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: phenytoin attending: chief complaint: sepsis major surgical or invasive procedure: intubation history of present illness: 42 yo male with traumatic brain injury d/t mva s/p vp shunt 2 years ago, organic affective disorder, depression, nursing home resident, found by another nh resident to be "turning purplish in his body, trunk, and extremities." they were unable to get an oxygen saturation but pt was still breathing. no bp obtained either. they started him on 4l 02 and called ems. per ems note, pt was found to have cyanotic extremities, no blood pressure, able to blink eyes on command, had a weak grip on command. his o2 sat was 99% on 6l. no radial pulses. taken to ed. there vs were hr 158, bp 91/52, rr 20, 92%4l, temp 97.8 po. he was given levoflox 500mg iv x 1, flagyl 500mg iv x 1, tlc placed in right groin, switched to nrb with sats 99%, given ivf 3.5 liters. pt then trasnferred to ed. pt was then intubated, given additional 4l ivf (7.5l total), 2u ffp, 1gm iv vancomycin, and transferred to . here, pt was having generalize shaking. given 1gm ativan with resolution. past medical history: 1. tbi: mva vs pedestrian s/p vp shunt 2 years ago 2. hypercholesterolemia 3. gerd 4. organic affective d/o 5. depression 6. irritable bowel social history: lives at nh physical exam: vs: 98, 130/84, 19, 100% on cmv 550 x 14 (actual rr 20) on fio2 0.50 and peep 5 gen: intubated, sedated, appears comfortable at 40 degrees hob heent: male pattern balding, left sid/temporal region with palpable catheter/shunt dvice, perrl, ogt and ett in place, taped to right side of mouth neck: unable to appreciate jvp cv: rr, nl s1 s2, no mrg, ?loud p2 pulm: cta ant, no wheeze abd: round, hypoactive bs, soft, nt, nd, no hsm, no masses gu: foley in place, blood around meatus, tlc in right femoral ext: dopplerable dp/pt pulses bilaterally, radial 1+ bilaterally neuro: skin: mottled lower abd/lower extremities, erythema around rectal area lines: r tlc in groin, r a-line, ogt/ett pertinent results: admit labs: 06:30am wbc-24.5* rbc-5.40 hgb-16.4 hct-48.8 mcv-90 mch-30.4 mchc-33.7 rdw-13.1 06:30am plt count-280 06:30am pt-17.2* ptt-36.3* inr(pt)-1.9 06:35am glucose-122* lactate-9.9* na+-153* k+-4.6 cl--114* tco2-17* lft's: 06:30am alt(sgpt)-30 ast(sgot)-29 ld(ldh)-256* alk phos-85 amylase-60 tot bili-0.2 urinalysis: 06:30am urine blood-lg nitrite-pos protein->300 glucose-tr ketone-15 bilirubin-sm urobilngn-1 ph-5.0 leuk-mod 06:30am urine rbc->50 wbc-* bacteria-mod yeast-none epi-0-2 06:30am urine color-red appear-cloudy sp ->=1.035 admit cxr: indication: 42-year-old man with sepsis, respiratory failure, intubated. single portable ap view of the chest shows an endotracheal tube with the tip approximately 4 cm above the carina. the lungs are clear. cardiac, mediastinal, and hilar borders are unremarkable. the osseous structures are unremarkable. impression: successful endotracheal tube placement. head ct: technique: noncontrast enhanced ct scan. findings: no previous examination available for comparison. left frontal ventricular shunt is present with the tip in the left frontal . the there is enlargement of the lateral and third ventricles and there is asymmetry of the lateral ventricles, the left side greater than the right, it is uncertain if this is a normal baseline for this patient or if there is acute dilitation. however, no transependymal edeam is evident. clinical correlation is necessary. diffuse areas of hypodensities are seen involving both frontal and temporal lobes consistent with patient's history of previous trauma. no intracranial hemorrhages are identified. midline structures are normal in position. mild mucosal thickening is seen involving both ethmoid sinuses. small mucous retention cyst versus polyp is seen in the anterior aspect of the left sphenoid air cell. interpretation: diffuse encephalomalacia involving bilateral frontal and temporal lobes. no intracranial hemorrhages identified. abdominal ct: technique: axial noncontrast multidetector ct images of the abdomen and pelvis were performed. abdomen ct without contrast: there is dependent atelectasis at both lung bases. there is no free intraabdominal air. the liver, gallbladder, spleen, pancreas, and adrenal glands appear unremarkable on limited noncontrast evaluation. the kidneys appear unremarkable without stones or hydronephrosis. opacified small bowel loops appear unremarkable. there is fat in the wall of the colon, which may be seen in chronic inflammatory bowel disease. there are no acute inflammatory changes in the colon to suggest acute disease. there is a filter in the ivc. there is a percutaneous catheter, most likely a ventricular peritoneal shunt, terminating in the upper pelvis. there is mesh in the anterior abdominal wall. pelvis ct without contrast: there is an indwelling catheter in the right common femoral vein. the bladder, prostate, seminal vesicles appear unremarkable. there is a catheter in the rectum. there is no free fluid. bone windows: there are no suspicious lytic or sclerotic lesions in the visualized osseous structures. impression: 1. no free air or hydronephrosis. 