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: no known allergies / adverse drug reactions attending: chief complaint: respiratory distress, hypotension major surgical or invasive procedure: ultrasound guided chest pigtail catheter placement left video-assisted thoracoscopic decortication dobhoff placement picc line placement history of present illness: history of present illness: mr. is a 69 year old pleasant gentleman with copd, atrial fibrillation on coumadin, history of ischemic right parietal stroke approximately 6 yrs ago resulting in seizure disorder, long history of etoh abuse, and recent subdural hematoma resulting in a one-month long hospitalization at with discharge on who presents in respiratory distress with appreciable left sided pleural effusion on cxr. . mr. was discharged from on following a one-month hospitalization for a subdural hematoma. following discharge, the patient's son reports continuing mental status changes, characterized mainly by increased somnolence, while the patient reports chills for the past month and non-productive cough as well. given his persistent mental status changes, his son brought him for a neurologic evaluation to . following the evaluation and head imaging, the patient developed sudden chest pain and sob in the east lobby and was subsequently taken to the ed. . in the ed, the patient's initial vs were: t: 99.6 hr: 113 bp: 110/65 rr: 16 o2sat: 96% 4l nc. the patient did not endorse any chest pain or fevers, but continued to have sob. a chest x-ray revealed a large left-sided pleural effusion, and the patient was administered 1l of ns, iv azithromycin and ceftraixone, and tylenol. interventional pulmonary was consulted to drain the pleural fluid, and removed approximately 1.7l of pleural fluid through placement of a pigtail catheter. however, during the procedure, the patient became hypotensive with sbps in the 80s, prompting his admission to the micu. . on arrival to the micu, the patient was in no acute distress, but appeared somewhat somnolent in response to questioning. his vs were: t: 98.4 hr: 96 bp: 98/57 rr: 33 o2sat: 96% 2l nc. past medical history: 1) copd 2) atrial fibrillation 3) ischemic stroke - r parietal lobe (6 yrs ago per the patient) 4) seizures - l hand rhythmic shaking, complex partial seizures 5) h/o etoh abuse 6) subdural hematoma social history: lives with wife in . retired exterminator. states drinks whiskey daily, but has been sober since . non-smoker. family history: non-contributory physical exam: admission physical exam: vitals: t: 98.7 bp: 92/50 p: 95 rr: 26 o2 sat: 96 on 2l nc general: aox2, no acute distress, somnolent heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: irregularly irregular, distant heart sounds lungs: audible air movement in all lung fields, with diffuse crackles throughout, no egophony in the ll lobe abdomen: soft, nt, nd, +bs, no hepatosplenomegaly gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: grossly intact . discharge physical exam: vs - tc 98.4 tmax 99.5 hr 94 (80-90) bp 128/91 (110-120/70-90) rr 18 satting 96%ra general - well-appearing man in nad, comfortable, appropriate, with dobhoff, in arm restraints heent - nc/at, perrl, eomi, sclerae anicteric, mmm, lungs - crackles at the bases bilaterally with weak inspiratory effort limited by patient's mental status. reduced air entry at left lung base heart - pmi non-displaced, irregular rate, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - alert, oriented (self, place), conversant, able to move all extremities spontaneously, follows commands pertinent results: admission labs: =============== 12:25pm blood wbc-15.9*# rbc-4.08*# hgb-11.8* hct-39.6* mcv-97 mch-28.9# mchc-29.8* rdw-14.4 plt ct-681*# 01:34pm blood neuts-89.6* lymphs-5.1* monos-4.5 eos-0.6 baso-0.2 12:25pm blood plt ct-681*# 01:34pm blood glucose-108* urean-12 creat-0.5 na-135 k-4.5 cl-95* hco3-33* angap-12 01:34pm blood ctropnt-<0.01 probnp-3166* 01:44pm blood lactate-2.0 05:23pm blood ph-7.12* comment-pleural 10:11pm urine color-yellow appear-hazy sp -1.029 10:11pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirub-neg urobiln-4* ph-6.0 leuks-neg 10:11pm urine rbc-1 wbc-1 bacteri-none yeast-none epi-0 transe-<1 05:21pm pleural totprot-3.5 glucose-55 ld(ldh)-412 05:21pm pleural wbc-6425* rbc-1475* polys-72* lymphs-10* monos-15* eos-3* nrbc-0 . dicharge labs: ============== 05:22am blood wbc-6.6 rbc-2.62* hgb-7.8* hct-26.1* mcv-100* mch-29.8 mchc-29.9* rdw-22.3* plt ct-380 05:22am blood glucose-105* urean-17 creat-1.0 na-136 k-3.7 cl-100 hco3-33* angap-7* 05:22am blood calcium-7.9* phos-3.7 mg-2.1 . micro/path: =========== blood culture: x 2: no growth x 2: no growth . urine: : no growth : no growth urine legionella ag: negative . pleural fluid: pleural fluid : no growth pleural fluid : strep anginosus (milleri) pleural debris tissue cx : strep anginosus (milleri) bal : commensal flora pleural fluid : no growth . mrsa screen : negative . cytology: pleural fluid procedure date of negative for malignant cells. . pathology of pleural debris : granulation tissue and fibrinopurulent exudate; bacterial