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, hematuria major surgical or invasive procedure: cvl placement with subsequent removal history of present illness: mr. is a 85 yo male recently discharged from to an extended care facility after being treated for hypoxia, hyponatremia, and acute renal failure. he was found to have an aspiration pneumonia and was given a two week course of levo/flagyl during his last admission. in addition, the pt was persistently hypoxic with room air oxgyen saturation 90-91%, and was discharged on one liter oxygen via nc. per the rehab notes, the pt had an episode of worsening hypoxia and hematuria and was brought to the ed. while in the ed, the pt became transiently hypotensive with a bp of 70's systolic (initially 100/60). the pt received blood and fluids, and bp improved to 90's. a sc cvl was placed, and urine/ blood cultures were sent. . in the icu, the patient remained normotensive following blood transfusions plus ivf. in fact, the icu team believed that some of his hypoxia could be due to fluid overload, so he did receive some diuresis. he was started on vanc/zosyn/levo on admission, but he levofloxacin was discontinued on as his urine legionella was negative. he had stim test in the icu which was < 9 at 2 hours, so he was started on steroids. these were subsequently discontinued as the patient had no evidence of sepsis and was able to maintain his blood pressure following fluid resuscitation. in addition, the patient's hematocrit has remained stable after two units of prbcs. he was seen by his usual hematologist, dr. , who feels as though his hematuria is chronic and would likely not require further intervention unless the patient's anemia was severe. in addition, the patient was evaluated by urology who have recommended continued foley use. past medical history: -metastatic prostate cancer: diagnosed in , currently not on therapy, does not want chemotherapy. by bone scan, known mets in thoracic and lumbar spine, ileums, right proximal femur, clavicles and ribs. + lung nodules, + abdominal lad. followed by dr. in heme-onc -benign prostatic hypertrophy s/p turp -bladder calculi s/p removal -dyslipidemia -mild ai -gastritis by egd social history: widowed, 3 sons (2 in , one here). previously lived at retirement community. used to own a small hardware store. quit tobacco in . rare alcohol. no drugs. now coming from nh unit at family history: brother with cancer physical exam: t 96 po bp 100/50 hr 88 rr 20 o2 sat 89% on ra, inc to 94% 2lnc gen:awake, a&ox3, thin but not cachetic. speaking full sentences. heent: wearing glasses. atraumatic, pupils small 1-2 mm, equal. eomi, no nystagmus. tongue somewhat dry. oropharynx w/out exudate but w/ thick brown coating on tongue. neck: jvd 8 cm, no lad cv: irregular rhythm, normal rate, 2/6 sem radiating to apex lungs: occasional crackles bilaterally abd: soft, nt, nd, positive bs ext: warm, dry. 2+ pitting edema to thighs. no rash but scattered scabs & ecchymoses. neuro: a/o x3, no focal deficits. moving all extremities. speaking clearly & in full sentences as above pertinent results: labs notable for elevated probnp, elevated ap, elevated creatinine to 1.5 (1.0 at discharge) and decreased hct to 28.4 from mid 30's. . cxr: increased left retrocardiac opacity in comparison to prior exam, which may represent an area of volume loss or consolidation. . lung scan: perfusion images in the same 8 views show demonstrate subsegmental defects in the right upper lung and defects in the bases chest x-ray shows patch infiltatrates and yesterday's cxr reveals pleural effusions. the above findings are consistent with a low likelihood ratio for recent pulmonary embolism. impression: low likelihood ratio for recent pulmonary embolism. . ruq us: no evidence of cholelithiasis. . echo: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 70%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. the aortic root is mildly dilated. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. . video swallow: no evidence of aspiration . renal us (): no evidence of hydronephrosis or stones. likely hematoma/clot seen within bladder. . cxr (): increased left retrocardiac opacity in comparison to prior exam, which may represent an area of volume loss or consolidation. . cxr (): tip of the new right subclavian line projects over the upper right atrium. mild interstitial pulmonary edema has worsened exaggerated by slightly lower lung volumes due to persistent bibasilar atelectasis. heart size top normal. small left pleural effusion increased. no pneumothorax. tracheal deviation is probably a function of upper thoracic scoliosis and tortuous head and neck vessels. . cxr (): there is a thoracic scoliosis convex to the right. there is cardiomegaly with pulmonary vascular engorgement and bilateral pleural effusions consistent with chf. in addition, there are bibasilar opacities, left greater than right, with obscuration of the left hemidiaphragm likely due to a combination of left pleural effusion and atelectasis or consolidation in the left lower lobe. the findings are similar to those noted on the prior study of but with probable increased patchy opacity at the right lung base. the previously noted right subclavian cv line has been removed. . lower extremity ultrasound (): no evidence of dvt bilaterally. . chest ct (): 1. there are bilateral moderate-sized pleural effusions with adjacent atelectasis. in conjunction with ground-glass opacity and areas of intralobular septal thickening, these findings are consistent with chf. 2. there are diffuse osseous sclerotic metastases, as identified on recent bone scan from . . cxr (): there is no significant change in the appearance of the normal heart and bilateral pleural effusions as well as the left lower lobe consolidation which is most likely _____ atelectasis but there is improvement of the bilateral pulmonary edema. . renal ultrasound (): 1. no evidence of hydronephrosis. 