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: history of present illness: the patient is an 85 year old male transferred to from rehabilitation secondary to acute onset of shortness of breath. at baseline, the patient is essentially nonverbal and is totally dependent for his activities of daily living. he had been living at home with his daughter until , when he was admitted to secondary to increased right thigh swelling. there he was found to have bilateral femur fractures which were thought to be secondary to a new lift at home. orthopedics evaluated the patient in house and felt that the best course of action would be healing without surgery with observation for three to six weeks and they planned to reevaluate for surgery if this conservative management failed. he was therefore transferred to rehabilitation on . his hospital course at was also notable for hyponatremia which resolved with free water; anemia with heme positive stools and iron deficiency (started on supplemental iron); and pyuria thought to be secondary to chronic indwelling foley. on , in the morning, he was found to have increased shortness of breath, increased to moderate amount of thick yellow secretions. he was given nebulizers with minimal effect. his vital signs at that time were a blood pressure of 150/75, pulse 120, respiratory rate 32, temperature 100.5, oxygen saturation 88% on two liters oxygen. he was transferred to our emergency department for further evaluation. in our emergency department, the patient was found to be in severe respiratory distress, gcs 3, hypoxic with an oxygen saturation in the 70s and a respiratory rate of 40. he was subsequently intubated in the emergency department. he was treated with levofloxacin and flagyl and received two liters of normal saline. he was subsequently transferred to the medical intensive care unit. past medical history: 1. right femoral fracture with prosthesis in , secondary to a mechanical fall. 2. gastroesophageal reflux disease with hiatal hernia . 3. peripheral vascular disease. 4. history of aspiration pneumonia. 5. depression. 6. ventral hernia. 7. status post percutaneous endoscopic gastrostomy placement. 8. contractures secondary to immobility. 9. dementia of questionable etiology. medications on admission: 1. fragmon 2500 units b.i.d. 2. reglan 10 mg p.o. t.i.d. 3. iron 325 mg p.o. t.i.d. 4. colace 100 mg p.o. t.i.d. 5. senna two tablets p.o. b.i.d. 6. lopressor 12.5 mg p.o. t.i.d. 7. prevacid 15 mg p.o. q.d. 8. vicodin p.o. p.r.n. allergies: no known drug allergies. social history: the patient came from rehabilitation. previously he lived in , with vna and home health aids. he is a former electronics technician and has no history of alcohol or tobacco use. he is a widower times eight years. his daughter is health care proxy and he also has one son in . the patient is a full code. physical examination: in general, the patient is a thin, elderly male, sedated, intubated. vital signs reveal pulse 116, blood pressure 96/45. head, eyes, ears, nose and throat examination is normocephalic and atraumatic. sclera anicteric. the mucous membranes are slightly dry, intubated. the neck is supple with no jugular venous distention. no lymphadenopathy. chest is rancorous throughout, decreased breath sounds at the base, right greater than the left. cardiovascular regular, difficult to appreciate over breath sounds. abdomen - gastrostomy tube without drainage, exudate, normoactive bowel sounds, soft, nontender, nondistended. extremities - right thigh swollen, no ecchymosis, positive contractures. skin - pink, macular small lesions around right intravenous. neurologically, the patient is sedated, does not respond to commands, withdraws from pain. laboratory data: on admission, white blood cell count was 15.4, hematocrit 32.5, platelets 545,000 with a differential of 78 neutrophils, 15 bands, 2 lymphocytes, 4 monocytes and 1 basophil. sodium 139, potassium 6.0, chloride 104, bicarbonate 23, blood urea nitrogen 14, creatinine 0.7, glucose 144. urinalysis revealed specific gravity 1.030, large blood, 100 protein, 0-2 epithelial cells, red blood cells, greater than 50 white blood cells, few bacteria, few yeast, few mucus, and culture is pending. arterial blood gases revealed ph 7.21. lactate 5.6, and repeat potassium 5.9. chest x-ray - enlarging mediastinum secondary to persistent rotation, left lower lobe consolidation consistent with pneumonia. ct angiogram revealed consolidative right lower lobe, bronchus obscured, questionable mucous plug versus neoplasm, no pulmonary embolism. electrocardiogram - sinus at a rate of 130 beats per minute, normal axis, normal intervals, t wave inversions in v1 and v2, 0. depressions in v3 through v5. hospital course: the patient is an 85 year old male with a recent discharge from after bilateral femoral fractures who presents with acute onset of shortness of breath. 