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: patient recorded as having no known allergies to drugs attending: chief complaint: altered mental status major surgical or invasive procedure: femoral line placed history of present illness: 75 y/o m speaking only pmh esrd on hd, cad, paf, copd, htn who presensts with altered mental status of 2 days duration. initially felt to be secondary to percocet use at rehab, but hd facility was concerned and sent patient to be evaluated. per family patient is aox3 at baseline but has been more confused recently. notes slow decline over several days since being at the rehab. states he was also given a "sleeping pill" the day before admission. family did not notice any increased cough, sob, or fever. . patient was recently admitted for left humeral fracture, hypoxia and inability to care for himself at home. for left humeral fracture patient was evaluated by ortho who recommended sling. hypoxia was felt to be secondary to mild copd exacerbation and was treated with aggressive neb therapy and oral steroids. at time of discharge his o2 sats were 90% on ra with occasional desats to the high 80s and discharged on 1l nc to be weaned as tolerated. patient was discharged to rehab. . in the ed, initial vs were: 96.9 86 107/84 22 91. patient spiked a temp to 100.2. rectally. ct head demonstrated no abnormalities. cxr demonstrated right lower lobe infiltrate. patient was given levofloxacin and zosyn and 1l ns. a groin cvl was placed. his lue was noted to be swollen and echymotic but an u/s revealed no dvt. ortho evaluated it in the ed and recommended continued sling and nwb. he was agitated and confused, so received 5mg zyprexa. vitals on transfer were 98.8 rectal, hr 63, bp 149/52, rr 13, 100% facemask. he would reportedly desat to upper 80s on 6l nc so he was admitted to the micu for further care. . on the floor, still mildly agitated and confused. unable to obtain further ros. past medical history: -esrd on hd via left avf from polycystic kidney disease. hd-m,w,f on st in -asymptommatic bradycardia/wct: single-lead pacemaker placed -cad - cath here in with moderate ramus intermedius disease (discrete 50% stenosis) and mild diastolic ventricular dysfunction -paf with documented once in the ed in -ett : atypical symptoms in the absence of ischemic ecg changes or reversible defects by thallium to the acheived low level of exercise -asthma/copd -hypertension -prostate ca -recent left humeral fracture social history: patient currently lives at rehab but lived alone before (wife has passed away recently). speaking only. currently smokes <10 cigs/day for 60yrs, /wk etoh, no ilicit drug use. family history: denies significant family history. physical exam: gen: well appearing elderly man in nad eye: extra-occular movements intact, pupils equal round, reactive to light, sclera anicteric, not injected, no exudates ent: mucus membranes moist, no ulcerations or exudates neck: no thyromegally, jvd: flat cardiovascular: regular rate and rhythm, normal s1, s2, no murmurs, rubs or gallops respiratory: clear to auscultation bilaterally, no wheezes, rales or rhonchi abd: soft, non distended, no heptosplenomegaly, bowel sounds present. mildly tender to palpation in ruq and llq. extremities: left arm in sling, painful with movement, warm, 2+ radial pulse, sensation intact, ecchymotic, no cyanosis, clubbing, joint swelling neurological: alert and oriented x2, cn ii-xii intact, normal attention, sensation normal pertinent results: labs during event leading to death: inr(pt)-7.8* hct-25.2* 06:28pm blood type-art po2-74* pco2-53* ph-7.21* caltco2-22 base xs--7 06:12pm blood glucose-161* urean-66* creat-5.1*# na-144 k-6.8* cl-97 hco3-20* angap-34* lactate 11.4 . labs on admission: 06:50pm blood wbc-10.3 rbc-3.26* hgb-9.8* hct-30.5* mcv-94 mch-30.1 mchc-32.1 rdw-17.5* plt ct-177 06:50pm blood neuts-95.1* lymphs-3.5* monos-1.0* eos-0.1 baso-0.2 06:50pm blood pt-19.4* ptt-47.3* inr(pt)-1.8* 06:50pm blood glucose-98 urean-33* creat-3.2*# na-145 k-3.7 cl-100 hco3-32 angap-17 06:50pm blood alt-36 ast-43* ld(ldh)-380* alkphos-90 totbili-0.5 . other pertinent labs: 06:00am blood vanco-13.4 09:28am blood vanco-22.4* 05:55am blood vanco-21.5* 07:01pm blood lactate-2.2* k-3.7 12:06am blood lactate-2.0 06:28pm blood lactate-11.4* 05:59am blood alt-12 ast-42* ld(ldh)-339* ck(cpk)-220* alkphos-49 totbili-0.5 . 06:50pm urine rbc-21-50* wbc-0-2 bacteri-occ yeast-none epi-0 06:50pm urine blood-lg nitrite-neg protein-500 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-8.0 leuks-neg . inr(pt)-1.8*, inr(pt)-2.1*, inr(pt)-1.8*, inr(pt)-2.0*, inr(pt)-2.9*, inr(pt)-5.2*, inr(pt)-4.5*, inr(pt)-5.1*, inr(pt)-7.8* hct-26.4, hct-27.2* hct-28.0*, hct-26.9*, hct-25.4*, hct-26.1*, . 6:50 pm blood culture **final report ** klebsiella oxytoca. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella oxytoca | ampicillin/sulbactam-- 8 s cefazolin------------- 8 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). reported by phone to at 14:08pm on . aerobic bottle gram stain (final ): gram negative rod(s). . blood cx negative . 