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/fever major surgical or invasive procedure: mechanical intubation. tracheostomy percutaneous gastrostomy tube. central venous catheter insertion. history of present illness: 78 yo m h/o htn, esrd on hd, asthma admitted with fever/unresponsiveness. pt has a complicated recent medical history and received all of his prior medical care at . briefly, the patient was discharged from after an admission for urosepsis. two days later he was admitted () for resp distress and fever, requiring intubation. he was diagnosed with septic shock. blood cultures ultimately grew vre with possible source and hd line which was pulled. pt also diagnosed with vre uti and e coli uti (cxs unavailable). pt was placed on ctx and linezolid for a planned three week course. pt was discharged to healthcare. this afternoon pt was found to be unresponsive to painful stimuli, t 102.4, bp 150/80, hr 117, rr 20, sat 94% 5l nc. on arrival ems noted pt's mouth clenched, placed nasal trumpets. coffee ground material suctioned from mouth. questionably on diversion: patient brought to . . in the ed, initial vitals t102.7, hr 132, bp 154/96, rr 31, 100% nrb. because of pt's clenched jaws nasotracheal intubation performed. wbc 6.4. lactate 2.8. u/a 11-20 wbcs, few bact. ekg: st@126 bpm, nml axis/int, twf in i, l, v2-4, no priors. ct head negative. in the pt given tylenol 650 mg pr, vanc 1 gram, cefepine 2 gm, fent/versed, protonix 40 mg, and approx 3 l of ns to maintain bp. pt transferred to micu. past medical history: htn gout esrd on hd, has one kidney asthma gerd social history: daughter is hcp family history: noncontributory physical exam: temp 96.7 bp 141/72 pulse 104 resp 22 o2 sat 100% on ac 450x16, fio2 100, peep5 gen - intubated, sedated heent - pupils sluggishly reactive, adentulous, mucous membranes dry neck - no jvd, no cervical lymphadenopathy chest - rhonchorous anteriorally cv - tachy regular, no murmurs abd - soft, nondistended, with hypoactive bowel sounds extr - no edema neuro - sedated skin - no rash discharge exam: bp:97/52 off of anti-hypertensives, on po midodrine. hr: 90s-100s gen - responds to vocal stimuli with opening eyes, tracks with eyes, blinks to threat heent: perrl neck: no jvd chest: + rhonchi cv: rrr no murmurs abd: nd, +bs ext: no oedema skin: no rashes pertinent results: 07:30pm blood wbc-6.4 rbc-4.09* hgb-12.0* hct-36.1* mcv-88 mch-29.5 mchc-33.3 rdw-19.8* plt ct-137* 02:03am blood wbc-6.1 rbc-3.07* hgb-9.1* hct-27.3* mcv-89 mch-29.5 mchc-33.2 rdw-19.9* plt ct-82* 03:11am blood wbc-6.1 rbc-2.80* hgb-8.5* hct-26.2* mcv-94 mch-30.4 mchc-32.5 rdw-21.5* plt ct-245 03:21am blood wbc-6.5 rbc-2.44* hgb-7.7* hct-23.7* mcv-97 mch-31.5 mchc-32.4 rdw-22.7* plt ct-257 04:20am blood wbc-6.4 rbc-2.42* hgb-7.4* hct-23.5* mcv-97 mch-30.8 mchc-31.6 rdw-21.8* plt ct-378 03:11am blood pt-16.0* ptt-150* inr(pt)-1.4* 03:21am blood pt-14.9* ptt-35.8* inr(pt)-1.3* 04:20am blood pt-22.1* ptt-68.0* inr(pt)-2.1* 07:30pm blood glucose-91 urean-16 creat-4.2* na-141 k-3.2* cl-101 hco3-25 angap-18 02:03am blood glucose-162* urean-15 creat-3.8* na-142 k-2.6* cl-107 hco3-24 angap-14 10:57pm blood glucose-110* urean-17 creat-3.8* na-142 k-3.2* cl-107 hco3-22 angap-16 03:11am blood glucose-107* urean-18 creat-3.2* na-143 k-3.8 cl-112* hco3-22 angap-13 03:21am blood glucose-67* urean-14 creat-2.6* na-143 k-3.8 cl-110* hco3-24 angap-13 04:20am blood glucose-78 urean-19 creat-3.3* na-143 k-3.9 cl-109* hco3-26 angap-12 07:30pm blood albumin-2.7* calcium-8.9 phos-3.1 mg-1.4* 02:03am blood calcium-7.4* phos-3.5 mg-1.2* 10:57pm blood calcium-7.5* phos-2.7 mg-2.1 03:11am blood calcium-7.9* phos-3.2 mg-2.0 03:21am blood calcium-7.7* phos-2.9 mg-1.7 04:20am blood calcium-7.8* phos-4.6*# mg-1.8 04:44am blood caltibc-65* ferritn-1172* trf-50* 04:00pm blood vitb12-1402* 08:15pm blood type-art po2-532* pco2-40 ph-7.47* caltco2-30 base xs-5 -assist/con intubat-intubated 02:15am blood type-art temp-35.4 fio2-100 po2-516* pco2-40 ph-7.40 caltco2-26 base xs-0 aado2-177 req o2-38 intubat-intubated 03:52am blood type-art temp-35.8 rates-18/ tidal v-560 peep-5 fio2-40 po2-119* pco2-36 ph-7.45 caltco2-26 base xs-2 intubat-intubated vent-controlled 09:19pm blood type-art temp-37.0 rates-/24 tidal v-500 peep-8 fio2-50 po2-109* pco2-36 ph-7.47* caltco2-27 base xs-2 intubat-intubated vent-spontaneou 03:52am blood