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: penicillins / aspirin / ibuprofen / ciprofloxacin attending: chief complaint: hypoxia and feeding tube replacement major surgical or invasive procedure: intubation on bronchoscopy history of present illness: 55-year-old male who is s/p orthotropic liver in for alcoholic cirrhosis, history of colon cancer s/p colectomy, on rapamune who was discharged from the icu on after an admission for sepsis, pneumonia, and severe malnutrition. he required intubation during that admission and sats were still low. he was bronched and suctioned for large mucus plugs. given his mucus plugging he was ultimately trached. he then had an ng tube placed for his poor nutrition. the decision was made not to place a feeding tube due to the liver team's concerns of infection. . per report from his nurse at rehab he weaned off the ventilator well. he was decanulated last week and tolerated it well. his ng tube had remained in place until earlier this week when it came out. 2 days ago there was an attempt to place a dubhoff but it could not be passed beyond the nasopharynx into the oropharynx. the catheter would repeatedly enter the trachea. he was supposed to have it placed under guidance yesterday but no anesthesiologist was available so he was sent back to spauling without the dubhoff placed. he has received no tf or po medications since with the exception of sirolimus which he has been allowed to take po. he's had no witnessed aspiration events. he's been on d5 1/2 ns at 80cc/hr. . yesterday evening when he became very anxious about not getting the dubhoff placed and said that he felt like he would die. he dropped his sats to the 70s and was placed on a nrb and it took almost an hour for his sats to normalize. his o2 sats increased when he finally fell asleep. he was maintained on the nrb overnight. he was weaned to nc of 2l this am but his sats dropped to 70s when at the side of the bed working with pt. earlier this week he was satting fine on 0-2l. . his most recent set of vitals at rehab were afebrile, bp 148/104 (generally 130-low 140s), hr 85, rr24 and 97% on 2l nc. he has been taking ice chips. he has been getting ativan 0.5mg iv q 6hrs and morphine 2mg q3hrs. hct was approx 29 on the 14th and 15th. then on and hct was 22. he received 2 units of blood and his hct increased to 37.5. he was a & o x3 prior to transfer. . on arrival to the icu, vital signs were 97.9 99 151/89 rr22 93% on 100% high flow face mask. he reports pain at the head of his penis and pain with urination. he also reports that over the last few days he has experienced spurts of sob that occur suddenly. he then begins to feel anxious like he is going to die. this occurs on and off. he was decanulated last week and says that his cough has improved over this time. his cough is productive of bloody mucusy sputum but only after traumatic dubhoff placement. he denies fevers or chills. . review of systems: (+) per hpi , + for nausea, + for diarrhea less now that he has not taken po x several days. last week had between bms a day. + for coughing up some blood since the attempts to place dubhoff. (-) denies fever, chills. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies vomiting, constipation, abdominal pain, no blood in stool, no black stool. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. past medical history: #. alcoholic cirrhosis, s/p liver , exploration for hematoma and fluid collection, last liver biopsy no acute cellular rejection, but for increased iron deposition. -h/o malnutrition -prior esld c/b ascites, hepatorenal syndrome, grade ii esophageal varices and portal gastropathy, candidal and bacterial (sbp) peritonitis post- course has been complicated by diarrhea and malnutrition s/p extensive workup that has not found a cause. this diarrhea is controlled with cholestyramine, imodium, tincture of opium, and he has bowel movements a day. #. recurrent utis: most recent cultures () grew pan sensitive kleb pnemonia and corynebacterium, but in the past has grown out resistant strains of pseudomonas sensitive only to meropenem (), to amikacin (). #. history of torsades while on ciprofloxacin. - of note: recent hospitalization w/ multiple episodes of vt/torsades s/p magnesium & cardioversion x2. at that time thought to meds (reglan, celexa, lyrica and bactrim) and contribution from congenital long qtc. qtc was 499-536 despite holding meds and given daily magnesium and potassium. - cardiology evaluated him ad thought not a candidate at that time for implantable device given recent infections. followed as outpatient by cardiology thought pt stress cardiomyopathy, recommended