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: no known allergies / adverse drug reactions attending: chief complaint: s/p fall major surgical or invasive procedure: none history of present illness: 83f transferred from hospital for acute on chronic subdural hematoma. pt reported that she fell while trying to get to the bathroom from bed, not sure from bed or while walking. she said she hit her head. fall was unwitnessed at nursing home. patient was found on the floor by staff complaining of left-sided head pain. it was unclear whether pt loss consciousness, but she seemed to remembered the event, but could not relate how she fell or the circumstances around on. per the nursing home she was last seen in bed 2 hours prior to being found in the floor. pt admits more frequent urination, poor po intake, but denied fever, chill, change in vision, cp, palpitation, sob, n/v/d, dysuria or weakness of her extremities. per her cousin, pt was quite functinoal at baseline, active in nursing home activities and very talkive. . pt was initially sent to hospital, where she was cleared for c-spine. ct-head showed subdural hematoma. pt was sent to or further management. . in the , pt was afebrile, 92, 92/44, 17-19, 94-96% on 2l. she had wbc of 14.1, cr 1.2, troponin 0.03 with flat ckmb, ekg consistent with rv pacing with no st-segment changes, ct-head was stable with no interval worsening, cxr has some haziness in rll/rml. pt was evaluated by neurosurgery team. she received vancomycin and zosyn for hcap and 500 cc ns at 75 cc/hr. . on arrival to the micu, pt continue to be afebrile with sbp decreased to 80s. after starting ns at 75 cc/hr, her sbp improved to 100s. past medical history: anemia hypothyroidism chf (previously uncharacterized, normal tte while at ) history of falls and unstable gait depression status post pacer (?heart block) hyperlipidemia gerd hx of left humeral fracture social history: pt lives at brighten at . per her cousin, she was quite active and functional at baseline. pt worked at government center for a long term. denies smoking, alcohol or recreational drug use. family history: unable to obtain physical exam: admission exam general: somnolent at times, orientedx3, no acute distress heent: eomi, perrl, sclera anicteric, dry mucosal membrane, oropharynx clear neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: bibasilar crackles, r worse than l abdomen: soft, non-distended, subrapubic tenderness on palpation, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact on discharge: crackles have improved. still requiring minimal o2 (~2l), much improved from 5-6l earlier in hospitalization. excoriations in perianal and coccyx areas, requiring wound care due to frequent stooling and incontinence. pertinent results: admission labs 06:53am blood wbc-14.1* rbc-3.71* hgb-11.1* hct-33.1* mcv-89 mch-29.8 mchc-33.5 rdw-13.4 plt ct-350 06:53am blood neuts-76.1* lymphs-19.3 monos-2.6 eos-1.4 baso-0.5 06:53am blood pt-13.0 ptt-21.7* inr(pt)-1.1 06:53am blood glucose-164* urean-56* creat-1.2* na-138 k-5.7* cl-107 hco3-19* angap-18 06:53am blood ck-mb-5 06:53am blood calcium-9.0 phos-4.7* mg-2.4 08:53am blood lactate-1.2 06:53am blood tsh-0.38 pertinent lab trends: wbc 07:15am blood wbc-11.5* 05:56am blood wbc-9.8 na and creatinine 07:20am blood creat-1.0 na-146* 02:36pm blood creat-1.4* 02:43am blood creat-1.1 na-143 11:51am blood creat-1.1 na-140 albumin 06:32am blood albumin-3.3* arterial blood gas 01:43pm blood type-art temp-36.9 po2-114* pco2-35 ph-7.48* caltco2-27 base xs-3 (on a non-rebreather) . discharge labs: 05:56am blood wbc-9.8 rbc-4.07* hgb-11.5* hct-36.1 mcv-89 mch-28.2 mchc-31.8 rdw-13.8 plt ct-346 11:51am blood glucose-89 urean-18 creat-1.1 na-140 k-3.9 cl-103 hco3-29 angap-12 05:56am blood calcium-8.1* phos-4.3 mg-2.1 microbiology: 9:25 am urine site: catheter **final report ** urine culture (final ): enterococcus sp.. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- <=1 s vancomycin------------ 1 s c. diff - negative x2 mrsa screen - positive blood and urine cultures - all negative, 2 blood cultures pending on discharge with no growth to date pertinent studies cxr (): impression: mild pulmonary edema superimposed on basilar interstitial lung process with possibly underlying emphysema. nodular opacity at the right lung base may relate to underlying fibrosis, but an underlying nodule is not excluded and could be further evaluated for on chest ct as clinically appropriate. possible small bilateral pleural effusions. reverse c-shaped calcific density projecting over the heart likely represents mitral annulus calcification. this could be confirmed with pa and lateral views. . cxr (): impression: right picc line ends at lower svc. there is no pneumothorax. a single lead from left