2. fatty infiltration of the colon wall, which may be seen in chronic inflammatory bowel disease. no inflammatory changes to suggest acute disease. head ct: indications: 42-year-old man with traumatic brain injury status post vp shunt 2 years ago admitted with urosepsis, now extubated but non-conversant with right greater than left-sided weakness. comparisons: prior head ct from . technique: noncontrast head ct. findings: there is a ventricular shunt in a similar position terminating in the left frontal , which is dilated as before. the degree of asymmetry and enlargement of the ventricles bilaterally is unchanged. diffuse areas of hypodensity, particularly in the left frontal, left apical, but also in the temporal horns bilaterally and in the white matter of the right frontal lobe have a similar appearance. the -white matter distinction is preserved, and there is no evidence of intracranial hemorrhage. there is no shift of the normally midline structures. no mass effect is seen. mucosal thickening is again seen in the ethmoid sinuses, but the osseous structures are otherwise unremarkable. impression: unchanged examination, with encephalomalacia bilaterally and stable bilateral dilatation of the lateral and third ventricles, particularly the left frontal ventricle. no intracranial hemorrhage identified. vp shunt in similar position. sinus ct: indications: 42-year-old with purulent nasal discharge and persistent fever. question sinusitis. comparisons: prior head ct scans from and . technique: noncontrast ct of the sinuses with coronal and sagittal reconstructions. findings: there are air fluid levels in the frontal sinuses. there are also bilateral fluid levels and mucosal thickening in the maxillary sinuses bilaterally, particularly on the right. there is a small air fluid level in the left sphenoid sinus wall with anterior mucosal thickening. there is a nasogastric tube passing through the left nasopharynx and into the throat. no fracture is identified. impression: evidence of sinusitis with air fluid levels in the sphenoid, maxillary and frontal sinuses. nasogastric tube passing through the left nasopharynx. ekg: electrocardiogram performed on: probable sinus tachycardia. there is much baseline artifact. non-specific st segment abnormalities. a repeat tracing of diagnostic quality is suggested. no previous tracing available for comparison. colonoscopy: indications: recent sepsis, ct scan with colonic fatty infiltration. procedure: the procedure, indications, preparation and potential complications were explained to the patient, who indicated his understanding and signed the corresponding consent forms. the efficiency of a colonoscopy in detecting lesions was discussed with the patient and it was pointed out that a small percentage of polyps and other lesions can be missed with the test. the patient was placed in the left lateral decubitus position and the colonoscope was introduced through the rectum and advanced under direct visualization until the cecum was reached. the appendiceal orifice was identified. careful visualization of the colon was performed as the colonoscope was withdrawn. the colonoscope was retroflexed within the rectum. the procedure was not difficult. the quality of the preparation was good. the patient tolerated the procedure well. there were no complications. findings: mucosa: localized erythema, nodularity and friability with contact bleeding were noted extending from the mid descending colon at 40cms upto the distal transverse colon at 60cms. additionally patchy erythema was noted in the proximal ascending colon, sigmoid colon and rectum. cold forceps biopsies were performed for histology at the proximal ascending colon. cold forceps biopsies were performed for histology at the distal transverse colon. cold forceps biopsies were performed for histology at the sigmoid colon. protruding lesions small grade 1 internal hemorrhoids were noted. impression: erythema and friability extending from distal transverse colon to