6:50 pm urine site: clean catch urine culture (final ): no growth. . 3:51 pm stool **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . ct head: impression: no acute intracranial abnormality. no significant change in cerebral volume loss and chronic microvascular ischemic changes. bilateral maxillary sinus disease. . humerus ap/lat: left humerus, three views: evaluation is limited by patient positioning. within this limitation, there is no significant change in the comminuted left humeral neck fracture with approximately 2 cm of foreshortening. there is nodislocation. there is no new fracture. there is subtle soft tissue calcification noted on the second and third images at the level of the fracture which may represent early callous formation. no radiopaque foreign body is identified. . rue ultrasound: impression: no evidence of dvt. exam is limited due to patient-related factors. . abdomen upright: impression: no evidence of obstruction; incomplete assessment for free air -upright or left lateral decubitus views are recommended to better assess for perforation. . ruq ultrasound: impression: 1. innumerable cysts seen within the liver and right kidney. 2. focally distended gallbladder at the fundus without signs of cholecystitis. if clinically indicated, a hida scan could be performed to further assess for cholecystitis. no gallstone is identified. 3. no biliary dilatation and no ascites in the right upper quadrant. . : single ap view of the chest: evaluation is limited by patient position. compared to the prior study, there is increased opacity at the right lung base concerning for infection. an opacity in the right upper lung is stable compared to prior and may represent a calcified granuloma. the heart is enlarged and there is a small residual right pleural effusion. the left costophrenic angle is excluded from view. a single lead follows a normal course from a right-sided battery pack terminating in the expected position over the right ventricle. there is a left tunneled internal jugular catheter terminating at the cavoatrial junction. there is no pneumothorax. left humeral fracture better evaluated on dedicated humeral radiographs. . video swallow: findings: barium passed freely through the oropharynx and esophagus without evidence of obstruction. there was aspiration with thin consistency. . cxr: findings: as compared to the previous radiograph, the patient has taken a better inspiration. there is unchanged extent of the bilateral basal areas of opacity. however, no opacity has newly occurred in the interval. moreover, no evidence of pulmonary edema is seen. the size of the cardiac silhouette is unchanged. unchanged moderate tortuosity of the thoracic aorta, unchanged position of central venous access line and the right-sided pacemaker. brief hospital course: assessment and plan: 75 year old speaking male with hx of copd, cad, and recent humerus fracture presents with altered mental status and found to have pneumonia and gnr bacteremia on . . #. his hospital course is detailed below. on the evening of i was called to evaluated him for "being less responsive and looking more blue." he was dnr/dni at the time. his initial bp was normal and then we were unable to obtain a blood pressure. o2 sats were being obtained on his forehead as he was satting higher on his forehead than on his digits earlier in the day. his initial o2 sat was 90 and then was unobtainable. he was noted to be in agonal breathing and had fixed non responsive pupils (minimally responsive pupils per neuro). a code stroke was immediately called. fluids were opened wide. labs were obtained and notable for ph 7.21 pco2 53 po2 74 on non rebreather, lactate of 11.4, wbc 22.4, hct stable at 25.2, inr of 7.8, and potassium of 6.8 (this k+ was obtained within 1 min of his death and thus no medication had been administered). ffp was ordered and brought down to the ct scanner but arrived within minutes of his death. the patient was rushed to the ct scanner for a head ct without contrast. while at the ct scanner he had an episode of bloody emesis. he died within seconds of his ct scan being completed and the scan showed no evidence of bleed or stroke. his family members and his primary care physician were about his death and declined autopsy. dr. was being updated throughout the code stroke. he likely did from a gi bleed in the setting of a high inr. . #. klebsiella bacteremia: his blood cx on were positive for pansensitive klebsiella bacteremia and he was on cefepime. subsequent blood cultures were found to be negative from . . # pneumonia: his cxr showed rul and rll pna. he was being treated with vancomycin and cefepime given need to cover for hap and he was on flagyl for possible hap. he had a new oxygen requirement throughout his hospitalization and he was continued on nebulizers. he was never able to produce a sputum for us. his blood cx grew klebsiella as detailed above. . #. elevated wbc: his elevated wbc was thought to be secondary to pna and klebsiella bacteremia. he was afebrile for several days prior to his