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: unresponsiveness, transferred with combativeness major surgical or invasive procedure: intubation at osh/extubation at peg placement picc placement history of present illness: the pt is a 67 year-old man who was transferred from . per report he was found unresponsive by his wife this morning "drooling". ems found him combative and his fs was 101. per his wife's description she heard him making "grunting sounds" and found him sitting in a chair, slumped to the r with eyes closed and "stiff all over" with extended fingers. his lip was also forward but no facial droop or eye deviation noted. he also seemed "ashen". this episode lasted about 10 minutes and he was then fighting ems as they were putting him into the ambulance. he was taken to the osh where he was persistently combative. from their notes he was initially tachycardic in the 130's and bp of 106/72 with a temp of 97.5 pr. the rn notes he was "agitated, awake, combative, non-verbal, pale, diaphoretic and bp elevated. he was give 2mg of ativan x 2 and 5mg of haldol x 2 without effect and then he was intubated. his max bp was 194/87, however after intubation and sedation with versed he was hypotensive in the 80/50's briefly. in one of the notes it also reports that he had a facial droop but the side was not documented and he was unresponsive after which he became agitated, combative and non-cooperative. his exam there was "non-focal" and his screening labs showed a sodium of 129, cl 94 and a hco3 of 16 (anion gap of 19). his glucose was 182 and his lfts were normal. cbc was unremarkable. his cr was 1.3 and his serum asa, tylenol and etoh were negative. it was positive for bensozs however this was drawn after the ativan was given. a repeat chemistry was done (however per the recorded timing on the forms they were drawn at the same time). this showed a na of 137. his troponin was < 0.03 and the ck was 180. an lp was obtained which showed 0 wbc in tubes 1 and 4 and 27 rbc in tube 1, but 0 in tube 4. csf glucose, protein and gram stain were not recorded and it is not documented if hsv was sent off. his ua was negative. i contact for his csf 77 gluc, 52 protein. they stated that the gram stain was not. past medical history: - early onset dementia (wife has been told he has ad or vascular dementia) - high-degree av block with a permanent pacemaker - hyperlipidemia - "mini stroke" in the past w/ baseline word sentences for fluency - recurrent episodes of syncope for last 8 yrs, resolved w/ pacer - prior reported eeg which was abnormal and mri brain with frontal atrophy - etohism, quit 14 years ago social history: history of etohism, quit 14 years ago. he lives at home with wife, can feed himself, needs help with bathing, speaks in word phrases. family history: no hx of strokes, seizures or dementia physical exam: exam on admission off propofol x 20 min vitals: t: 98.7 p: 66 r: 16 bp: 127/70 sao2: 100% on et general: intubated, off sedation heent: nc/at, no scleral icterus noted, et in place neck: supple, no carotid bruits appreciated. pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no edema. bilateral ankle contracture skin: no rashes or lesions noted. neurologic: -mental status: unresponsive to verbal or tactile stimuli but does withdraw all extremities (no localization to pain) cn i: not tested ii,iii: no blink to threat, pupils 1mm->0.5mm bilaterally, unable to visualize fundi iii,iv,v: no oculocephalic, no ptosis. no nystagmus v: + corneals & nasal tickle bilaterally vii: face symmetric w/ et in place viii: ua ix,x: + gag : ua xii: ua motor: normal bulk, slightly increased tone throughout. symmetric withdrawal throughout but not brisk reflex: no clonus tri bra pat an plantar c5 c7 c6 l4 s1 cst l 1--------- 0 0 up r 1--------- 0 0 up -sensory: as above pertinent results: labs: 01:28pm blood wbc-9.6 rbc-4.08* hgb-13.9* hct-40.0 mcv-98 mch-34.0* mchc-34.7 rdw-13.1 plt ct-171 05:58am blood wbc-8.7 rbc-4.05* hgb-13.5* hct-38.8* mcv-96 mch-33.4* mchc-34.9 rdw-13.1 plt ct-494* 01:28pm blood neuts-85.2* lymphs-8.9* monos-4.8 eos-0.9 baso-0.2 06:10am blood neuts-84.3* lymphs-7.4* monos-6.7 eos-1.4 baso-0.3 01:28pm blood pt-13.6* ptt-26.0 inr(pt)-1.2* 01:28pm blood glucose-103 urean-10 creat-0.9 na-142 k-3.8 