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: unasyn attending: chief complaint: "cardiogenic shock, chf, critical as" major surgical or invasive procedure: cardiac catheterization attempted balloon angioplasty cvvh intubation history of present illness: 71-year-old man with as undergoing corevalve eval for critical aortic stenosis, s/p complicated cardiac cath on (hematoma) groin p/w with cp and sob s/p intubation was at rehab after admission (see below). on he was combative, delirious. on he c/o cp and sob. sent to nvmc ed with t98.3, hr 108, rr 18, bp 117/47, 84% on ra. he received 60mg iv lasix and bipap. admitted to a telemetry float. iv dapto (600) and gent (120) given. on , at 0120, he received 40mg iv lasix for sob and was intubated at 2am and started on propofol. no vasopressors. cxr with "extensive fluffy infiltrates that appeared nodular". abg showed 7.35/40/94 on 100%fi02, peep 5, tv 700 on ac at rr12. net fluid balance was 800 negative. cultures were drawn. wbc 6.7, hbg 9.3, hct 26.3, plt 312. na 132, k 3.6, cl 94, hco3 26, bun 33, cr 2.28 (from 1.86 overnight. ace and bb were held due to "soft" blood pressures. he was transferred to the ccu intubated on propofol. in the ccu, he was tachy to 130 and hypotensive to 90's. his cxr yielded a diffuse patchy infiltrate. his picc line transduced a cvp of 9. he received 2.5 mg of metoprolol tartrate to bring rate to 100. ekg was unchanged despite rate decrease with precordial st-depressions, avr elevation. he received 500cc of ns bolus (250 x 2). propofol was dc'd. last admission was admitted on with hematoma following cardiac catheterization which disclosed rca disease. he had ecchymoses throughout right groin, including swelling and discoloration of genitals. ultrasound revealed pseudoaneurysm of the femoral artery with bleeding resolved by thrombin injection, confirmed by us. the patient developed fever on and increased oxygen requirement. 8/8 bottles were growing enterococcus faecalis as was his urine. tte was without vegetation. he was treated as endocarditis. wbc scan showed a single focus near posterior liver, may also be in pleural space, but no reason to believe aaa graft was infected by scan. infectious disease was consulted and started patient on regimen of daptomycin (patient had anaphylaxis to unasyn) and gentamicin. within 48 hours, the patient had defeveresced. his blood cultures from onward were negative. assorted problems during last admission during an episode of oxygen desaturation, an ekg was checked, which showed no st or t wave changes. the patient had troponin elevation (0.57), but ck-mb (2) resolved. patient's cr rose to 1.6 from 1.2 and later fell to 1.3 on discharge. cardiac surgery has declined av replacement. patient underwent cta chest/ct cardiac and pfts as part of corevalve work-up. episodes of abdominal pain with negative bloodtests. ruq ultrasound ordered for unclear indications and showed cholelithiasis without cholecystitis. past medical history: -peripheral vascular disease: s/p endovascular aaa repair with a excluder device on . 23 x 160 mm main body device and a 12 x 100 mm right iliac contralateral limb device cta post implantation have failed to show any evidence of endoleak. non healing ulcer . he underwent left femoral to posterior tibial bypass graft with nonreversed saphenous graft and angioscopy by dr. . following surgery, his left leg ulcer had improved. -s/p right carotid endarterectomy with patch angioplasty . -hypertension, essential -hyperlipidemia -right eye cataract last year; left cataract is pending. -chronic renal insufficiency -history of osteomyelitis -osa -history of gi bleed -chronic back pain -chronic tremor social history: he has been living with his sister since with his medical disability. he does not currenly smoke but did smoke 3 packs per day for 20 years. he does not drink alcohol. family history: there is a family history of diabetes and heart disease. there is no history of hypertension or strokes. his mother died at age years of alzheimers and his father died at 69 of diabetes and coronary artery disease. he has three healthy children. physical exam: admission exam t 97.2 bp 134/53 hr 63 rr 18 96% ra : tm 99.0 bp 104-134/61-71 hr 78-99 rr 16-18% ra gen: nad, intubated, sedate. responded to questions, squeezed hand. heent: ncat perrla, intubated resp: lungs rhonchorous with diffusely decrease sounds, crackles. cv: tachy, s1/s2, holosystolic murmur that radiates to carotids. abd: soft, non-tender, protuberant, bowel sounds positive. no tenderness to palpation. ext: slighlty mottled l>r leg, thready dp bilaterally. edematous (mild pitting) . discharge exam: temp current: 98.4 hr: 80-81 rr: 18 bp: 128-132/44-64 o2 sat: 98% ra gen: nad, appears comfortable heent: ncat, mmm, no jvp elevation cv: rrr, crescendo/decrescendo murmur at rusb resp: ctab anteriorly and upper post abd: soft, nt/nd, pos bs ext: no le edema, dp pulses 2+ neuro: moves all extremities, follows commands, responds with yes/no skin: warm, dry, no open areas noted (back not assessed) pertinent results: admission labs: