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: no known allergies / adverse drug reactions attending: chief complaint: respiratory failure and septic shock major surgical or invasive procedure: central venous catheter placement history of present illness: 88 y/o russian male with alzheimer's dementia, remote latent tuberculosis treated w/rifampin and pyrazadine in , af on coumadin, htn sent in from rehab for dyspnea, fever, and hypoxia. on the day prior to presentation () he was noted to be tired and weak, and he fell. he has not complained of respiratory symtpoms. overnight at 0100 he dropped to below 90% and placed on 2lnc. he had respiratory distress, was given nebulizer and tylenol without improvement. later, his o2 sat dropped to 70 on 2l, and he was switched to nrb with 15l, then 96%. temp was 99.6, given albuterol, but respirations increased to 37. two other people were ruled out for flu on the floor. urine legionella is pending. . in the ed, initial vs - 101, 125 (af), 148/70, 32, 94% 15l nrb. exam notable for tachypnea, 94% on nrb, diffuse rhonchi. labs notable for lactate 5.8, cr 1.1, bicarb 19, wbc 10.3 (29% bands), inr 2.2. bcx pending. cxr showing right sided pneumonia. ekg showing st 125, lad, first degree av delay, no ischemic changes. patient was given vancomycin, zosyn, combivent x 3, tylenol. only received 1l ivf. his vitals on transfer - 96 on 10l, rr 27, and his access was 1 piv. . on the unit, he was tachypneic, but appeared comfortable and denied any symptoms. he had a few episodes of relative hypotension to the 80s-90s systolic. his oxygenation improved to low-mid 90s on 5l. his lactate rose to 9. he was given 2l of lr and his lactate trended down to 6. a second iv was placed and he was started on vancomycin, cefepime, and levofloxacin. past medical history: - copd (unclear history, always a nonsmoker) - htn (active) - af on coumadin (active) - colon cancer (inactive) - dementia (ao x 1 at baseline) - history of tuberculosis, found to have 10mm ppd in , had a negative cxr so treated in for 9 months for latent tuberculosis. cxr repeat in looked increased density at the bases - bph (active) - gerd (active) social history: lives at rehab family history: no family history of tuberculosis. physical exam: on admission: gen: pleasantly demented, aox2 (knew he was in a hospital) comfortable but tachypneic, nad, pulling at lines heent: perrl, anicteric, mmm, no jvd, resp: right basilar rales and reduced breath sounds, otherwise clear. no wheezes. cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox2. symmetric strength throughout upper and lower extremities. no pronator drift., downgoing toes, 1+dtr's-patellar and biceps. . on discharge: gen: alert, comfortable, no increased work of breathing heent: sclera anicteric. mmm cards: rrr s1/s2 heard. no murmurs/gallops/rubs. pulm: limited by cooperation. bibasilar rales abd: +bs, soft, nt, nd gu: + foley extremities: warm, +scds neuro/psych: face symmetric, moves all extremites pertinent results: admission: 06:00am blood wbc-10.3 rbc-5.53 hgb-14.2 hct-43.4 mcv-79* mch-25.6* mchc-32.6 rdw-14.8 plt ct-177 06:00am blood neuts-62 bands-29* lymphs-5* monos-1* eos-0 baso-0 atyps-0 metas-3* myelos-0 06:00am blood pt-23.7* ptt-36.7* inr(pt)-2.2* 06:00am blood glucose-172* urean-27* creat-1.1 na-140 k-5.0 cl-104 hco3-19* angap-22* 06:00am blood ctropnt-0.01 probnp-1255* 04:25am blood calcium-7.6* phos-1.8* mg-1.4* . discharge: 06:00am blood wbc-11.4* rbc-4.95 hgb-12.4* hct-38.5* mcv-78* mch-25.1* mchc-32.3 rdw-15.5 plt ct-367 06:00am blood pt-30.3* ptt-34.4 inr(pt)-3.0* 06:00am blood glucose-112* urean-21* creat-1.2 na-146* k-3.5 cl-105 hco3-27 angap-18 06:00am blood calcium-8.8 phos-2.3* mg-2.3 . 10:08 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. singly in pairs. respiratory culture (final ): commensal respiratory flora absent. yeast. sparse growth. legionella culture (preliminary): no legionella isolated. . 1:55 pm blood culture source: line-rt cvl. blood culture, routine (preliminary): enterococcus _________________________________________________________ enterococcus sp. | ampicillin------------ r levofloxacin---------- r vancomycin------------ r anaerobic bottle gram stain (final ): gram positive cocci in chains. . 3:07 pm catheter tip-iv source: rt ij. **final report ** wound culture (final ): no significant growth. . 5 sets of blood cultures pending, all no growth to date brief hospital course: 88 year-old russian-speaking m with dementia, suspected copd, afib on coumadin, htn who presented with dyspnea, hypoxia, and fever, s/p micu course for treatment of respiratory failure and septic shock likely secondary to healthcare-associate pneumonia, transferred to the medicine floor for continued management, which was complicated by delerium and subsequent uretheral injury from self-discontinuation of foley placement. also found to have vre bacteremia for which he was started on 14 days of linezolid. . # acute respiratory distress/healthcare associated pneumonia: presentation with dyspnea, fever, bandemia, hypoxia, and cxr findings all consistent with acute pneumonia. given his residence at rehab, he was started on vancomycin, cefepime, and levofloxacin. tuberculosis