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: quinolones attending: chief complaint: primary care physician: home physician . chief complaint: l sided pleuritic pain, transferred for slt hypotension in setting of dilt gtt for afib. major surgical or invasive procedure: picc line placement egd emg history of present illness: history of present illness: 81m chronic af, chf, bullous pemphigoid, h/o sbos, recently admitted for urosepsis, here w/ afib rvr and pleuritic chest pain. was recently admitted to with urosepsis w/ acute renal failure in the setting of this, further complicated by lll pneumonia - unclear if patient was ventilated, but did have a r subclavian placed. received azithro/ceftriaxone for the pneumonia w/ improvement. discharged with plans for outpt continuation of ceftriaxone for an addition 4 days (suggesting pna was dx ~). . following discharge, continued complaining of cough productive of yellowish sputum, then on day of admission developed pleuritic chest pain on l. on transfer from nh to was noted to be in afib/rvr and was given dilt 18mg bolus w/ good effect by ems (notes pulse of 190, bp 90/palp, but strip shows ~150-160). hr improved to 100-104, sbp 100. . at osh, 129 93/46 24 99%nrb on arrival, started dilt 5mg push, then 2.5mg gtt, given 1g ceftaz and 60mg lovenox @ 0351. transferred for addition care at . on arrival to er, 99.2 56 91/57. dilt gtt stopped when bp to 83/54, bp to 90s-100s, hr continued to be in low 100s. . on arrival to micu, 96.2 120 103/65 16 98% 4lnc. given 10mg iv dilt push, then started on 5/hr gtt. . micu course: afib rate was controlled with dilt gtt then switched to po and rate is now in the 80s. he was placed on vanc/zosyn for hosp-acquired pna + uti. wbc count has come down and is now afebrile. was placed on metronidazole for + cdiff cx. was initially hypotensive likely dilt but bp now stable. past medical history: dvt pernicious anemia esophageal stricture hernia chf ef 45-50% gerd gout htn s/p thoracotomy for hiatal hernia hyperlipidemia copd sbos diverticulitis tremor oa osteoporosis bullous pemphigoid s/p ccy s/p gastro-duodenectomy social history: nursing home resident for the past year, previously in ; no living relatives. had a brother and two sisters that have died in the past two years. his parents died about 10 years ago. he does not have any family living with whom he communicates. family history: no know history of stroke, alzheimers, parkinsons or other neurologic conditions. physical exam: vs 96.2 120 103/65 16 98% 4lnc general: nad, lying comfortably in bed heent: arcus senilis. anicteric, pinpoint pupils. neck: jvp ~7cm, supple, no lad. cardiovascular: s1, s2, , i-ii systolic murmur. lungs: crackles at 1/2 up, mild exp wheezes. abdomen: soft, nt, nd, no rebound or guarding. extremities: warm, no cce neuro: a/ox3, dotw backwards 10s pertinent results: 145/3.6 na/k 117/21.3 cl/hco3 12/0.9 . 05:30am blood wbc-13.9* rbc-2.95* hgb-9.3* hct-27.3* mcv-93 mch-31.4 mchc-33.9 rdw-16.1* plt ct-261 05:59am blood wbc-8.4 rbc-3.19* hgb-9.1* hct-29.7* mcv-93 mch-28.6 mchc-30.8* rdw-16.7* plt ct-410 05:30am blood neuts-90* bands-3 lymphs-2* monos-3 eos-0 baso-0 atyps-0 metas-1* myelos-1* 10:13am blood pt-16.5* ptt-36.6* inr(pt)-1.5* 05:30am blood glucose-88 urean-11 creat-0.8 na-145 k-3.3 cl-117* hco3-19* angap-12 04:25am blood glucose-85 urean-3* creat-0.8 na-140 k-3.8 cl-108 hco3-25 angap-11 04:33am blood alt-8 ast-8 alkphos-47 totbili-0.2 05:30am blood ck(cpk)-14* 05:30am blood ctropnt-0.26* 04:25am blood calcium-7.7* phos-1.5* mg-1.7 04:08am blood albumin-2.0* calcium-6.9* phos-2.7 mg-1.6 05:55am blood vitb12-673 folate-17.7 05:30am blood cortsol-28.3* 11:47am blood cortsol-43.0* 01:22pm blood pep-two abnorm igg-673* iga-99 igm-45 ife-monoclonal 05:59am blood vanco-19.2 . renal u/s the right kidney measures 8.9 cm and the left kidney measures 9.5 cm. there is no hydronephrosis in either kidney. there are multiple anechoic lesions bilaterally, consistent with appearance of simple cyst. there is no evidence of masses or calculi. the examination is limited to patient's inability to cooperate. urinary bladder is collapsed around the foley catheter. impression: no evidence of hydronephrosis. bilateral renal cysts. . cxr one view. comparison with the previous study done . bilateral pulmonary infiltrates persist. there is increased density at the lung bases consistent with small pleural effusions as well. compared with the previous study, interstitial markings in the right upper lung are more apparent. the heart and mediastinal structures are unchanged. a central venous catheter remains in place. impression: persistent bilateral pulmonary infiltrates and pleural effusions. development of increased interstitial markings, which may represent developing edema. . echo conclusions: ef 45-50% the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. there is mild (non-obstructive) focal hypertrophy of the basal septum. overall left ventricular systolic function is mildly depressed. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. significant pulmonic regurgitation is seen. there is a trivial/physiologic pericardial effusion. . mri brain findings: there are multiple small regions of signal loss within the atrophy cerebellar vermis, best appreciated on the sagittal t1-weighted sequence, raising a suspicion for enlarged vessels that may signal a vermian avm. no clear enlarged feeding artery or draining vein, however, are identified. in addition, there is notable linear susceptibility artifact in the subarachnoid spaces surrounding both cerebellar hemispheres, brainstem, and supratentorial brain. this finding most likely represents siderosis secondary to repeated subarachnoid hemorrhage, perhaps from the proposed vermian avm. there are extensive focal and confluent t2 hyperintensities in the subcortical and periventricular white matter of both cerebral hemispheres, brainstem, and the cerebellar hemisphere, representing chronic microvascular ischemia. around csf signal structure of 8-mm in the region of the left basal ganglia, probably represents a dilated perivascular space. there is approximately 3.5 x 4.2 x 3.5 cm arachnoid cyst in the posterior fossa to the left of midline. severe generalized atrophy is present. there is no acute infarct, shift of midline structures, or hydrocephalus. major vascular flow voids are preserved. there is a 2.0 x 2.5 x 0.8 cm low t1/high t2 signal lesion within the occipital bone in the midline, at the level of the skull base, which likely represents an epidermoid. there is likely a mucus retention cyst in the right maxillary sinus. there is mucosal thickening in bilateral ethmoid air cells. impression: 1. no acute infarct. 2. findings concerning for vermian avm and superficial siderosis, secondary to repeated hemorrhages from it. but, evaluation with mra would be achieved. 3. extensive chronic small vessel ischemic change in the supra and infratentorial white matter. 4. severe generalized atrophy. 5. arachnoid cyst in the posterior fossa. 6. likely small occipital bone epidermoid, which could further be evaluated with ct, if needed. 7. mucous retention cyst in the right maxillary sinus and mucosal abnormalities in bilateral mastoid air cells. . mri c-spine findings: there is a pronounced thoracic kyphosis with a compensatory cervical lordosis. there are degenerative changes in the cervical spine with osteophyte formation from c4 through c7 and thickening of the ligamentum flavum from c3 through c6. these cause mild narrowing of the spinal canal but no evidence of spinal cord compression. the study is somewhat limited by motion artifact and not appropriate for evaluating the neural foramina. there appear to be numerous narrowed foramina. however, due to the motion, this is not a reliable assessment. incidentally noted is a cystic-appearing lesion in the occipital bone. recommend correlation with a ct scan. however, this is most likely an epidermoid. there also appears to be a posterior fossa arachnoid cyst. conclusion: no evidence of spinal cord compression. pronounced cervical lordosis with small osteophytes and ligamentum flavum thickening. . lue u/s without dvt brief hospital course: 81m chf, bullous pemphigoid, s/p urosepsis and resolved arf, here w/ afib rvr, multifocal pna, uti and cdiff colitis. . * dysphagia: now known to be s/p gastro-duodenectomy after egd. per s/s eval, aspirates much of what he eats (although this is chronic per his former pcp . . patient states that he does not want a feeding tube. - frequent small meals with thickened liquids - appreciate neuro and gi consults . * weakness: appreciate neuro input. mri brain with microvasc disease + vermian avm and superficial siderosis, secondary to repeated hemorrhages from it. mri cspine without cord compression. tsh, b12, fa wnl. rpr negative. thiamine pending. emg shows severe, chronic, generalized axonal sensorimotor polyneuropathy, generalized myopathy with denervating features. no motor-neuron or pre/post synaptic disorders of neuro-musc. transmission. - f/u as outpatient with neurology. appt made. . * mgus: in his work-up of weakness, spep was sent and was