wbc-9.8# rbc-3.55* hgb-10.5* hct-30.9* mcv-87 mch-29.4 mchc-33.8 rdw-14.2 plt ct-557*# neuts-75* bands-1 lymphs-18 monos-4 eos-0 baso-0 atyps-1* metas-0 myelos-1* pt-14.3* ptt-27.9 inr(pt)-1.2* glucose-204* urean-40* creat-2.7*# na-137 k-4.2 cl-95* hco3-27 angap-19 calcium-8.5 phos-7.6*# mg-2.2 gentamycin-5.5 type-art po2-51* pco2-65* ph-7.23* caltco2-29 base xs--1 lactate-3.0* wbc-5.5 rbc-3.38* hgb-9.7* hct-29.4* mcv-87 mch-28.8 mchc-33.1 rdw-14.2 plt ct-595* glucose-270* urean-51* creat-2.9* na-134 k-4.9 cl-97 hco3-23 angap-19 glucose-298* urean-63* creat-3.7* na-131* k-4.5 cl-94* hco3-19* angap-23* ck-mb-3 ctropnt-0.13* calcium-8.0* phos-6.8* mg-2.2 lactate-6.7* 04:00am blood wbc-6.4 rbc-2.91* hgb-8.6* hct-25.0* mcv-86 mch-29.7 mchc-34.6 rdw-14.5 plt ct-483* alt-447* ast-685* alkphos-56 totbili-0.7 gentamycin-0.5* lactate-1.8 alt-51* ast-34 ld(ldh)-278* alkphos-73 totbili-0.3 discharge labs: wbc-7.5 rbc-3.89* hgb-10.9* hct-34.8* mcv-90 mch-28.1 mchc-31.4 rdw-17.1* plt ct-406 glucose-205* urean-54* creat-2.3* na-140 k-4.1 cl-104 hco3-27 angap-13 calcium-8.6 phos-4.1 mg-2.3 wbc-8.1 rbc-3.79* hgb-10.5* hct-33.8* mcv-89 mch-27.8 mchc-31.2 rdw-17.0* plt ct-452* glucose-176* urean-49* creat-2.4* na-140 k-4.5 cl-104 hco3-26 angap-15 calcium-8.7 phos-3.6 mg-2.3 wbc-9.3 rbc-4.03* hgb-11.3* hct-35.9* mcv-89 mch-28.1 mchc-31.6 rdw-16.9* plt ct-464* pt-26.9* ptt-30.5 inr(pt)-2.6* glucose-158* urean-38* creat-2.0* na-142 k-4.1 cl-108 hco3-28 angap-10 calcium-8.7 phos-3.6 mg-2.2 microbiology: blood culture source: line-picc. blood culture, routine (final ): no growth. sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): sparse growth commensal respiratory flora. stool consistency: not applicable source: stool. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). urine source: catheter. urine culture (final ): proteus mirabilis. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- 8 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s tobramycin------------ 4 s trimethoprim/sulfa---- <=1 s imaging tte (): focused views pre/post aortic valvuloplasty. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. no aortic regurgitation is seen prior to valvuloplasty. mild (1+) aortic regurgitation is seen after valvuloplasty. there is moderate thickening of the mitral valve chordae. moderate (2+) mitral regurgitation is seen. there is no pericardial effusion. kub (): 1. no evidence of obstruction or ileus. 2. no evidence of free air on these supine radiographs. ct head () impression: left parietal hypodensity extends to the cortex and has an appearance of subacute infarct of few days' duration. however, clinical correlation recommended. no hemorrhage seen eeg () impression: this is an abnormal eeg due to the presence of a background frequency asymmetry suggesting a large area of subcortical abnormality involving the left hemisphere. additionally, the presence of a slower than normal background with bursts of generalized slowing is consistent with a mild to moderate encephalopathy of toxic, metabolic, or anoxic etiology. cta head/neck () impression: subacute-appearing infarct with some blood products in the left parietal lobe. no acute infarct is seen. no mass effect or hydrocephalus. note is made of decreased flow void in the right cavernous carotid artery. impression: right internal carotid artery has markedly diminished flow. the internal carotid was described to be normal on a previous duplex ultrasound on . axial source images do not give appearance of a dissection, but further evaluation with cta is recommended after consideration of patient's renal insufficiency. mpression: diminished flow signal in the right cavernous and petrous carotid could be due to occlusion or markedly slow flow. carotid u/s () right - nice brisk upstoke, minimal diastolic flow, diminuitive ica and potential dissection versus intracranial carotid disease- cta and clinical correlation is suggested. brief hospital course: 71 m with as (0.8) and one vessel cad p/w resp. distress that prompted intubation. he is presently hypotensive, tachycardic and profoundly hypoxic. . acute issues: # hypoxia - patient arrived intubated after presenting to osh with sob. bilateral pulm infiltrates were severe and most radiologically c/w pulm edema. however, the patient had fluid responsive tachycardia and a low cvp (through the picc). his resp distress progressed despite lasix diuresis at nvmc. accordingly, initial differential included ards from sepsis (see below), dad, multifocal pna, flash pulmonary edema and daptomycin pneumonitis. he was ventilated with ardsnet settings. pt was able to be weaned to minimal ventilator settings by day 8 of intubation. however, extubation was delayed due to pt's mental status. despite holding sedation for several days, pt remained non-responsive. he was successfully extubated on day 11 of intubation. he successfully transitioned from nasal canula to room air and has an oxygen saturation of 97-100% on room air at time of discharge. . # hypotension - inital presentation with low cvp implies poor preload implicating aortic stenosis as a cause. tachycardia improved with