2. layering echogenic material in urinary bladder that most likely represents presence of hemorrhage. . labs prior to discharge notable for platelets 46,000, wbc 12.3, creatinine 3.3, bun 64, inr 1.6, albumin 2.8 . microbiology: c. diff negative x 2 sputum culture pending but multiple organisms on gram stain from mrsa in urine from but not present on repeat urine culture brief hospital course: mr. is an 85 yo male with history of metastatic prostate cancer, bladder varices, and chronic bladder obstruction who presents as a transfer from the micu for hypotension, now resolved, and hematuria, thought to be chronic. at this time, he and his family would like to pursue palliative care measures. . * after an extensive discussion between dr. , the patient, and the patient's son, it was decided that they would not like to have any further studies or lab draws. the patient's current problems of acute renal failure and thrombocytopenia in conjunction with hypoxia have an unclear etiology. we have tried various interventions without success. the palliative care team has evaluated the patient, and the patient's wishes are to return to tower . his prognosis is very poor, likely weeks, and he should therefore be evaluated by the local hospice team that serves tower . the patient's primary oncologist, dr. , recommended palliative care/hospice as a viable option after his review of mr. case last week. as the patient's primary goal of care at this point is comfort, extraneous medications were discontinued. . # acute renal failure: the patient's creatinine is climbing and was 3.3 yesterday. the renal service evaluated the patient and suspect acute tubular necrosis in this patient. however, it is difficult to provide fluids to the patient as he has congestive heart failure with hypoxia as well. the urology team was involved and changed mr. foley catheter over the weekend due to concern for obstruction. this foley should remain in place due to clot/hematoma seen within the bladder. however, a clear, reversible cause of renal failure was not found in this gentleman. he did not initially respond to fluid boluses, and we were hesitant to further diurese him due to his rapidly rising creatinine. . # metastatic prostate cancer: the patient has known metastatic prostate cancer with bony metastases. his pain is typically well-controlled. we are discharging him on a regimen of tylenol around the clock with an order for additional if his pain is not well-controlled. in addition, the patient has morphine elixir ordered for severe pain. . # hypoxia: the patient was admitted to the hospital on 1 l via nasal cannula. his oxygen requirements have also increased for unclear reasons. he does have congestive heart failure evident on chest ct, but due to his renal failure, we did not feel comfortable diuresing him. he does not have evidence of deep venous thromboses. he currently has a productive cough, for which he should continue to receive guaifenesin and dextromethorphan. he should also continue on albuterol/atrovent nebs and saline nebs to assist in sputum expectoration. . # thrombocytopenia: the patient's platelet count has continued to decline. he has likely low-grade dic versus ttp/hus. this is likely related to his underlying malignancy. it is also possible that he has some marrow infiltration, though his wbc and rbc counts are not as low as one would expect with this. he has chronic hematuria and some bloody sputum production, but he does not have other active bleeding. . # swallowing difficulties: the patient reports that he is having difficulty swallowing. however, it is unclear to me whether this represents true difficulty swallowing or disinterest in eating. he does drink boost shakes, so these or an appropriate alternative should be provided to him. i emphasized that he could eat whatever he would like. we did give him ritalin for several days in an attempt to increase his appetite. this did not have much effect, so have discontinued this medication. . # anxiety/sleep: the patient should remain on remeron at night for sleep. i have also ordered ativan to use as needed should the patient become anxious. . # communication- , , is his healthcare proxy. . # code status: the patient clearly has stated that he is a dnr/dni and has appropriate paperwork to this effect. it is my understanding that both he and his son are agreeing on a do not hospitalize order. the patient's prognosis is very poor, on the order of a few weeks. therefore, the focus of this patient's care should be comfort measures. he should be evaluated by the hospice team at tower . medications on admission: atorvastatin colace lopressor asa oxycodone guaifenesin albuterol heparin sc zolpidem lasix tylenol pantoprazole discharge medications: 1. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 2. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed. 3. acetaminophen 160 mg/5 ml solution sig: six y (650) mg po q6h (every 6 hours). 4. albuterol sulfate 0.083 % solution sig: one (1) treatment inhalation q4h (every 4 hours). 5. acetaminophen 160 mg/5 ml solution sig: 650 mg po every eight (8) hours as needed for pain: maximum of 4 g total of acetaminophen in one day. 6. morphine 10 mg/5 ml solution sig: five (5) mg po q4-6h (every 4 to 6 hours) as needed for pain. 7. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for sore throat. 8. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. ativan 0.5 mg tablet sig: one (1) tablet po every 4-6 hours as needed for anxiety/discomfort. 11. saline nebulizer as needed to promote easier expectoration discharge disposition: extended care facility: - discharge diagnosis: metastatic prostate cancer chronic hematuria hypotension, resolved and likely secondary to dehydration acute on chronic renal failure thrombocytopenia discharge condition: hemodynamically stable, on 35% fio2 via face mask, afebrile discharge instructions: please take your medications as prescribed. please let the nursing staff at your facility know if you are uncomfortable so that measures can be taken to make you more comfortable. md procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia infection with microorganisms resistant to penicillins chronic kidney disease, unspecified other and unspecified hyperlipidemia hypotension, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site malignant neoplasm of prostate hypoxemia encounter for palliative care secondary malignant neoplasm of lung secondary and unspecified malignant neoplasm of intrathoracic lymph nodes secondary malignant neoplasm of bone and bone marrow urinary obstruction, unspecified 

Answer: The patient is high likely exposed to