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: sulfa (sulfonamides) attending: chief complaint: fever and respiratory distress. major surgical or invasive procedure: endotracheal intubation post-pyloric tube placement picc line placement history of present illness: mr. is a 68 year-old man with a history of hepatitis c/ cirrhosis hepatocellular carcinoma s/p cadaveric liver transplant in , also with a history of cad s/p rca and lad stenting in , htn, gerd, dm type 2, dementia, recently admitted to for fever and hypoxia felt rll pneumonia and treated with flagyl, vancomycin and levofloxacin empirically, now presenting with recurrent fever, hypoxia and mental status changes for 1 day. per rehab reports, on , patient developed a fever (to 102), hypoxia (91% on 2l) and lethargy ("stopped speaking"). in the ed, t 102, hr 112, bp 144/63, r 27, o2 sat 92% 5l. an abg initially revealed 7.43/37/76. a cxr revealed persistent bilateral pleural effusions and rll atelectasis versus infiltrate. he was started on vancomycin, ceftazidime and metronidazole. however, while in the ed, mr. developed increasing respiratory distress and was intubated for increased work of breathing. he was transferred to the for further care. past medical history: 1. hepatitis c/cirrhosis /hcc, status post cadaveric liver transplant in 2. coronary artery disease, status post rca and lad stenting 3. hypertension 4. gastroesophageal reflux disease 5. diabetes mellitus type 2 6. dementia social history: ms. recently moved to a nh () secondary to his progressive dementia. he was born in sicily. ex-smoker, with 10 pack-year smoking history. no h/o ivdu or blood transfusion prior to . past history of etoh consumption. of note, received flu shot in 12/. family history: liver disease per omr notes. physical exam: per initial icu evaluation: vitals: t 102, bp 140/80, hr 70s regular, rr 25, sat 95% on 3l via nc. general: ill-appearing elderly male, lethargic, not responding verbally but opens eyes to name and follows commands. heent: perrl, eomi, anicteric. resp: bibasilar rales. cvs: normal s1, s2. no s3, s4. no murmur or rub. gi: bs hypoactive. abdomen soft and non-tender. ext: 3+ pitting edema bilaterally to hips. in ed, patient subsequently developed increased work of breathing and was intubated, although a repeat blood gas was essentially unchanged. pertinent results: relevant laboratory data on admission: cbc: wbc-13.0*# rbc-4.51* hgb-12.4* hct-37.5* mcv-83 mch-27.4 mchc-32.9 rdw-17.3* (neuts-87.5* lymphs-7.7* monos-4.5 eos-0.2 basos-0.1) plt count-280 coagulation profile: pt-13.9* ptt-23.9 inr(pt)-1.2 chemistry: glucose-235* urea n-30* creat-1.1 sodium-138 potassium-5.6* chloride-107 total co2-21* anion gap-16 alt(sgpt)-17 ast(sgot)-42* alk phos-65 amylase-44 tot bili-0.4 lipase-19 tot prot-6.1* albumin-2.8* globulin-3.3 calcium-8.5 lactate-2.3* abg in ed: type-art rates-/27 o2 flow-10 po2-170* pco2-34* ph-7.42 total co2-23 urinalysis: color-straw appear-hazy sp -1.020 blood-tr nitrite-pos protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod rbc-0-2 wbc-21-50* bacteria-mod yeast-none epi-0-2 ekg on admission: sinus rhythm, rate 100. normal tracing. compared to the previous tracing of , upright t waves in leads v3-v4. cxr : the heart size and mediastinal contours are unchanged. in comparison with the previous examination, the lung volumes have increased. there are stable emphysematous changes bilaterally, and stable prominence of the interstitial markings and upper zone pulmonary vascular redistribution. moderate right pleural effusion appears slightly increased. no pneumothorax. persistent opacity at the right base is suggestive of compressive atelectasis versus consolidation within the right lower lobe. the osseous structures appear unremarkable. impression: increased right pleural effusion. persistent bibasilar atelectasis versus consolidation at the right lower lobe. stable pulmonary congestion and emphysematous change. relevant data in hospital: u/s abdomen: a 4-quadrant son examination of the abdomen was performed to evaluate for ascites. no ascites was demonstrated. no attempted paracentesis or marking of spot was made. cxr an endotracheal tube terminates at the thoracic inlet. an ng tube curls within the stomach with its distal tip at the fundus. the heart is not enlarged. there is mild pulmonary edema. bilateral effusions are present along with atelectasis at both