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: gentamicin / ibuprofen / lisinopril / ms contin attending: chief complaint: severe back and right leg pain major surgical or invasive procedure: intubation and mechanical ventilation l chest tube history of present illness: 53yo with complex past medical history including newly diagnosed sacral fracture and large l4-5 disc herniation with compression of the right l4 nerve root who now presents with worsening low back pain. of note, pt was admitted few weeks ago to with pna (w/ mssa bacteremia) and complaints of low back pain. he was found to have small non-displaced sacral fracture (on xray) and large l4-5 disc extrusion with severe compression of the right l4 nerve root (on mri). the pt was seen by dr. of . surgery was planned on an outpatient basis following resolution of the pt's pna & bacteremia. the pt had been doing well at home on pain meds until the day prior to admission, when his pain worsened significantly. oxycodone prn (5mg tabs, 2 tabs q4hrs) no longer helps. no identified trigger/trauma as cause of worsening pain. pt denies numbess, urinary or bowel incontinence, though he has been needing to straight cath himself over the past 3wks. . in the , pt afebrile, vitals stable, rle weak w/ +r-straight-leg-raise, poor bilateral le reflexes. good rectal tone. pt admitted for further evaluation & possible surgical intervention. . . ros: as above. , pt notes ~60lb wt loss over past yr, no fever/chills, sob, cp, n/v/d. pt ambulating some on own w/ cane, though he has resorted to pushing self around his apt on rolling chair (while seated). he expresses concern over his ability to continue to care for himself with the severity of pain he is experiencing, particularly as higher doses of narcotics tend to "make vision blurry." past medical history: - small non-displaced sacral fracture and large l4-5 disc extrusion with severe compression of the right l4 nerve root - coronary artery disease, status post mulitple pci w/ stenting of rca (' & '), om1 (') and lcx ('). - echo , ef>60%, mild lvh - status post living related kidney transplant from his sister on . - end-stage renal disease with a baseline creatinine around ~1.9 -2.2 secondary to type 1 diabetes mellitus with retinopathy and neuropathy. - history of multiple urinary tract infections & pyelonephritis. - bph, status post transurethral resection of the prostate in . - hypertension. - hypercholesterolemia. - peripheral disease with severe claudication s/p stent of the left superficial femoral artery - hepatitis b of unclear etiology and hepatitis c - left eye prosthesis secondary to traumatic injury. - right eye legally blind secondary to cataract and intraocular hemorrhages. - throat cancer, status post right neck dissection and xrt in . - history of cerebral aneurysm, asymptomatic. - status post c5-6 diskectomy for cord compression with c4-6 fusion with a right iliac bone graft. - gastroesophageal reflux disease. - depression. - multiple basal & squamous cell carcinoma of the skin. - bursitis with infection caused by mycobaterium marinum. - orthostatic hypotension - documented by tilt-table testing in ; thought to be diabetic autonomic neuropathy, treated with florinef social history: lives alone in one room apt in boarding house w/ shared bathroom. grocercies supplied blind support group. pt cooks & cares for himself. strained relationship w/ brother (who pushed him down stairs in , causing pt to sustain his low back injury). he quit smoking in . rare etoh. family history: mother with alzheimer's physical exam: temp: bp: / hr: rr: o2sat general: pleasant, comfortable, nad heent: right pupil responds to light, right eomi, left eye prosthesis intact, anicteric sclera, no sinus tenderness, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy lungs: ctab heart: rrr, s1 and s2 wnl, no murmurs, rubs or gallops appreciated abdomen: nd, +b/s, soft, nt, no masses or hepatosplenomegaly extremities: no cyanosis, clubbing or edema skin: no rashes neuro: aaox3. cn ii-xii intact. 5/5 strength b/l ue. 4(-) hip flexor strength on r. knee flex/ext on right. dorsiflexion on r. plantarflexion on r. 5/5 strength on left le. no sensory deficits to light touch appreciated throughout, though pt notes slightly decreased sensation on right inner thigh to light touch. sluggish patellar reflexes b/l. toes downgoing. rectal: normal rectal tone pertinent results: admission labs: 01:30pm glucose-149* urea n-30* creat-2.0* sodium-138 potassium-4.9 chloride-103 total co2-27 anion gap-13 01:30pm wbc-6.9 rbc-4.27* hgb-12.4* hct-36.4* mcv-85 mch-29.0 mchc-34.0 rdw-18.0* 01:30pm neuts-83.1* lymphs-9.8* monos-5.6 eos-1.1 basos-0.3 . mr lumbar spine : 1. unchanged large disc protrusion which has migrated superiorly posterior to the vertebral body of l4 which causes severe narrowing of the lateral and subarticular recesses on the right and compresses the traversing l4 and l5 nerve roots. this appearance is unchanged from the prior examination of . 2. probable nondisplaced fracture of the sacrum as noted on the prior plain films of . this area was not included on the prior mri. . cxr : 1. slight interval clearing of the previously described patchy lower lobe airspace disease with more focal confluent opacity in the peripheral aspect of lft lower lobe with associated basilar atelectasis. 