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: zosyn attending: chief complaint: ams and agitation major surgical or invasive procedure: - lumbar puncture - g-j tube repositioning history of present illness: 71 yo m with pt with hx of htn, hl, osa, s/p unrestrained mvc rollover on with tbi, l open ankle fracture, r closed ankle fracture and dislocation, scalp laceration discharged with hospital course complicated prolonged intubation, peri-operative pea arrest and apnea post-op requiring tracheostomy placement on . he was discharged to rehab on on trach collar, and was readmitted from with fever and ams. his infectious source during the last admission was felt to be related to his deep left leg wound, and he subsequently underwent bka on and revision on . he also completed a course of vanco/zosyn during that admission. per in , ma (), he was initially a&ox1 when he arrived on . over the past 2 days prior to admission, he had become more agitated and aggressive. no report of fevers and no diarrhea, they reported that he had no bms since . he had been receiving haldol 2mg via g-tube 3-4 times per day and ativan 0.5mg-1mg for agitation. no report of other new medications started since recent discharge. per his wife and son-in-law, his mental status has been very variable over the past 2 months. at his best, he is a&ox1, calm, and recognized his family members although he is disoriented to time and place. they reoprt that he has not been sleeping much, if at all, since arriving to rehab last week. in the ed, initial vs were: bp 82/36 and spo2 93% (on trach mask, fio2 not recorded, rest of admission vs not recorded). he was febrile to 101.2 in the ed and received 2g ctx for presumed uti (although ua with only 6wbcs and neg nitrite). also received 1000cc ns and ativan 0.5mg iv. prior to transfer to , he received morphine 4mg iv x2 and ativan 0.5mg iv x2. he required frequent trach suctioning and had copious thick secretions. cxr was not appreciably different from cxr prior to recent discharge. on arrival to the micu, patient's vs were t 96.5 hr 99 bp 172/80 rr 20 spo2 93% on trach mask 35% fio2. he is agitated, swinging all 4 extremities and not interactive. unable to follow simple commands and does not answer questions. review of systems: unable to obtain past medical history: htn hypercholesterolemia osa s/p mvc with tbi s/p tracheostomy s/p peg placement s/p ex-fix l ankle; closure scalp lac s/p orif r ankle, washout l ankle s/p debridement l foot/heel. longer trach s/p left bka for deep tissue infection with revision on . social history: presenting from rehab after recent seies of admissions. married and has a daughter. previously reported occasional etoh per omr, none while at rehab recently. family history: non-contributory physical exam: admission exam: t 96.5 hr 99 bp 172/80 rr 20 spo2 93% on trach mask 35% fio2 general: agitated and does not respond to voice heent: sclera anicteric, mmm. pupuls are sluggishly reactive (r more reactive than l) but equal in size neck: supple, trach in place, unable to assess jvp given habitus cv: rrr, no appreciated m/r/g but exam limited by pt's agitation lungs: diffuse ronchi in anterior lung fields abdomen: soft, no appreciable tenderness, obese. gu: foley in place ext: picc in r arm, site is c/d/i. l bka with mild erythema around the incision, no discharge. sutures still in place. neuro: agitated and not following commands, moving all 4 extremities non-purposefully. pertinent results: admission labs: 07:15pm blood wbc-10.2 rbc-3.32* hgb-9.9* hct-30.6* mcv-92 mch-29.7 mchc-32.3 rdw-15.0 plt ct-316 07:15pm blood neuts-82.4* lymphs-9.3* monos-5.8 eos-1.9 baso-0.6 07:15pm blood pt-11.9 ptt-28.4 inr(pt)-1.1 07:15pm blood glucose-138* urean-27* creat-1.1 na-144 k-4.2 cl-108 hco3-26 angap-14 07:15pm blood ck(cpk)-47 05:20am blood alt-44* ast-32 ld(ldh)-236 ck(cpk)-30* alkphos-212* 07:15pm blood ck-mb-2 ctropnt-0.01 07:15pm blood calcium-8.9 phos-4.1 mg-2.1 07:30pm blood lactate-1.3 07:15pm urine color-yellow appear-hazy sp -1.016 07:15pm urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-tr 07:15pm urine rbc-18* wbc-6* bacteri-few yeast-none epi-0 07:15pm urine castgr-9* casthy-11* csf studies: 06:31pm cerebrospinal fluid (csf) wbc-1 rbc-2685* polys-64 lymphs-25 monos-5 eos-6 06:31pm cerebrospinal fluid (csf) wbc-60 rbc-* polys-88 lymphs-4 monos-7 eos-1 06:31pm cerebrospinal fluid (csf) totprot-65* glucose-77 06:31pm cerebrospinal fluid (csf) herpes simplex virus pcr-pnd discharge labs: 05:35am blood wbc-6.6 rbc-2.64* hgb-8.0* hct-23.9* mcv-91 