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: history of present illness: the patient is a 58 year old caucasian male with a history of diabetes mellitus type 1, chronic renal insufficiency, status post transplant in , recurrent pneumoniae and coronary artery disease who has been admitted to the medical intensive care unit (micu) on with hypoxic respiratory failure and subsequently transferred to the floor. the patient was in his usual state of health until the morning of , when he had an acute episode of hypoglycemia with a blood sugar of 27. the patient reports taking his normal dose of insulin the night before and eating his bedtime snack and, in the middle of the morning, was shaking and unresponsive. his wife called emergency medical services, who came and treated the patient with juice and possibly an ampule of d50 and the patient subsequently aroused. he had some dyspnea and some abdominal discomfort and he and his wife came to the emergency room. in the emergency room, the patient was noted to have a temperature of 102 and decreased oxygen saturation to 80%. a chest x-ray done was consistent with right middle lobe and right lower lobe pneumonia and the patient was intubated for hypoxic respiratory failure and transferred to the micu. past medical history: 1. type 1 diabetes mellitus diagnosed at age 28, complicated by retinopathy leading to blindness, neuropathy leading to both autonomic and sensory motor disease with orthostatic hypotension, gastroparesis and loose stools as well as nephropathy. 2. status post living related donor kidney transplant in with chronic renal insufficiency; done in showed chronic inflammatory changes without acute rejection. 3. recurrent pneumoniae and multiple pulmonary nodules with multiple broncho-alveolar lavages that have been negative on culture and a recent transbronchial that showed patchy interstitial fibrosis; patient also had a vas with a right lower lobe wedge showing patchy acute and organizing pneumonia. 4. mgus with s-pep significant for monoclonal igg spike; bone marrow in and significant for increased plasma cells with eosinophilic material/nucleoli. 5. obstructive sleep apnea. 6. anemia. 7. deep vein thrombosis of left thigh. 8. coronary artery disease, status post non-st elevation myocardial infarction in , status post percutaneous transluminal coronary angioplasty with stent of the left anterior descending artery in . 9. left ventricular systolic/diastolic dysfunction with an echocardiogram in significant for a left ventricular ejection fraction of 45%, mild left ventricular hypertrophy, moderate left axis deviation, akinesis of the distal septum. 10. right pontine lacunar infarction. 11. gastroesophageal reflux disease with barrett's esophagitis. 12. diverticulosis. 13. clostridium difficile. 14. methicillin resistant staphylococcus aureus bacteremia complicated by septic pulmonary emboli and empyema. 15. hypoglycemic coma in . medications on admission: midodrine 5 mg p.o.t.i.d., prednisone 5 mg p.o.q.d., neurontin 300 mg p.o.b.i.d., atenolol 200 mg p.o.q.d., pravachol 40 mg p.o.q.d., isosorbide 90 mg p.o.q.d., nitroglycerin p.r.n., lantus insulin 34 units q.p.m., lyspro insulin sliding scale, procrit 20,000 units twice weekly, levoxyl 25 mcg p.o.q.d., protonix 40 mg p.o.q.d., procardia xl 60 mg p.o.q.d., lasix 60 mg p.o.q.a.m. and 40 mg p.o.q.h.s., calcitriol, vitamin d 0.25 mcg p.o.b.i.d., niferex 150 mg p.o.b.i.d. allergies: dicloxacillin and compazine. social history: the patient lives with his wife and daughter. quit tobacco 18 years ago with a 20 pack year history. he has a distant history of exposure. physical examination: vital signs: temperature 101.9, pulse 83, blood pressure 159/60, oxygen saturation 100% on 100% fio2 ac 600/14, peep 10. general: intubated, sedated. head, eyes, ears, nose and throat: anicteric sclerae, oropharynx clear, ptosis of right eye, surgical left pupil, right sided cataract, moist mucous membranes. pulmonary: crackles at right base. cardiovascular: regular rate and rhythm, normal s1 and s2, no murmur, rub or gallop. abdomen: soft, nontender, nondistended, positive bowel sounds. extremities: no edema, no rashes. neurologic: withdraws to pain. laboratory data: white blood cell count 8.6 with 79% polycytes, 1% bands, 9% lymphocytes, 10% monocytes and 1% eosinophils, hematocrit 44.4, platelet count 118,000, sodium 137, potassium 5.1, chloride 104, bicarbonate 20, bun 108, creatinine 8.3, glucose 278, anion gap 13, prothrombin time 12.9, partial thromboplastin time 26.2, inr 1.1, alt 14, ast 16, alkaline phosphatase 106, amylase 56, total bilirubin 0.8, lipase 15, albumin 3.7. urinalysis: straw, clear, 1.017, small blood, negative nitrites, 500 protein, 1,000 glucose, negative ketones, negative leukocyte esterase. chest x-ray: right lower lobe and right middle lobe pneumonia. ct of abdomen: right middle lobe, right lower lobe, left lower lobe consolidation, small pleural effusions bilaterally, no free air/fluid in abdomen, bowel loops normal, evidence of diverticulosis. electrocardiogram: sinus rhythm with first degree a-v block, borderline left axis, st elevations v1 through v3, st elevations which are old, lateral t wave inversions and st depressions which are also old. hospital course: 1. pulmonary: the patient was admitted to the micu intubation for hypoxic respiratory failure. he was started on levofloxacin for a -lobar pneumonia noted on chest x-ray. the patient remained intubated for two days in the micu and was eventually weaned and extubated without problems. throughout the remainder of his hospital course on the floor, the patient was completely stable from a respiratory standpoint. his oxygen was eventually weaned and a repeat chest x-ray prior to discharge showed dramatic improvement in his -lobar pneumonia. he will complete a full 14 day course of levofloxacin. flagyl was added several days after levofloxacin for a concern of aspiration during his hypoglycemic coma and during resuscitation by the emergency medical technicians with juice. 