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: vancomycin attending: chief complaint: s/p fall, unresponsive, hypotensive major surgical or invasive procedure: scalp laceration repair at the intubation and mechanical ventilation picc line placement history of present illness: 78 yo cantonese speaking m w/ h/o prostate ca on radiation, g6pd deficiency, anemia, myelodysplastic syndrome, hypothyroidism s/p thyroidectomy, and hypertension who presents from osh, transferred with concern for t1 fracture. . was seen in clinic today in routine follow up where vs were wnl- at that time bp 100/58 mmhg pulse 71 temp 97.4 ??????f spo2 100 %. per report, was subsequently running errands when had a mechanical slip and fell. was transported to . in osh ed, alert and hemodynamicaly stable w/ vs: t 97.0, bp 105/46, hr 53, rr 16, o2 sat 99% on ra. labs were notable for hyponatremia to 128, hyperkalemia to 6.4, creatinine of 4.5 and bicarb of 18. lipase was 105. he received bacitracin, lidocaine, tetanus, calcium gluconate 1 g, dextrose, insulin 10 units, 1 l ns, 50 meq nahco3. he underwent ct head and c spine- negative for acute bleed, but showed concern for fracture at t1 involving r pedicle. his forehead laceration was cleaned and repaired w/ sutures and he was transferred to for further management. . in the ed, initial vs were: t 96.5 bp 110/57 hr 66 rr 18 o2 sat 94% on ra. on arrival here, he was arousable only to vigerous sternal rub, w/ some spontaneous movements of all 4 extremities. pupils were midsize equal and reactive. he quickly became hypotensive to 70s systolic. fast exam negative, no pericardial effusion on bedside ultrasound. normal rectal tone, guaiac negative. son was notified and reported pt is full code so was intubated w/ 7.5 endotracheal tube w/ 20 mg etomidate, 60 mg rocuronium, lidocaine 100 mg, and was started on a propofol gtt running at 10. he received 2 l ns w/ response in bp and was started on levophed. he was able to be weaned off this within one hour. he received an additional liter of ns, vancomycin and zosyn for broad coverage. a triple lumen femoral line was placed under sterile conditions. ua remarkable for >182 wbcs, + le, but no nitrites or bacteria. ucx, and blood culture were sent. he underwent pan ct scan of head, c-spine, and torso which in prelim showed no fractures, but some fluid/stranding at the pancreas. surgery was consulted who remarked that ct abd findings were unlikely to be related to trauma, and that the pt may have some pancreatitis- they recommended repeat ct abd w/ po contrast. pt was admitted to micu7 for further management- vs on transfer were: hr 67 bp 119/63 rr 16 o2 sat 100% on 500 x 16 peep 5 fio2 50%. . on arrival to the micu, patient was intubated and sedated and unresponsive to verbal stimuli. mild response to sternal rub, and was moving all extremities spontaneously. past medical history: prostate cancer (gleasons 4+3 adenocarcinoma s/p zoladex, xrt) hypertension ckd stage 3 hyperparathyroidism ckd g6pd anemia- macrocytic (early mds, g6pd, neg ) myelodysplastic syndrome osteoporosis h. pylori w/ chronic gastritis (on egd ) hypothyroidism s/p thyroidectomy hld trigeminal neuralgia gout social history: lives alone in a senior housing complex in . widower. has two children- son (here in ma) and daughter (in ). widower. formerly worked at in food services. no tobacco, etoh, or illicits. family history: non-contributory. physical exam: admission exam: vitals: t: 92.3 (rectal) bp: 165/63 p: 65 r: 15 o2: 100% general: intubated, sedated, arouses faintly to sternal rub heent: sclera anicteric, dry mm, og and ett in place, perrl neck: cervical collar in place, unable to assess jvp cv: bradycardic rate and rhythm, normal s1 + s2, diastolic murmur, no rubs, gallops lungs: coarse bs b/l anteriorly, no wheezes, rales, ronchi abdomen: soft, distended, bowel sounds present gu: foley ext: cool, 2+ radials, dps, pts; no clubbing, cyanosis or edema neuro: sedated, but arouses to sternal rub w/ eye opening, perrl, moves all four extremities spontaneously discharge exam: vitals: tm 99.4 tc 97.7 130-140s/60-70s 58 18 96ra general: nad, alert, awake, interactive. heent: front scalp laceration s/p repair at osh dressing covered, partially stained with dry serous drainage. no e/o active drainage. non-tender. no surrounding erythema. no warmth. sclera anicteric, mmm, eomi ear: external exam: no erythema or edema. no tenderness with pulling the auricles. no tenderness to palpation over the mastoid. no discharges. neck: neck supple cv: rrr, normal s1, s2, iii/vi sem heard best at the lusb, not radiating, no rubs, gallops lungs: ctab abdomen: soft, mildly distended, non-tender, no organomegaly, bowel sounds present. no cva or suprapubic tenderness. ext: warm, no edema 2+ dps, 2+ radial neuro: cnii-xii grossly intact. no focal deficits. skin: marked improvement with leg rash now only involving the l outer thigh. blanching. confluent coalescing small erythematous macules pertinent results: admission labs: 10:54pm lactate-1.5 10:30pm glucose-179* urea n-65* creat-3.5* sodium-133 potassium-5.0 chloride-109* total co2-11* anion gap-18 10:30pm ld(ldh)-254* ck(cpk)-290 10:30pm ck-mb-7 ctropnt-0.01 10:30pm calcium-7.6* phosphate-4.5 magnesium-2.3 10:30pm free t4-1.1 10:30pm cortisol-14.2 10:30pm wbc-6.7# rbc-2.53* hgb-8.7* hct-25.8* mcv-102* mch-34.5* mchc-33.8 rdw-15.5 07:40pm urine color-straw appear-hazy sp -1.008 07:40pm urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-lg 07:40pm urine rbc-2 wbc->182* bacteri-none yeast-none epi-0 07:40pm urine hours-random urean-365 creat-44 na-47 k-21 cl-35 07:40pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 07:40pm urine osmolal-282 other labs: 10:54pm blood lactate-1.5 04:55pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 07:41am blood vanco-15.7 10:30pm blood cortsol-14.2 10:30pm blood free t4-1.1 04:55pm blood tsh-5.4* 02:32am blood osmolal-302 02:30am blood albumin-2.6* calcium-7.9* phos-5.3* mg-1.9 04:55pm blood ctropnt-<0.01 10:30pm blood ck-mb-7 ctropnt-0.01 04:55pm blood lipase-96* 02:30am blood lipase-45 04:55pm blood alt-12 ast-20 alkphos-41 amylase-108* totbili-0.1 02:30am blood alt-18 ast-42* ld(ldh)-328* alkphos-42 amylase-115* totbili-0.7 discharge labs: 05:49am blood alt-17 ast-30 alkphos-39* totbili-0.5 05:51am blood pt-12.1 ptt-70.5* inr(pt)-1.1 05:09am blood wbc-5.5 rbc-2.72* hgb-9.0* hct-25.1* mcv-92 mch-33.0* mchc-35.7* rdw-17.2* plt ct-178 05:09am blood glucose-103* urean-44* creat-2.6* na-141 k-4.3 cl-111* hco3-21* angap-13 microbiology: blood cultures 3/1: pending, no growth to date at time of discharge urine culture : negative blood cultures : pending, no growth to date at time of discharge sputum culture : sparse growth commensal respiratory flora, rare growth gnrs urine culture : yeast ~/ml. urine legionella antigen : negative stool : negative for c. diff stool : negative for c. diff imaging: ct head: no acute intracranial process or fractures. ct c-spine: 1. no acute fracture or malalignment. 2. small amount of fluid superior to the endotracheal tube balloon. ct torso: 1. peripancreatic fluid - could be related to pancreatic injury or acute pancreatitis. clinical correlation is recommended, correlate with serum pancreatic enzyme levels. 2. thick urinary bladder wall - correlate clinically for underlying infection. 3. bilateral dependent opacities in the lungs likely atelectasis and/or aspiration. echo: the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef 75%). 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. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is borderline/mild posterior leaflet mitral valve prolapse. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. ct abd/pelvis w/oral contrast: 1. mild stranding and free fluid in the upper abdomen. based on prior ct, early pancreatitis is favored, with gastritis and duodenal injury less likely. 2. increasingly distended gallbladder, with possible sludge/stones. consider ultrasound if there is clinical concern for acute cholecystitis. 3. thickwalled bladder, suggesting outlet obstruction versus infection/inflammation. 4. mild volume overload with pleural/pericardial effusions, ascites, and anasarca. 5. infrarenal aortic ectasia. lenis: impression: non-occlusive peripheral deep vein thrombosis of the proximal femoral vein with central flow within it. this is consistent with an old recanalized deep vein thrombosis. no acute dvt. cxr: tip of the endotracheal tube has been partially withdrawn, now no less than 3 cm from the carina. nasogastric tube loops in the stomach ending in the fundus. mild-to-moderate cardiomegaly and mild pulmonary vascular congestion have both improved, and there is no pulmonary edema. greater opacification at the base of the left lung is probably a combination of persistent atelectasis and increasing small left pleural effusion. no pneumothorax. cxr: continued decrease in central pulmonary vascular prominence. no edema. small bilateral pleural effusions, with interval improvement on the left. improved bibasilar atelectasis, particularly at the left base. brief hospital course: 78m with past medical history notable for prostate adenocarcinoma on xrt, ckd stage iii, mds, g6pd deficiency, hypothyroidism and recent uti on treatment transferred from osh after a mechanical fall with concern for t1 fracture, with course c/b hypotension and hypothermia presumably secondary to septic shock, initially requiring intubation, mechanical ventilation, aggressive ivf, pressors, and broad spectrum antibiotics. was ultimately felt shock was due to