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: respiratory distress major surgical or invasive procedure: picc placement history of present illness: 78m s/p fall complicated by r frontal/occipital sdh, discharged yesterday to rehab who returned today with fever and hypoxia. the patient has had a steady decline over the last several months. he had a fall in and was admitted to hospital for 12 days per family and was disharged to a rehab for a 20 day stay. he then had a fall at his home where he lives alone on . his family found him there on new years at the bottom of around 7 hard stairs. he was brought to and found on imaging to have a bilateral subarachnoid /intraparenchymal hemorrhages, right mastoid fracture,right lateral rib fractures, l1 transverse process fracture, l2 severe compression fracture of undetermined chronicity. he was admitted to trauma service with neurosurgery team involved as well. he was followed with serial ct scans. he had dysphagia on speech swallow eval and had peg placed. he was treated for pna and was discharged to rehab yesterday as above. . at rehab yesterday evening, he was noted to have a fever and hypoxia to sats in the 80s and was referred back to ed. cta showed no pe though was c/w pna. he had recieved levo and gent at rehab. he was admitted to hospitalist service for further management. . in the ed, patient had t of 97.5, bp 147/100, hr 122, rr 26 with sat of 94% (unclear what type of oxygen patient was on). he was intermittantly placed on nrb and then down to 4l fm satting 96%. . on the medical floor, the patient had been tachycardic in the 120s throughout the day. of note, the patient had an episode of psvt at 200 bpm lasting ~15 seconds with stable bp at 135/98. hr returned to 120s without intervention. around 8:00 pm he had an acute decompensation and had increased oxygen requirement to maintain sats > 95%, from 2l nc to 6l nc. additionally, continued to be tachycardic with rates up into the 130s. patient was beginning to require accessory muscles for respiration though was able to maintain sats in the mid-90s on regular face mask at 6l. temperature at the time was 100.5. icu consult called at that time. . on arrival to the icu, the patient had oxygen saturations in the high 90s on 6l fm. he was somnolent but arousable. he denies any pain, but reports some difficulty with breathing. minimal accessory muscle use at this time. past medical history: s/p fall with subdural/multiple intraparenchymal hemorrhages transverse fracture of r temporal bone hypertension hypercholesterolemia bph depression/anxiety type 2 dm social history: quit tobacco 25 yrs ago. nno etoh. worked in the past as salesman. hcp per hospital course - sister. family history: non-contributary physical exam: gen: sleepy, though awakens and answers questions heent: perrl, eomi. no scleral icterus. no conjunctival injection. mucous membranes moist. no oral ulcers. neck: supple, no lad, no jvp elevation. lungs: basilar crackles, no wheezes. cv: tachy, regular, no murmurs abdomen: soft, nt, nd, nabs, no hsm. peg in place extremities: warm and well perfused, no cyanosis, clubbing, edema. neurological: alert and oriented x 1, cn exam ii-xii reveals l facial droop otherwise intact. muscle strength is at least in rue, rle, at least 4-/5 lue, at least lle. sensation to light touch is intact throughout. reflexes brisk at knees and ankles bilaterally, increased tone lle. skin: no rashes or ulcers. area of exoriated skin on dorsum of r hand with white exudate psychiatric: tachypneic, states he's at . unable to complete full sentences pertinent results: echo: impression: suboptimal 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 appears normal. no pathologic valvular abnormality seen. pulmonary artery systolic pressure could not be determined. <br> 10:45pm type-art temp-36.4 rates-/32 o2-70 o2 flow-10 po2-72* pco2-25* ph-7.50* total co2-20* base xs--1 intubated-not intuba comments-simple fac 09:29pm glucose-156* urea n-19 creat-1.1 sodium-136 potassium-3.6 chloride-102 total co2-20* anion gap-18 09:29pm calcium-8.2* phosphate-2.6* magnesium-2.2 09:29pm wbc-25.7* rbc-3.79* hgb-11.9* hct-34.1* mcv-90 mch-31.4 mchc-34.9 rdw-15.5 09:29pm neuts-89.9* lymphs-4.3* monos-4.2 