mch-30.4 mchc-33.6 rdw-14.5 plt ct-159 03:54am blood neuts-87.4* lymphs-5.6* monos-4.0 eos-2.9 baso-0.2 05:35am blood glucose-108* urean-14 creat-0.8 na-142 k-3.6 cl-104 hco3-34* angap-8 05:35am blood calcium-8.4 phos-3.6 mg-2.1 micro: -bcx x5: no growth; one blood culture still pending. -ucx x2: no growth -c. diff pcr: negative -sputum x2: no growth -csf cx: no growth; hsv pcr negative -wound culture: rare albicans imaging: -cxr (): findings most suggestive of mild vascular congestion without definite pneumonia. patchy retrocardiac opacity appears minor and may be associated with coinciding atelectasis. if concern for the possibility of pneumonia persists, however, then short-term followup radiographs could be considered, preferably with pa and lateral technique if feasible. -ct head (): stable appearance of the brain. -cta chest/abd/pelvis (): 1. limited assessment of the pulmonary vasculature due to poor iv access without evidence of central or large pulmonary embolism. 2. heterogeneous renal enhancement. correlate with urine culture to assess for pyelonephritis. 3. g-j tube bulb within the anterior abdominal wall (rectus abdominus muscle). 4. small bilateral pleural effusions with dependent atelectasis vs consolidations. 5. mildly enlarged mediastinal nodes. -g/j tube change (): uncomplicated replacement/exchange of 18-french mic gj tube over a guidewire. brief hospital course: 71 yo m with pt with hx of htn, hl, osa, tbi s/p mvc, l open ankle fracture, r closed ankle fracture and dislocation, s/p pea arrest and apnea post-op requiring tracheostomy placement on who now presents with ams and agitation from rehab. ultimately, his agitation was thought to be secondary to a malpositioned gj tube and possible delirium from a pneumonia. his mental status at discharge is dramatically improved. please see below. . # ams and agitation: his baseline mental status is very poor after he suffered from a tbi after an unrestrained mva earlier this year. at his best, he follows commands, nods appropriately, and makes eye contact with family members. his ams and agitation this admission were likely pain from improperly placed g-j tube, may also be from infection as discussed below. his agitation was initially controlled with iv haldol and ativan with moderate success. he briefly required propofol for agitation. his ct abd/pelvis showed that his g-j tube was misplaced with the balloon located in the abdominal wall. it is unclear whether pain from this malposition led to his agitation or whether he pulled the tube during his agitation. regardless, his agitation improved after repositioning by ir and he no longer required standing haldol or propofol. he was started on prn fentanyl for pain control. during the last 24 hours of his hospitalization, his mental status was dramatically improved. he was conversational, oriented to self, hospital and season intermittently but still has some confusion and nonsensical conversations. however, this was much better than his initial presentation. . both neuro and psych were consulted this admission for assistance with his agitation. eeg showed encephalopathy with epileptogenic potential per neurology and he was continued on keppra and started on depakote for mood stabilization. depakote was later stopped per neuro's recs. the pt never had a seizure clinically or on eeg. a repeat eeg was done on which did not show evidence of seizure so they recommended just continuing the low dose keppra. his mental status was dramatically improved and he did not require additional mood stabilizing effects from the depakote. he was also restarted on seroquel 100 po qhs for sleep to help regulate his sleep wake cycle. . of note,the pt reportedly did not respond well to ativan at rehab in the past per the family. . # hcap: pt found to be febrile with leukocytosis, left retrocardiac opacity. other sources of infection were ruled out including urinary, c.diff and intra-abdominal infxn. csf cultures were negative and hsv pcr was negative. he also had an lp which was negative for a bacterial meninigitis. he was empirically started on acyclovir for hsv coverage which was negative when the hsv pcr came back negative. he was treated with 8 days for hcap with vanc and zosyn () initially but he developed worsening fevers which were thought to be a drug reaction and was switched to vanc/meropenem () and defervesced. id followed the patient during this hospitalization. . # hypernatremia: na trended up to 149 and his free water flushes were increased to 150cc q4hr. his serum sodium improved with free water