sepsis, from urinary source. # fall and head injury: fall mechanical in nature. was initially concern for t1 fracture based on osh imaging, though imaging at did not show evidence of a fracture. additionally, no acute intracranial process was seen on imaging. patient did not have any focal neurologic deficits on exam. he did sustain a scalp laceration that was sutured at prior to transfer. there was no evidence of infection involving the scalp laceration. patient will need suture removal if scalp laceration appears healed. will need pt at rehab. # shock patient suddenly became hypotensive with sbp to 70s in the ed. fast was negative. there was no pericardial effusion on bedside echo. he was guaic negative. he was intubated and sedated given altered mental status (as below). received 2l ns with bp response and was put on levophed. bp improved quickly and he came off pressors within hours. ua was notable for many wbcs and + le, but no nitrates or bacteria. he was admitted to micu. in the micu, he again required pressors, but briefly and in setting of being on sedation. he continued to have aggressive fluid resuscitation. he received broad spectrum antibiotics, including vancomycin, zosyn, cefepime, levofloxacin, azithro, flagyl. antibiotics eventually narrowed to levofloxacin for presumed uti, given known history of urinary retention, prostate cancer currently on radiation treatment, prior utis, and dirty ua on presentation. ucx and bcx were negative (though in setting of recent outpatient antibiotics). sputum cx revealed gn rods, but cxr revealed no e/o infective process. patient was also found to have purulent discharge from both ears, consistent with bilateral otitis media. there was no leukocytosis, but he has mds. he was extubated without difficulty on , and transferred to medicine floor on . he remained hemodynamically off pressors and continued to do well on throughout the remaining hospital course. it was thought that septic shock from urinary source was the most likely explanation for his hypotensive episode. of note, patient had a peri-pancreatic inflammatory picture and gallbladder distention on ct, with no clinical correlation (unremarkable lfts, only slightly elevated lipase that trended down to normal, and no abdominal pain). other causes of shock, such as cardiogenic shock, deemed less likely in the setting of normal lv function on echo and negative cardiac enzymes. history of poor po intake suggested possible hypovolemic status, but there was no evidence suggesting large volume loss on imaging studies or lab tests. adrenal insufficiency unlikely given normal cortisol level. he was discharged with plan to complete 10d course of levofloxacin (last day ) which will cover both uti and otitis media. # hypothermia: likely secondary to septic shock. tsh slightly elevated but free t4 normal, and cortisol wnl. temperature improved quickly with antibiotic therapy and bair hugger. # respiratory failure: he was intubated due to an unresponsive state and failure to protect his airway, but there was no clear h/o any hypoxia. abgs while on mechanical ventilation suggested that he was oxygenating relatively well. did however have a-a gradient and some opacities in bases, likely atelectasis, which gradually improved. he was extubated on without incident prior to transfer to the floor. he was diuresed with lasix 10mg iv prior to transfer. did not require supplemental o2 on the floor. repeat cxr did not show any edema, bilateral effusions had improved, and atalectasis had improved. should have repeat cxr in several weeks to confirm that there are not any persistent abnormalities. # unresponsiveness he had sudden onset on unresponsiveness w/o any known prodrome. given hypotension on presentation, possibly related to hypoperfusion. no evidence of other toxins on serum/urine tox screen. no historical clues to suggest meningitis, but likely that infection played a large role given degree of hypotension and hypothermia. neuro exam was non focal. ct head negative for any acute pathology. mental status improved after abx and ivf resuscitation. he remained alert, awake and interactive throughout the remaining hospital course. # otitis media: per patient, he had purulent discharge from both ears starting two days before the admission. he continued to have purulent discharge l > r. the ear cannals appeared erythematous and injected. patient remained asymptomatic without significant change in hearing difficulty (hard of hearing at baseline). discharge gradually subsided throughout the remaining hospital course. he was discharged with the plan to complete total 10d course of levofloxacin as above (last day ). . # on ckd: he had elevated cr at 4.5 at osh prior to transfer from baseline of 1.3. urine chemistry and clinical history was