forms present. . imaging/studies: ================ chest (pa & lat) : impression: marked new opacification of the left mid to lower hemithorax with a lenticular shape which may potentially imply a large loculated pleural effusion in addition to parenchymal opacification. . portable tte : pleural effusions are present. the left atrium is dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is unusually small. overall left ventricular systolic function is normal (lvef 65%). there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm. the right ventricular cavity is dilated with depressed free wall contractility. there is no aortic valve stenosis. no aortic regurgitation is seen. there is mild pulmonary artery systolic hypertension. the branch pulmonary arteries are dilated. there is no pericardial effusion. . ct chest w/o contrast : impression: extensive highly loculated and only partially drained left pleural effusion. small right pleural effusion. extensive pulmonary emphysema with areas of non-characteristic scarring and atelectasis. extensive coronary and aortic calcifications. calcified gallstones, calcified upper abdominal vessels. . unilat up ext veins us right : impression: no evidence of dvt in the right upper extremity. . chest xrays, most recently: chest (portable ap) : impression: 1. dobbhoff feeding tube has its tip projecting over the expected location of the stomach. right subclavian picc line has its tip in the proximal svc, unchanged. bilateral airspace opacities, left greater than right with probable associated layering effusions are again seen. two surgical clips are again identified at the left lung base. no overt pulmonary edema. the lung apices are not entirely included; therefore, evaluation for a pneumothorax is limited on this examination. calcification of the aortic knob and descending aorta consistent with atherosclerosis. overall, cardiac and mediastinal contours are stable. . chest (portable ap) : findings: as compared to the previous radiograph, there is no relevant change. the monitoring and support devices are in constant position. unchanged size of the cardiac silhouette. unchanged left and right pleural effusions, left more than right. unchanged bilateral parenchymal opacities, left more than right. unchanged mild-to-moderate retrocardiac atelectasis and right basal atelectasis. no parenchymal opacities have newly occurred. . video swallow evaluation : findings: barium passes freely from the oropharynx into the cervical esophagus without evidence of obstruction. gross aspiration was witnessed with thin and nectar thick liquids. moderate vallecular residue was noted with all consistencies of barium. for full details, please see the speech and language pathology report in the omr. impression: 1. gross aspiration of thin and nectar thick liquids. 2. moderate vallecular residue. . ct head without contrast findings: the previously described right frontal subdural collection is stable. there are no areas of acute intracranial hemorrhage. the previously described hypodensity involving the right temporoparietal region with associated encephalomalacia and ex vacuo dilatation of the right occipital persists. the visualized paranasal sinuses and mastoid air cells are clear. calcified atherosclerotic disease is present in both cavernous portions of the internal carotid arteries. impression: stable right frontal subdural collection and right temporoparietal old infarct; no intracranial hemorrhage or ct evidence for acute cva, although mr would be more sensitive in detecting such. . video swallow evaluation swallowing videofluoroscopy: oropharyngeal swallowing videofluoroscopy was performed in conjunction with the speech and swallow division. multiple consistencies of barium were administered. barium passed freely through the oropharynx without evidence of obstruction. there was penetration with nectars and thick liquids. the patient aspirated thin liquids. there is a swallow delay. impression: aspiration of thin liquids. summary: mr. presents with a mild progression of his dysphagia compared with video swallow performed . he continues to have intermittent aspiration of thin liquids, especially when clearing solid residue from the pharynx. his risk for aspiration of nectar-thick liquids is felt to be mildly increased compared to previous evaluation, and overall, there appears to be an increase in muscle weakness which is not unexpected as pt has been npo since . brief hospital course: mr. is a 69 year old gentleman with copd, atrial fibrillation, history of ischemic right parietal stroke resulting in seizure disorder, long history of etoh abuse, and recent subdural hematoma resulting in a one-month long hospitalization at with discharge on . he re-presented to on in respiratory distress secondary to a parapneumonic effusion. hospital course was complicated by seizures, altered mental status, acute renal failure, ventricular tachycardia, and dysphagia. . active diagnoses: ================= . # left-sided parapneumonic effusion: likely secondary to aspiration pneumonia. he was initially hypotensive following a thoracentesis