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: aspirin attending: chief complaint: abdominal pain, confusion major surgical or invasive procedure: picc line placement history of present illness: 86 m with cabg, chf ef 25% with biv icd/pacer, afib, diet-controlled dm, r ear melanoma, here with confusion, abdominal pain, diarrhea, cough for several hours. his son noticed that his father sounded confused and disoriented on the phone today, and he had been normal in mental status earlier today and yesterday. he entered his father's house and his father was looking up at the ceiling and his speech was making no sense, so his son called an ambulance to take him to the hospital. abdominal pain was described as moderate, sharp and dull, and in lower quadrants. diarrhea characteristics/color could not be described, but was little in volume and rare frequency. cough was productive with sputum of unknown color. . he has had no fever, no chills, no cp, no sob, no headache, no dizziness, no leg swelling. he has no sick contacts, no recent travel, and is compliant with all medications and salt-restricted diet. he is on home o2 2l nc, but has never been diagnosed with a lung disease per patient. he used to smoke cigars for 5 years, but quit decades ago, and he never smoked cigarettes in his life. . in the ed, he had a fever to 104, wbc 17.6 with 0 bands, lactate 2.3, abg 7.48/31/89. rij central line was placed, received 4l ns with 1l out, received levo/flagyl. cxr showed rll opacity, ua was positive. ct head was negative, ct abd was negative for acute process or bleed. past medical history: 1) cad s/p cabg in 2) chf with last in showed ef<20% 3) h/o afib, now with aicd/pacer 4) bph 5) diet controlled dm 6) gib without clear etiology and resulting anemia 7) hypothyroidism 8) r ear melanoma, surgically removed social history: used to deliver milk for job. lives by himself but son is in same house, widower, retired. denies tobacco past or present, previous moderate etoh use, no ivdu. family history: father>>tuberculosis physical exam: vs: t 97.9 99/47 / 82 / 20 / 100% shovel mask gen: a&ox3, speaks clearly, pleasant heent: jvd difficult to assess for rij line, mild lad, op clear, dry mm lungs: rales in l base, rales and cardiac wheezing in r base, both way up heart: rrr, 3/6 sem radiating up, s3 abd: moderately distended, firm, nd throughout extr: l inguinal hernia easily reduced, soft, no erythema or edema. no c/c/edema, 2+ dp bilaterally. neuro: motor throughout pertinent results: . radiology cxr: mild pulmonary vascular cephalization consistent with slightly worsened fluid overload as compared to yesterday. otherwise grossly unchanged appearance. . ct abd w/o contrast: no evidence of colitis or diverticulitis (noncontrast). bilateral dependent atelectasis and additional possible infectious consolidation at the right lung base. gallbladder sludge without evidence of cholecystitis. multiple hypoattenuating lesions in both kidneys, incompletely assessed on this noncontrast study. additional us could be performed on a nonemergent basis. high atherosclerotic burden of abdominal aorta and major tributaries. . head ct: no evidence of acute intracranial hemorrhage. extensive periventricular and deep white matter hypodensities consistent with chronic small vessel infarcts. . cxr: perihilar fullness and perivascular haze with increased opacity in the right lower lung zone. findings are consistent with failure with possible focal consolidative process in the right lower lung. . : ef 30% la mod dilated, ra markedly dilated, no asd by doppler. mod symm lvh, mod global lv hypok. no mass or thrombi, no vsd. rv dilated w/ depressed systolic fx, mod dilated asc aorta, no av vegetations. minimal as, trace ar. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. ap supine and erect views of the abdomen show no distention of bowel in the imaged areas. the lower pelvis is excluded from the examination. there is heavy atherosclerotic calcification extending from the iliacs into the pelvic arteries. larger calcific ring shadows in the left upper abdominal quadrant could be a combination of colonic diverticula with residual barium or smaller arterial aneurysms and calcified left renal mass as evaluated on recent abdomen ct, . 