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: this is a 68 year old gentleman with a history of parkinson's disease and a recent prolonged complicated admission, status post motor vehicle accident where he was hit by a car as a pedestrian who returned with fever, shortness of breath and hypotension from rehabilitation. he was admitted on to after being struck by a car. in that admission he had a complicated course including a right fibular fracture and right acetabular fracture and multiple left rib fractures and left perisplenic hematoma and left common femoral vein deep vein thrombosis and had a inferior vena cava filter placed on . he also had evidence of right lower extremity skin necrosis in the thigh and cellulitis which was debrided and had a skin graft from his thigh. also during that hospitalization, he had an exploratory laparotomy which showed left retroperitoneal, perinephric hematoma, also complicated by pancreatitis status post endoscopic retrograde cholangiopancreatography and sphincterotomy and methicillin-resistant staphylococcus aureus pneumonia which was treated with vancomycin. he was discharged on to . he was there two to three days prior to representation at . he developed fevers, tachypnea and shortness of breath at that rehabilitation and was sent back in for further evaluation. on admission he had evidence of a right lower lobe pneumonia. he was started on flagyl for concern for aspiration pneumonia. he was given a dose of azotreanam at the rehabilitation and was started on vancomycin given his history of methicillin-resistant staphylococcus aureus. review of systems was positive for fevers, shortness of breath, cough which was nonproductive with a rare yellowish sputum. he had dark brown diarrhea, positive back pain since his accident. no abdominal pain. he was taking p.o., no coughing after eating. no nausea, vomiting or dysuria. in the emergency room, he was noted to have temperature to 101.5 with systolic blood pressure of 84, respiratory rate between 30 to 40 and 87% saturations on room air. he was given 3 liters of normal saline. his blood pressure came up to 133/86. a central line was placed in his right internal jugular vein. he was given ceftriaxone and admitted to the medicine intensive care unit. past medical history: past medical history includes 1. parkinson's disease since ; 2. hypertension; 3. status post motor vehicle accident trauma, being hit as a pedestrian; 4. prostate cancer, status post prostatectomy. allergies: zosyn and levaquin. medications on admission: sinemet, senna, atrovent, albuterol, seroquel, ultram, entacapone with the sinemet, cream glycerine, lactulose, colace, multivitamin, tylenol, fragmin, prevacid, flagyl started on , azotreanam started on and then vancomycin given one dose on . social history: negative tobacco or alcohol. he was an engineer on a ship with positive asbestosis exposure, currently at rehabilitation. he has a wife and daughter in the nearby town. family history: negative for coronary artery disease, diabetes and coronary artery disease or cancers. physical examination on admission: notable for temperature 101.5, blood pressure 181/76, heart rate 109, respiratory rate 30, saturations 95% on 3 liters of nasal cannula. in general, he was an elderly russian-speaking only male, tachypneic. head, eyes, ears, nose and throat, flat neck veins, pupils equal, round and reactive to light, anicteric sclera, moist mucous membranes, left subclavian triple lumen with some secondary erythema but no tenderness, warmth or fluctuance. chest with bronchial breath sounds and rhonchi of the left base with right bibasilar rales. heart was tachycardiac with heart sounds obscured by rapid breath sounds. abdomen was soft with a healed midline scar, nontender. extremities, trace to 1+ patchy edema in bilateral lower extremities. well granulation tissue over graft on his right lower extremity. back, left stage 1 decubitus ulcer over his left buttocks, no surrounding cellulitis. rectal, guaiac negative. neurological, cogwheel rigidity, alert and oriented. laboratory data: laboratory data on admission revealed white count 17.5, hematocrit 28.6, platelets 292. sodium 140, potassium 4.1, chloride 104, bicarbonate 27, bun 26, creatinine 0.9, glucose 99, lactate 2.1, inr 1.4. urinalysis was hazy with a specific gravity of 1.029, 30 protein, 15 ketones, trace leukocyte esterase, large blood, 11 to 20 of red blood cells, treated by white blood cells, moderate bacteria. cultures were pending on admission. an echocardiogram in with normal ejection fraction, no wall motion abnormality, no valvular disease. chest x-ray with left lower lobe opacity. hospital course: this is a 68 year old gentleman with parkinson's disease, status post recent long complicated hospital course, status post a motor vehicle accident who presented with fevers, shortness of breath and hypotension. 