1. pulmonary - the patient was intubated in the emergency department and started on cpap. there was no evidence of pulmonary embolism on ct angiogram. however, there was evidence of consolidation in the right lower lobe consistent with aspiration versus community or hospital acquired pneumonia. the patient was therefore continued on levofloxacin and flagyl and a bronchoscopy was performed to evaluate for possible mucous plug. it was also determined to start the patient on vancomycin given the possibility of a hospital acquired pneumonia. the initial bronchoscopy demonstrated extensive mucous plugs aspirated from the right lower lobe, however, no endobronchial lesions. samples were sent for culture which eventually grew methicillin resistant staphylococcus aureus. the patient was therefore continued on antibiotics for aspiration pneumonia as well as methicillin resistant staphylococcus aureus. the patient was started on a trial of pressure support which was decreased as tolerated. chest x-ray demonstrated poor reexpansion of the right lower lobe. therefore, a second bronchoscopy was performed in order to remove further mucous secretions and aid in reexpansion of the right lobe. as the patient's secretions decreased, he was extubated on , without any complications. on the following day, the patient was transferred to the floor and he was continued on his antibiotic regimen of levofloxacin, flagyl and intravenous vancomycin to treat an aspiration pneumonia and methicillin resistant staphylococcus aureus. over the course of the hospital stay, the patient's pulmonary status improved. he was continued on chest physical therapy and aspiration precautions. a repeat chest x-ray one week into the course of admission demonstrated significant improvement in the lower lobe consolidation. at the time of discharge, the patient still had small to moderate amounts of secretions which required periodic suctioning, however, he had remained afebrile for days and his oxygen requirement had been titrated down to a periodic use of two liters oxygen therapy. 2. cardiovascular - the patient was tachycardic on arrival and responded well to fluid resuscitation. there was no history of any cardiac disease. the patient was continued on his lopressor dose once his blood pressure had stabilized which was presumably started for hypertension at . over the course of the hospital stay, the patient remained hemodynamically stable with a systolic blood pressure of approximately 110 to 120 and a heart rate in the 70s. the patient had no further cardiovascular issues. 3. gastrointestinal - the patient had a percutaneous endoscopic gastrostomy tube in place on arrival which was functioning without difficulty. it was continued to be used for p.o. medications and for tube feeds. the patient tolerated his tube feeds without difficulty and was able to obtain adequate nutrition through the percutaneous endoscopic gastrostomy tube. the patient was also continued on his prevacid per gastrostomy tube. 4. renal - the patient had a normal blood urea nitrogen and creatinine at the time of admission which remained within normal limits over the course of the hospital stay. the patient had no further renal issues. 5. infectious disease - the patient presented with symptoms suggestive of a pneumonia and bronchoscopy demonstrated mucous plugging and thick secretions with culture results suggestive of a methicillin resistant staphylococcus aureus pneumonia possibly complicated by an aspiration pneumonia. therefore, the patient was continued on levofloxacin, flagyl and vancomycin with the intent to treat for 21 days total. over the course of the hospital stay, the patient's white blood cell count trended down to normal levels and, at the time of discharge, he had remained afebrile for days. the patient has chronic foley use and his initial and subsequent urinalysis demonstrated funguria. however, this was felt likely secondary to colonization due to chronic foley use and it was decided not to treat the patient for funguria unless he became systemically ill with an increased white blood cell count, fevers or other signs of abdominal distress. 6. hematological - at the time of admission, the patient was being treated with a prophylactic dose of lovenox and there was no evidence of pulmonary embolus by ct angiogram. he was therefore continued on lovenox over the course of the hospital stay. the patient was noted to be anemic on arrival and it was found that his anemia had been worked up at . he had been thought to have an iron deficiency anemia likely secondary to a slow gastrointestinal bleed. he had been started on p.o. iron supplements which were continued. the patient's hematocrit remained stable over the course of the hospital stay. he did not require transfusion. 