mid ascending colon consistent with colitis of unclear etiology (multiple biopsy). grade 1 internal hemorrhoids. brief hospital course: mr. is a 42 year old male nursing home resident with traumatic brain injury secondary to mva in s/p vp shunt 2 years ago, organic affective disorder, depression, admitted with sepsis, uti, and sinusitis. the following issues were addressed on this admission: (icu stay from , floor stay from on. concerning infectious disease: patient was admitted with septic physiology, fevers, leukocytosis to 24.5, hypotension. he received aggressive fluid resuscitation and very short period with dopamine. his blood pressure quickly stabilized. he was empirically treated with antibiotics for presumed urosepsis with ceftriaxone for one day. he had been given one dose of levoquin and flagyl at osh before transfer. given rapid improvement he was switched back to levofloxacin and flagyl on the second day of admission (). remained afebrile from . spiked again at that time. original assessment for sepsis etiology included a negative csf, negative chest x-ray. his admit urinalysis was consistent with urinary tract infection but urine cultures were not obtained until once the patient was on antibiotics and returned negative. his initial blood cultures of were positive bottles for gram negative coccobacilli which ultimately returned veillonella species. other blood cultures from returned negative. the patient was maintained on levoquin, flagyl and was clinically improving, afebrile until when he spiked fever. urine, blood cultures were re-sent. additionally, with concern for possible sinusitis, ent saw patient and ct sinus obtained. felt to have sinusitis, levoquin and flagyl considered adequate treatment and therefore were continued. repeat urine and blood cultures from returned negative. from on the patient remained afebrile. throughout his course his mental status improved and from on was considered back at previous baseline. the low grade veillonella bactermia was concerning as to its likely pathogenicity and unknonw source. infectious disease was thus consulted. veillonella is flora of mouth, gi tract and can be cause of chronic sinusitis. with history of sinusitis and ct abdomen demonstrated fatty infiltrate of colon consistent with colitis, sinus and colon thought to be two most likely sources. dental consult was obtained to rule out oral abcess. exam was inconsistent with abcess. although sinus source possible, felt unlikely and needed to pursue possible gi source given ct findings and patient's questionable history of irritable bowel syndrome. therefore, gi was consulted and colonoscopy was performed. colonosocpy was consistent with colitis, either infectious, ischemic or inflammatory. biopsies were taken and demonstrated colitis consistent with ischemic colitis. unsure etiology, thinking is that patient may have had colitis secondary to sepsis. the patient was maintained on levoquin flagyl and will complete 14 day course to cover for likely uropathogen that was not cultured because of delayed urine culture and to cover for veillonella species. additionally, these antibiotics should effectively treat sinusitis. needs four more days. concerning respiratory issues: pt was intubated for airway protection. he did well on minimal settings and was extubated on . he had some supplemental oxygen requirements until felt to be due to volume overload secondary to aggressive ivf's and possible aspiration. by he was satting well on room air. patient was noted to have lower extremity cyanosis on admission which was not thought due to resp dysfunction as patient was satting well, intubated only for airway protection. cyanosis resolved over course of admission. concerning neurologic issues: history of traumatic brain injury, organic affective disorder and is s/p vp shunt. pt was non-conversant after extubation with right > left sided weakness. felt secondary to sedating meds with intubation. per wife, pt can speak, feed self, walk with walker at baseline. head ct obtained on and again on after extubation were unchanged from baseline. after extubation and with no further sedating meds, the patient's mental status improved to baseline by . he speaks in short sentences with some mumbling of words and is at times difficult to understand. he is able to follow simple commands. haldol and benzodiazepines were held until when low dose haldol was re-instituted due to minor agitation, pulling at tubes. the patient required restraint to prevent him from pulling ngt out which occurred more than once. patient had been on