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: hypotension major surgical or invasive procedure: none history of present illness: 76 year old male with h/o dementia and schizophrenia presents with hypotension in setting of decreased po intake. patient has experienced a decline in mental status over last 5-10 years with prior episodes of wandering. over last 8 days patient has started having decreased po intake of food and fluids. patient was recently hospitalized from - for failure to thrive. following discharge patient was noted to have poor po intake. wife also reports that he appeared to have some trouble breathing along with a chronic dry cough which has not worsened in severity. patient at times endorses pain, but has not been able to localize the pain at any point and does not give a consistent history of having any pain. home vna evaluated the patient today and found him to be hypotensive and febrile. ems was subsequently called and the patient was transported by ambulance to the ed. in the ed, initial vs were: hr67 bp88/53 rr16 98% 4l nasal cannula temp 101.8 (rectal) patient triggered upon arrival to the ed for hypotension. he received a ua which was questionable for uti with 13 wbc, moderate leuks, negative nitrites and negative bacteria. cxr shows interval development of pulmonary edema and concern for left lower lobe pneumonia vs atelectasis. patient received 5l iv fluids and was started on empiric broad spectrum antibiotics including vanc, cefepime and levofloxacin. in spite of fluid resuscitation the patient remained hypotensive. a right ij line was placed and the patient was started on levophed. while in the ed the patient experienced an episode of bradycardia to 38bpm, he subsequently received an ekg which showed bradycardia to 48, diffuse twf. on arrival to the micu, patient was on pressors, alert but agitated. saturating well on o2 by nasal canula. past medical history: - schizophrenia: history of paranoia and delusions, previously treated with seroquel, but this was discontinued due to somnolence - dementia social history: lives with son and wife. been declining for at least the past 5-10 years. previously worked as police officer - tobacco: none - alcohol: none - illicits: none family history: wife is unaware of any family history of heritable illness. physical exam: admission exam vitals: t 97.8 hr 93 rr 33 o2 sat 95% bp 135/90 (on norepi .1mcg/kg/min) general: laying in bed, appears agitated, answers questions and follows commands intermittently heent: dry oral mucosa, poor dentition. neck: supple, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, severe onychomycosis of all toe nails neuro: perrl, alert but completely disoriented, intermittently answers questions and mutters, moves all extremities. discharge pe: vs: t 98.6 bp 116-126/64-88 hr 74-89 rr 18-20 o2 96-98%ra 24 i/o: 3bms, inc uop / nr po 8 i/o: 1bm, inc uop / nr po general: alert, oriented x2 (self and year), nad, resting comfortably in bed heent: sclera anicteric lungs: anteriorly clear, with some crackles at left base, poor inspiratory effort, pt cannot sit up cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, nontender, nondistended, +bs ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, 1+ pedal edema. pertinent results: admission labs 05:00am blood wbc-3.1* rbc-2.81* hgb-11.8* hct-31.8* mcv-113* mch-41.8* mchc-37.0* rdw-15.7* plt ct-149* 01:00pm blood neuts-62 bands-1 lymphs-22 monos-14* eos-1 baso-0 atyps-0 metas-0 myelos-0 01:00pm blood hypochr-normal anisocy-normal poiklo-normal macrocy-2+ microcy-normal polychr-occasional 06:24am blood pt-13.2* ptt-33.7 inr(pt)-1.2* 05:00am blood glucose-89 urean-16 creat-0.8 na-135 k-4.1 cl-104 hco3-23 angap-12 06:48pm blood ck(cpk)-387* 06:24am blood alt-45* ast-37 alkphos-55 totbili-0.7 05:00am blood calcium-7.6* phos-1.9* mg-2.0 pertinent labs and studies 02:52am blood ck-mb-4 ctropnt-<0.01 06:48pm blood ck-mb-2 ctropnt-<0.01 03:15am blood ck-mb-2 ctropnt-<0.01 03:45pm blood hbsag-negative 03:45pm blood hiv ab-negative 03:07am blood type- temp-37.3 o2 flow-4 po2-37* pco2-31* ph-7.40 caltco2-20* base xs--3 intubat-not intuba 01:43pm blood lactate-2.0 03:07am blood lactate-0.9 cxr 1. pulmonary edema, new since . mild cardiomegaly. 2. left lung base consolidation, may represent atelectasis or infection in the appropriate clinical setting. follow-up to resolution. echo the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. micro _________________________________________________________ staphylococcus, coagulase negative | staphylococcus, coagulase negative | | staphylococcus epidermidis | | | clindamycin-----------<=0.25 s <=0.25 s r erythromycin---------- =>8 r <=0.25 s =>8 r gentamicin------------ <=0.5 s <=0.5 s <=0.5 s levofloxacin----------<=0.12 s 0.25 s <=0.12 s oxacillin-------------<=0.25 s <=0.25 s =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s <=1 s 2 s vancomycin------------ <=0.5 s 1 s 2 s urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. discharge labd and studies: 10:20am blood wbc-7.7 rbc-3.33* hgb-12.3* hct-38.1* mcv-114* mch-36.9* mchc-32.3 rdw-15.2 plt ct-621* 07:35am blood glucose-68* urean-7 creat-0.8 na-135 k-5.4* cl-103 hco3-22 angap-15 07:35am blood calcium-7.9* phos-3.2 mg-2.3 brief hospital course: mr. is 76m with h/o dementia and schizophrenia found to have coag negative staph bacteremia course c/b hcap. acute care # staph bacteremia: the patient was found to have coag negative staph bacteremia, as well as urinary tract infection. he had recently been hospitalized (discharged just the day prior to admission) so possible that the source of bacteria is iatrogenic. on