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: hypotension. major surgical or invasive procedure: vac placement leg i&d for cellulitis subclavian line placement history of present illness: 47 yo man with down's syndrome who is transferred from iwth hypotension, lle cellulitis, fever. per his home ( ) he was in his usual state of health until this morning when redness of his left leg was noted. in vs t 101.5, hr 76 bp 76/42, sat 94% ra. his labs were notable for wbc 15.2, 87% pmn, 8 bands, bun 24, creatinine 1.8 (old 13/1.0 ), lactate 1.2, ua neg, valproate level low at 21.6. cxr there concerning for 'failure', left lower extremity us showed cellulitis with no discrete loculation or abscess. blood cultures x4, urine culture done. in he rec'd ceftriaxone 1gm iv, 4l ns, 1 gm of tylenol. bp did not improve. he was transferred to . on arrival vs t 101.8, hr 66 bp 91/43 rr 16 sat 95% ra. his bp dropped to 70's, code sepsis initiated, he rec'd flagyl 500mg iv, vanco 1gm iv, levophed, 4l ns. bp improved to 120 on levophed, uop 1300. he was transferred to . . on arrival he states 'yes' to ha, dizziness, cp, sob, abdominal pain, nausea, vomitting, diarrhea, and pain in his left leg. in er pt was given clinda and zosyn iv as well as fluid resuscitation and stress dose steroid. he did not require pressor support and blood pressure responded to the above therapy. his steroid was subsequently stopped. he underwent surgical biopsy without clear organism identified. transferred to the floor for further care. past medical history: down's syndrome hypercholesterolemia hypothyroidism pernicious anemia intermittent explosive disorder senile dementia heart murmur requiring antibiotic ppx prior to dental procedures social history: he lives in a group home ( ). no etoh or tobacco. family history: unknown. physical exam: vs: t 98.5 bp 134/58 hr 102 rr 58 sat 96% 3l nc gen: nad heent: very dry mm with fissured tongue, sclera inicteric, pink conjunctiva neck: no lad, jvp 6 cm respiratory: rales left base, otherwise ctab, no w/r/r cv: rrr, ii/vi systolic murmur at left lower sternal border, 2+ dp/pt/radial pulses bilaterally abdomen: soft, nt, nt, +bs, no organomegally extremities: lle with anterior erythema spreading laterally beyond previously marked area with warmth, ttp, induration and possible overlying bite marks but no openings or discharge, no streaking up the leg, no popliteal or inguinal lad; skin: except lle erythema no rashes, hyperpigmented area on right shin neuro: cn ii-xii intact, sensation intact to light touch ue/le pertinent results: 07:50am blood wbc-5.7 rbc-3.25* hgb-11.6* hct-34.4* mcv-106* mch-35.6* mchc-33.6 rdw-14.8 plt ct-293 02:00pm blood wbc-13.5* rbc-3.43* hgb-12.2* hct-36.6* mcv-107* mch-35.6* mchc-33.4 rdw-14.1 plt ct-204 05:23am blood wbc-9.9 rbc-2.69* hgb-9.7* hct-27.7* mcv-103* mch-36.0* mchc-34.9 rdw-13.8 plt ct-159 06:13pm blood pt-15.7* ptt-29.9 inr(pt)-1.4* 10:51pm blood fdp-0-10 10:51pm blood fibrino-574* d-dimer-726* 07:50am blood glucose-98 urean-15 creat-1.0 na-139 k-4.6 cl-100 hco3-32 angap-12 02:00pm blood glucose-100 urean-20 creat-1.4* na-141 k-3.9 cl-106 hco3-25 angap-14 03:29pm blood glucose-170* urean-6 creat-0.8 na-147* k-3.2* cl-113* hco3-27 angap-10 06:28am blood probnp-1531* 06:13pm blood alt-9 ast-17 ld(ldh)-163 ck(cpk)-102 alkphos-97 totbili-0.4 07:50am blood calcium-8.2* phos-3.2 mg-2.4 05:23am blood albumin-2.4* calcium-7.5* phos-2.1* mg-1.7 06:13pm blood vitb12-881 folate-18.5 02:00pm blood tsh-0.30 09:44pm blood cortsol-35.9* 08:43pm blood cortsol-35.0* 06:13pm blood cortsol-34.2* 10:19am blood type-mix temp-36.6 po2-40* pco2-38 ph-7.34* caltco2-21 base xs--4 10:11am blood lactate-1.3 10:11am blood freeca-1.06* 07:20am urine color-yellow appear-clear sp -1.015 07:20am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 4:56 pm stool consistency: watery source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. (reference range-negative). blood cultures from , negative at discharge. 2:05 pm tissue site: leg wide excision of left lower leg. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): no growth. anaerobic culture (final ): no growth. chest (pa & lat) 10:57 am chest (pa & lat) reason: compare for worsening/improvement. medical condition: 47 year old man with rt effusion on poor portable film reason for this examination: compare for worsening/improvement. pa and lateral chest, . history: right pleural effusion. impression: pa and lateral chest compared to through 16: a portion of the small-to-moderate right pleural effusion, which increased between and is collected along the right heart border, simulating an increase in cardiac size. small volume of pleural effusion layers posteriorly on both sides of the chest. pulmonary vascular congestion and borderline interstitial edema are