eos-1.3 basos-0.3 09:29pm plt count-616* 08:25pm type-art po2-69* pco2-25* ph-7.48* total co2-19* base xs--2 intubated-not intuba 09:29pm pt-14.8* ptt-28.5 inr(pt)-1.3* 03:11pm ck(cpk)-31* 03:11pm ck-mb-3 ctropnt-<0.01 03:11pm calcium-8.6 phosphate-2.7 magnesium-2.2 03:11pm wbc-30.2* rbc-3.97* hgb-12.5* hct-35.0* mcv-88 mch-31.4 mchc-35.7* rdw-15.3 11:00am ctropnt-<0.01 04:02am lactate-1.1 04:00am ctropnt-<0.01 04:00am calcium-8.4 phosphate-3.2 magnesium-2.1 04:00am wbc-26.8*# rbc-3.93* hgb-12.4* hct-34.4* mcv-87 mch-31.6 mchc-36.1* rdw-15.3 04:00am neuts-88* bands-0 lymphs-6* monos-5 eos-1 basos-0 atyps-0 metas-0 myelos-0 04:00am hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 04:00am urine blood-lg nitrite-neg protein-30 glucose-neg ketone-50 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:00am urine rbc->50 wbc- bacteria-few yeast-none epi-0-2 04:00am urine rbc->50 wbc- bacteria-few yeast-none epi-0-2 05:55am vanco-26.6* <br> ct head: indication: 78-year-old male with known subdural hemorrhage and subarachnoid hemorrhage post fall with increasing lethargy. technique: non-contrast imaging was obtained from the skull vertex to the skull base. comparison: multiple prior exams dating to , the most recent, . findings: a right parafalcine subdural hematoma again measures 8 mm in thickness, but is less dense since . isodense right frontal subdural collection is unchanged, and scattered foci of subarachnoid hemorrhage are less prominent since the most recent study. there is no shift of normally midline structures. moderate ventricular dilation is also unchanged. a transverse fracture through the right temporal bone with associated mastoid sinus opacification is unchanged. carotid and vertebral artery calcifications are redemonstrated. the paranasal sinuses and mastoid air cells are unremarkable except to note a stable focus of mucosal thickening and debris in the sphenoid sinus. impression: 1. evolving right parafalcine subdural hematoma is less dense, but unchanged in thickness and degree of mass effect since . 2. scattered subarachnoid hemorrhage is slightly less prominent. 3. moderate ventricular enlargement is also unchanged, and may relate to underlying central atrophy or communicating hydrocephalus. 4. unchanged right temporal bone transverse fracture. <br> cta chest, ab/pelvis: final report indication: fever, increased shortness of breath, query pe. comparison: . technique: multiple mdct-axial images were obtained from the base of the neck through the proximal thighs with and without the administration of 133 ml of optiray 350 intravenously. enteric contrast was not administered. coronal, sagittal reformats was derived and maximal intensity projections obtained on a separate workstation. findings: ct chest of the with and without intravenous contrast: central airways are patent to the level of the subsegmental bronchi. there are extensive atherosclerotic vascular calcifications again seen. a central line terminates in the lower svc. there is no intramural hematoma. there is no central pe or aortic aneurysm. there are bilateral pleural effusions right greater than left with associated relaxation atelectasis. there are no pulmonary nodules or pneumothorax. there is no axillary or mediastinal pathologic lymphadenopathy although scattered small prevascular upper and lower paratracheal nodes are seen. ct abdomen with intravenous contrast: there are persistent hypodense lesions in the liver likely to represent cysts. there is extensive pneumoperitoneum accompanying interval placement of a g-tube. the adrenals, pancreas, and gallbladder appear normal. again seen is a hypoattenuating area within the spleen likely a cyst. again seen are bilateral renal hypodensities in the kidneys (likely cysts). the kidneys symmetrically take up and excrete contrast. visualized loops of small and large bowel appear normal. there is no pathologic abdominal lymphadenopathy or free fluid. again atherosclerotic disease demonstrated by vascular calcifications is seen extensively throughout the vasculature in the abdomen and pelvis. ct pelvis with iv contrast: the bladder and distal ureters appear normal and there is a foley catheter and intracystic dependent