05:00am blood wbc-6.3 rbc-3.27* hgb-9.2* hct-28.2* mcv-86 mch-28.2 mchc-32.8 rdw-17.8* plt ct-251 07:40pm blood wbc-17.6*# rbc-4.11* hgb-12.0* hct-34.6* mcv-84 mch-29.1 mchc-34.6 rdw-17.9* plt ct-195 04:23am blood neuts-87.7* lymphs-7.2* monos-4.9 eos-0.1 baso-0.1 07:40pm blood neuts-93.0* bands-0 lymphs-3.5* monos-3.2 eos-0.1 baso-0.2 05:00am blood pt-27.5* inr(pt)-2.8* 07:40pm blood pt-22.5* ptt-38.3* inr(pt)-2.2* 04:38pm blood fibrino-304 d-dimer-744* 04:38pm blood fdp-0-10 05:00am blood glucose-87 urean-20 creat-0.9 na-135 k-4.0 cl-102 hco3-25 angap-12 07:40pm blood glucose-182* urean-35* creat-1.6* na-135 k-4.2 cl-99 hco3-24 angap-16 05:25am blood alt-17 ast-14 alkphos-54 totbili-1.0 04:56am blood alt-30 ast-38 ld(ldh)-211 alkphos-58 totbili-1.0 04:23am blood ck(cpk)-838* 08:51am blood ck(cpk)-286* 05:25am blood lipase-20 05:40pm blood ck-mb-3 ctropnt-0.04* 04:23am blood ck-mb-5 ctropnt-0.04* 08:51am blood ck-mb-6 ctropnt-0.04* 04:21am blood mg-2.2 05:25am blood albumin-3.2* calcium-7.9* mg-2.1 01:34am blood albumin-3.6 calcium-8.4 mg-2.1 04:17am blood calcium-8.2* phos-2.4* mg-2.2 iron-41* 04:56am blood albumin-3.6 calcium-7.6* phos-4.1 mg-2.1 04:17am blood caltibc-300 vitb12-214* folate-greater th ferritn-150 trf-231 06:33am blood tsh-1.9 06:33am blood tsh-1.9 06:11am blood cortsol-45.0* 04:56am blood cortsol-25.9* 06:45am blood vanco-12.6 06:33am blood digoxin-0.3* 08:00pm blood type-art po2-89 pco2-31* ph-7.48* caltco2-24 base xs-0 11:34am blood lactate-1.2 07:56pm blood lactate-2.3* 01:15pm urine color-amber appear-cloudy sp -1.025 01:15pm urine blood-lge nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 01:15pm urine rbc-374* wbc->1000* bacteri-occ yeast-none epi-0 07:40pm urine color-yellow appear-hazy sp -1.010 07:40pm urine blood-sm nitrite-pos protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-mod 07:40pm urine rbc-0-2 wbc-21-50* bacteri-few yeast-none epi-0-2 12:00pm urine hours-random urean-862 creat-123 na-12 date 6 specimen tests ordered by all all blood culture catheter tip-iv stool urine all emergency inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient urine urine culture-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient catheter tip-iv wound culture-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient urine urine culture-final {pseudomonas aeruginosa, 2nd isolate} inpatient urine urine culture-final {pseudomonas aeruginosa} emergency blood culture aerobic bottle-final {staph aureus coag +}; anaerobic bottle-final {staph aureus coag +} emergency brief hospital course: 86 m with 86 m with cabg, chf ef 25% with aicd/dual chamber pacer, afib, diet-controlled dm, r ear melanoma, here with uti, rll pna, diarrhea, severe sepsis. . # sepsis: urine was grossly purulent following foley placement on admission. in review of previous culture data, he has a history of quinolone resistant proteus and pseudomonas in past urine cultures. he was started on meropenem and vancomycin on admission. 2/2 blood cultures from grew out coagulase positive staph. aureus. urine culture grew pseudomonas which had intermediate resistance to meropenem --> he was subsequently switched to cefepime for his uti. levophed was required to maintain maps of >65, discontinued on . source of mrsa unclear. was negative for masses or vegetations, but in setting of thickened aortic valve, will need tee to rule out endocarditis. patient also has a pacemaker in place which could also be a source of bacteremia. pacer site is not red or fluctuant. id followed him in hospital. they did not think the pacer needed to be removed at this time since the repeat cultures were negative. he will be followed by id in clinic - dr (instructions below). weekly cbc, lft, bun, creat, vancomycin trough levels should be faxed todr as below. vancomycin should be continued for atleast 4 weeks and maybe more at the discretion of dr . cefepime should be continued for 6 more days. id did not think pt needed a tee. . # hypoxemic respiratory insufficiency: unknown intrinsic lung disease, but pfts show restrictive and diffusion defect consistent with interstitial process. was on amiodarone, and no signs of pulmonary toxicity on high res ct chest in , but difficult to read hrct in setting of active chf exacerbation. hrct shows ground glass opacity, septal thickening, bilateral pleural effusions. smoked cigars for 5 yrs, has never smoked cigarettes in his life. usually on home o2 2l nc at baseline. is ambulatory and active normally. there is evidence of chf on chest imaging and, thus, this may have played role in original increased o2 requirement from baseline. he will need pulm outpatient followup for pfts with dlco when euvolemic. . # chf with ef 25%: had biv icd/pacer interrogated on in device clinic showing good function. used to be on amiodarone for significant ventricular arrhythmia and then for afib. per pcp< this was stopped over a year ago. had 6 beat vt spontaneously aborted. followed by dr. as an outpatient. he was admitted on metoprolol and moexipril which were both held for hypotension. as bp stabilised, metoprolol, moexepril and lasix and digoxin were restarted. . # urinary retention: from a large prostae. he failed void trials twice. the second time pvr was 1500ml. foley was placed and is on flomax and terazosin. gu follow up should be arranged in