present, unchanged in severity, though somewhat different in distribution over the past several days. there is no pneumothorax. tip of a right subclavian catheter ends in the mid-to-lower svc. no pneumothorax. dr. approved: mon 2:16 pm chest (portable ap) 5:28 am chest (portable ap) reason: resolution of ? ptx medical condition: 47 year old man with fever, hypotension, tx from . ? right ptx after line in ed reason for this examination: resolution of ? ptx history: follow up line placement, question pneumothorax. findings: there is a right subclavian line with tip in the superior vena cava. there is obscuration of the lateral aspect of the right hemidiaphragm, likely representing a small effusion. there is right lower lobe volume loss and consolidation. there is perihilar haze and vascular plethora. no pneumothorax is identified. impression: new right lower lobe volume loss with infiltrate and effusion. likely chf. dr. approved: sat 6:46 pm echo - conclusions: the left atrium is mildly dilated. the estimated right atrial pressure is 11-15mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%) there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no vegetations seen if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. pathology tissue: fs wide exc. lt. lower leg. , t. not finalized -- pending at discharge. left lower leg, two views. no fracture, focal lytic or sclerotic lesion, or periosteal new bone formation is identified involving the left lower leg. no subcutaneous emphysema or radiopaque foreign body is identified. brief hospital course: septic shock with cellulitis of leg - aggressively treated with iv antibiotics in the icu. transiently needed pressors. there was a concern for necrotizing fasciitis hence surgery was consulted who did perform surgery i&d and a biospy was taken (pending at discharge). no signs of necrotizing fasciitis noted at surgery. wound care was maintained during the stay. after the bp was stabilized, he was transferred to the floor for futher management. all cultures - blood, urine and tissue (leg) were negative for any organisms. with the consultation from id, eventually was changed to po antibiotics as below- to complete a 14 days course (total). he was afebrile at discharge. surgery placed a wound vac to assist healing and will follow up patient in clinic. he is advised non-exertional work till then. letter provided and discussed with nurse at the group home. pleural effusions, hypoxia - with aggressiven fluid resuscitaion, he developed pleural effusions. improved with minimal diureses. no pneumonia seen on chest xray. the patient was ambuating well at discharge with > 95% on room air. hypoalbuminemia could also contribute to the effusions. anemia - hematocrit was stable at dischare. no new bleeding noted. downs syndrome / mental retardation, hypothyroidism, hyperlipidemia - out-patient management was continued. medications on admission: lactaid daily multivitamins daily tums vitamin b12 1cc q month neurontin 400 po tid depakote 500mg po qhs levoxyl 125mcg po daily gemfibrozil 600mg po bid chlorhexidine rinse prn hydrocortizone 2.5% cream prn discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 5 days. disp:*40 capsule(s)* refills:*0* 3. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. disp:*5 tablet(s)* refills:*0* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. lactaid oral 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 8. vitamin b12 take vitamin b 12 every month as you were taking prior to the hospital visit 9. gabapentin 400 mg capsule sig: one (1) capsule po tid (3 times a day). 10. divalproex 500 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po hs (at bedtime). 11. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 12. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane once a day as needed for as needed . 13. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: home with service facility: discharge diagnosis: septic shock with cellulitis of leg pleural effusions, hypoxia hypoalbuminemia anemia downs syndrome mental retardation hypothyroidism hyperlipidemia discharge condition: stable discharge instructions: return to the hospital if you notice any new symptoms of concern to you. keep your appointments the nurse with start to visit you for the vac starting friday . complete the course of antibiotics as prescribed. followup instructions: provider: . phone: date/time: 1:00 please call your primary doctor an appointment with dr procedure: open biopsy of soft tissue diagnoses: anemia, unspecified pure hypercholesterolemia unspecified pleural effusion acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism cellulitis and abscess of leg, except foot septic shock down's syndrome senile dementia, uncomplicated 

Answer: The patient is high likely exposed to