death. his white count trended up to 23 and then remained stable between 17-18 until the time of his death when his wbc was 22.4. his stool was negative for c diff. his abdominal exam was followed and was benign and he denied abdominal pain. . # altered mental status: his ct scan of his head was negative. his ams was likely due to bactermia and pna. his mental status improved after he started treatment for his pna & bacteremia and then again after narcotic medications & clonazepam were discontinued. the days prior to his death he was oriented to himself and his location. the only exception to this was the evening of when he received a dose of pain medication for his broken humerus and he delirius. his family member (who speaks ) noted to me early in the day on that he was much clear compared to the evening before and knew where he was and who he was. . # anemia: his hct was 30.5 on arrival on . his hct remained stable in the 25-28 range for the several days prior to his death and his transfusion threshold was<25. please see humerus fracture below. on ortho came to evaluate the patient as his left arm (where he had humeus fracture) looked larger and there was concern that he could be bleeding into it in the setting of his elevated inr. his hct was followed closely and was stable. he had no evidence of compartment syndrome on exam. he was found to be guaiac positive on exam but was having rare bowel movements. the late morning of his death he had question of coffee ground emesis. this was discussed with the attending and it was decided not to place an ng tube in the setting of a high inr. the patient was started on an iv ppi. . # elevated inr: he was given reduced dosing of coumadin given that he was on antibiotics. his inr became supratherapeutic on to 5.9. on the morning of his inr was 5.1. his coumadin was held. in the setting of ? coffee ground emesis (detailed below under anemia section) on in am he was given vitamin k. . # copd: he was on standing nebs and advair with a clear lung exam. . # esrd: he received dialysis throughout his hospitalization. he had one episode of hypotension post dialysis but otherwise tolerated it well. . # humerus fracture: on ortho came to evaluate the patient as his left arm (where he had humerus fracture) looked larger and there was concern that he could be bleeding into it in the setting of his elevated inr. his hct was followed closely and was stable. he had no evidence of compartment syndrome on exam. pain was controlled with tylenol and lidocaine and no narcotics were given since they were thought to contribute to his ams. . # paroxysmal atrial fibrillation: he was continued on home dronedarone and diltiazem. his coumadin was held in the setting of his high inr. . # hypertension, benign: he was continue on his home diltiazem, lisinopril, and valsartan. . # coronary artery disease: he was continued on his home ace, , and aspirin . # dementia: he was continued on his home aricept. . # depression: he was continued on his home citalopram. . # fen: he was on a puree diet and nectar thick liquids given concern for aspiration and was followed by speech and swallow. medications on admission: 1. clonazepam 1 mg po qhs as needed for insomnia. 2. citalopram 20 mg po daily 3. warfarin 5 mg t po qhs 4. simvastatin 10 mg po qhs 5. donepezil 5 mg po hs 6. amylase-lipase-protease 60,000-12,000- 38,000 unit capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. montelukast 10 mg po daily 8. fexofenadine 180 mg po daily 9. lisinopril 20 mg po bid 10. hyoscyamine sulfate 0.375 mg capsule, sust. release 12 hr sig: one (1) capsule, sust. release 12 hr po bid 11. valsartan 80 mg po daily 12. aspirin 81 mg po daily 13. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) capsule po once a day. 14. fluticasone-salmeterol 250-50 mcg 15. tiotropium bromide 18 mcg daily 16. diltiazem hcl 60 mg po bid 17. dronedarone 400 mg po bid 18. sevelamer carbonate 800 mg po tid w/meals 19. albuterol sulfate 2.5 mg /3 ml (0.083 %) q6h 20. ipratropium bromide 0.02 % q6h 21. lidocaine 5 %(700 mg/patch) q24h (every 24 hours) as needed for shoulder pain. 22. oxycodone-acetaminophen 5-325 mg 1-2 tablets po every 4-6 hours as needed for pain 23. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 24. lactulose (30) ml po q8h as needed for constipation. 25. docusate sodium 100 mg po bid 27. prednisone taper: now on 20mg qdaily x 2d, then take 10mg x2d, then stop. discharge medications: deceased discharge disposition: expired discharge diagnosis: deceased discharge condition: deceased discharge instructions: deceased followup instructions: deceased md, procedure: venous catheterization, not elsewhere classified hemodialysis diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery tobacco use disorder friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site atrial fibrillation depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bacteremia cardiac pacemaker in situ chronic obstructive asthma, unspecified hematemesis polycystic kidney, unspecified type 

Answer: The patient is high likely exposed to