fluid boluses supporting poor preload. differential also included cardiac event, sepsis, peep effect and propofol. fluids and pressors were administered with goal map > 60. palliative valvuloplasty was attempted. tte showed post-valvuloplasty aortic valve area of 0.8cm2. he was pan-cultured and initially continuted on vancomycin (gentomycin was held given ). he was successfully weaned off pressors and maintained map >65. . # e. faecalis infection: pt diagnosed with e.faecalis on previous admission and was discharged on dapto/gentamycin. in interim, pt developed that was attributed to gentamycin toxicity. dapto/gent was discontinued and he was started on vancomycin (vanc sensitivity mic of 2). infectious disease team was consulted and per their recommendations, vancomycin was discontinued due to risk of increasing kidney injury. pt was resumed again on daptomycin. blood cultures remained negative during this hospitalization. he is to complete a 6 week course of daptomycin for bacteremia (should be discontinued around - however exact date of discontinuation should decided at follow-up id appointment on ). . # uti: pt developed fever and leukocytosis during his icu stay. a ua demonstrated pyuria, and he grew proteus resistant to cipro but sensitive to ceftriaxone. he was started on ceftriaxone 1gm daily for a 14 day course which should be completed on . . # atrial fibrillation: pt developed new onset paroxysmal atrial fibrillation during hospitalization with heart rates up to 150s. he was rate controlled with iv and po metoprolol. he was loaded with amiodarone and was started on anticoagulation with heparin and coumadin. he spontaneously converted back to sinus rhythm and has remained in sinus for several days without any recurrence of afib. he was taken off heparin drip once inr was theraputic at 2.0-3.0. he should be continued on amio 400 mg po daily for 1 week, and then decreased to maintenance dose of amio 200 mg po daily. his inr has been theraputic on coumadin 5mg po daily. . # renal failure - pt presented with acute renal failure, thought to be secondary to gentamicin use with a creatinine that peaked at 3.7. pt' severe respiratory distress was thought to be due to volume overload so cvvh was initiated. there were issues of kinking with the cvvh catheter and the line had to be replaced two times in order to achieve adequate flow. pt tolerated cvvh well with only one episode of hypotension thought to be related to excessive fluid shifts during the cvvh. cvvh was discontinued on when pt began putting out good urine to iv lasix. by the end of his stay, pt was euvolemic, his creatinine was trending down and he no longer required lasix. . # altered mental status/stroke - there was difficulty extubating patient due to persistent mental status alteration. he was inconsistently responsive to painful stimuli and failed to respond to simple commands even though he had been quite alert and interactive prior to his hospitalization. this altered mental status was initially attributed to oversedation during intubation so sedation was withheld for several days without any improvement in mental status. concern was then raised for ischemic stroke given his recent episodes of atrial fibrillation (see below). on exam, it was noticed that he seemed to had clonus on his right side and appeared to have gaze preference to the left. neurology was consulted who recommended a ct head and mri/mra of the head. ct head showed left parietal hypodensity extending to the cortex with an appearance of subacute infarct of few days' duration. follow-up mri/mra confirmed these findings but also showed diminished flow in the right ica. f/u ultrasound of the carotids demonstrated intracranial dissection on the right but per vascular surgery, no intervention is needed and he can follow-up with vascular surgery in six months for interval evaluation of any changes. however, he should be further evaluated with cta once his renal function improves. most likely etiology of the stroke is thrombus dislodged during valvuloplasty or during pt's episodic episodes of atrial fibrillation. after patient was successfully extubated, his mental status improved significantly. he was alert and able to follow commands consistently. he had a tremor in his face and extremities (though this was present at baseline) and pt has an expressive aphasia, able to answer questions only in short sentences. per neurology, pt is now exhibiting symptoms of parkinsonism but would defer treatment at this point. . # diabetes: pt continue to have elevated bg to 300s during icu stay. he required insulin drip to manage his sugars. clinic was consulted and pt was started on lantus 45 units along with sliding scale insulin as attached. . chronic issues: # aortic stenosis: prior to admission pt was being evaluated for corevalve procedure, however evalution was complicated by enterococcus infection. because of hypotension on presention, palliative valvuloplasty was attempted but was not successful because of technical difficulties. post-valvuloplasty aortic area was 0.8cm2. volume status was monitored closely during admission because pt is very preload depended. even if deemed an appropriate candidate, he will not be eligable for corevalve for at least 6 months now given acute cva. . # cad: pt continued on aspirin, metoprolol, and rosuvastatin during hospitalization. . # hypertension: pt resumed on metoprolol once hypotension resolved. . # hyperlipidemia: continue rosuvastatin . transitional issues: he remained full code this admission. acute parietal infarct has left pt with many residual deficits and will require intense rehab and close follow-up with many specialties. medications on admission: 1. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 2. oxazepam 10 mg tid 3. klor-con 10 10 meq qd 4. gabapentin 800 mg tid 5. metoprolol tartrate 50 mg 6. rosuvastatin 5 mg daily 7. glimepiride 4 mg tablet sig: one (1) tablet po daily (). 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. docusate sodium 100 mg 10. insulin aspart sliding scale (gent and dapto) discharge medications: 1. senna 8.8 mg/5 ml syrup sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 2. docusate sodium 50 mg/5 ml liquid sig: po bid (2 times a day). 3. rosuvastatin 5 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. warfarin 5 mg tablet sig: one (1) tablet po days (,mo,tu,we,th,fr,sa). 7. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 9. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours). 10. daptomycin 500 mg recon soln sig: six hundred (600) mg intravenous q24h (every 24 hours). 11. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 12. dextrose 50% in water (d50w) syringe sig: one (1) intravenous prn (as needed) as needed for hypoglycemia protocol. 13. insulin glargine 100 unit/ml solution sig: forty five (45) units subcutaneous once a day: at lunch. 14. oxazepam 10 mg capsule sig: ten (10) mg po three times a day as needed for anxiety. 15. gabapentin 800 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: - discharge diagnosis: acute renal failure requiring cvvh acute respiratory distress requiring intubation stroke critical aortic stenosis urinary tract infection discharge condition: mental status: minimally interactive due to expressive aphasia level of consciousness: alert ambulatory: out of bed with assistance discharge instructions: it was a pleasure taking care of you at . you were hospitalized for acute shortness of breath likely related to an antibiotic you were taking that lead to acute kidney injury. you required intubation, mechanical ventilation, and initiation of hemodialysis. you were also found to have suffered a stroke during your hospitalization for which you will need rehab. . please call your doctor if you notice any increased shortness of breath or notice any weight gain. . please note that you are currently taking antibiotics for an infection in your urine and an infection in your blood. stop taking the daptomycin on and stop taking the ceftriaxone on . . the following medications were changed during your hospitalization: 1. stop taking aspirin 325mg and instead take aspirin 81mg by mouth daily. 2. stop taking lasix. 3. continue taking oxazepam 10mg by mouth up to 3 times a day for anxiety 4. stop taking gabapentin 800 mg three times a day and instead take 800mg by mouth twice a day. 5. stop taking glimepiride and instead take lantus 45 units with sliding scale insulin following scale provided. 6. continue taking daptomycin 600 mg iv daily - end date to be set during id appointment on 7. continue taking ceftriaxone 1 gm iv daily until 8. take amiodarone 400mg daily for 1 week, then decrease to 200 mg by mouth daily. 9. take coumadin 5mg by mouth daily followup instructions: department: infectious disease when: tuesday at 2:30 pm with: , md building: lm bldg () campus: west best parking: garage . department: cardiac services when: friday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage . also, please set-up follow up appointments with neurology (dr. at ) for your stroke, and (dr. at ) for your diabetes, renal (dr. at ) for your kidney and dr. (vascular surgery)at for your carotid artery disease. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis atrial cardioversion percutaneous balloon valvuloplasty replacement of indwelling urinary catheter diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders paralysis agitans chronic kidney disease, stage iii (moderate) other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure bacteremia cardiogenic shock dissection of carotid artery infection with microorganisms without mention of resistance to multiple drugs cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hyperosmolality and/or hypernatremia acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities, unspecified other specified antibiotics causing adverse effects in therapeutic use cerebral artery occlusion, unspecified with cerebral infarction aphasia proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site iatrogenic cerebrovascular infarction or hemorrhage infection and inflammatory reaction due to indwelling urinary catheter nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to