arrival to the ed, a rij was placed and the patient was started on vasopressors because he was hypotensive. he was empirically treated with vancomycin, cefepime, and later, flagyl was started for aspiration pna coverage (see below). the patient was initially admitted to the micu where he was maintained on vasopressors. a tte showed no signs of vegetation. the patient was taken off vasopressors on and called out to the floor. on the floor, the patient was seen by the infectious disease team who recommended completing a course of antibiotics for pneumonia (as discussed below) in the hospital and then switching to oral on discharge to complete 4 week total of antibiotics for his bacteremia. the patient was transitioned to oral on without further event and will continue for three weeks total (end date ). his surveillance blood cultures remained negative and he was discharged to rehab. the patient should have weekly cbcs drawn and faxed to dr. at . # pneumonia: the patient was found to have left lower lobe infiltrate in the setting of fever and hypotension concerning for pneumonia, possibly secondary to aspiration. due to the patient's very poor dentition, he did meet criteria for treatment with antibiotics, and was thus treated with flagyl. attempts were made to obtain a panorex however the patient could not stand and this was not completed. he was treated with an 8-day course of vanc/cefepime/flagyl. he was then started on a 3 week course of , id recs. at discharge, his o2 sat was 95-96% on ra. chronic care # b12 deficiency anemia: the patient has with known history of b12 deficiency on recent admission with continued macrocytic anemia. he was started initially on po repletion in house, and was later transitioned to im b12 injections -> regimen will be daily injections for one week, weekly injections for one month, then monthly injections indefinitely after that, as outlined in his page 1. # bradycardia: pt had a few brief episodes of bradycardia to high 30s/low 40s while sleeping, other vital signs normal. ekg showed prolonged pr interval, consistent with previous ekg (180-200ms). # dementia/schizophrenia: the patient oriented to himself primarily during this hospitalization, but as per his family members, this has been his baseline mental status. # po intake: there was concern that patient's pneumonia could be related to aspiration events. speech and swallow evaluated the patient and recommendation for thin liquids and soft solid diet were made. transitional issues: # code: the patient was dnr/dni while in house. - the patient will have to continue to complete a 4-week course. the patient will follow with the infectious disease clinic. end date on po is . the patient should have weekly cbcs drawn and faxed to dr. at . he has outpatient id follow up scheduled for him. - b12 deficiency: started on vitamin b12 injections for anemia and low b12 levels. take daily for 1 week ( - ). then take weekly for 1 month ( - ). then take monthly on an ongoing basis, stop only if instrcuted by your pcp or other healthcare provider. - our speech and swallow specialists felt that there was some increased risk of aspiration and recommended thin liquids, and moist, ground solids. medications on admission: 1. donepezil 5 mg po hs 2. multivitamins w/minerals 1 tab po daily rx *multivitamin,tx-minerals 1 capsule(s) by mouth daily disp #*30 capsule refills:*0 3. cyanocobalamin 250 mcg po daily discharge medications: 1. donepezil 5 mg po hs 2. 600 mg po q12h 3. outpatient lab work please check cbc weekly and fax to , attn , md mph 4. multivitamins w/minerals 1 tab po daily 5. cyanocobalamin 1000 mcg im/sc daily b12 deficiency, anemia duration: 1 weeks start , end 6. cyanocobalamin 1000 mcg im/sc 1x/week (mo) b12 deficiency, anemia duration: 1 months start , end 7. cyanocobalamin 1000 mcg im/sc qmon b12 deficiency, anemia start discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: staph bacteremia pneumonia secondary diagnosis: dementia discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: it was a pleasure taking care of you at ! you were admitted due to low blood pressures and were found to have both a pneumonia and an infection in your blood. you were initially cared for in the intensive care unit and improved on antibiotics. you completed your course of antibiotics without any problems. are now ready for discharge to an extended care facility to complete rehabilitation and an extended antibiotic course. new medications: start 600 mg by mouth twice daily for three weeks (end date ). take this medication by crushing it and mixing with chocolate pudding or applesauce. start vitamin b12 1000 mcg intramuscularly for one week daily (end date ) start vitamin b12 1000 mcg intramuscularly once per week for four weeks (start , end ) start vitamin b12 1000 mcg intramuscularly once per month stop vitamin b12 pills by mouth see below for instructions regarding follow-up care. followup instructions: department: gerontology when: tuesday at 1:30 pm with: , md building: lm bldg () campus: west best parking: garage department: infectious disease when: thursday at 2:00 pm with: , md building: lm campus: west best parking: garage procedure: central venous catheter placement with guidance diagnoses: urinary tract infection, site not specified toxic encephalopathy severe sepsis other b-complex deficiencies other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus septic shock do not resuscitate status other staphylococcal septicemia paranoid type schizophrenia, unspecified physical restraints status dermatophytosis of nail dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to