type-art temp-36.1 rates-/24 tidal v-550 peep-8 fio2-50 po2-128* pco2-35 ph-7.44 caltco2-25 base xs-0 intubat-intubated vent-spontaneou 03:22am blood type-art temp-38.2 peep-5 fio2-40 po2-148* pco2-43 ph-7.44 caltco2-30 base xs-5 intubat-intubated 07:27pm blood lactate-2.8* 07:17pm blood lactate-2.9* 08:46pm blood lactate-3.6* 07:22pm blood lactate-1.4 test result ---- ------ heparin dependent antibodies negative comment: negative for heparin pf4 antibody by . complete report on file in the laboratory. test result reference range/units gad-65 ab <1.0 <=1.0 u/ml test performed at: institute p.0. box chantilly, ct head on : non-contrast head ct no priors are available. there is no evidence of intracranial hemorrhage, mass effect, shift of midline structures, hydrocephalus, or acute major vascular territorial infarct. ex vacuo dilatations of the lateral ventricles is consistent with the underlying atrophy, which is likely age appropriate. periventricular hypoattenuating changes within the white matter are consistent with chronic small vessel disease. mild atherosclerotic disease is noted within the anterior and posterior circulations. soft tissues are unremarkable. no underlying osseous abnormalities are identified. there is dense opacification involving the sphenoid sinuses, right and left maxillary sinuses, and the majority of the ethmoid air cells. the frontal sinuses are well aerated. there is near-complete opacification with increased sclerosis involving the mastoid air cells. impression: no acute intracranial pathology. chronic-appearing sinus disease as described above ct abd/pelvis on : impression: 1. rectosigmoid colitis, likely infectious or inflammatory. 2. centrilobular and tree-in- opacities within the visualized lung bases with bilateral small pleural effusions, left slightly greater than right. findings are most suggestive of an underlying infectious bronchiolitis, aspiration or due to chronic infection. 3. bilateral hypoattenuating renal lesions, some of which are clearly simple cysts and others which are not definitively characterized. right sided hyperattenuating lesions, incompletely characterized. underlying neoplasm cannot be excluded. given the atypical location of the kidney, ultrasound will likely not be able to assess this and an mri would be recommended on a non-emergent basis to exclude neoplasm. 4. diffuse aortic ectasia with right common iliac ectasia/aneurysm as described above. : bilateral upper extremity ultrasound. grayscale and color doppler son of the right and left internal jugular, subclavian, axillary, brachial, basilic, and cephalic veins was performed. the left internal jugular vein does not demonstrate any flow and is not compressible compatible with an intraluminal thrombus; it is small in caliber. a picc line is noted within the left brachial vein. the remainder of the veins demonstrate normal flow, compressibility, augmentation, and waveforms. impression: findings consistent with a left internal jugular vein occlusive thrombus; given its small caliber this may be a chronic finding. chest x-ray : impression: 1. advancement of endotracheal tube and nasogastric tube advised as described above. 2. ill-defined reticular opacity within the mid right hemithorax is of uncertain etiology, may represent a small focus of infection/aspiration, linear atelectasis, or regions of scarring. ct chest: impression: 1. innumerable bilateral pulmonary nodules noted in the left upper lobe measuring 8 mm. close attention and short-term followup at three months is recommended. entered in critical results communication. 2. bilateral pleural effusions, left more than right. evidence of patchy tree and opacities predominantly at bilateral lung bases may represent inflammatory or a multifocal infectious process. 3. multiple low-attenuating lesions within the left kidney as described above. 4. no evidence of superior vena cava syndrome. 