avoiding zofran. #. anemia with baseline hct 27-30 #. hydroureteroephrosis/urinary retention: seen by as outpatient. most recent omr note: secondary to recurrent infections and that intermittent catheterization led to hydronephrosis. managed w/ indwelling foley. #. colorectal cancer (stage unknown) s/p colectomy in #. cervical stenosis #. history of c diff colitis #. history of depression #. bph #. chronic pancytopenia . psh: s/p colectomy in s/p olt , s/p exlap for hematoma and fluid collection s/p exlap/loa s/p exlap/loa/washout, temp closure s/p exlap/abd closure, cmpt separation s/p trach s/p r hip fx social history: lives with daughter. wife died 4 weeks ago. has not had any etoh use in "years." smoking history: 1/2ppd for 20 yrs, quit over 5 years ago. no illicit drug use. family history: non-contributory physical exam: admission pe: vs: temp: afebrile, bp 148/104 (generally 130-low 140s), hr 85, rr24 and 97% on 2l nc gen: emaciated, chronically ill appearing man, alert and interactive heent: perrl, eomi grossly, anicteric, mmm, op without lesions. trach site well healed. resp: diffuse rhonci l lung> r cv: rr, s1 and s2 wnl, no m/r/g abd: severly cachectic, decreased b/s, soft, nt, no masses or hepatosplenomegaly, + suprapubic tenderness ext: mildly cold, thin extremities, dp and radial pulses intact, no edema or clubbing skin: no rashes/no jaundice/no splinters neuro: a & o x3, ue and le strength 5/5 pertinent results: 09:21pm blood wbc-7.7# rbc-4.00*# hgb-12.4*# hct-36.0*# mcv-90 mch-30.8 mchc-34.3 rdw-15.2 plt ct-151 02:36am blood wbc-8.2 rbc-4.03* hgb-12.6* hct-36.2* mcv-90 mch-31.4 mchc-35.0 rdw-15.3 plt ct-157 04:08am blood wbc-4.4 rbc-3.06* hgb-9.4*# hct-27.0*# mcv-88 mch-30.6 mchc-34.7 rdw-15.0 plt ct-123* 05:11am blood wbc-3.0* rbc-3.10* hgb-9.7* hct-28.0* mcv-90 mch-31.3 mchc-34.6 rdw-15.1 plt ct-105* 04:18am blood wbc-3.7* rbc-3.24* hgb-10.0* hct-28.7* mcv-89 mch-30.7 mchc-34.7 rdw-14.9 plt ct-105* . 09:21pm blood neuts-79.8* lymphs-14.2* monos-3.4 eos-2.1 baso-0.5 04:08am blood neuts-70.6* lymphs-18.7 monos-4.0 eos-6.4* baso-0.3 . 09:21pm blood pt-14.5* ptt-37.5* inr(pt)-1.3* 04:08am blood pt-14.5* ptt-37.0* inr(pt)-1.3* 05:11am blood pt-14.3* ptt-41.7* inr(pt)-1.2* 04:18am blood pt-13.8* ptt-37.8* inr(pt)-1.2* . 09:21pm blood glucose-72 urean-47* creat-1.2 na-140 k-5.2* cl-108 hco3-23 angap-14 02:36am blood glucose-79 urean-52* creat-1.3* na-139 k-5.4* cl-107 hco3-20* angap-17 12:51pm blood glucose-122* urean-46* creat-1.2 na-134 k-5.4* cl-103 hco3-21* angap-15 05:11am blood glucose-81 urean-30* creat-1.1 na-133 k-3.7 cl-105 hco3-22 angap-10 04:18am blood glucose-102* urean-26* creat-1.1 na-137 k-3.7 cl-106 hco3-23 angap-12 . 09:21pm blood alt-46* ast-41* ld(ldh)-174 alkphos-147* totbili-0.5 02:36am blood alt-45* ast-47* ld(ldh)-211 alkphos-147* totbili-0.6 04:08am blood alt-32 ast-30 ld(ldh)-153 alkphos-121 totbili-0.4 . 09:21pm blood albumin-3.1* calcium-9.1 phos-3.5 mg-1.9 04:08am blood calcium-8.3* phos-2.9 mg-1.7 04:18am blood calcium-8.3* phos-2.4* mg-1.6 . 04:08am blood rapmycn-17.6* 05:11am blood rapmycn-7.8 . 04:55am blood type- temp-36.4 po2-43* pco2-47* ph-7.33* caltco2-26 base xs--1 intubat-intubated 10:45am blood type- temp-36.0 rates-/20 tidal v-450 fio2-40 po2-34* pco2-47* ph-7.34* caltco2-26 base xs-0 intubat-intubated 12:37pm blood type- rates-/22 po2-34* pco2-45 ph-7.34* caltco2-25 base xs--1 intubat-not intuba comment-50% open f . 01:50am urine rbc-21-50* wbc->50 bacteri-few yeast-none epi-0 01:50am urine blood-lg nitrite-neg protein-500 glucose-neg ketone-15 bilirub-neg urobiln-neg ph-7.0 leuks-sm 01:50am urine color-yellow appear-hazy sp -1.025 . 03:53pm bal polys-91* lymphs-4* monos-0 eos-1* macro-4* . 1:50 am urine source: catheter. **final report ** urine culture (final ): gram positive bacteria. 10,000-100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. gram negative rod(s). ~4000/ml. . 5:54 am sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. . 3:53 pm bronchoalveolar lavage gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. ~7000/ml. of two colonial morphologies. sensitivities performed on culture # 310-5543s . legionella culture (preliminary): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies is strongly suspected, contact the microbiology laboratory (7-2306). if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): . cardiology report ecg study date of 11:16:10 pm normal sinus rhythm. moderate baseline artifact. low voltage in the limb leads. poor r wave progression. diffuse t wave flattening. compared to the previous tracing of there was moderate baseline artifact in that tracing as well. there is probably no diagnostic