1. sepsis - the patient's likely sources were considered to be pneumonia, urinary tract infection and diarrhea, given his history of clostridium difficile colitis. also a source could have been decubitus ulcer. the patient was admitted to the intensive care unit and started on broad spectrum antibiotics, including vancomycin, ceftriaxone for pneumonia, and flagyl to cover for clostridium difficile. the patient's previous left subclavian central line was pulled and sent for cultures. he had a new right internal jugular central line placed. he continued to have aggressive intravascular repletion with intravenous fluids to which he responded, presumably initially hypovolemic secondary to diarrhea, fevers, tachypnea. chest x-ray confirmed left lower lobe collapse, consolidation which has increased in prominence since the previous study. he does have a known elevated right hemidiaphragm and this was stable from the previous chest x-ray. however, the patient was treated as a nosocomial pneumonia with his recent hospitalization. as he was coming from the nursing home, the patient was treated broadly with goal to complete a 14 day course of vancomycin and ceftriaxone of which he started on , and which will be completed on . blood cultures drawn on the day of admission and follow up cultures remained negative. the patient's stool was positive for clostridium difficile and sputum was positive for methicillin-resistant staphylococcus aureus and the patient is to complete the two week courses of both, and both will be completed on . his leukocytosis from an admission of 17,000 did trend down during the course of his stay with antibiotics. his hypotension through the course of the medicine intensive care unit stay and on the floor was fluid-responsive and remains stable. eventually he was restarted on his outpatient hypertensive regimen. 2. respiratory distress - the patient was noted to have some episodes of respiratory distress in the medicine intensive care unit, he was treated with bipap as he was hypercapnic and this did help improve his ventilatory status. he tolerated bipap well. he was eventually weaned just to bipap nightly. he continued to retain carbon dioxide with a rise in bicarbonate throughout the course of his stay and this was considered likely secondary to a persistent carbon dioxide retention. his respiratory distress and hypercapnia were attributed to his pneumonia. eventually also evidence of right lower lobe pneumonia and right lower lobe collapse likely was more susceptible secondary to his elevated right hemidiaphragm which was chronic and more susceptible to atelectasis in light of his hypotension and mental status issues. his respiratory status remained stable on the floor. he was continued on oxygen by nasal cannula at a rate of 3 liters. he tolerated this well with stable saturations around 96%. he was continued on nebulizers q. with good results and continued to produce good cough efforts, although still gaining back strength. he was continued on bipap at settings of 10 and 5 with three to four liters of bleeding over night with good result. this is to be continued at rehabilitation. his chest x-ray confirmed small right pleural effusion which was stable in size and improving through the course of his stay as was the respiratory status. no plans were made to tap as it was considered increasing risk for thoracentesis than to just continue treatment. again the patient has completed a two week course of ceftriaxone and vancomycin for nosocomial acquired pneumonia at the nursing home and his course will be completed on . the patient had a mid line placed in his right forearm to complete the rest of his antibiotics at rehabilitation. 3. clostridium difficile colitis - the patient again had stool samples which were positive for clostridium difficile and the patient was again restarted on flagyl to complete a two week course which he will complete on . otherwise his diarrhea improved throughout the course of his stay with treatment and this was stable at the time of discharge. 4. wound care - the patient does have a stage 1 to 2 grade sacral decubitus ulcer, continue wound care at rehabilitation as had been appropriate. continue to ambulate and improve the patient's nutritional status to help wound healings. 5. parkinson's disease - he was stable from his parkinson's issues on his home medications of sinemet and entacapone. continue his home brands in five times a day dosing of entacapone and parkinson's was stable here. 6. altered mental status - noted in medicine intensive care unit to have some change in mental status. this was attributed to multiple factors including overuse of intravenous morphine. once this was cut back his mental status and agitation improved. also the patient was started on b.i.d. dosing of seroquel which he tolerated well with improvement in his mental status. he was also started on prn doses of zyprexa which he did not require as he remained stable. for a short time he was on a 1:1 sitter which was discontinued as the patient was stable and was not agitated further. for altered mental status, the patient was restarted on smaller doses of percocet for pain control and he tolerated this well without altered mental status. he continued to improve and was back to baseline per family. he did recognize them alert and oriented, even per interpreter, except did note that the patient continued to have some strange dreams which have been chronic issues with him and his parkinson's disease per family and are unchanged from his baseline. so, his altered mental status was likely delirium from infectious causes and over-narcotics. concern was also related to hypercarbia, however, this was stable, his pco2 and his mental status improved. 