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: sulfa (sulfonamide antibiotics) / bactrim attending: chief complaint: fever/hypotension major surgical or invasive procedure: central line placement. picc line placement. history of present illness: history of present illness: mr. is a 36 yo nh resident with quadraplegia tbi and a demyelinating cns vasculitis w/ pseudobulbar effects (per nh) who presents as a transfer from his nh for fever to 104f and hypotension to 90's this am. nh noted no prior fevers but did note a "dry cough" x approximately 2 weeks. pt is nonverbal, but espouses through finger motion that he has had chest pain, cough, pain on urination and shortness of breath x 7 days. pt also notes arthralgias and myalgias. . in the , pt was found to be hypotensive to sbp of 80's and tachy to 120's with a temp of 104f. pt recieved 2l ns, 1g vancomycin, 60mg phenylephrine, 2 amps (8mg) norepinephrine. a central line was placed. on the floor, pt was initially found to be normotensive with bp 140/80, and hear rate of 90's. continued bleeding from r ij however resulted once he arrived on the floor saturating 2 dressings over 1 hour. surgery was consulted and were able to halt bleeding s/p suturing. past medical history: pmhx (per nh): tbi 22 years ago, demyelinating disorder with cns vasculitis resulting in paraplegia, osteomyelitis, dmii (diet controlled), gerd, anemia allergies sulfa abx, bactrim social history: nh resident rosscomm in , previous smoking history (quit 10 years ago), no current drug use. family history: no h/o neurologic disorders, no recent sick contacts, father deceased at an "early age". mother lives abroad but is in "good health". physical exam: general: alert, oriented, diaphoretic heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: rhochorous bilaterally, +/- wheezes, cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops (cv exam limited by rhoncorous breath sounds). abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 05:20am blood wbc-10.3 rbc-3.61* hgb-10.6* hct-31.8* mcv-88 mch-29.5 mchc-33.5 rdw-15.2 plt ct-287 10:50am blood wbc-7.6 rbc-3.61* hgb-10.8* hct-31.7* mcv-88 mch-30.1 mchc-34.2 rdw-14.5 plt ct-287 02:55am blood wbc-9.2 rbc-3.45* hgb-10.3* hct-30.2* mcv-88 mch-29.8 mchc-34.1 rdw-14.5 plt ct-244 03:00am blood wbc-14.3* rbc-3.91* hgb-11.9* hct-34.6* mcv-88 mch-30.5 mchc-34.5 rdw-14.4 plt ct-293 10:00pm blood hct-37.1* 04:30pm blood hct-35.4* 11:15am blood wbc-20.6* rbc-4.85 hgb-14.7 hct-42.7 mcv-88 mch-30.3 mchc-34.4 rdw-15.3 plt ct-382 11:15am blood neuts-80* bands-4 lymphs-7* monos-9 eos-0 baso-0 atyps-0 metas-0 myelos-0 11:15am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 05:20am blood glucose-120* urean-5* creat-0.8 na-139 k-3.6 cl-104 hco3-26 angap-13 10:50am blood glucose-150* urean-6 creat-0.8 na-136 k-3.7 cl-102 hco3-23 angap-15 02:55am blood glucose-120* urean-7 creat-0.8 na-138 k-3.5 cl-104 hco3-24 angap-14 04:22pm blood glucose-221* urean-11 creat-0.9 na-141 k-3.8 cl-107 hco3-23 angap-15 03:00am blood glucose-147* urean-13 creat-1.1 na-147* k-3.3 cl-109* hco3-22 angap-19 11:15am blood glucose-310* urean-21* creat-2.0* na-140 k-4.0 cl-97 hco3-19* angap-28* 05:20am blood alt-54* ast-60* alkphos-77 totbili-0.7 10:50am blood alt-45* ast-47* ld(ldh)-215 alkphos-65 totbili-0.7 02:55am blood alt-52* ast-50* ld(ldh)-219 alkphos-57 totbili-0.7 03:00am blood alt-68* ast-55* ld(ldh)-280* alkphos-66 totbili-0.6 11:15am blood alt-94* ast-51* alkphos-95 totbili-0.5 05:20am blood phos-3.9 mg-2.1 10:50am blood calcium-8.4 phos-3.5 mg-2.1 02:55am blood calcium-7.7* phos-2.6* mg-2.2 iron-61 03:00am blood albumin-3.7 calcium-8.4 phos-2.0* mg-1.5* 11:15am blood albumin-4.4 02:55am blood caltibc-189* ferritn-197 trf-145* 10:50am blood vanco-8.0* 10:20pm blood lactate-4.1* 04:53pm blood lactate-4.4* 12:19pm blood lactate-5.2* 11:41am blood lactate-7.8* . cxr -impression: left lower lobe patchy opacity may represent atelectasis or pneumonia in the appropriate clinical setting. . cxr -impression: 1. status post left internal jugular central venous line with tip at the cavoatrial junction. 