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: olanzapine attending: chief complaint: tachycardia, hypotension major surgical or invasive procedure: intubation, arterial line, right internal jugular central line history of present illness: 82m hx severe dementia, dm, left aka, chf, pvd (stent x2, most recent ), reported recent nstemi on , recent admission from for a fib with rvr as well as for chf exacerbation presenting with tachycardia and hypotension. following his recent admission (), during which he required lasix gtt for diuresis and was discharged on torsemide, he was discharged to rehab where he was noted to be tachycardic and hypotensive with sbp 70s-80s on day of admission. . in the ed, initial vs were: 97.3 106 108/54 20 98% 4l. he had episodes of svt with hr 160s that self-resolved with ekg showing rate related st depressions in v2-v4. cxr showed possible aspiration pna. he received iv vancomycin, ciprofloxacin, and flagyl. he also had diffuse abdominal tenderness; ct abdomen was performed that was unremarkable. ct head was also performed for altered mental status that was unremarkable. he became hypotensive requiring iv fluids but also showing signs of respiratory distress with tachypnea and oxygen desaturations. he was intubated in the ed, a right ij was placed, and he was started on levophed prior to transfer to micu. past medical history: pmh: - dementia - alzheimers - bipolar (hx of hypersexual behaviour) - type 2 dm - aka - cad, history of mi - chf (ef 30%) - hypertension - hyperlipidemia - pvd - hx of tia/cva (left frontal, right occipital, right basal ganglia - severe dysphagia s/p g-tube - recurrent aspiration pneumonia - andemia - chronic nausea - ulceration of right big toe - c diff, vre, mrsa psh: right lower extremity diagnostic angiography () left above knee amputation () cholecystectomy social history: born in , never married, 2 adult children with minimal involvement. history of 2ppd x 40 years, quit ~15-20 year ago. non-ambulatory, incontinent of bowel/bladder. dependent of all adls. sister is hcp ; . family history: non-contributory physical exam: admission exam: . vitals: 97.1 123/54 89 20 100%ra (cmv/assist, tv 500, rr 14, fio2 100%, 5 peep) general: intubated, sedated heent: sclera anicteric, dry mm, pupils constricted, minimally reactive to light neck: jvp not elevated, no lad cv: irregularly irregular, normal s1 + s2, no murmurs, rubs, gallops lungs: bibasilar crackles, no wheezes abdomen: soft, non-tender, non-distended, g tube site with surrounding erythema and fungal infection, multiple areas of ecchymoses gu: foley draining clear urine, brown exophytic lesion on right side of genitals ext: cold extremities, left aka, trace dp pulse on right foot neuro: sedated, not following commands, does not react to pain . exam: . deceased cv: no heart sounds lungs: no breath sounds neuro: no response to noxious stimuli pertinent results: admission labs: . 06:16pm blood wbc-9.6 rbc-3.18* hgb-8.9* hct-28.4* mcv-89 mch-28.1 mchc-31.5 rdw-16.9* plt ct-104* 06:16pm blood neuts-78* bands-0 lymphs-9* monos-12* eos-0 baso-0 atyps-0 metas-0 myelos-1* nrbc-1* 06:16pm blood hypochr-3+ anisocy-1+ poiklo-1+ macrocy-normal microcy-1+ polychr-normal 06:16pm blood pt-12.1 ptt-24.9* inr(pt)-1.1 06:16pm blood glucose-292* urean-157* creat-4.3*# na-156* k-3.9 cl-106 hco3-38* angap-16 06:16pm blood alt-43* ast-44* alkphos-129 totbili-0.3 06:16pm blood ck-mb-11* ctropnt-0.16* probnp-<5 10:35pm blood ck-mb-9 ctropnt-0.14* 08:01am blood ck-mb-6 ctropnt-0.15* 06:16pm blood albumin-2.6* calcium-8.6 phos-1.5*# mg-3.0* 10:06pm blood type-art rates-14/ peep-5 po2-463* pco2-45 ph-7.53* caltco2-39* base xs-13 -assist/con intubat-intubated 06:25pm blood lactate-2.4* 10:06pm blood lactate-2.0 01:09pm blood freeca-1.06* . pertinent labs: . 04:03am blood wbc-10.3 rbc-3.38* hgb-9.7* hct-30.7* mcv-91 mch-28.6 mchc-31.5 rdw-17.4* plt ct-106* 02:34am blood pt-14.8* ptt-40.7* inr(pt)-1.4* 04:03am blood glucose-171* urean-103* creat-4.3* na-145 k-3.9 cl-112* hco3-22 angap-15 02:34am blood alt-31 ast-25 alkphos-148* totbili-0.3 08:01am blood ck-mb-6 ctropnt-0.15* 10:35pm blood ck-mb-9 ctropnt-0.14* 06:16pm blood ck-mb-11* ctropnt-0.16* probnp-<5 04:03am blood calcium-8.4 phos-5.6* mg-2.0 . microbiology: urine culture - proteus mirabilis, e.coli sputum culture - coagulase positive staphylococcus wound culture - albicans, enterococcus sp. . imaging studies: chest (portable ap) - et tube and right internal jugular line are in standard placements. mild pulmonary edema has improved since . moderate bilateral pleural effusion and moderate cardiomegaly are stable. no pneumothorax. brief hospital course: 82m hx severe dementia, dm, chf, pvd (stent x2, most recent ), reported recent nstemi on , recent admission from for a fib with rvr as well as for chf exacerbation presenting with tachycardia and hypotension. . # hypotension: pt presented with tachycardia, hypotension, minimal urine output. given na elevated to 156, cr elevated to 4.3 (baseline 2.0-2.3), weight loss and recent aggressive diuresis with torsemide, initial presentation felt to be related in part to severe volume depletion. however, patient also with notable elevated wbc count, grossly positive ua, and cxr suggestive of possible pna so patient was covered broadly with vancomycin and cefepime. patient was initially started on flagyl as well given patient's questionable endorsement of abdominal discomfort on presentation but as ct abdomen was negative, flagyl was discontinued on hd #3. culture data eventually showed proteus and e.coli in the urine sensitive to cefepime as well as mrsa in the sputum sensitive to vancomycin. blood cultures remained negative. despite initial volume resuscitation, patient remained pressor dependent for a majority of his hospital course with maps >55 on phenylephrine and vasopressin. though his lactate trended down, his central venous o2 sats were greater than 70 indicating persistent septic physiology despite