air. there is an enlarged prostate containing calcifications. the rectosigmoidal area appears normal with no pericolonic fat stranding and gas seen within the rectum. there is no extensive pelvic free fluid. locules of free air is seen within the pelvis. there are bilateral fat-containing inguinal hernias again. musculoskeletal: again seen are minimal displaced rib fractures bilaterally including lateral third through 10th ribs, right posterior sixth through ninth and left lateral fourth through eighth. healing rib fractures are again seen. again seen are transverse process fractures on the right at l2, l3 and l4. again seen is a l1 compression fracture of indeterminate chronicity and a mild anterior deformity of t8. again seen is a old t11 spinous process fracture. there is no suspicious lytic or sclerotic lesion. extensive degenerative changes are seen throughout the spine. impression: 1. no central pe. 2. bilateral pleural effusions and associated relaxation atelectasis right greater than left. 3. pneumoperitoneum status post g-tube placement; given recent g-tube placement this extensive pneumoperitoneum may be normal; consider followup to assure decreasing quantity and no leak. 4. other findings include persistent liver, spleen and kidney cysts, atherosclerotic disease, enlarged prostate, rib fractures, compression deformities, and transverse process fractures and bilateral fat-containing inguinal hernias. <br> ct head (without contrast): final report indication: 78-year-old male with fall and traumatic subarachnoid hemorrhage. comparison is made to the multiple prior studies dating back to . non-contrast head ct: the study is somewhat limited by the patient motion. there has been no interval change in the subdural hematoma layering along the falx, right occipital region, and along the inferior border of the tentorium. the bifrontal subdurals are not well visualized. there has been no interval change in the small subarachnoid hemorrhage. no new hemorrhage is identified. no shift of midline structures noted. no microvascular infarction is identified. there is disproportionate ventriculomegaly, considering the amount of prominence of the sulci. transverse fracture of the right temporal bone is unchanged. this fracture cannot be completely evaluated in this study, which is degraded by the patient motion. impression: 1. unchanged subdural hematoma along the falx and in the right occipital region. 2. unchanged extensive bilateral subarachnoid hemorrhage. 3. disproportionate ventriculomegaly considering the degree of widening of the sulci. this finding suggests either central atrophy or communicating hydrocephalus. 4. unchanged transverse fracture of the right temporal bone. brief hospital course: 78 m s/p fall complicated by r frontal/occipital sdh, discharged to rehab who returned this stay with fever and hypoxia felt to persistant pna - bcx neg - sx esculated - required tx to <12h on floor for resp distress/tachycardia (not intubated) - +clinical improvement tx back to floor . overall, the patient has had a steady decline over the last several months. he had a fall in and was admitted to hospital for 12 days per family and was disharged to a rehab for a 20 day stay. he then had a fall at his home where he lives alone on . his family found him there on new years at the bottom of around 7 hard stairs. he was brought to and found on imaging to have a bilateral subarachnoid /intraparenchymal hemorrhages, right mastoid fracture,right lateral rib fractures, l1 transverse process fracture, l2 severe compression fracture of undetermined chronicity. he was admitted to trauma service with neurosurgery team involved as well. he was followed with serial ct scans. he had dysphagia on speech swallow eval and had peg placed. he was treated for pna and was discharged to rehab. pt returned next day with a fever and hypoxia to sats in the 80s and was referred back to ed. cta showed no pe though was c/w pna. he had recieved levo and gent at rehab. he was admitted to hospitalist service for further management. later than day of admission () - pt became more acutely tachycardic and hypoxic and was tx to the for further care, abx were changed for more pulm focus - azithro/vanc/cefepime - aggressive pulm toilet - sx improvement - tx back to floor for further care. pt overall maintained with antibiotics above, aggressive sunctioning/chest pt, but initially had spiking temps - added flagyl to regime with high clinical susp for continuous aspiration (noted c.diff have been negative). pt afebrile for a few days but now again with intermittant low grade temps - several cxr not consistant with worsening pna/empyema developing, c. diff neg, urine clear - plan for tomorrow if still with temps will be to change picc. note during the past few days pt's significant leukocytosis has been improving, pt's overall without changes in his clinical status. (low functional level - occasionally will whisper yes and no but usually can nod to yes and no questions). on floor, had family meeting and arranged for patient to be dnr/dni - ok for icu care for monitoring purposes/abx/fluids - but no pressors. at this point, awaiting ltac placement along with monitoring temps - pt overall unable to clear secretions and with very poorly recovering pna. with minimal movements will have significant tachycardia/tachypnea (very poor reserve currently), (on tele just due to prior svts and likely sign that pt need immediate aggressive suctioning/chest pt as has been his cause). <br> ##. healthcare-asocciated/aspiration pneumonia/hypoxia: pt was transferred from the floor to the icu for respiratory distress after the pt was noted to be tachypneic, with an acute increase in oxygen from 2l to 6l n.c. a cta was also performed which showed no p. embolism, but did have b/l pleural effusions and atelectasis. on arrival to the unit pt received nasopharyngeal suctioning x 2 which revealed pt had large amount of secretions that he was unable to clear with cough. overnight pt's oxygenation status improved to on room air oxygenating >90% on nasopharyngeal suctioning. occas triggered on floor for tachypnea/tachycardia - resolves with aggressive suctioning, again requires suctioning support. pt was continued on his nebs of xopenex and ipratropium. the patient should continue to receive sunctioning and chest pt frequently. the patient should complete a 10 day course of azithro/vanc/cefepime and flagyl. <br> ##. sinus tachycardia: on the floor prior to transfer pt was reported to have a 15sec burst of svt to the 200s, on the night of transfer to the unit pt was noted to be in sinus tachycardia to ther 150s. pt was given metoprolol 12.5mg x 1 po and tylenol #3 (pt appeared to be in pain) after which his rate responded and returned to the mid 90s. pt still remains borderline tachycardic ranging from the mid 90s to low 100s, pe has been ruled out, no acute blood loss noted. tachycardia may be secondary to his pleural effusions, excessive secretions (rather difficulty clearing), gen poor respiratory status. metoprolol should be titrated as bp tolerates. <br> ##. subdural hematoma: head ct on admission shows sdh stable from prior. neuro exam shows some deficits c/w imaging findings. pt during the unit appeared to improve, prior to leaving the icu he was able to voice simple yes, no, head shake/nod responses to simple questions. he was also able to move his extremities and obey simple commands. on previous discharge was to follow up with dr. , neurosurgery in about 4 weeks. <br> ##. temporal bone fracture: ent was consulted during prior admission. recommended cipro otic drops x 7 days and follow up as an outpatient with dr. in weeks for audiogram. <br> ##. dysphagia: per swallow consult, npo includiung meds, everything through peg. if patient appears to be handling his own secretions, can consider re-eval at ltac. <br> ##. anemia, nos: prior to icu stay pt was reported to have guaiac positive stools. on the am of transfer pt was noted to have dark stools (?melena). hct has remained stable on floor. <br> ##. type 2 dm: controlled, without complications: pt was not on insulin at rehab, however his last discharge summary showed insulin sliding scale. continued pt on sliding scale, but with coverage yesterday - to assist overall infx recovery - start lantus 4units qhs pm with better control. continue to monitor. <br> proph: scds, no hep with sdh fen: re-started tf and 1/2 dose on code - dnr/dni noc: hcp sister - , - call if pt decompensates <br> dispo - resp status stabilization where then pt to return to rehab/ltac - had family discussion - plan for pt now to be dnr/dni - no pressors, ok for icu level care if needed for just monitoring. ok for abx, conservative treatment. medications on admission: medications: d/c medications from : 1. insulin regular human 100 unit/ml solution : one (1) dose injection four times a day as needed for per sliding scale. 