6. acid base - the patient initially with respiratory acidosis which improved with bipap, however, secondary to prolonged respiratory acidosis, compensated with a metabolic alkalosis, the patient was alkalinizing his urine appropriately and his metabolic alkalosis was attributed in part to post hypercarbic respiratory acidosis and post hypercarbic metabolic alkalosis in response to his hypercarbic state. also, compounding that was a contraction alkalosis and he remained stable in terms of his acid base status and we will continue to follow his bicarbonates in his chemistries. however, his blood gases remained stable with pco2 ranging from 50s and with some respiratory distress up to 70s, however, persistently in the 50s. this may be his new baseline. his bicarbonate was stable at 38 at the time of discharge. 7. atrial fibrillation - he did have new onset atrial fibrillation while in the intensive care unit. he was cardioverted and loaded on amiodarone and remained stable in sinus throughout the rest of his stay. 8. left thigh pain - originally, known fractures of the right acetabulum and right femur and has had extensive necrosis of his right thigh, status post debridement and status post skin graft placement in , the surgical team. however, per patient this intermittent cramping type pain has been with him over the past month and he describes it as an intermittent cramping type pain. the patient was started back on percocets with good relief. he was also started back on anti-inflammatories like ultram and also started on quinine to help with leg cramps and for concern of possible neuropathic pain was started on low doses of neurontin which can be titrated up at rehabilitation. 9. nutrition - the patient passed a video speech and swallow evaluation with no evidence of aspiration and originally had been on nectar-thickened liquids after having been on tube feeds in the medicine intensive care unit. however, as he showed no signs of aspiration, he was started on regular consistency diet with thin liquids which he tolerated well, however, just required assistance in terms of feeding. the patient admitted he had very little appetite but when encouraged to eat and drink boost supplemental drinks, he would, knowing that the alternative to poor p.o. intake was a possible feeding tube. he agreed with continuing to try and family agreed trying to encourage p.o. intake as they wanted to avoid placing an nasogastric tube or possible gastrostomy tube if his nutritional intake does not increase. the patient's electrolytes were followed closely and were repleted as needed. 10. right lower extremity deep vein thrombosis - the patient had a right lower extremity deep vein thrombosis after his fracture, and had an inferior vena cava filter placed at the time in . he was continued on his lovenox here and started on coumadin to be titrated up with goal inr between 2 and 3. his lovenox should be discontinued once he reached his goal inr. 11. hypertension - although throughout much of his stay, he was slightly hypotensive, by the time of discharge he was started back on his home regimen of metoprolol but to continue at low doses. discharge diagnosis: 1. sepsis. 2. pneumonia. 3. pleural effusion. 4. urinary tract infection. 5. clostridium difficile colitis. 6. parkinson's disease. 7. status post deep vein thrombosis. 8. delirium. 9. atrial fibrillation. 10. failure to thrive. discharge medications: 1. entacapone 200 mg p.o. five times a day. 2. multivitamin one p.o. q. day. 3. acetaminophen 325 mg one to two p.o. q. 4-6 hours. 4. albuterol nebulizers one neb q. 2 hours prn. 5. albuterol nebulizers, one neb inhaled q. 4 hours. 6. atrovent nebulizers, one neb q. 6 hours. 7. carbidopa/levodopa 25-250 mg p.o. five times a day. 8. zyprexa rapid release 5 mg tablet, one p.o. q. day prn agitation. 9. metoprolol 25 mg p.o. b.i.d., hold for systolic blood pressures less than 110. 10. pantoprazole 40 mg p.o. q. day 11. seroquel 50 mg p.o. b.i.d. 12. lovenox 80 mg p.o. subcutaneously q. 12 until inr is greater than 10. 13. warfarin 5 mg tablets, p.o. q.h.s. to be titrated to goal inr between 2 to 3. 14. ultram 50 mg p.o. q.i.d. 15. quinine 260 mg p.o. b.i.d. 16. guaifenesin 10 ml p.o. q. 6 hours. 17. percocet 5/325 mg one p.o. q. 4 hours prn pain. 18. colace 100 mg p.o. b.i.d. 19. senna 1 tablet p.o. b.i.d. 20. flagyl 500 mg p.o. t.i.d. to be completed . 21. vancomycin 1 gm q. 12 hours to be completed . 22. ceftriaxone 1 gm q. 24 hours to be completed . 23. neurontin 100 mg p.o. q. 8 hours to be titrated up as tolerated. discharge follow up/instructions: the patient is to follow up with his primary care physician in seven to ten days after discharge from rehabilitation. the patient is to follow up with the trauma clinic as was previously recommended. the patient is to follow up with the plastic surgery team as was previously recommended. the patient is to continue with aggressive pulmonary toilet and suctioning, supplemental oxygen, bipap at night with settings of 10 and 5, to be continued with aggressive physical therapy in rehabilitation. the patient is to continue to be encouraged to take p.o. intake to improve nutritional status. dispo: prior to transfer to rehab, the patient was scheduled for monitoring and continued hospital level treatment over the weekend to assess for stability. he became acutely dyspneic with worsening respiratory acidosis and hypoxemic, and was transferred to the icu. please see a subsequent d/c addendum for further details. , m.d. 12- ahu dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified unspecified septicemia severe sepsis pulmonary collapse acute respiratory failure intestinal infection due to clostridium difficile 

Answer: The patient is high likely exposed to