found to have - monoclonal igg kappa, plus monoclonal igg lambda detected: a true biclonal gammopathy. upep neg. per heme/onc curbside, he should have cbc, renal fx, calcium, spep and upep sent q 6 months. low-threshold for xr if he complains of bone pain with concern for multiple myeloma. . * uti: now afeb. fulminant uti at osh in setting of indwelling foley and h/o urosepsis. foley now out. - cover w/ zosyn x 14 days for nosocomial organisms (d10/14) . * multifocal pna: known lll pneumonia at osh - treating for nosocomial pneumonia w/ vanco/zosyn d10/14 (per id curbside). concern that aspiration may be causing this speech and swallow eval but patient willing to take that risk. contine vanc/zosyn per instructions. . * afib/rvr: now rate controlled. continue dilt 30 mg po tid. mri w/ evidence with prior sah so will continue asa but will not re-start coumadin given fall risk and evidence of hemorrhage on mri brain. . * cdiff: stool + for cdiff. was treated with flagyl and diarrhea seemed to resolve but then got worse again. started vanc 250 mg po q6 hrs x 7 days (first day ). . * ? adrenal insufficiency: -stim with appropriate resp. - re-start prednisone 5 mg/day once finished antibiotic course for his h/o bullous pemphigoid . * fen: very nutritionally deficient gastro-duodenal bipass. we are allowing him to take pos in spite of s/s eval. he is aware of risks. he should get frequent, small meals as outlined in the instructions. - electrolytes should be checked on admission and prn - b12, fa, mvi, mag, kcl . * prophylaxis: sqh, ppi. . * access: r picc placed . . * disposition: to nh with pt. . * code status: dnr/dni (confirmed with patient). . communication: with patient and hcp tel . . medications on admission: allopurinol 100 warfarin 2.5 prilosec 20 prednisone 5 lisinopril 2.5 vit b12 meclizine 12.5 tid asa 81 folate 1 apap prn tamsulosin 0.4mg lasix 40 po nectar thickened discharge medications: 1. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q 24h (every 24 hours) for 3 days: through (14-day course). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day): while primarily in bed. 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. diltiazem hcl 30 mg tablet sig: one (1) tablet po tid (3 times a day). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day) as needed for with meals. 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 9. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation every 4-6 hours as needed for shortness of breath or wheezing. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 11. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 4 days. 12. piperacillin-tazobactam 4.5 g recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 4 days: through (14-day course). 13. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 14. magox 400 mg tablet sig: one (1) tablet po once a day. 15. potassium chloride 10 meq tablet sustained release sig: one (1) tablet sustained release po once a day. 16. folic acid plus b12 1-0.8 mg tablet sig: one (1) tablet po once a day. 17. multi-vitamin tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: house rehab & nursing center - discharge diagnosis: multifocal pna uti c. diff colitis afib with rapid ventricular response chronic aspiration secondary to dysphagia mgus generalized sensorimotor polyneuropathy generalized myopathy discharge condition: hemodynamically stable. discharge instructions: you were admitted with a pneumonia that was in many places in your lungs. you are still on antibiotics for this. you developed an infectious diarrhea called clostridium difficile colitis as a result of taking antibiotics. you are still on antibiotics for this. . we discussed that you are likely to continue to develop pneumonias secondary to aspiration but you do not want a feeding tube. followup instructions: you will be followed by the physician at your nursing home. dr. will have a copy of your discharge summary. please make an appointment to see him as needed. tel (. . we have made a follow-up appointment with a neurologist to follow your neuropathy. provider: . / phone: date/time: 2:30 e. campus, bldg, . procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine injection or infusion of thrombolytic agent colonoscopy diagnoses: esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension gout, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation hypotension, unspecified pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes myopathy, unspecified pemphigoid hereditary sensory neuropathy 

Answer: The patient is high likely exposed to