5. mild aortic ectasis without aneurysmal dilation. mri head on : findings: there is no evidence of hemorrhage, edema, mass, mass effect, or infarction. there is a prominent amount of bilateral extra-axial csf, which is noted to have increased signal throughout on flair images, suggestive of increased protein content within this fluid. csf within the ventricular system shows normal flair signal intensity. there is some moderate periventricular white matter flair signal hyperintensity, most consistent with chronic microangiopathic change. a tiny focus of increased diffusion signal just lateral to the atrium of the left lateral ventricle most likely represents t2 shine through artifact. no other diffusion abnormality is detected. there is a moderate amount of fluid seen within the sphenoid sinus, and posterior ethmoid air cells, most probably related to the patient's intubated status. visualized vascular flow voids are normal. impression: abnormal increased flair signal in the extra-axial csf spaces relative to csf in the ventricles is suggestive of increased protein content, and could be seen with meningitis. please correlate with results from lumbar puncture. echocardiogram on : findings left ventricle: suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. suboptimal image quality - poor parasternal views. suboptimal image quality - poor apical views. suboptimal image quality - poor subcostal views. conclusions very limited image quality. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is grossly normal (lvef>55%). right ventricular chamber size and free wall motion are also grossly normal. there is no pericardial effusion. eeg on : impression: this is an abnormal portable eeg due to the abnormal background consisting of low voltage fast activity intermixed with bursts of moderate amplitude generalized delta frequency slowing consistent with a mild to moderate encephalopathy suggesting dysfunction of bilateral subcortical or deep midline structures. medications, metabolic disturbances, and infection are among the common causes of encephalopathy but there are others. there were no areas of prominent focal slowing although encephalopathic patterns can sometimes obscure focal findings. there were no epileptiform features and no electrographic seizure activity was noted. the low voltage fast background activity likely reflects medication effects from concomitant benzodiazepine or barbiturate admininstration. chest x-ray : findings: in comparison with study of , there is little change. the various monitoring and support devices remain in place. mild prominence of interstitial markings with several dense small granulomas at the left base and old right rib fractures are again noted. there is also some thickening of the lateral aspects of the minor fissure. brief hospital course: 1. sepsis: pt meets sirs criteria with urine as suspected source. pt's bp responded well to fluid challenge. he required pressors in setting of initiating hd, and was weaned off the phenylephrine on (transitioned to po midodrine 10mg prior to dialysis) antibiotic coverage as follows: initially continued linezolid for h/o vre and broadened from ceftriaxone=>cefepime. linezolid was discontinued for thrombocytopenia on . spiked temp to 102 on with worsening secretions, added vancomycin and cefepime=>meropenem for better gn coverage. vancomycin discontinued on given worsening thrombocytopenia. he was started on daptomycin/meropenem meningitis doses on given unresponsiveness in absence of sedation since admission and mri with extra-axial csf protein noted. lp attempted on per attending and resident, unsuccessfully-pt already on meningitis doses of abx. patient's femoral line placed in ed was pulled, his l picc line and tip were sent for culture on . sputum positive for pseudomonas, sensitive to meropenem which was continued for tx of vap, to finish course of meropenem 500mg daily, last day on . daptomycin was discontinued on given absence of gram positives in culture data. 2. respiratory distress: pt was initially nasally intubated due to locked jaw and unresponsiveness at his nh and upon ed presentation. his nt was switched over to ett. he remained intubated due to unresponsiveness in absence of sedation for at east 1 week. additionally the patient had significant amt. of secretions with little gag. tracheostomy and peg on . he had a trial on trach collar on but had to go back on to pressure support ventilation due to respiratory fatigue. 3. neuro: dementia and mobility disorder likely secondary to severe parkinson's disease. he was started on sinemet at and titrated to escelating doses prior to transfer which was continued here with some improvement. mri (non contrast) done with extraaxial protein noted, non-specific finding but ?meningitis. lp attempt on w/attndg-unsuccessful. sinemet dose uptitrated to 250/50 tid. patient should receive tube feeds at night so that they do not interfere with sinemet absorption. 