benzodiazepines and haldol before admission. he was maintained on depakoate, prozac for his history of traumatic brain injury/organic affective disorder/depression. depakote level subtherapeutic at 25 on admit, and dose was increased per pharmacy recs. re-checked on and demonstrated levels within appropriate range. as his mental status improved, were able to move from ngt to diet. (see below) concerning renal issues: creatinine elevated on admission, felt to be secondary to hypovolemia. quickly returned to previous normal baseline with iv fluids. patient with hematuria. had foley catheter on this admission. should have urinalysis repeated as outpatient, consider cystoscopy at discretion of pcp. concerning hematologic issues: patient had hematocrit drop to low 30's from high 30's during icu stay. felt likley due to hydration, blood draws. guiaic negative until when he was positive but in setting of rectal tube with likely trauma. iron studies consistent with anemia of chronic disease. had colonoscopy as above to assess for colitis which did not demonstrate significant bleeding. crit stable throughout the rest of admission. additionally, patient had coagulopathy on admission felt likely secondary to sepsis. he recieved 2 units of ffp on admission for inr 1.9. coagulopathy resolved with one dose vitamin k in unit. no significant bleeding or other complications from anemai/coagulaopathy. concerning cardiovascular issues: no known history of cad or other significant heart disease. maintained on lipitor throughout admission for hypercholesterolemia. concerning nutrition: patient failed speech and swallow evals on and and ngt was maintained through until patient considered safe to eat. with improving mental status, eventually passed speech and swallow on . on ngt pulled, ground diet with thickened liquids instituted. prophylaxis: patient was maintained on subcutaneous heparin for dvt prophylaxis, protonix for gi prophylaxis. he was full code throughout admission. medications on admission: 1. mvi 2. lipitor 10 qd 3. fluoxetine 60 qd 4. protonix 40 qd 5. metamucil 6. depakote 300 7. alprazolam 0.25 tid 8. colace 100 tid 9. haloperidol 5 10. haloperidol 5mg prn q4hr 11. ativan 1 q4hr prn discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 3. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. atorvastatin calcium 10 mg tablet sig: one (1) tablet po hs (at bedtime). 7. valproate sodium 250 mg/5 ml syrup sig: two (2) po bid (2 times a day). 8. valproate sodium 250 mg/5 ml syrup sig: one (1) po daily (daily). 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 10. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 11. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 12. pseudoephedrine hcl 30 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 13. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 4 days. 14. metronidazole 500 mg tablet sig: one (1) tablet po three times a day for 4 days. 15. fluoxetine hcl 20 mg capsule sig: three (3) capsule po daily (daily). 16. haloperidol 1 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). 17. haloperidol 1 mg tablet sig: two (2) tablet po hs (at bedtime). discharge disposition: extended care facility: healthcare - discharge diagnosis: primary: 1. sepsis 2. uti 3. sinusitis 4. bacteremia 5. colitis secondary: 1. tbi: mva vs pedestrian s/p vp shunt 2 years ago 2. hypercholesterolemia 3. gerd 4. organic affective d/o 5. depression 6. irritable bowel discharge condition: at previous known baseline mental status, stable discharge instructions: contact md if you develop any fevers or any other concerning symptoms. all medications as prescribed. follow-up as below. followup instructions: contact dr. to make a follow-up appointment. he can be reached at . care as per physicians at healthcare. you must follow-up with gastoenterology. you should call to arrange a follow-up appointment with a gastroenterologist. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube closed [endoscopic] biopsy of large intestine transfusion of other serum infusion of vasopressor agent diagnoses: other and unspecified noninfectious gastroenteritis and colitis esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified acute kidney failure, unspecified unspecified septicemia severe sepsis acute respiratory failure presence of cerebrospinal fluid drainage device mood disorder in conditions classified elsewhere acute sinusitis, unspecified late effects of motor vehicle accident late effect of intracranial injury without mention of skull fracture 

Answer: The patient is high likely exposed to