interval change. read by: , m. intervals axes rate pr qrs qt/qtc p qrs t 88 152 76 370/419 72 45 78 . chest xray portable impression: ap chest compared to : large scale consolidation in the right lung has worsened appreciably since , while less pronounced consolidation in the left mid lung has improved. left lung is markedly emphysematous. small right pleural effusion has increased. no nasogastric tube is in place, but i cannot assess the caliber of the stomach. patient has had tracheostomy in the past. these recurrent severe pneumonias suggest either free reflux or tracheoesophageal fistula. heart size normal. no pneumothorax. . brief hospital course: 55-year-old male who is s/p orthotropic liver in for alcoholic cirrhosis, history of colon cancer s/p colectomy, on sirolimus who presents with need for placement of dobhoff tube and with hypoxia of 90% on 100% face mask. . #. hypoxia: infiltrates in his right lung on cxr are concerning for pna. on admission, he required non-rebreather to maintain his sats. it was decided to electively intubate the patient for placement of his nj tube endoscopically. a bronch was also performed which revealed rll mucous plugging that was easily suctioned. his sputum was sent for culture from the bal. he was started on vanco/meropenem for hap coverage given his past respiratory isolates of pseudomonas sensitive only to meropenem. he was given aggressive chest pt and suctioning for thick secretions. after bronchoscopy, secretion burden lessened and he was easily extubated. he was transferred to the general liver wards for further management. abx were continued for presumed hap. he was mid 90s on ra and occasionally wearing nc o2 for comfort. cough productive of yellow/white sputum reported per pt. no longer on o2 supplement at time of discharge. plan to monitor vanco troughs daily and dose per level w goal 15-20 for total of 14 days, started on . dose needs to be adjusted to his renal function despite normal serum cr, pt is cachectic and has likely renal failure unaccounted for in normal labs. cont meropenem as well. . #. malnutrition: pt without any po access at time of admission. lost ng tube earlier this week and pt came to 2 days ago and they were unable to place dubhoff as it was coming out through trach site. unfortunately pt returned to for guided placement of dobhoff but no anesthesiologist was available so pt unfortunately did not get it placed. nj tube was placed in the icu under endoscopic guidance. he was started on tube feeds per nutrition recs on . phos levels monitored for refeeding syndrome and repleted as needed. plan for ltac to monitor levels daily and replete as needed in acute refeeding period. . #. normocytic anemia: baseline hct per old notes 26-28. likely anemia of chronic disease liver failure. b12 and folate have been normal/high in the past also. signout hct was approx 29 on the 14th and 15th. then on and hct was 22. he received 2 units of blood and his hct increased to 37.5 at rehab. hct here 36. unclear whether low hct could have been secondary to traumatic placement of dubhoff. increased hct likely secondary to hemoconcentration in the setting of npo although his platelets are not hemoconcentrated. hct had been stable on the general wards and at his baseline. he did not require transfusion of any blood products during his stay. . #. alcoholic cirrhosis s/p liver in : ast/alt/alk ph all elevated from baseline. post- course has been complicated by diarrhea and malnutrition s/p extensive workup with no obvious cause. this diarrhea in the past was controlled with cholestyramine, immodium, tincture of opium. sirolimus was restarted when po access became available. he was restarted on 2mg daily w drug levels followed. dosing based on labs. . #. irritation at urethral meatus/pain with urination: lidocaine was used for comfort. pt with long h/o utis. urine culture did not suggest acute uti - inconclusive results. pt afebrile w resolved leukocytosis on vanco and meropenem for hap. . #. depression/anxiety: home antidepressants were held until dobhoff in place. psychiatry to follow at - pt would benefit from therapy and acute grief counseling. would consider adding antidepressant if clinically appropriate. uptitrated remeron for incr'd appetite. . #. chronic pancytopenia: relative leukocytosis w left shift wbc 7.7 on admission, likely indicating infection. this fell with treatment of pneumonia. cell counts at baseline at time of discharge. . #. pain control: lidocaine patch, fentanyl patch, po oxycodone and iv morphine were continued. . #. comm: (mother) ; (daughter) medications on admission: --amitriptyline 50 mg po qhs --mirtazapine 15 mg