lung bases that appear unchanged when compared to the prior examination. no osseous abnormalities are seen. no pneumothorax is identified. cxr: ap single view obtained with the patient in semierect position, is analyzed in direct comparison with a previous chest examination dated . the patient is now extubated. an ng tube remains and reaches below the diaphragm, apparently curled up in the stomach. there is no evidence of pneumothorax. both lungs are well expanded. the bases are somewhat diffusely obscured, more marked on the right than on the left. a right diaphragmatic contour is obliterated and a density along the lateral wall is suggestive of pleural effusion layering mostly posteriorly. there is no conclusive evidence for any parenchymal infiltrate. in answer to specific question of free abdominal air, there is no conclusive evidence of such finding, but this cannot be completely eliminated as the patient is in semierect position only. brief hospital course: 68 year-old man with a history of hepatitis c/cirrhosis/hepatocellular carcinoma s/p cadaveric liver transplant in , also with a h/o cad s/p rca and lad stenting, dementia and recent admission for pneumonia, now presenting with a 1-day history of fever, hypoxia and mental status changes. his hospital course will be reviewed by problems. 1) fever: a cxr on admission was suspicious for a rll infiltrate (atelectasis versus pneumonia), and mr. was initially started on broad spectrum antibiotics with vancomycin, flagyl and ceftazidime pending culture data. his urine eventually grew klebsiella, and sputum cultures revealed gnr. in light of these results, vancomycin was d/c'd on , and cipro was added for double gram negative coverage pending final organism identification and sensitivites. sensitivities revealed klebsiella resistant to cephalosporins, and sensitive to imipenem. hence, ceftazidime and flagyl were d/c'd on , and imipenem was started. the sputum culture eventually grew klebsiella with the same sensitivities as in the urine, and cipro was d/c'd on . the patient defervesced on the above antibiotherapy, and plan is to complete a 14-day course of imipenem monotherapy (last doses on ). while in hospital, he developed diarrhea, negative for c.difficile. also of note, mr. has sacral and heel pressure ulcers, which will need to be followed up. the patient was seen by the wound care nurse while in hospital. 2) respiratory failure: his initial respiratory failure was felt most likely secondary to pneumonia +/- chemical pneumonitis in the setting of a depressed mental status. as noted above, mr. was intubated shortly after admission, and transferred to the for further care. he was quickly extubated on at night, and remained stable from a respiratory standpoint following extubation. he was transferred back to the floor on on supplemental oxygen 4l via nc. a cxr on was consistent with mild chf, and mr. was gently diuresed while on the floor with lasix 20 mg iv prn with goal negative 500cc/day, with good response. he was weaned from 4 to 1l/min via nc at the time of discharge, and was able to tolerate extended periods on room air (94%). he will need continued chest physiotherapy as an out-patient. 3) hypertension: patient hypertenssive in the icu and on the floor. both metoprolol and captopril were titrated up, with improved blood pressure control, although systolic blood pressure remains elevated at discharge (130-160). regimen at discharge includes metoprolol 100 mg po tid and captopril 50 mg po tid. 4) cad: patient with known cad s/p rca and lad stenting in 2/. while in hospital, mr. was continued on bb, acei. aspirin therapy was resumed (stopped for an unclear reason during a prior admission) after confirming with dr. . no acute issues while in hospital. 5) status post liver transplant: patient on tacrolimus therapy 1.5 mg po bid with goal trough . mr. was followed by the hepatology service throughout his hospital stay. tacrolimus levels therapeutic (5.6 on ) and lft wnl during hospital course. 6) dm type 2: while in hospital, avandia was held and patient was kept on a regular insulin sliding scale, with fair glycemic control. avandia 8 mg po qam resumed on . 