2. ng tube above the level of diaphragm and needs to be advanced. . cxr : 1. support lines in place. no pneumothorax seen. 2. increased airspace opacities involving the bilateral mid and lower lungs. diagnostic considerations include pneumonia . cxr : an et tube is present, tip approximately 7.7 cm above the carina, at the level of the upper clavicles slightly high but unchanged. an ng tube is present, tip beneath the diaphragm extending off film. a left-sided chest tube is present, in nominal position. a right subclavian central line is present, tip over distal svc. at the periphery of these films, hardware in the cervical spine is noted. no pneumothorax is detected. the lungs are hyperinflated, which could relate to underlying copd. there is also biapical pleural thickening. heart size is at the upper limits of normal. no chf is identified. there is patchy alveolar and interstitial opacity at the left base, consistent with a pneumonic infiltrate versus aspiration pneumonia. there is some prominence of the markings at the right cardiophrenic region, improved compared with one day earlier -- ? resolving infiltrate and/or atelectasis. there is minimal blunting of both costophrenic angles, without gross effusion. tiny 3 mm density in the right upper zone overlying the right sixth rib most likely represents a vessel seen on end. a nonacute fracture of the seventh posterior rib is noted. compared with , there has been considerable interval clearing of collapse/consolidation at the left base and some interval improvement in the right cardiophrenic findings. the left effusion is significantly smaller. . cxr : right subclavian catheter is unchanged in position. endotracheal tube and nasogastric tube have been removed, and a left-sided chest tube remains in place coursing medially in the lower left hemithorax. no pneumothorax is identified. cardiac and mediastinal contours are stable. patchy bibasilar areas of consolidation are again demonstrated, minimally improved on the left with slightly worse on the right. these findings may be due to the clinically provided history of aspiration pneumonia. . cxr : compared with 2/26 at 8:18 p.m., the remaining left chest tube has been removed. there has been increased subcutaneous emphysema on the left. a left arm picc line is now present with its tip at the mid svc level. the pneumomediastinum has essentially cleared. the left pneumothorax is now tiny. patchy right infrahilar atelectasis/infiltrate appears grossly stable, as does that in the retrocardiac region at the left base. . labs on discharge: brief hospital course: 53 yo m with multiple medical problems including significant cardiac history, dm type i, cri s/p renal transplant, pvd who presented in the setting of severe back and r leg pain. . # l4-5 disc herniation & sacral fx: pt sustained these injuries during traumatic injury in , when he was reportedly thrown down stairs by his brother. these injuries were discovered during hospitalization in early , when pt had bilateral pneumonia & mssa bacteremia. pt evaluated by at that time. plan for surgery once pneumonia & bacteremia resolved. pt discharged home, where his pain was poorly controlled and thus represented to the ed. though pt has some weakness on right, he does not have incontinence/saddle anesthesia. thus, he did not need emergent surgery. was consulted who scheduled the patient to have surgery on with dr. . he was placed on prn oxycodone for pain control and benzos for increasing agitation. he was given a total of 55 mg oxycodone when he was noted to be experiencing respiratory distress and increasing delirium. an abg that was checked was 7.39/48/68. given the poor air movement on exam and erratic breathing pattern, the decision was made to intubate the patient and he was transferred to the icu. please see below for further details. upon extubation and transfer back to the floor, the pt was started on a fentanyl patch with prn acetaminophen and limited amounts of prn oxycodone for pain control which were titrated up with good effect and without further episodes of respiratory depression. he is to follow-up with dr. of for pre-op. . # respiratory depression/aspiration pna: as above, secondary to narcotics and benzos. intubation was difficult due to marked edema of the upper airway and previous throat cancer, mass resection, and xrt changes. in the micu, it was noted that the pt had a small l sided pneumothroax likely secondary to small blebbing in the setting of ventilation. a l chest tube was placed and then later d/c'd with resolution of the pneumothorax. during the micu course, the pt was also placed on iv vancomycin, zosyn, and flagyl for a hospital acquired aspiration pneumonia. he was briefly on pressors for hypotension. he was successfully extubated and was switched to po levaquin and flagyl for treatment of aspiration pna upon transfer to the floor for completion of a 10 day course. . # cri s/p renal transplant: baseline cr between 1.9 - 2.3. during his micu course, his cr was noted to peak at 2.9, likely atn due to hypotension and pressor requirement. once he was weaned off the pressors, his cr trended back to his prior baseline. the renal transplant team also followed the pt while in house. he was maintained on his usual immunosuppresion regimen and rapamycin levels that were checked were at goal at approximately 5. . #dm: the patient's nph dose was lowered to 20 u qam on admission as his diet would be better controlled while in house. he was continued on 10 u qpm nph and a hiss. his insulin requirements were titrated up during the hospital course with good effect. . # htn: while in the micu, his anti-hypertensives were held hypotension. however, upon transfer back to the floor, it was noted that the pt's bps were in the 200s/100s without symptoms. he was given his bp meds as well as iv hydralazine with response in bps down to the 150s/80s. throughout his remaining hospital course, his bp meds were steadily titrated up due to persistent elevated bps (pt reported that his baseline home bp is 130s/70-80s), which were thought to be most likely secondary to increased pain. his