felt unlikely given the rapid acuity of symptoms and lack of other more subacute constitutional symptoms. moreover, patient had documented adequate treatment of latent tuberculosis (with negative cxr) in . additional processes, such as pulmonary embolism, seemed unlikely given his therapeutic inr. patient was treated with bipap and appeared to improve, but on hospital day #2, he was tachypneic to the 30s, somnolent and working very hard to breath so he was intubated and placed on ards net ventilation. once stable he was 12l positive and diuresis with iv lasix was initiated. he responded well to lasix 20mg iv and was extubated on without complication. diuresis was continued until his volume status was optimized. an echocardiogram showed normal systolic function. he completed a 7 day course of broad antibiotics. . # severe sepsis: patient presented with pneumosepsis and elevated lactate up to 9. his lactate trended down to 2 after 6l ivf in the ed. his pressures maintained map >60 until the patient was intubated when he became hypotensive. a central line was placed and he was started on levophed. he was given bolus fluids for cvp <10 and weaned off pressors. he was put on vanc/levo/cef for presumed hap. he did have bcx positive for gpcs after resolution of sepsis, which were ultimately speciated to vre (vancomycin resistant enterococcus). his central venous catheter was removed. he was started on a 14 days course of po linezolid 600 mg twice daily, which should continue until . surveillence blood cultures have shown no growth to date. these are still pending and should be followed up on. . # delerium: likely secondary to toxic/metabolic encephalopathy from infection in a patient with underlying dementia. we attempted to minimize unecessary lines and tubes, provide frequent orientation, and avoid aggravating medications/sedatives. . # atrial fibrillation: rate controlled without medications. on coumadin for anticoagulation. his inr was elevated at 3 (likely secondary to antibiotics and poor nutrition), so coumadin has been held at discharge. his inr should be monitored and coumadin re-started once necessary. . # bph/urinary obstruction: tamsulosin held on admission during severe sepsis, but re-started upon transfer to the floor. the patient self-discontinued his foley and had subsequent traumatic injury resulting in blood clots that would cause painful obstruction. a foley was placed and will need to remain until he is healed and a voiding trial can be attempted. frequent irrigation should be provided to prevent blood clots. . # : mild, but egfr of 40 on admission with elevated bun. creatinine improved from 1.1 to 0.8 after ivf resuscitation in the micu, but increased after diuresis. 1.2 at discharge, which should be monitored in the future. . # suspected copd: patient continued on nebulizer treatement. . # microcytic anemia: remained relatively stable throughout the admission. he required no blood products. medications on admission: - warfarin 3 mg daily - aspirin 325 mg daily - flomax 0.4 mg daily - senna 17.2mg po hs - trazodone 12.5mg po hs - albuterol nebs 0.083% - tylenol 650mg po prn pain discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 3. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 5. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for pain. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed for shortness of breath, wheezing. 7. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 11 days: last day . discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: health-care associated pneumonia bacteremia toxic/metabolic encephalopathy urinary obstruction . dementia anemia atrial fibrillation discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were initially admitted to the intensive care unit (icu) for treatment of your difficulty breathing, which was likely secondary to a pneumonia. you were given medications and you improved. you were also found to have a bacteria in your blood, for which you will continue to take an antibiotic for after discharge. . your inr was elevated from the antibiotics you are receiving. today the level was 3. we are holding your coumadin (3 mg daily), but this will need to be re-started once the level falls. . additionally, when you were confused you pulled out your foley, which caused an injury and subsequent blood clots. you will be discharged with the foley, which will be removed once you heal. . -please start linezolid 600 mg by mouth twice daily for a total of 14 days (last day ) -please hold coumadin for now until labwork shows inr falls below 2.5 followup instructions: a physician at your facility will be taking care of your needs. md procedure: venous catheterization, not elsewhere classified injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified toxic encephalopathy unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure septic shock long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine iron deficiency anemia, unspecified alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance delirium due to conditions classified elsewhere personal history of tuberculosis urinary obstruction, not elsewhere classified 

Answer: The patient is high likely exposed to