2. low lung volumes with retrocardiac density compatible with atelectasis or pneumonia in the appropriate clinical setting . cxr - left internal jugular line tip is at the level of mid low svc. no evidence of pneumothorax is present. cardiomediastinal silhouette is unchanged. right lung is essentially clear. left basal opacity is unchanged since the prior study and might reflect area of atelectasis but infectious process would be another possibility to consider. . ekg - baseline artifact. sinus rhythm. no previous tracing available for comparison. . rle u/s-impression: no evidence of deep venous thrombosis in the right lower extremity. . micro data-date 6 lab # specimen tests ordered by all all blood culture mrsa screen rapid respiratory viral screen & culture urine all emergency inpatient blood culture blood culture, routine-pending inpatient mrsa screen mrsa screen-final inpatient rapid respiratory viral screen & culture respiratory viral culture-final; respiratory viral antigen screen-final inpatient -negative urine legionella urinary antigen -final inpatient negative mrsa screen mrsa screen-final inpatient urine urine culture-final emergency no growth blood culture blood culture, routine-pending emergency blood culture blood culture, routine-pending brief hospital course: mr. is a 36 yo w/ a pmhx of tbi with secondary demyelinating disorder/cns vasculitis resulting in paraplegia, dm2, gerd, neurogenic bladder who presented with fever/sepsis due to pneumonia. . #sepsis (s/p fever, leukocytosis/tachycardia)/health care acquired pneumonia-pt presented with fever, cough, chest pain, and cxr findings suggestive of pna. pt is a nh resident and necessitated coverage for health care associated organisms as well as atypicals. urine was negative for legionella. respiratory viral screen and culture were negative. pt with h.o neurogenic bladder with intermittent catheterization, but urine culture was negative. initially pt with hypotension in the ed and central line was placed. however, hypotension was fluid responsive and no pressors were required in the icu. pt was started on vanco/zosyn and azithromycin for pneumonia. blood cultures remain negative. pt was called out of the icu on and there was no evidence of hemodynamic instability on the medical floor. he will need to complete a 5 day course of azithromycin (1 more day) and 8 day total course of vanco and zosyn (4 more days). pt was initally on 4l of oxygen and weaned to room air by time of transfer to the medical floor. picc can be removed when antibiotic course is complete. . # hypotension likely was secondary to sepsis and likely complicated by decreased po intake. per , pressors never given, but orders were taken off in the ed. hypotension responsive to ivf. pt without hypotension on in the and did not require iv fluids for hypotension on the medical floor. . # bleeding from pt. had significant bleed from central line insertion site ~ 500cc in the ed/icu. bleeding has stopped s/p suturing. cvl removed on and there has not been further incident. . # acute renal failure. unsure of patient??????s baseline was likely due to sepsis as above. fena <1%. resolved with iv fluids. cr 0.8 on day of discharge. . # hypernatremia, likely secondary to lack of access to free water. resolved. per report given d51/2 ns in icu. . # transaminitis-could be due to above infection and possible hypoperfusion during hypotension. alk phos and bili normal. lfts are still slightly elevated at time of discharge. alt 54, ast 60 on day of discharge. lfts should be monitored at nursing facility. if persistent, should perform ruq u/s and hepatitis serologies. . #dm2-fs qid, placed on humalog sliding scale while admitted. pt had minimal requires. can continue former plan of care present at nursing facility. can consider need for humalog sliding scale at nursing facility. . # post tbi/demyelinating vasculitis w/ chronic spasticity and chronic pain. pt was continued on his previously ordered baclofen and vicodin. on his medication list, it appears that the patient was being given