7. orthopedic - the patient has a history of bilateral femoral fractures as per records per . he was evaluated by the orthopedic consult service who determined that conservative measures were in the patient's best interest. the patient's daughter requested a second opinion regarding this thought and an orthopedic consultation was obtained here at . review of films from as well as a repetition of the plain films of the bilateral lower extremities suggested that the patient did have bilateral femoral fractures. it was decided that the patient would likely suffer unnecessary risks and pain from surgery which was not likely to do him much benefit. they recommended conservative therapy with follow-up within three to six weeks. this was discussed with the daughter who was in agreement with this plan. 8. endocrine - the patient does not have a history of diabetes mellitus but occasionally was noted to have elevated blood sugar on periodic laboratory tests. he was therefore covered on a regular insulin sliding scale p.r.n. a tsh was tested during admission which was found to be within normal limits. 9. fluids, electrolytes and nutrition - the patient was maintained on his tube feeds including promote with fiber at a goal of 60 to 70 cc/hour over the course of the hospital stay. his electrolytes were checked and repleted as needed. the patient had no further nutritional issues. 10. neurological - the patient was known to have a history of dementia at the time of admission, however, the patient's primary care physician was unavailable to explain the nature of any workup that had been done in the past. therefore, a neurology consultation was obtained in order to evaluate for any possible reversible causes of dementia. review of ct scan obtained from , as well as examination by the neurology consultation team, suggested that this patient was most likely suffering a severe dementia of alzheimer's type with diffuse atrophy. they did suggest a dementia workup and laboratories were found to be within normal limits. there was, however, some question of possible parkinson's disease on examination and therefore, it was determined to try the patient on a trial of sinemet to see if there was any improvement in his clinical status. the patient appeared to tolerate the sinemet without difficulty and this can be continued as an outpatient and followed up by the patient's primary care physician. a fibrinogen and were also checked during the hospital admission in order to evaluate for the possibility of autoimmune disease. while the patient was found to have a mildly elevated fibrinogen level and an equivocal esr, it was felt that the patient would likely suffer further side effects from a trial of steroids which would outweigh the potential benefits. 11. lines - the patient had a central line placed on admission to the medical intensive care unit. this was replaced with a picc line once the patient came to the floor. he will keep this picc line in place until he completes his course of intravenous antibiotic therapy. condition on discharge: the patient was discharged to rehabilitation in stable condition. he is to follow-up with his primary care physician, . , within the next month. medications on discharge: 1. reglan 10 mg p.o. t.i.d. 2. iron 325 mg p.o. t.i.d. 3. colace 100 mg p.o. b.i.d. 4. senna two tablets p.o. b.i.d. 5. paxil 10 mg p.o. q.d. 6. prevacid 15 mg p.o. b.i.d. 7. flagyl 500 mg p.o. q6hours. 8. tylenol 650 mg p.o. q4hours p.r.n. 9. vicodin one to two tablets p.o. q4hours p.r.n. pain. 10. lactulose 30 cc p.o. q4hours p.r.n. 11. sinemet one tablet p.o. t.i.d. 12. miconazole powder to the axilla b.i.d. 13. levofloxacin 500 mg p.o. q.d. times fourteen days. 14. lopressor 12.5 mg p.o. b.i.d. (hold for systolic blood pressure of less than 100 and heart rate less than 50). 15. lovenox 30 mg subcutaneous b.i.d. 16. vancomycin one mg intravenous q18hours times fourteen days. 17. promote with fiber at 70 cc/hour. , m.d. dictated by: medquist36 d: 19:10 t: 19:24 job#: procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy other bronchoscopy other lavage of bronchus and trachea other lavage of bronchus and trachea diagnoses: paralysis agitans pneumonitis due to inhalation of food or vomitus other shock without mention of trauma methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site iron deficiency anemia, unspecified nonspecific abnormal findings in stool contents alzheimer's disease foreign body in larynx late effect of fracture of lower extremities 

Answer: The patient is high likely exposed to