyperpotassemia urinary tract infection, site not specified acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation atrial flutter pulmonary collapse paralysis agitans chronic kidney disease, stage iii (moderate) intestinal infection due to clostridium difficile do not resuscitate status pressure ulcer, heel pressure ulcer, stage iii malignant neoplasm of other specified sites of bladder 

Answer: The patient is high likely exposed to