po hs --sirolimus 3 mg po daily (1mg/ml oral solution) --ferrous sulfate 300mg/5ml tid --calcium carbonate-vitamin d3 500 mg(1,250mg) -400 unit tablet 1 tab twice a day. --multivitamin po daily --thiamine hcl 100 mg po daily --albuterol 90mcg inhaler 4 puffs q4hrs --fentanyl patch 12mcg/hr q72hrs (last changed on ) --fondaparinux 2.5mg/0.5ml 2.5mg sq daily --guaifenesin 600mg --omeprazole 20mg daily --protein supplement- beneprotein resource instant protein 2 scoops --trazodone 12.5mg qhs --xenaderm ointment tp tid --ativan 0.5mg iv q6hrs prn anxiety --morphine 2mg iv every 3 hrs --compazine 10mg q6hrs prn nausea --oxycodone 7.5mg q3hrs prn pain discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day): for dvt prophylaxis to be continued while bedbound and at rehab. 2. lidocaine hcl 2 % gel : one (1) appl mucous membrane prn (as needed) as needed for pain at urethral meatus . 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily). 4. fentanyl 12 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours): last change . 5. therapeutic multivitamin liquid : five (5) ml po daily (daily). 6. amitriptyline 50 mg tablet : one (1) tablet po hs (at bedtime). 7. mirtazapine 15 mg tablet : two (2) tablet po hs (at bedtime). 8. sirolimus 1 mg/ml solution : two (2) ml po daily (daily). 9. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid : five (5) ml po tid (3 times a day). 10. oxycodone 5 mg/5 ml solution : 7.5 ml po q4h (every 4 hours) as needed for pain: hold for sedation. 11. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 12. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for cough. 13. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : four (4) puff inhalation q4h (every 4 hours) as needed for sob, wheezing. 14. heparin, porcine (pf) 10 unit/ml syringe : two (2) ml intravenous prn (as needed) as needed for line flush. 15. lorazepam 0.5 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for anxiety. 16. calcium carbonate 200 mg (500 mg) tablet, chewable : one (1) tablet, chewable po bid (2 times a day). 17. prochlorperazine edisylate 5 mg/ml solution : ten (10) mg injection q6h (every 6 hours) as needed for nausea. 18. morphine 100 mg/4 ml solution : two (2) mg intravenous q3h as needed for pain: hold for sedation or rr<12. 19. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 20. meropenem 1 gram recon soln : one (1) recon soln intravenous every twelve (12) hours for 9 days. 21. potassium & sodium phosphates 280-160-250 mg powder in packet : two (2) packet po once a day: consider dc at follow up at hepatology . 22. vancomycin 1,000 mg recon soln : dose by level intravenous dose by level for 9 days: goal trough 15-20. please follow daily levels, dose by level. . discharge disposition: extended care facility: hospital - discharge diagnosis: hospital acquired pneumonia malnutrition discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: you were admitted to the hospital from rehab for low oxygen and pneumonia. you were started on antibiotics that must be continued through your picc line. you also required replacement of your feeding tube. you required intubation for your breathing and for stability while your tube was replaced. tubefeeds were restarted on . you were restarted on your home medications as well. . the following changes were made to your medications: started vancomycin iv antibiotic for 2 week course (day 1 ) started meropenem iv antibiotic for 2 week course (day 1 ) restarted tubefeeds started phosphate supplement during initial restart of tubefeeds to prevent refeeding syndrome/hypophosphatemia increased remeron for better appetite . we recommend that you continue to see psychiatry at to see if you require an antidepressant or additional therapy. continued on sirolimus, vitamin supplements, home anti-depressants . please follow up with your physicians as stated below. followup instructions: department: when: wednesday at 8:40 am with: clinic building: lm campus: west best parking: garage department: when: wednesday at 1:20 pm with: clinic building: lm campus: west best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy other lavage of bronchus and trachea arterial catheterization diagnoses: pneumonia, organism unspecified personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) dysthymic disorder acute respiratory failure personal history of malignant neoplasm of large intestine liver replaced by transplant foreign body accidentally entering other orifice nutritional marasmus alcohol abuse, in remission foreign body in other specified parts bronchus and lung other symptoms involving urinary system 

Answer: The patient is high likely exposed to