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: aspirin attending: chief complaint: tachypnea major surgical or invasive procedure: none history of present illness: patient is 84 male w/pmhx recent sah + aneurysm clipping, vp shunt placement, trach and peg (), multiple subsegmental pe (admitted from 12/12-15/11), who presents from rehab w/ progressively worsening tachypnea and respiratory distress. his rr was elevated to the 40s-60s. he was given an albuterol neb without improvement. patient is non-verbal at baseline, but per facility report he has been less responsive than usual. a blood gas done at rehab showed ph 7.52, co2, 30, o2 76. inr was 3.8 on coumadin which was held today. in the ed, initial vs were: 98.8 94 116/78 20 96%, rr ranging from 30s to 50s. physical exam was notable for mental status that was not responsive to voice but withdrawing to pain, 2+ reflexes, eomi, perrl. lungs were distant but diffuslely ctab in setting of tachypnea. labs were signifcant for leukocytosis to 14, lactate 2.2, inr 5.5. ct head showed no new ich. cta chest showed decreased clot burden, new patchy infiltrates on left, stable opacities on the right. he was given on ceftriaxone, levo (vanco ordered but not received in ed). he was given tylenol for fever. vs prior to transfer were t: 101.4, 91, rr 50, bp: 114/60, 98% on trach mask. . on arrival to the micu, patient was tachypneic. past medical history: - bilateral pes on coumadin (diagnosed ) -subarchnoid hemorrhage aneurysm and s/p vp shunt placement, tracheostomy and peg placement -hyptertension -hyperlipidemia -tia -? prior thalamic bleed social history: widowed, lives in rehab, has 2 adult daughters family history: non-contributory physical exam: admission: vitals: t: 97 bp: 118/44 p: 91 r: 31 18 o2: 97% onm 50% trach mask general: trach in place, opens eyes occasionally, not following commands heent: whitish plaque over tongue, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: tachypneic, clear to auscultation bilaterally, no wheezes, rales, ronchi, sl. diminished at bilateral bases abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: not following commands, withdrawing to pain pertinent results: admission labs: 09:00pm blood wbc-14.0*# rbc-4.03*# hgb-12.5*# hct-37.8*# mcv-94# mch-31.0 mchc-33.1 rdw-14.0 plt ct-457*# 09:00pm blood neuts-85.2* lymphs-9.0* monos-5.3 eos-0.3 baso-0.2 09:00pm blood pt-54.9* ptt-51.8* inr(pt)-5.5* 09:00pm blood glucose-159* urean-55* creat-1.1 na-138 k-4.4 cl-105 hco3-24 angap-13 09:00pm blood calcium-9.0 phos-3.5 mg-2.2 09:16pm blood po2-86 pco2-31* ph-7.50* caltco2-25 base xs-1 comment-green top 09:16pm blood lactate-2.2* ct head findings: the patient is status post acom aneurysm coiling. a right frontal approach ventriculostomy catheter terminates within the anterior of the right lateral ventricle, unchanged in position in comparison to examination. the ventricles are enlarged though stable in size. there has been interval decrease in blood products seen layering posteriorly within the occipital horns of lateral ventricles (2:16). previously seen subarachnoid hemorhage no longer visualized. no acute hemorrhage or large vascular territorial infarction is seen. focal hypodensities along the periventricular white matter (2:20, 21) and within a large area along the aca territory bilaterally (2:10) are unchanged, compatible with encephalomalacia and chronic microvascular ischemic disease. there is no acute fracture. a large scalp lipoma overlying the left calvarium (2:19) is again seen. there is mild mucosal thickening within the right ethmoid air cells. impression: 1. decreased intraventricular hemorrhage. 2. resolved subarachnoid hemorrhage. no new hemorrhage. 3. unchanged ventriculomegaly with a right frontal approach ventriculostomy catheter. 4. bifrontal aca distribution infarcts superimposed on chronic microvascular ischemic changes within the periventricular white matter. ct chest technique: mdct-acquired 5-mm axial images of the chest were obtained prior to and following the uneventful administration of 100 cc of intravenous contrast. coronal and sagittal reformations were performed at 2-mm slice thickness. additional right and left oblique reconstructions were performed for further evaluation of the pulmonary vasculature. findings: the thyroid is normal. the patient is status post tracheostomy (2:28). a ventriculoperitoneal shunt transverses along the right chest wall (2:31). the heart is mildly enlarged. there is no pericardial effusion. moderate atherosclerotic calcifications are seen throughout the thoracic aorta which is normal in caliber. no intramural or intramural hematoma is detected. there is no dissection. previously seen bilateral pulmonary emboli are no longer visualized to the subsegmental levels, although evaluation of the lower segmental and subsegmental branches is limited due to patient motion. there is persistent moderate right basilar atelectasis with air bronchograms (3:56, 58); an early consolidation in this region cannot be excluded. a trace right pleural effusion is decreased in size. scattered opacity is new in the left lower lobe posteriorly(3:52), concerning for aspiration and/or early pneumonia. the left upper lobe remains clear. there is no pneumothorax. osseous structures: there is no acute fracture. no concerning blastic or lytic lesions are identified. impression: 1. interval resolutino of pulmonary emboli. 2. new left lower lobe opacity concerning for pneumonia or aspiration. 