beta-blocker dosing was changed from to tid dosing and titrated up and his calcium channel dosing was increased. he was also restarted on nitroglycerin qam, qnoon, and qpm. standing po hydralazine was also added. the pt's cardiologist, dr. , was also contact during the admission regarding the pt's elevated bps. it was noted that he was on a very atypical anti-htn regimen as an outpatient. by the time of discharge, the pt's bps were ranging between 140-160s/70-90s. . # cad: titrated up anti-htns as above. continued asa, plavix, statin. . # code: full . the pt was discharged to rehab for further pt and ot as well as continued titration of bps meds as needed. he will follow-up with dr. of as an outpatient. medications on admission: - acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h rpn - diltiazem hcl 30 mg po bid - docusate sodium 100 mg po bid - ferrous sulfate 325 mg daily - atorvastatin 40 mg tablet po daily - gabapentin 600 mg po daily - clopidogrel 75 mg po daily - prednisone 10 mg tablet po daily - diazepam 5-15 mg tablet po q 8h - metoprolol tartrate 125 mg po bid - sirolimus 2 mg tablet po daily - bupropion 150 mg tablet sustained release po bid - novolin n 30 units qam & 8-10units qpm - regular insulin human sliding scale - oxycodone 5-10 mg po q6h prn discharge medications: 1. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. disp:*5 tablet(s)* refills:*0* 2. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 days. disp:*15 tablet(s)* refills:*0* 3. fentanyl 100 mcg/hr patch 72hr sig: one (1) patch transdermal q72h (every 72 hours): for total of 150 mcg/hr q72h. disp:*10 patch* refills:*2* 4. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. sirolimus 1 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 7. diltiazem hcl 90 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. nitroglycerin 2.5 mg capsule, sustained release sig: two (2) capsule, sustained release po bid (2 times a day): qam, qpm. disp:*120 capsule, sustained release(s)* refills:*2* 9. nitroglycerin 2.5 mg capsule, sustained release sig: one (1) capsule, sustained release po noon (at noon). disp:*30 capsule, sustained release(s)* refills:*2* 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed: do not exceed 4 gm/day. disp:*60 tablet(s)* refills:*0* 11. gabapentin 300 mg capsule sig: two (2) capsule po daily (daily). disp:*60 capsule(s)* refills:*2* 12. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 16. bupropion 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). disp:*60 tablet sustained release(s)* refills:*2* 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 18. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 19. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 20. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 21. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 22. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed: hold for rr < 10. disp:*30 tablet(s)* refills:*0* 23. insulin nph human recomb 100 unit/ml suspension sig: thirty (30) units subcutaneous qam. disp:*1000 units* refills:*2* 24. insulin nph human recomb 100 unit/ml suspension sig: ten (10) units subcutaneous qdinner. disp:*500 units* refills:*2* 25. humalog 100 unit/ml solution sig: per enclosed insulin sliding scale units subcutaneous qachs. disp:*500 units* refills:*2* 26. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch transdermal every seventy-two (72) hours: for total of 150 mcg/hr q72 h. disp:*10 patches* refills:*2* 27. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: primary diagnosis: l4-5 disc hernation sacral fracture aspiration pneumonia l ptx s/p chest tube hypothyroidism secondary diagnosis: cad s/p multiple pcis dm type i cri s/p renal transplant htn hypercholesterolemia pvd s/p stent of l sfa depression discharge condition: good, breathing well on room air, ambulating with assitance of walker, eating well. discharge instructions: you were admitted for pain control secondary to a disc hernation and fractured sacrum. please take all of your medications as directed. you were started no several medications during your hospitalization including: you will need to complete a 10 day course of antibiotics, called levaquin and flagyl to treat an aspiration pneumonia. you were started on a fentanyl patch that needs to be changed every 3 days for pain control along with tylenol and oxycodone as needed. you were started on a new medication called levothyroxine, which is a thyroid replacement hormone. you were started on a low dose of this (25mcg). it should be increased in approximately 3 to 6weeks. call your doctor or return to the emergency room if you experience any of the following: increasing back and leg pain not responsive to pain medications, fever > 101, worsening cough, shortness of breath, continued drainage from prior chest tube site after 4-5 days, or chest pain. followup instructions: you have the following appointments: provider , west date/time: 9:15. report to . provider , md phone: date/time: 9:40 provider stone, date/time: 10:45 please have your thyroid function tests done in 3 to 6 weeks with your primary care doctor. procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube infusion of vasopressor agent diagnoses: acute kidney failure with lesion of tubular necrosis chronic hepatitis c without mention of hepatic coma unspecified septicemia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified polyneuropathy in diabetes acute respiratory failure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta complications of transplanted kidney diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled intervertebral disc disorder with myelopathy, lumbar region 

Answer: The patient is high likely exposed to