and required an icu admission and pressor support. he was initially started on vancomycin and zosyn. thoracic surgery was consulted given the complicated nature of his pleural effusion and he underwent vats decortication and chest tube placement. he remained intubated following the or and was extubated without complication. pleural fluid and tissue cultures from the vats grew strep anginosus (milleri) and cytology was negative for malignancy. both chest tubes were removed three days after the patient was transferred to the medical floor. he was switched to vancomycin/flagyl, then vancomycin/cefepime, and finally just to zosyn. he completed a total of 21 days of antibiotics (end date ). on exam he continues to have decreased air entry at the left lung base but has been saturating in the mid 90's on room air. . # seizures: patient has a history of seizures, likely secondary to prior right parietal stroke and alcohol abuse. he was initially on valproic acid and levetiracetam. he was noted to have 3 seizures on . after the seizures he had left-sided paralysis which was thought to be most likely paralysis, but in order to rule out stroke patient underwent a head ct, which was negative for new stroke or hemorrhage. he was started on phenytoin and continued on the valproic acid and levetiracetam and has remained seizure-free. upon discharge he should continue valproic acid 750mg tid, levetiracetam 1500mg , and phenytoin 100mg tid. . # altered mental status: likely secondary to underlying parapneumonic effusion/infection and seizures (treatment discussed above). his mental status has been gradually improving and he is currently a&ox2-3. . # code blue for hypoxemia/unresonsiveness: patient alarmed on tele for afib with rvr to the 140's, nurses found the patient unresponsive and per report his saturation was in the 50's. he was bag masked and became responsive almost instantaneously with sat of 99%. on transfer back to the micu, patient underwent ct head which did not show progressive subdurals, and repeat infectious workup was unremarkable. patient was evaluated by neurology team and eeg was reviewed but there was no evidence of seizures during that episode. patient had gradual improvement of his mental status without evidence of seizures and was called back out to the floor for further management. . # atrial fibrillation/ventricular tachycardia: on aspirin 325mg daily but not anticoagulated with warfarin given history of subdural hematoma. he had several episodes of asymptomatic sustatined ventricular tachycardia so cardiology was consulted and metoprolol tartrate was started which was uptitrated to 37.5mg tid. afterward, his hr has been well controlled in the 80s-90s. . # acute renal failure: patient developed acute kidney injury with creatinine which peaked at 2.3 from baseline 0.5. likely prerenal vs atn in setting of hypotension. urine sediment analysis revealed granular casts, ua reveals trace protein, 11 whites, 8 rbcs, few bacteria. fena 1.2 and negative urine eos. patient had anasarca from fluid rescusitation in the icu and was thus diuresed with iv lasix with significant post-atn diuresis. creatinine gradually improved back to 1.0 upon discharge. . # dysphagia: longstanding issue, patient presented with poor nutritional status with albumin 1.9. pneumonia suspected to be secondary to aspiration. he failed a video speech and swallow evaluation so an ng tube was placed and tube feeds were initiated. repeat video swallow evaluation on showed worsening swallowing abilities and continued aspiration so the patient's family decided to keep the patient npo and continue feeds via the dobhoff (see goals of care below). . # goals of care: patient has had a complicated medical course as outlined above. after frequent meetings with his family including his health care proxy/son , the decision was made to change his status to dnr/dni. on (after a second video swallow evaluation showed no improvement) another family meeting occurred in the presence of both sons. a decision was made to continue feeds via the dobhoff and keep him npo in anticipation that mr. mental status will continue to improve. while he continues to be intermittently confused, he should remain in soft wrist restraints in order to keep him from pulling at the feeding tube. . chronic diagnoses: ================== . # h/o etoh abuse: the patient has a significant etoh abuse history complicated by hospitalizations with delirium tremens. the patient endorses that he has not had a drink since and was without any suicidal ideations or symptoms that could be explained by etoh withdrawal but he seemed to have elements of dementia likely related to significant prior etoh use. he was started on thiamine, folate, and a multivitamin. . transitional issues: ==================== - code status: dnr/dni - soft restraints while not observed since might pull the dobhoff tube - tube feeding - aspiration precaution - mental status is partially oriented, most of the time aox2, occasionally aox3 medications on admission: 1) valproic acid (as sodium salt) 250 mg/5 ml solution 2) levetiracetam 100 mg/ml solution 3) simvastatin 40 mg tablet 4) acetaminophen 325 mg tablet po q6h prn 5) guaifenesin 100 mg/5 ml syrup po q4h prn for cough discharge medications: 1. valproic acid (as sodium salt) 250 mg/5 ml solution : seven y (750) mg po tid (3 times a day). 