4. thrombocytopenia: presumed from linezolid and sepsis. received 1 unit of platelets, hit negative, and subsequently resolved. patient continued to receive heparin gtt for left ij clot until inr was therapeutic. 5. esrd on hd: on monday/wednesday/friday schedule at . renal following, cvvh attempted on several occasions due to hypotension. hd initially not tolerated due to hypotension, but now tolerating with pre-treatment with 10mg midodrine. 6. ileus: pt started on reglan on for ? ileus, which was discontinued once the ileus resolved resolved. 7. htn: discontinued anti-hypertensives given persistent hypotension and requiring midodrine to maintain this. 8. nutrition: tube feeds, probalance full strength at rate of 130/hour, cycled from 9pm to 7am, held for residuals > 150, free water flushes q6h. cycled at night to avoid interference with sinemet absorption. 9. prophylaxis: started on warfarin for 6 weeks for left ij thrombosis. 10. code status - full code communication: with daughter, work: home: medications on admission: meds at rehab: linezolid 600 mg (to be finished ) ctx one gram daily (to be finished ) norvasc 5 mg daily sinemet 25/250 tid catapres 0.2 mg qweek atrovent coumadin 2 mg daily toprol 150 mg daily folate prevacid atrovent allopurinol 100 mg daily spiriva epogen 20,000 units qhd albuterol mom senna tylenol dulcolax discharge medications: 1. albuterol 90 mcg/actuation aerosol : 6-10 puffs inhalation q4h (every 4 hours). 2. ipratropium bromide 17 mcg/actuation aerosol : 6-8 puffs inhalation q4h (every 4 hours). 3. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 4. acetaminophen 160 mg/5 ml solution : one (1) po q6h (every 6 hours) as needed. 5. midodrine 2.5 mg tablet : three (3) tablet po tid (3 times a day). 6. warfarin 2.5 mg tablet : one (1) tablet po daily16 (once daily at 16). 7. carbidopa-levodopa 25-250 mg tablet : one (1) tablet po tid (3 times a day): please give morning dose 1 hour after tube feedings are turned off. 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 9. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 10. 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. 11. meropenem 500 mg recon soln : one (1) recon soln intravenous q24h (every 24 hours) for 3 days: please give after dialysis on days when patient goes for dialysis. last dose is . 12. sodium citrate 4% 1 ml iv asdir after hd sessions, please lock catheter with citrate solution, fill to volume specified on each port. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: nosocomial pneumonia septic shock parkinson's disease left ij thrombosis acute renal failure discharge condition: stable on ventilator, tolerating g-tube. discharge instructions: you were admitted for treatment of pneumonia and low-blood pressure. you required placement of a breathing tube and a tracheostomy tube for long-term use of a mechanical ventilatory (breathing machine). you received antibiotics for the pneumonia. you received hemodialysis for kidney failure. you were also found to have a clot in a vein of your neck and will need to be on a blood thinner for 6 weeks. followup instructions: you have an appointment made in the neurology movement disorders clinic on at 4pm with dr. in the clinical center, on . please call to reschedule the appointment or with any questions. please follow-up with your primary care physician 2 weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] other intubation of respiratory tract temporary tracheostomy transfusion of packed cells transfusion of other serum transfusion of platelets injection or infusion of oxazolidinone class of antibiotics diagnoses: end stage renal disease acute kidney failure, unspecified severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure pneumonia due to pseudomonas pneumonitis due to inhalation of food or vomitus septic shock paralytic ileus dementia in conditions classified elsewhere without behavioral disturbance streptococcal septicemia other and unspecified complications of medical care, not elsewhere classified other specified anemias hypotension of hemodialysis dementia with lewy bodies infectious colitis, enteritis, and gastroenteritis meningitis, unspecified 

Answer: The patient is high likely exposed to