and d5 flushes. . # hypertension: he was hypertensive to 190s systolic upon arrival to the osh and had systolics up to the 170s at in the ed at . his bp remained intermittently elevated to the 170-180s this admission, especially while he was unable to receive meds though his g-tube when is was malpositioned. also, his lisinopril was initially held for elevated creatinine. his bp improved once he was restarted on all of his home medications. . # : creatinine elevated this admission with peak creatinine of 1.4. this improved with holding lisinopril initially and iv hydration. cr improved and he was restarted on lisinopril. . # left bka - ortho rec leaving cast on for now. take off intermittently for a few minutes at a time for comfort prn. discussed with surgery. sutures should be removed next week in ortho clinic. he should be non weight bearing on the right and will have repeat x-rays when he follows up with ortho. . # anemia: hct remained at stable in the mid 20s this admission. . # chronic respiratory failure: he initially had significant sputum production but it improved with suctioning and treatment for pneumonia. he was continued on albuterol and atrovent inhalers. . #fen - the patient was on tube feeds for most of his hospitalization. prior to discharge he had a speech and swallow who recommended thin liquids and ground solids. tube feeds can be adjusted by nutrition depending on po intake. . #ppx - ppi, heparin sc tid. . #access - the patient had a right picc line placed which was repositioned by ir on . the subclavian line placed in the icu was d/ced. medications on admission: -tf - osmolite 1.2 at 45cc/hr -beneprotein 35g daily -protonix 40mg iv daily -labetalol 800mg g-tube q8h -lansoprazole 30mg g-tube daily -calcium carbonate 500mg g-tube tid -seroquel 100mg tid -colace 50mg -mvi 1 tab daily -heparin 5,000 units sc tid -ipratropium 2 puffs q6h -keppra 1500mg -lisinopril 40mg daily -clonidine 0.3mg -amlodipine 10mg daily -haldol 2mg g-tube q8h (started ) -ativan 0.25-1mg iv (started ) discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. labetalol 200 mg tablet : four (4) tablet po tid (3 times a day). 3. calcium carbonate 200 mg calcium (500 mg) tablet, chewable : one (1) tablet, chewable po tid (3 times a day). 4. quetiapine 25 mg tablet : four (4) tablet po qhs (once a day (at bedtime)). 5. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 6. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 7. therapeutic multivitamin liquid : one (1) tablet po daily (daily). 8. clonidine 0.1 mg tablet : three (3) tablet po bid (2 times a day). 9. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 4-6 puffs inhalation q4h (every 4 hours) as needed for prn wheezing. 11. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : 4-6 puffs inhalation q4prn () as needed for prn wheezing. 12. lisinopril 20 mg tablet : two (2) tablet po daily (daily). 13. levetiracetam 100 mg/ml solution : one (1) po bid (2 times a day). 14. haloperidol lactate 5 mg/ml solution : one (1) injection q4h (every 4 hours) as needed for agitation. discharge disposition: extended care facility: - discharge : encephalopathy malpositioned gj tube healthcare associated pneumonia traumatic brain injury left bka discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. right le is non weight bearing. discharge instructions: you were admitted for further evaluation of agitation. you were found to have a malpositioned feeding tube which was repositioned. you were also treated for pneumonia. your mental status improved. you were evaluated by orthoepedic surgery who recommended leaving your sutures in on your left leg until next week. you should follow up with them as scheduled. followup instructions: you should follow up with your pcp when you are discharged from rehab. you should follow up in neurology in months. department: orthopedics when: tuesday at 10:00 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 10:20 am with: , np building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung replacement of gastrostomy tube central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mechanical complication due to other implant and internal device, not elsewhere classified other encephalopathy hyperosmolality and/or hypernatremia delirium due to conditions classified elsewhere below knee amputation status chronic respiratory failure tracheostomy status mechanical complication of gastrostomy late effects of motor vehicle accident personal history of traumatic brain injury 

Answer: The patient is high likely exposed to