2. levetiracetam 100 mg/ml solution : 1500 (1500) mg po bid (2 times a day). 3. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 4. phenytoin 125 mg/5 ml suspension : one hundred (100) mg po three times a day. 5. aspirin 325 mg tablet : one (1) tablet po daily (daily). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. metoprolol tartrate 25 mg tablet : 1.5 tablets po tid (3 times a day). 8. acetaminophen 325 mg tablet : one (1) tablet po every six (6) hours as needed for pain. 9. codeine-guaifenesin 10-100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for cough. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheezing. 11. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 12. folic acid 1 mg tablet : one (1) tablet po daily (daily). 13. therapeutic multivitamin liquid : five (5) ml po daily (daily). discharge disposition: extended care facility: northeast - discharge diagnosis: seizures altered mental status ventricular tachycardia complicated left parapneumonic effusion aspiration secondary diagnoses: anemia subdural hematoma atrial fibrillation discharge condition: mental status: level of orientation varies however coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr , . it was a great pleasure taking care of you as your doctor. as you know you were admitted to because of breathing difficulty. . the fluid around your left lung was drained and was found to be infected. a tube was placed to keep draining it out. afterwards, a surgery was done to help reduce re-accumulation of the fluid. you received iv antibiotic called zosyn for this infection. . given your seizure activity, a new medication called dilantin was started. in the meantime, your brain electrical activity was monitored. the brain doctors were involved in the care provided to you and were following with us on daily basis. . while your heart was being monitored, you had a few episodes of fast heart beat in a rhythm called ventricular tachycardia. for this, a new medication was started called metoprolol as below. . you were disoriented during your stay and we had to utilize soft restraints at your hands to avoid self-pulling of tubes which you did a few times during your stay when there was no restraints. also, restraints were required for your safety to avoid being out of bed and falling without prior notice. . you were provided nutrition through a tube from your nose down to your stomach. you were evaluated by speech and swallow team who found that you are aspirating. you were re-evaluated after improvement in your mental status and unfortunately found no significant change from prior. it was decided to discharge you from the hospital to a rehab and to continue to feed you through the feeding tube. you will be going to a rehab for further physical therapy and management. . we made the following changes in your medication list. - please start phenytoin 100 mg three times daily - please start aspirin 325 mg daily - please start metoprolol 37.5 mg three times daily - please start lansoprazole oral disintegrating tablet 30mg daily - please start thiamine 100 mg daily - please start folic acid 1 mg daily - please start multivitamins 1 tablet daily - please continue valproic acid at 750 mg three times daily - please continue levetiracetam at 1500 mg twice daily . please continue the rest of your home medications the way you were taking them prior to admission. . please follow with the appointment as illustrated below. . we wish you all the best at the rehab. followup instructions: department: cognitive neurology unit when: monday at 2:30 pm with: , md building: ks building (/ complex) campus: east best parking: main garage . department: radiology when: wednesday at 10:00 am with: cat scan building: cc campus: west best parking: garage . department: neurosurgery when: wednesday at 10:45 am with: , md building: lm campus: west best parking: garage procedure: enteral infusion of concentrated nutritional substances thoracentesis thoracoscopic decortication of lung central venous catheter placement with guidance diagnoses: other iatrogenic hypotension acute kidney failure with lesion of tubular necrosis unspecified pleural effusion other and unspecified alcohol dependence, in remission chronic airway obstruction, not elsewhere classified atrial fibrillation paroxysmal ventricular tachycardia pneumonitis due to inhalation of food or vomitus other late effects of cerebrovascular disease long-term (current) use of anticoagulants hyperosmolality and/or hypernatremia empyema without mention of fistula other specified paralytic syndrome other alteration of consciousness streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b edema of male genital organs alcohol-induced persisting dementia dysphagia, unspecified localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy 

Answer: The patient is high likely exposed to