cl-109* hco3-25 angap-12 02:56pm blood na-129* 01:28pm blood alt-19 ast-24 ck(cpk)-493* alkphos-83 totbili-0.7 02:16am blood ck(cpk)-555* 07:50am blood ck(cpk)-114 01:28pm blood ck-mb-3 01:28pm blood ctropnt-0.03* 02:16am blood ck-mb-3 ctropnt-<0.01 07:50am blood ck-mb-2 ctropnt-<0.01 01:28pm blood lipase-42 01:28pm blood albumin-3.9 calcium-7.8* phos-2.0* mg-2.2 05:58am blood calcium-8.4 phos-2.7 mg-2.4 05:45am blood osmolal-267* 05:55am blood osmolal-280 05:58am blood osmolal-269* 02:16am blood tsh-0.46 05:45am blood cortsol-32.1* 01:28pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 01:33pm blood lactate-1.6 01:28pm urine color-yellow appear-clear sp -1.010 01:28pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-neg ph-6.0 leuks-neg 06:08am urine color-yellow appear-cloudy sp -1.023 06:08am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-8* ph-7.5 leuks-neg 06:08am urine rbc-26* wbc-0 bacteri-none yeast-mod epi-0 05:10pm urine hours-random creat-76 na-130 06:27pm urine hours-random urean-285 creat-49 na-164 04:26pm urine hours-random creat-110 na-67 05:10pm urine osmolal-533 06:27pm urine osmolal-490 04:14pm urine osmolal-699 04:26pm urine osmolal-631 micro: blood cx ( x2): no growth urine cx (): no growth urine cx (): no growth urine cx (): no growth blood cx ( x2): staphylococcus, coagulase negative. final sensitivities. coag neg staph does not require contact precautions,regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. specimen will be held in micro until form is received. staphylococcus, coagulase negative. second morphology. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | staphylococcus, coagulase negative | | clindamycin-----------<=0.25 s <=0.25 s erythromycin----------<=0.25 s <=0.25 s gentamicin------------ <=0.5 s <=0.5 s levofloxacin---------- 4 r 4 r oxacillin------------- =>4 r =>4 r rifampin-------------- <=0.5 s <=0.5 s tetracycline---------- <=1 s <=1 s vancomycin------------ 2 s 2 s blood cx ( x2, x2, x2, x2): ngtd peg drainage (): gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram negative rod(s). 3+ (5-10 per 1000x field): gram positive cocci. in pairs and chains. wound culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. anaerobic culture (preliminary): no anaerobes isolated. imaging: cxr (): impression: 1. orogastric tube side port may be just above the ge junction and would benefit from advancement. 2. mild blunting of both costophrenic angles, which may relate to small effusions. no focal pneumonia identified. cta head/neck (): impression: 1. no evidence of acute intracranial abnormalities. 2. normal cta of the head and neck. 3. emphysema. 4. the orogastric tube is coiled in the pharynx. eeg (): impression: this telemetry captured no pushbutton activations. routine sampling showed a slow and low voltage background suggestive of a widespread encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. the low voltage faster patterns suggest medication. there were no areas of prominent focal slowing, but encephalopathy may obscure focal findings. routine sampling, as well as automated spike and seizure detection programs, showed no epileptiform features or electrographic seizures. eeg (): impression: this telemetry captured no pushbutton activations. routine sampling showed a very low voltage slow background, indicative of a widespread and severe encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. there were no epileptiform features on routine sampling or by automated detection, and no electrographic seizures were recorded. cxr (): findings: in comparison with study of , the patient has taken a much better inspiration. the cardiac silhouette remains within normal limits and there is no evidence of vascular congestion or acute pneumonia. monitoring and support devices remain in place. tte (): the left atrium is normal in size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef 55-60%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: poor technical quality due to patient's body habitus. left ventricular function is probably normal, a focal wall motion abnormality cannot be fully excluded. the right ventricle is not well seen. no pathologic valvular abnormality seen. pulmonary artery systolic pressure could not be determined. ct head (): impression: there is no evidence of acute intracranial abnormality. no significant changes since the prior examination dated . persistent areas of low attenuation in the periventricular white matter, likely consistent with chronic microvascular ischemic changes. there is no evidence of hemorrhage, mass, mass effect, or large territorial infarction. ct abd/pelvis (): impression: 1. satisfactory gastrostomy tube placement, with mild soft tissue stranding and postprocedural free intraabdominal air. 2. no focal fluid collection or evidence of obstruction. peg study (): impression: gastrografin contrast flows freely into the stomach confirming appropriate placement. no evidence of leakage. most recent lab results: 05:05am complete blood count white blood cells 9.5 k/ul 4.0 - 11.0 red blood cells 3.78* m/ul 4.6 - 6.2 hemoglobin 13.0* g/dl 14.0 - 18.0 hematocrit 36.1* % 40 - 52 mcv 95 fl 82 - 98 mch 34.3* pg 27 - 32 mchc 36.0* % 31 - 35 rdw 12.7 % 10.5 - 15.5 neutrophils 80* % 50 - 70 bands 1 % 0 - 5 lymphocytes 7* % 18 - 42 monocytes 9 % 2 - 11 eosinophils 3 % 0 - 4 basophils 0 % 0 - 2 atypical lymphocytes 0 % 0 - 0 metamyelocytes 0 % 0 - 0 myelocytes 0 % 0 - 0 red cell morphology hypochromia normal anisocytosis normal poikilocytosis normal macrocytes normal microcytes normal polychromasia normal basic coagulation (pt, ptt, plt, inr) platelet smear normal platelet count 402 k/ul 150 - 440 05:05am renal & glucose glucose 105 mg/dl 70 - 105 urea nitrogen 13 mg/dl 6 - 20 creatinine 0.7 mg/dl 0.5 - 1.2 sodium 134 meq/l 133 - 145 potassium 4.8 meq/l 3.3 - 5.1 chloride 96 meq/l 96 - 108 bicarbonate 32 meq/l 22 - 32 anion gap 11 meq/l 8 - 20 enzymes & bilirubin alanine aminotransferase (alt) 90* iu/l 0 - 40 asparate aminotransferase (ast) 39 iu/l 0 - 40 alkaline phosphatase 147* iu/l 39 - 117 bilirubin, total 0.5 mg/dl 0 - 1.5 chemistry albumin 3.4 g/dl 3.4 - 4.8 calcium, total 9.1 mg/dl 8.4 - 10.2 phosphate 2.7 mg/dl 2.7 - 4.5 magnesium 2.4 mg/dl 1.6 - 2.6 brief hospital course: 1. episode of unresponsiveness-seizure vs. syncope. the patient is a 67 year-old man with a history of early onset dementia, high grade av block s/p ppm, and hld who presented with an episode of unresponsiveness associated with an "ashen" appearance, and subsequent combativeness at an osh requiring ativan, haldol, and intubation. an lp at the osh showed 0 wbc in tubes 1 and 4 and 27 rbc in tube 1, but 0 in tube 4, 77 glucose, 52 protein, and hsv reportedly negative. he was initially on acyclovir, but this was discontinued when the hsv came back negative. he was transferred to the neuroicu, where he was subsequently extubated. serum and urine tox were positive only for bzd. eeg showed widespread encephalopathy, but no epileptiform features or electrographic seizures. cta head/neck was normal and showed no acute intracranial abnormalities. he was started on dilantin and lamictal for the presumed seizure (with the goal of titrating off dilantin once the lamictal was therapeutic). he was transferred to the neurology floor. his mental status continued to wax and wane while on the floor. cardiology interrogated his ppm on which showed no abnormal rhythm or rate since to explain his episode of unresponsiveness. tte showed lvef 55-60% and no pathologic valvular abnormality. his altered mental status was thought to be due to his bacteremia and hyponatremia (see below), but also due to the antiepileptic drugs which had been started. therefore, both the dilantin and lamictal were discontinued. he was given seroquel as needed for agitation. the patient was scheduled to follow up with his outpatient neurologist. last physical exam at discharge: patient was awake, responsive not following commands properly, however he was able to say isolated words. not oriented. moving all four extermities antigravity. 2. staph coagulase negative bacteremia. the patient had blood cultures on admission () which showed no growth x2. the patient had a peg placed by surgery on , and had a low grade fever to 100.2 associated with tachycardia and tachypnea when he returned to the floor. blood cultures were drawn () which showed staph coagulase negative x2. he was started on vancomycin iv bid to complete a 2 week course last day on . vancomycin last two doses should be on . there was concern that brown drainage was leaking around the peg site on . culture of the drainage showed 4+ gnrs and 3+ gpcs in pairs and chains. ct abdomen/pelvis showed no focal fluid collection or evidence of obstruction. peg study showed no evidence of leakage. 