3. interval decrease in trace right pleural effusion. brief hospital course: primary reason for hospitalization: 84m with recent admission for sah secondary to aneursym s/p coiling, intraventricular shunt, trach and peg (), and bilateral pes (12/12-15/11) presenting from rehab with tachypnea and found to have pneumonia, likely secondary to aspiration. active issues: # healthcare associated pneumonia: likely secondary to aspiration event from tube feeds. he was initially started on vanco, cefepime and levofloxacin (day 1=). levofloxacin was stopped , and he will be continued on vancomycin and cefepime through picc line for total 8 day course, through . vanc trough on was 16. picc line can be d/c'd once iv antibiotics are completed. (of note, only received 1 dose of levofloxacin due to low suspicion for resistant gnr infection. if pt worsens after discharge would recommend restarting levofloxacin for double coverage.) he was evaluated by speech & , family request, who confirms that patient should remain npo, everything per g-tube. # multiple pulmonary emboli: patient had rul,rll, lul and left lingula lobar and segmental pulmonary emboli at last hospitalization 12/12-19/11 and was started on coumadin with lovenox bridge. inr supratherapeutic on admission. he was given 5 mg vitamin k to lower inr when it peaked at 7. elevated inr likely related to metronidazole and levofloxacin use. he was restarted on warfarin dose 2.5mg on , and his inr on discharge was 2.3. his inr should be monitored frequently while on metronidazole (see attached sheet). # c. diff: diagnosed at rehab and started on oral metronidazole which was continued during this admission. no further diarrhea by time of admission here on . he should continue metronidazole 500mg q8 hours until 2 weeks after completion of iv antibiotics for hcap (until ). # arf: presented with acute renal failure (creatinine elevated to 1.1 from baseline 0.5), likely prerenal infection, which resolved with hydration. on discharge his creatinine was 0.4. his losartan was held during hospitalization and should be restarted on discharge. # uti: ua consistent with uti. foley was placed during admission , and family understands the benefit in setting of sacral ulcers. he was treated with vancomycin and cefepime as above for pneumonia. chronic issues: # hx sah: patient was admitted on w sah and ivh now s/p acom coiling, vp shunt placement, tracheostomy and peg placement. had repeat mri/mra per neurosurg recs, will be contact by dr. (neurosurg) as outpatient regarding these results. # hypertension: pt's home losartan held during hospitalization for arf, should be restarted on discharge. transitional issues: - inr should be monitored closely while on metronidazole (was supratherapeutic on admission and warfarin held, restarted ) - would recheck wbc if respiratory status worsens, if increasing consider restarting levofloxacin - should continue iv vanc/cefepime until , can d/c picc once antibiotic course complete - should continue po metronidazole until 2 weeks after completing iv antibiotics for c diff infection - dr. (neurosurgery) will contact patient as outpatient with results of mri. if he is not contact within a few days, please contact his office at (. - pt maintained dnr/dni status throughout hospitalization medications on admission: vitamin d3 800 units po daily (daily). calcium carbonate 200 mg calcium (500 mg) po tid (3 times a day). albuterol nebs q6h prn tachypnea chlorhexidine gluconate 0.12 % mouthwash esomeprazole 40 mg po daily acetaminophen 650 mg po q6h as needed for pain or fever. multivitamin warfarin losartan 50 mg po once a day metronidazole 500 mg po q8h (started ) discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation every six (6) hours as needed for shortness of breath or wheezing. 2. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain, fever. 3. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 19 days: take until 2 weeks after completion of iv antibiotics (until ). 4. warfarin 2.5 mg tablet : one (1) tablet po once daily at 4 pm. 5. vancomycin in d5w 1 gram/200 ml piggyback : 1000 (1000) mg intravenous q 12h (every 12 hours) for 5 days: continue until . 6. cefepime 2 gram recon soln : two (2) gram injection q12h (every 12 hours) for 5 days: continue until . 7. vitamin d-3 400 unit capsule : two (2) capsule po once a day. 8. calcium carbonate 200 mg calcium (500 mg) tablet, chewable : one (1) tablet, chewable po three times a day. 9. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane twice a day. 10. esomeprazole magnesium 40 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day. 11. multivitamin tablet : one (1) tablet po once a day. 12. losartan 50 mg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: discharge diagnosis: hospital-acquired pneumonia urinary tract infection clostridium difficile infection subarachnoid hemorrhage discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were admitted to because of pneumonia. you were started on iv antibiotics, which you should continue at your rehab facility until . you were also started on an oral antibiotic (metronidazole) for an intestinal infection called c diff. you should continue to take metronidazole until 2 weeks after you complete your iv antibiotics for pneumonia. while you were here, your inr was elevated so your coumadin was held. you were restarted on your coumadin at 2.5 mg by mouth daily. you should continue to have your inr level monitored regularly at your rehab facility. you were also seen by the neurosurgery service while you were here because of your history of a brain hemorrhage. you had an mri of your brain, and you will hear from dr. within the next few days regarding these results. if you do not hear from dr. or his staff, please contact his office at (. it was a pleasure taking care of you at and we wish you a speedy recovery. followup instructions: you will be contact by dr. (neurosurgery) regarding the results of your brain mri. at this time you do not need to follow up in his clinic. if you do not hear from dr. or his staff, please contact his office at (. md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: unspecified essential hypertension acute kidney failure, unspecified pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile long-term (current) use of anticoagulants pressure ulcer, lower back personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hyperosmolality and/or hypernatremia gastrostomy status tracheostomy status presence of cerebrospinal fluid drainage device pressure ulcer, stage iii personal history of pulmonary embolism 

Answer: The patient is high likely exposed to