pectoral pacemaker device ends into the right ventricle. dense calcification of mitral valve annulus is present. since , , moderate to sever pulmonary edema, moderate to large right and mild left pleural effusions are new. mild cardiomegaly is stable. mediastinal and hilar contours are unchanged. . cxr (): impression: ap chest compared to through 21: pulmonary edema which improved between and returned with a large pleural effusion on and made it impossible to say whether pneumonia has changed. today, there is less of a moderate-sized right pleural effusion. small left pleural effusion is stable. there is at least some pulmonary edema and very heterogeneous opacification in the right lung and at the left lung base, all of which makes it difficult to distinguish edema from pneumonia. heart is mildly enlarged, predominantly due to a very dilated left atrium as denoted by the heavily calcified mitral annulus which can contribute to mitral regurgitation. no pneumothorax is present. transvenous right ventricular pacer lead is unchanged in the expected position. . ct head w/o contrast () impression: 1. slight increase in the right frontotemporal subdural hematoma, particularly inferiorly at the frontotemporal junction now measuring 12 mm in maximum transverse dimension. no change in mass effect. 2. no evidence of subfalcine or transtentorial herniation. 3. no new intra- or extra-axial hemorrhage outside of the previously described subdural collection. 4. stable global atrophy and small vessel ischemic changes. . ct head w/o contrast (): impression: right frontotemporal subdural hematoma, unchanged. . tte (): the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is moderate thickening of the mitral valve chordae. there is moderate functional mitral stenosis (mean gradient 6 mmhg) due to mitral annular calcification. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: suboptimal image quality. normal global biventricular systolic function. technically suboptimal to exclude focal wall motion abnormality. mild mitral regurgitation. moderate functional mitral stenosis from annular calcification. brief hospital course: 83f nh resident w/ hx of recurrent falls and recurrent uti present with new fall, presenting with subdural hematoma and uti. . active issues # subdural hematoma: pt presented from osh with subdural hematoma. she was evaluated by neurosurgery in the ed and was thought to have acute on chronic sdh. no intervention was indicated. neuro exam was nonfocal. repeated ct on following days did not reveal interval changes. she was started on dilantin 1 g in the ed, and continued with 100 mg dilantin tid for 10 days while in the hospital. this was discontinued prior to discharge. . # uti: pt was incontinent and wore diaper at baseline. uti appears recurrent per discussion with covering physician at . no evidence of sepsis or pyelonephritis. pt was initially covered with vancomycin/cefepime for uti, which was later converted to zosyn to more completely covered a suspected aspiration pneumonia (see next issue) when urine culture was positive for pan-sensitive enterococcus. she completed a full course of 7 days while in house. # aspiration pneumonia with concurrent pulmonary edema: although pt was afebrile and had no cough, she was initially treated with vancomycin and zosyn given the concerning chest x-ray findings in the ed. she was evaluated by the speech and swallow team and they witness frank aspiration. her cxr revealed ?infiltrate in the right lower lobe along with mild pulmonary edema. she was started on zosyn for an 10-day course. her pulmonary edema was managed with lasix and progress was tracked with cxrs that showed improvement. an echocardiogram was done and showed no abnormalities. # dehydration with hypernatremia: on initial presentation, we appeared dry likely secondary to poor po intake in the setting of uti. her echo last year was notable for pulmonary hypertension with moderate tr, but preserved lv function per osh report. she received ns boluses in the micu, and tolerated well these well. however, she developed pulmonary edema as above, managed with intermittent lasix dosing. an echocardiogram did not show any abnormalities, not even the ones indicated above (i.e. pulmonary hypertension, moderate tr). therefore, she was discharged without any standing lasix due to concern for her poor po intake. her sodium was managed initially with d5w, but this contributed to her volume overloaded state and we instead allowed her to drink to thirst to correct her sodium, which was normal on discharge. # s/p fall: pt had a history of recurrent fall per report from nursing home. the mechanism of all has been felt to be mechanical. ekg on this admission has been stable, and no cardiac enzyme elevation