7) dementia: patient admitted with acute on chronic mental status change, likely in the setting of his acute infection. at baseline, he is minimally verbally responsive, but certainly interactive. his mental status gradually improved while in hospital, and back at baseline at the time of discharge (per wife). of note, prior to admission, patient started on sinemet and ? ritalin , and unclear if prozac d/c'd. while in hospital, he was continued on fluoxetine. will discharge on fluoxetine and sinemet, and leave it to his pcp to decide re: ritalin. 8) fen: while in the icu, a bedside swallowing evaluation and video swallowing revealed aspiration with thin liquids but adequate swallowing with pureed foods/nectar-thick liquids consistency. a caloric count was performed while in hospital, which revealed sub-optimal caloric intake. after discussion with the patient and his wife, a post-pyloric feeding tube was placed and tube feeds initiated on . unfortunately, patient removed tube on . by the wife account, patient able to consume enough calories if he is fed slowly. she expressed a desire to feed him and ensure adquate caloric intake. when fed adequately, patient does have adequate intake. hence, the feeding tube was not replaced and mr. was discharged on po feeds. medications on admission: 1. fluoxetine hcl 20 mg po qd 2. multivitamin 1 tablet po qd. 3. metoprolol 50 mg po bid. 4. docusate sodium 100 mg po bid. 5. galantamine 12 mg po bid. 6. tamsulosin 0.4 mg po qhs. 7. trimethoprim-sulfamethoxazole 80-400 mg po qd. 8. tacrolimus 1.5 mg po bid. 9. captopril 25 mg po tid. 10. albuterol 0.083 % 1 neb inhaled q6h. 11. ipratropium 0.02 % 1 neb inhaled q6h. 12. ferrous sulfate 325 (65) mg po tid. 13. riss. 14. heparin 5,000 u sc tid. discharge medications: 1. fluoxetine hcl 20 mg capsule sig: one (1) capsule po daily (daily). 2. multivitamin capsule sig: one (1) cap po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. galantamine hydrobromide 4 mg tablet sig: three (3) tablet po bid (). 6. tamsulosin hcl 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 7. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 8. tacrolimus 5 mg capsule sig: three (3) capsule po bid (2 times a day). 9. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po tid (3 times a day). 10. heparin sodium (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 11. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 12. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q1-2h () as needed for wheezing. 13. ipratropium bromide 18 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours). 14. captopril 25 mg tablet sig: two (2) tablet po tid (3 times a day). 15. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 16. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 17. imipenem-cilastatin 500 mg recon soln sig: five hundred (500) mg intravenous every six (6) hours for 8 days: please give last doses on . 18. sinemet 25-100 mg tablet sig: one (1) tablet po three times a day. 19. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid:prn as needed for constipation: titrate to 1 bm per day. 20. regular insulin sliding scale 21. lasix 20 mg tablet sig: one (1) tablet po once a day. 22. tylenol 325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for fever or pain. 23. rosiglitazone maleate 8 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: urosepsis right lower lobe pneumonia hypertension coronary artery disease status post rca and lad stenting status post cadaveric liver transplant in diabetes mellitus type 2 dementia discharge condition: patient discharged to nursing home in fair condition. discharge instructions: ms. has a scheduled appointment with dr. on , at 08:40. he also has a scheduled appointment with neurology on , at 14:30. please see below for location. please call patient's pcp and schedule an appointment to see him within 2 weeks of discharge. patient should return to the ed if recurrent fever, n/v, increasing oxygen requirements or mental status change. followup instructions: please follow-up with dr. and dr. as scheduled below. 1. provider: , md where: lm phone: date/time: 8:40 2. provider: md where: neurology phone: date/time: 2:30 please also call mr. pcp and schedule an appointment to see him within 2 weeks of discharge. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere acute respiratory failure pneumonitis due to inhalation of food or vomitus other emphysema pressure ulcer, lower back pressure ulcer, heel personal history of malignant neoplasm of liver liver replaced by transplant pneumonia due to klebsiella pneumoniae 

Answer: The patient is high likely exposed to