tizanidine 4mg tid. he was not given this medication during admission and did not appear to require it. in addition, he was not given trazodone. speech and swallow consult was ordered given nursing concern and his diet was downgraded to ground solids and nectar prethickened liquids. pt was verbal and answering questions appropriately during admission. . #normocytic anemia-unclear baseline. hct 42.7 on admit. however, 42.7 is likely a reflection of hemoconcentration given hypernatremia and arf on admit. pt did have a significant bleed from his cvl, but cvl discontinued on and bleeding has stopped. iron studies c/w anemia of chronic disease. pt can have cbc checked as needed. can consider need for colonoscopy. hct on discharge 31.8. . # chronic gerd-continued omeprazole . #fen-regular; mechanical soft consistency: ground (dysphagia); nectar prethickened liquids requires assistance with feeding. please give meds whole with nectar thick liquids -s+s consult performed . #prophylaxis: while admitted-hep sc tid, ppi, bowel reg . #code-dnr/dni . # healthcare proxy: sunday/monday(aunt), cell , medications on admission: tizanidine 4mg tid trazodone 25mg qhs vitamin c 500mg vit d 400mg daily asa 325mg daily baclofen 20mg daily calcium carbonate 500mg colace 100mg hydrocodone/vicodin 5/500mg daily lactulose 30ml daily prilosec 20mg daily miralax daily prednisone 10mg daily?? discharge medications: 1. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 4 days. 2. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 4 days. 3. tizanidine 2 mg tablet sig: one (1) tablet po three times a day. 4. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime. 5. vitamin c 500 mg tablet sig: one (1) tablet po twice a day. 6. vitamin d 400 unit capsule sig: one (1) capsule po once a day. 7. aspirin 325 mg tablet sig: one (1) tablet po once a day. 8. baclofen 10 mg tablet sig: two (2) tablet po q 24h (every 24 hours). 9. calcium 500 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po twice a day. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q 24h (every 24 hours). 12. lactulose 10 gram/15 ml solution sig: thirty (30) ml po once a day as needed for constipation. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 14. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 15. azithromycin 250 mg tablet sig: one (1) tablet po once a day for 1 days. 16. insulin continue prior finger stick regimen as prior to admission. can consider need for humalog sliding scale if hyperglycemia. 17. outpatient lab work lfts in 1 week, hct in 1 week. discharge disposition: extended care facility: extended care center - discharge diagnosis: sepsis health care acquired pneumonia acute renal failure hypernatremia history of traumatic brain injury discharge condition: level of consciousness: alert and interactive. activity status: bedbound. mental status: clear and coherent. discharge instructions: you were admitted from your nursing facility with fever and cough and found to a pneumonia with severe infection (sepsis). for this, you were started on antibiotics and your symptoms improved. in addition, you were found to have an impairment in your kidneys and an elevated blood sodium that improved. . medication changes: 1.vanco/zosyn for a total of 8 days. azithromycin for 1 more dose . please take all of your medications as prescribed and follow up with the appointments below. followup instructions: please continue to follow up with your providers at your nursing facility after discharge. procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified other chronic pain anemia, unspecified esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis do not resuscitate status hyperosmolality and/or hypernatremia other complications due to other internal prosthetic device, implant, and graft quadriplegia, unspecified nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] abnormal involuntary movements cerebral arteritis other demyelinating diseases of central nervous system personal history of traumatic brain injury 

Answer: The patient is high likely exposed to