most consistent with ischemic atn superimposed upon his ckd. he briefly required lasix in the micu. he otherwise maintained good uop on the floor. cr continued to improve (2.6 on the day of discharge) with improved hemodynamic state and aggressive fluid resuscitation. he remained hemodynamically stable, asymptomatic. enalapril was held, but can likely be restarted in outpt setting once renal function improves back to baseline. medications were renally dosed when appropriate. . # diarrhea he developed frequent loose stools after transfer to the floor. this was thought to be related to recent multiple abx administration, and possibly related to his recent radiation treatments. c diff testing was negative x2. given no abdominal pain, leukocytosis or fever, had low clinical suspicion for c. diff. abdominal exam was benign. patient received continued fluids. . # anemia: he presented with a hct that 6 points lower than his recent hct on . baseline hct appears to be 29-30. he was transfused 2 units with an appropriate bump in hct. has had extensive w/u including negative egd and colonoscopy outpatient. anemia currently attributed primarily to early myelodysplastic syndrome. patient also has h/o g6pd. no evidence of hemolysis during the admission. patient was guiac neg in ed, and did not have any evidence of bleeding on imaging. hct was trended daily and ranged 23-27 on the floor. . # rash he developed confluent coalescing blanching erythematous macules covering the entire lower extremities, sparing a few ovoid patches over the shins and back in the setting of multiple abx administration. rash improved after most of the antibiotics were discontinued (including vancomycin; as above) to near resolution prior to discharge. . # non-occlusive chronic dvt he was started on a heparin drip after he was noted to have r dvt on lower extremity ultrasound. however, final report of ultrasound suggested a non-occlusive peripheral deep vein thrombosis of the proximal femoral vein with central flow within it, consistent with an old re-canalized deep vein thrombosis. he was asymptomatic, and could not recall a history of dvt/pe. as dvt not felt to be acute, heparin gtt d/c'd. . # peripancreatic fluid collection on ct: there were ct findings concerning for pancreatitis, but there was no clinical correlation. patient did not have any nausea, vomiting, or abdominal pain and had and unremarkable abdominal exam. amylase and lipase only mildly elevated. no intervention other than fluid resuscitation and serial abdominal exams. . # hypothyroidism: s/p thyroidectomy. tsh was slightly elevated, and free t4 was normal. his home levothyroxine was continued. should have repeat tfts in outpatient setting once acute issues resolve. . #. htn: his home atenolol and enalapril were initially held in setting of hypotension and . atenolol restarted prior to discharge. enalapril was held given , but can likely be restarted in outpatient setting once renal function improves. . # osteoporosis: calcium, vitamin d. receives alendronate every 2 weeks. . #. chronic gastritis: continued ppi. . # hyperlipidemia: continued statin. . # trigeminal neuralgia: continued gabapentin, renally dosed. . # gout: continued allopurinol, renally dosed. # prostate cancer: patient currently getting xrt and per his son he only has a few sessions left. he is having difficulty with excessive urination at home and per report has not been drinking as much as a result. he also reportedly had hypotension on flomax which was recently stopped and has led to an exacerbation of his symptoms. he would likely benefit from re-initiation of flomax if bp remains stable at rehab. he is scheduled to return to xrt . transitional issues: -needs removal of sutures from the scalp laceration repair on -should continue levofloxacin for 5 additional days (last day ) to treat uti, otitis media -picc line should be removed prior to discharge home from rehab -please monitor renal function (check chem7 on and at least 3 times per week at rehab) to ensure renal function trending back to baseline (cr 1.3-1.5) -please re-dose meds for renal function (including levofloxacin, allopurinol, gabapentin) -restart home enalapril once kidney function back at baseline. -repeat thyroid function tests once acute illness resolved -home safety evaluation for elderly fall risk -patient's code status was confirmed as full code this admission -contact is patient's son medications on admission: enalapril maleate 10 mg oral tablet 1 po bid gabapentin 300 mg tid allopurinol 200 mg daily tamsulosin 0.4 mg er po daily finasteride 5 mg po daily simvastatin 40 mg po daily docusate sodium 100 mg prn levothyroxine 100 mcg oral (take 1 tablet four times per week and of a tablet three times per week.) alendronate 70 mg q2weeks atenolol 12.5 mg po daily omeprazole 20 mg daily triamcinolone acetonide 0.1 % dental paste tid prn calcium-cholecalciferol (d3) 600 mg (1,500 mg)-400 unit cap (calcium carbonate/vitamin d3) daily discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 2. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 3. finasteride 5 mg tablet sig: one (1) tablet po once a day. 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po every other day (every other day): four times per week. 6. levothyroxine 50 mcg tablet sig: one (1) tablet po every other day (every other day): three times per week. 7. alendronate 70 mg tablet sig: one (1) tablet po q2wks. 8. atenolol 25 mg tablet sig: 0.5 tablet po daily (daily). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. triamcinolone acetonide 0.1 % paste sig: one (1) application dental three times a day as needed. 11. calcium 600 + d(3) 600 mg(1,500mg) -400 unit tablet sig: one (1) tablet po once a day. 12. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. 13. levofloxacin 250 mg tablet sig: one (1) tablet po once a day for 5 days: last day . 14. picc line flush heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: health care center discharge diagnosis: primary diagnoses: mechanical fall scalp laceration shock acute toxic metabolic encephalopathy urinary tract infection otitis media acute kidney injury anemia drug rash secondary diagnoses: prostate cancer hypertension hyperlipidemia gout hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were transferred to after falling and hitting your head on . you were initially brought to , where there was concern for a fracture in your back. however, our scans here did not show any evidence of a fracture. while you were in the emergency department, your temperature and blood pressure dropped suddenly and you became unresponsive. you needed a breathing tube to help protect your airway, and fluids and medications to help raise your blood pressure. you stayed in the intensive care unit briefly. you were treated with various antibiotics for your ongoing urinary tract infection and ear infection. you improved rapidly. you stayed free of fever and had no pain anywhere. your ear infection improved. your kidney function also started to improve. you should finish your prescribed antibiotics course (last dose ) for your urinary tract infection and ear infection. your scalp laceration was repaired at the . you should get the stitches removed after if the laceration on your head is well healed. your pcp or doctors at the rehab will help arrange this. you developed rash on your legs which may have been caused by one of the antibiotics you received (vancomycin). the rash improved when we stopped this medication. you developed diarrhea. we think this is related to antibiotics. we tested you for an infectious cause of diarrhea called c. difficile, but this test was negative. your diarrhea should improve on its own shortly. please make sure to drink plenty of water (at least 6 glasses of water daily) when you go home. we have made the following changes to your medications: - stopped enalapril (you can restart this when your kidney function returns to normal, please discuss with your doctors) - stopped docusate sodium (colace) while you are having diarrhea - decreased gabapentin to 300 mg daily - decreased allopurinol to 100 mg every other day - added levofloxacin 250 mg daily (for urinary tract and ear infections), last day will be - added sarna cream as needed for itching we have continued all your other medications and adjusted some of their doses for your decreased kidney function. followup instructions: please follow-up with your primary care doctor, dr. , following your discharge from rehab. the number to schedule an appointment is . ongoing radiation treatment at the atrius cancer center drs. and next appointment at 14:15 dr. nephrology 10:30 am appointment procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization central venous catheter placement with guidance diagnoses: acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified septicemia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified pulmonary collapse open wound of forehead, without mention of complication myelodysplastic syndrome, unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) osteoporosis, unspecified septic shock dermatitis due to drugs and medicines taken internally secondary hyperparathyroidism (of renal origin) metabolic encephalopathy accidents occurring in residential institution fall from other slipping, tripping, or stumbling mixed acid-base balance disorder trigeminal neuralgia unspecified antibiotic causing adverse effects in therapeutic use glycogenosis nonsuppurative otitis media, not specified as acute or chronic 

Answer: The patient is high likely exposed to