3. hyponatremia/siadh. his na on admission was 142. on , his sodium decreased to 132, and subsequently ranged 126-132. his sodium began to trend down around the same time lamictal was started, so drug effect was thought to be the cause of his hyponatremia. urine osms were concentrated (490-699) even though sodium and serum osm were low, so siadh was thought to be the cause of his hyponatremia. medicine was consulted to help manage the hyponatremia, and lamictal was discontinued. renal was also consulted who recommended adding salt tabs and starting lasix po. these improved his na to 132, so were subsequently discontinued. 4. early onset dementia. he was continued on his home doses of aricept and namenda. 5. high degree av block s/p ppm. cardiology interrogated the patient's pacemaker on , which did not show any abnormal rhythm or rate. 6. hyperlipidemia. medications on admission: - aspirin 81mg po daily - namenda 10mg - aricept 10mg qhs - vitamin b12 daily - folic acid daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. namenda 10 mg tablet sig: one (1) tablet po twice a day. 3. aricept 10 mg tablet sig: one (1) tablet po at bedtime. 4. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. therapeutic multivitamin liquid sig: one (1) tablet po daily (daily). tablet(s) 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 8. quetiapine 25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)) as needed for agitation. 9. vancomycin 500 mg recon soln sig: three (3) recon soln intravenous q 12h (every 12 hours): 1500mg until . 10. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: episode of unresponsiveness: seizure vs. syncope staph coagulase negative bacteremia hyponatremia/siadh secondary: early onset dementia high degree av block s/p ppm hyperlipidemia discharge condition: stable discharge instructions: you were admitted to the hospital with an episode of unresponsiveness, followed by combativeness at an outside hospital. you were intubated at the outside hospital and transferred to for further evaluation. it was initially thought that this episode was a seizure, and you were started on anti-seizure medications. however, it was later determined that these anti-seizure medications may be contributing to your altered mental status and causing your low sodium level, so they were discontinued. subsequent eeg were negative for seizures or epileptiform features. you had a peg tube placed to help with your nutritional input. after that was placed you developed bacteremia which is being treated with antibiotics. the following changes were made to your medications: you were prescribed vancomycin iv twice daily (until for a two week course). you were started on a multivitamin and thiamine daily. you were started on seroquel as needed for agitation. patient will require bladder training: clamp and unclamp foley every 4 hours round the clock for three days then discontinue foley and monitor urine output, bladder scan if necessary and straight cath every 8 hours until able to void. of note, family reports patient typically needs to be standing in order to urinate on his own. if you develop unresponsiveness, weakness or numbness, difficulty swallowing, decreased vision or blurry vision, headache, fevers/chills, or any other symptoms that concern you, call your pcp or return to the ed. followup instructions: you will need to follow up with your pcp, . () in the next 1-2 weeks. you have a follow up appointment with dr. in neurology () on at 3:00 in . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] artificial pacemaker rate check diagnoses: coronary atherosclerosis of unspecified type of vessel, native or graft other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia bacteremia other encephalopathy alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus other disorders of neurohypophysis leukocytosis, unspecified attention to gastrostomy postprocedural fever other chronic allergic conjunctivitis 

Answer: The patient is high likely exposed to