was observed. pt denied history of seizure. her tsh was normal. she will require 1:1 assistance with all transfers and has been continually encouraged to ask for help getting out of bed. . chronic issues # hyperkalemia with diarrhea: pt takes kayaxelate on mon and thurs at home. with her worsening diarrhea in house, we stopped this and it should not be continued unless follow-up show worsening hyperkalemia. her c. diff toxin tests were negative x2. . # depression: we continued her citalopram 20 mg daily and initially held mirtazepine to prevent sedation. she should continue on both upon discharge. . transitional issues - pt declared a code status of dnr/dni - -weekly lab draws to ensure stable electrolytes and creatinine - please encourage po intake, keeping mind aspiration precautions - monitor oxygen saturation and please keep above 92% with nasal cannula prn. - ms. is very reliant on others for her care. her respiratory status was of concern to us during this hospitalization. if she continues to require a higher level of care to manage these issues, we would recommend considering hospice care. medications on admission: mvi fluticasone 50mcg spray daily artificial tears senna loratadine prn omeprazole 20mg daily bicarb citalopram 20mg daily kayexalate twice weekly (m/th) ear drops- 3 drops into right ear for the first 3 days of every month calcium carbonate 200(500)mg tablet tid mirtazapine- 30mg po qhs refresh tears 0.5% drops- 1 drop each eye tid lasix 20mg daily (started ) discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 4. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for dry eyes. 5. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 8. calcium acetate-aluminum sulf packet sig: one (1) packet topical (2 times a day) as needed for wound care. 9. loratadine 10 mg tablet sig: one (1) tablet po once a day as needed for allergy symptoms. 10. senna 8.6 mg tablet sig: one (1) tablet po once a day as needed for constipation. 11. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po three times a day. discharge disposition: extended care facility: brighten at discharge diagnosis: primary diagnoses: subdural hemorrhage aspiration pneumonia pulmonary edema delirium urinary tract infection discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , it was a pleasure caring for you at the . you were initially admitted after you fell and had some bleeding in your head. the neurosurgeons felt that you were safe to allow this to resolve on its own. you spent a short amount of time in the intensive care unit and then were transferred to the medical floor. you had difficulty with your breathing and required extra oxygen. we gave you some medication to prevent fluid build-up in your lungs and did some tests of your heart to help determine a cause. this test ("echocardiogram") was very normal and you will not be continued on this medication (diuretics). you are also having some difficulty with eating and sometimes choke on your food and drinks. you should continue to drink only thickened liquids and ground solids so that swallowing is easier for you. otherwise you could develop more difficulty breathing and even a pneumonia, which you did while you were here. you were a little bit confused at times during your hospitalization but are doing much better now after we treated both your pneumonia and urinary tract infections. we have made the following changes to your medications: stop lasix, since we do not want to dehydrate you if you're unable to drink enough. stop kayexelate, as your potassium is normal and your diarrhea worsened while on it. we have not started any new medications. please only take the colace and senna if you are constipated. followup instructions: while you are at brighten at , you will be seen by their doctor. you will not need to call dr. for an appointment unless you leave this facility procedure: venous catheterization, not elsewhere classified diagnoses: acidosis hyperpotassemia anemia, unspecified esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified toxic encephalopathy acute kidney failure, unspecified unspecified protein-calorie malnutrition unspecified acquired hypothyroidism acute on chronic diastolic heart failure other chronic pulmonary heart diseases unspecified fall depressive disorder, not elsewhere classified abnormality of gait chronic kidney disease, unspecified other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus cardiac pacemaker in situ diarrhea streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness hyperosmolality and/or hypernatremia tricuspid valve disorders, specified as nonrheumatic bacterial pneumonia, unspecified other diuretics causing adverse effects in therapeutic use dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to