2. heparin (porcine) 5,000 unit/ml solution : one (1) ml's injection tid (3 times a day). 3. phenytoin 125 mg/5 ml suspension : one y (150) mg po q8h (every 8 hours). 4. protonix 40 mg susp,delayed release for recon : forty (40) mg po once a day. 5. roxicet 5-325 mg/5 ml solution : ml's po every four (4) hours as needed for pain. 6. ciprofloxacin 0.3 % drops : two (2) drop ophthalmic (2 times a day) for 7 days: instill in right ear. 7. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) gram intravenous q 12h (every 12 hours) for 11 days. 8. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback : 4.5 grams intravenous q8h (every 8 hours) for 11 days discharge medications: 1. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 12h (every 12 hours) for 1 days. 2. cefepime 2 gram recon soln : one (1) recon soln injection q24h (every 24 hours) for 2 days. 3. metoprolol tartrate 25 mg tablet : 0.5 tablet po q8h (every 8 hours). 4. phenytoin 125 mg/5 ml suspension : one (1) po q8h (every 8 hours). 5. levalbuterol hcl 0.63 mg/3 ml solution for nebulization : one (1) ml inhalation q6h (every 6 hours). 6. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 7. acetaminophen-codeine 300-30 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. 8. azithromycin 250 mg tablet : one (1) tablet po q24h (every 24 hours) for 1 days. 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. acetaminophen 160 mg/5 ml solution : one (1) po q6h (every 6 hours) as needed for pain. 11. insulin glargine 100 unit/ml cartridge : four (4) units subcutaneous once a day. 12. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 1 days. 13. insulin regular human 300 unit/3 ml insulin pen : as dir subcutaneous as dir: as per sliding scale. discharge disposition: extended care facility: discharge diagnosis: # pneumonia, with aspiration # subdural hemorrhage # temporal bone fracture # dysphagia # anemia # type 2 diabetes mel;litus discharge condition: fair/stable discharge instructions: continue medications as prescribed, patient will require frequent (roughly q2-3 hours suctioning with chest pt for aggressive pulmonary support. tube feeds are as recommended - note with plan to increased to double the current goals as was the prior nutrition recommendations. pt initially not tolerating levels due to clinical susp of ileus - with more consistant bowels to consider then advancing to double the current rate. <br> please contact an emergency facility if the patient's symptoms worsen, though note pt does have baseline tachycardia in 110-120s, very low functional reserve so will expect relative brief increased tachycardia/tachypnea when moving patient. if hr increased suddenly - (svt) - pt with history of then requiring immediate aggressive suctioning/pulmonary support for rapid treatment. <br> complete antibiotics for one more day. remove picc once antibiotics are complete. <br> sister as noted in the discharge summary is the hcp and to be informed of changes in care or patient status. followup instructions: -follow up in 4 weeks with dr. , trauma surgery. call for an appointment. -follow up in 4 weeks with dr. , neurosurgery. call for an appointment. inform the office that you will need a repeat head ct for this appointment. -follow up with dr. in weeks for audiogram. call for an appointment. md procedure: enteral infusion of concentrated nutritional substances diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis subarachnoid hemorrhage acute respiratory failure pneumonitis due to inhalation of food or vomitus pressure ulcer, other site paralytic ileus paroxysmal supraventricular tachycardia pressure ulcer, stage ii late effect of fracture of skull and face bones late effects of accidental fall 

Answer: The patient is high likely exposed to