2. endocrine: the patient was admitted to the micu after a hypoglycemic coma and was started on fluids with dextrose. he subsequently had high fingerstick glucoses and was started on an insulin drip in the unit. on transfer to the floor, he was switched back over to subcutaneous insulin, with poorly controlled blood sugars in the 400s. his total daily dose of insulin was calculated, his sensitivity ratio was calculated and his insulin to carbohydrate ratio was calculated, and the patient was started on a new regimen with glargine 20 units in the evening and a new insulin sliding scale, with subsequent excellent control of his blood sugars. once the patient was on nothing by mouth for various catheter placements, his blood sugars were again poorly controlled and the endocrinology/diabetes consult service was contact. they changed his regimen and his blood sugars were noted to be under improved control. the patient was kept on his operating table dose of levoxyl for hypothyroidism. 3. renal: the patient was admitted with a history of chronic renal insufficiency, status post a kidney transplant in , and was thought to have chronic rejection, though previous biopsies show no evidence of rejection. the renal team followed the patient throughout his entire hospitalization. once the patient was transferred to the floor, he received a hemodialysis catheter and received hemodialysis three days. he was maintained on sodium bicarbonate and calcium acetate as well as nephrocaps throughout his hospital course. the patient was supposed to get a peritoneal dialysis catheter placed on the day prior to discharge but, due to a hypertensive crisis, this will be done as an outpatient and the patient will receive hemodialysis as a bridge to peritoneal dialysis. 4. cardiovascular: on admission to the micu the patient was transiently hypotensive and required fluid resuscitation and a brief course of levophed. on transfer to the floor, he was normotensive and restarted on his outpatient antihypertensive regimen. the patient was hemodynamically stable throughout his stay on the floor until the day prior to discharge, when the patient's blood pressure went up to 236/110. the etiology of this is not clear at this point, though it is considered possible that this was a reaction to intravenous epogen, as the patient had a similar reaction 13 years ago with intravenous epogen. once the patient was dialyzed and brought back to the floor, he was given 10 mg of intravenous hydralazine with good response. he was restarted on his oral antihypertensives, which were stopped for his upcoming procedure, and the patient was again normotensive. 5. hematology: the patient is noted to be anemic and thrombocytopenia at baseline. his counts were monitored throughout his hospital course and noted to be stable. he was maintained on his outpatient dose of epogen, but this was stopped the day prior to discharge secondary to his hypertensive crisis and the thought that it could be related to intravenous epogen. 6. infectious disease: the patient was noted to have a -lobar pneumonia on admission to the micu and was started on levofloxacin, of which he is to receive a full 14 day course. given a concern for aspiration pneumonia, the patient was started on flagyl for anaerobic coverage and will take this with levofloxacin for a full course. the patient was febrile on admission but his fever curve gradually decreased over his hospital stay and he was afebrile for four to five days prior to discharge. the patient's white blood cell count was noted to be normal throughout his hospital stay. multiple cultures were sent and were noted to be negative. a nasopharyngeal swab was sent and was noted to be positive for coagulase positive staphylococcus, thought to be the patient's methicillin resistant staphylococcus aureus (mrsa) and the patient was kept on mrsa precautions throughout his hospital stay. condition on discharge: good. discharge status: the patient is to be discharged home and will be followed closely by dr. with hemodialysis on mondays, wednesdays and fridays. discharge diagnoses: 1. pneumonia. 2. diabetes mellitus. 3. chronic renal insufficiency, status post kidney transplant. 4. mgus. 5. hypertension. discharge medications: 1. prednisone 5 mg p.o.q.d. 2. levothyroxine 25 mcg p.o.q.d. 3. nephrocaps one p.o.q.d. 4. calcium carbonate 1,000 mg p.o.q.i.d. 5. calcitriol 0.25 mcg p.o.q.d. 6. pantoprazole 40 mg p.o.q.d. 7. nifedipine sr 60 mg p.o.q.d. 8. calcium acetate 1,334 mg p.o.t.i.d. with meals. 9. isosorbide mononitrate sr 60 mg p.o.q.d. 10. colace 100 mg p.o.b.i.d. 11, neurontin 300 mg p.o.b.i.d. 12. pravastatin 40 mg p.o.q.d. 13. midodrine 5 mg p.o.t.i.d. 14. atenolol 200 mg p.o.q.d. 15. levofloxacin 250 mg p.o.q.o.d. times four days. 16. flagyl 500 mg p.o.t.i.d. times four days. 17. insulin glargine 18 units s.c.q.p.m. 18. insulin sliding scale with humalog insulin. follow-up: the patient will have hemodialysis on mondays, wednesdays and fridays at with dr. , with whom he will follow up. the patient has a scheduled visit with dr. , endocrinologist at the clinic on at 9:00 a.m. he also has a scheduled visit with the diabetic dietitian at the clinic on at 9:00 a.m. the patient also has a follow-up appointment with his cardiologist, dr. , on at 11:40 a.m. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis bronchoscopy through artificial stoma diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure complications of transplanted kidney diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled diabetes with other coma, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to