weeks. # diarrhea - 3 days prior to discharge, the patient developed profuse diarrhea. likely antibiotic associated. flagyl was started and diarrea slowed down. c diff was negative x3. should have follow up of lytes if diarrhea continues. # acute renal failure: baseline creatinine 0.9-1.1. admission creatinine was 1.6 which improved with fluids, pressor support, and treatment of his infection/sepsis. # anemia - lower b12 levels for which oral b12 was started. pcp follow up. . # atrial fibrillation: inr was 2.3 on admission. his coumadin was continued on his home dose of 5mg qhs. . # dm2: diet controlled. he was placed on hiss and did require coverage (bs 140s-180s). . # hypothyroidism: he was continued on levothyroxine. medications on admission: medications obtained from last discharge summary from 5/. son will bring current list of medications. 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 3. levothyroxine sodium 25 mcg tablet sig: one (1) tablet po daily (daily). 4. multivitamin capsule sig: one (1) cap po daily (daily). 5. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 6. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 7. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. terazosin hcl 5 mg capsule sig: two (2) capsule po hs (at bedtime): please hold for sbp<100. 12. moexipril hcl 7.5 mg tablet sig: one (1) tablet po daily (daily): please hold for sbp<110. 13. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day): please hold for sbp<100 or hr<55. 14. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). 15. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 16. amiodarone hcl 200 mg tablet sig: 0.5 tablet po daily (daily). discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 3. hexavitamin tablet sig: one (1) cap po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 6. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 7. cefepime 1 g recon soln sig: one (1) g intravenous once a day for 6 days. 8. olanzapine 2.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for agitation. 9. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 10. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 11. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 12. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 13. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous q 24h (every 24 hours) for 4 weeks. 14. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 11 days. disp:*0 tablet(s)* refills:*0* 15. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). 16. moexipril 7.5 mg tablet sig: one (1) tablet po daily (daily). 17. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 18. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 19. sodium chloride 0.65 % aerosol, spray sig: sprays nasal (2 times a day) as needed. 20. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 21. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary: sepsis due to pseudomonal uti, mrsa septicemia congestive heart failure, systolic acute renal failure, resolved diarrhea - likely antibiotic associated urinary retention anemia, low b12 levels secondary: h/o atrial fibrillation restrictive lung disease home oxygen user hypothyroidism kidney lesions on ct (seen since ct ) discharge condition: stable discharge instructions: 1) weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.2l 2) please follow-up as indicated below 3) please come to the emergency room or see your pcp if you develop chest pain, worsening shortness of breath, persistent diarrhea, abdominal pain, fevers, chills, or other symptoms that concern you. 4. you have a few more days of cefepime. vancomycin will haave to be completed for atleast 4 weeks. thereafter, as per the discretion of id physician. 5. weekly blood tests will have to sent to dr as below. 6) inr should be closely monitored while on flagyl and may cause elevated levels. followup instructions: 1) infectious disease provider: . phone: date/time: 11:30 2) primary care: follow-up with dr. () within 1-2 weeks following discharge 3) provider: . /cut. onc. derm date/time: 10:45 4) provider: , cutaneous oncology date/time: 11:00 5) weekly cbc, differential, lft, bun/creat, vancomycin trough levels should be drawn and results faxed to dr at procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified other primary cardiomyopathies urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis atrial fibrillation aortocoronary bypass status methicillin susceptible staphylococcus aureus septicemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) retention of urine, unspecified automatic implantable cardiac defibrillator in situ acute on chronic systolic heart failure personal history of malignant melanoma of skin diseases of tricuspid valve 

Answer: The patient is high likely exposed to