appropriate antibiotic treatment. given the absence of clinical improvement despite appropriate therapy, the patient was transitioned to cmo and expired on in the afternoon. his family was at his bedside. . # respiratory distress: pt with tachypnea and possible oxygen desaturations in ed and was intubated to protect airway. initial cxr showed bibasilar opacities suggestive of atelectasis vs aspiration and cultures confirmed mrsa pneumonia. extubation was attempted on hd#1 but he had to be re-intubated due to tenacious secretions. persistent volume overload also contributed to difficulty with extubation. on hd #8, patient was terminally extubated and transitioned to cmo. . # acute renal failure: cr elevated to 4.3 on admission from recent baseline of 2.0-2.3. pt was recently admitted for chf exacerbation, had been getting aggressive diuresis until recently. despite agressive fluid resuscitation and pressor support, patient's urine output remained minimal and his creatinine failed to improve. his electrolytes remained within normal limits but he became progressively volume overloaded, failing to respond appropriately to diuresis with a lasix gtt partly due to persistently low blood pressures. family felt dialysis was not consistent with patient's long-term goals of care so lasix diuresis was discontinued when patient was transitioned to cmo. . # tachycardia: pt with sinus rhythm in the low 100s on arrival to ed. pt then had episodes of svt in the ed with hr 160s that spontaneously converted. throughout his hospital stay, patient would intermittently go into afib with rvr v svt with an accompanying drop in blood pressures that would spontaneously convert to nsr or require lopressor 2.5mg iv prn. . # hypernatremia: na elevated to 156 on admission, likely from volume depletion given elevated cr, history of minimal urine output, and recent aggressive diuresis. per rehab notes, na has been 151-156 since . hydrated with half normal saline initially and then transitioned to fluid resuscitation. . # abdominal pain: per ed report, pt with diffuse abdominal tenderness. ct abdomen does not show any acute abdominal process. no further indication of abdominal tenderness during his hospital stay. . # cad: pt with reported nstemi at osh , also has remote hx of mi. initially ekg shows afib, st depressions in v1-4, worse when tachycardic, likely due to demand. trop elevated to 0.16 but in setting of acute renal failure. was continued on baby aspirin but his metoprolol was held in the setting of hypotension. . # iddm: blood glucose elevated 200s-400s since arrival to ed. sugars improved on hiss and low-dose lantus. . # anemia: baseline hct ranges from low to high 20s. pt with history of significant gi bleeding. patient had one episode of a large, bloody bowel movement so he received 2u prbcs and underwent egd which showed no signs of active bleeding. presumed to be lower gi source. patient's hct remained stable for the remainder of his hospital stay. . # dementia: pt with advanced dementia. incontinent at baseline, dependent on all adls. had g tube for all feedings. . # exophytic lesion: pt with brown exophytic lesion near genitals. . # code status: after repeated discussions with the family and absence of clinical improvement despite appropriate antibiotic therapy, patient was terminally extubated on hd#8 and transitioned to cmo. patient was discharged from the icu on glycopyrrolate and morphine gtt for comfort. . transition of care issues: 1. patient's family declined autopsy. 2. patient's primary care physician and attending of record were notified at the time of death. medications on admission: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 3. insulin glargine 100 unit/ml solution sig: twenty eight (28) units subcutaneous at bedtime: 13 units before breakfast. 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for sob, wheeze. 5. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. isosorbide dinitrate 20 mg tablet sig: one (1) tablet po tid (3 times a day): hold sbp < 100. 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold sbp < 100, hr < 60. 8. miconazole nitrate 2 % powder sig: one (1) application topical twice a day. 9. omeprazole 2 mg/ml suspension for reconstitution sig: forty (40) mg po once a day. 10. sertraline 50 mg tablet sig: three (3) tablet po daily (daily). 11. hydralazine 10 mg tablet sig: two (2) tablet po tid (3 times a day): hold sbp < 100. 12. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po bid (2 times a day). 13. ondansetron 4 mg iv q8h:prn nausea please give with tube feeds 14. ciprofloxacin 250 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 9 days: total of 10 days ofr complicated uti. tablet(s) 15. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. normal saline flush 0.9 % syringe sig: three (3) cc injection every eight (8) hours. 17. furosemide 10 mg/ml solution sig: 20-40 mg injection twice a day as needed for for weight gain or sob. medications: none disposition: expired diagnosis: immediate cause of death: uremia, anuric renal failure primary cause of death: cardiovascular disease condition: not applicable instructions: patient expired, not applicable. followup instructions: not applicable md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances endoscopic control of gastric or duodenal bleeding diagnoses: anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia severe sepsis peripheral vascular disease, unspecified personal history of tobacco use other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin septic shock chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled do not resuscitate status alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia diastolic heart failure, unspecified subendocardial infarction, subsequent episode of care gastrostomy status above knee amputation status methicillin resistant pneumonia due to staphylococcus aureus benign neoplasm of stomach 

Answer: The patient is high likely exposed to