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: s/p fall in nursing home major surgical or invasive procedure: none history of present illness: the patient is an 82-year-old male who is status post a witnessed fall at his nursing home. the patient had loss of consciousness and vital signs were stable at the time of the episode. was being seen at center for 2 weeks history of failure to thrive, decreased po intake, abd. distention and incontinence being treated for uti. he normally ambulates with a cane and is non verbal at baseline. needs assist with most adl's. past medical history: includes a history of cva, hypertension, dementia, hypernatremia, history of uti. social history: lives in nursing home, has family involved in care no reported use of alcohol or tobacco physical exam: reveals vital signs with a temperature of 100.2, heart rate of 108 and blood pressure 162/51. saturation 98% with a respiratory rate of 21 on room air. the patient is awake and alert and responsive to voices but is otherwise a poor historian. the patient's head and neck exam reveals intact vision and cranial nerves intact. chest exam reveals some slight crackles at the lung bases but otherwise clear. heart is regular rate and rhythm. abdominal exam is soft, nontender, nondistended, neuro:neuro: pts eyes closed, not opening to voice or stim, pupils reactive slightly 2.5mm b/l, roving eye movements, localizes to sternal rub briskly (l>r), no posturing, withdraws lower extremeties r>l, toes downgoing bilaterally, no clonus/spasticity. heent: no obvious csf rhinorrhea/otorrhea (+cerument impactions bilaterally), no battle/raccoons sign pertinent results: 10:07pm lactate-3.8* 10:00pm urea n-19 creat-1.0 sodium-143 potassium-4.4 chloride-110* total co2-19* anion gap-18 10:00pm ck(cpk)-314* 10:00pm ctropnt-0.05* 10:00pm ck-mb-4 10:00pm calcium-7.5* phosphate-2.1* magnesium-1.6 10:00pm wbc-23.3*# rbc-3.07* hgb-9.7* hct-27.8* mcv-91 mch-31.4 mchc-34.7 rdw-12.8 10:00pm plt smr-normal plt count-352 10:00pm pt-13.0 ptt-26.6 inr(pt)-1.1 08:35pm pt-13.2 ptt-29.5 inr(pt)-1.2 05:14pm lactate-2.5* 04:55pm urine rbc->1000 wbc-* bacteria-few yeast-none epi-0 04:55pm urine blood-lge nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 04:20am blood wbc-6.3 rbc-2.56* hgb-7.9* hct-23.6* mcv-92 mch-30.9 mchc-33.6 rdw-14.5 plt ct-530* 04:33am blood wbc-5.5 rbc-2.90* hgb-8.9* hct-25.8* mcv-89 mch-30.7 mchc-34.6 rdw-14.7 plt ct-559* 05:30am blood wbc-5.0 rbc-2.86* hgb-8.9* hct-25.5* mcv-89 mch-31.0 mchc-34.8 rdw-14.7 plt ct-591* 04:33am blood glucose-93 urean-11 creat-1.0 na-135 k-4.4 cl-103 hco3-24 angap-12 11:23pm blood glucose-89 urean-10 creat-1.0 na-136 k-4.1 cl-104 hco3-22 angap-14 05:30am blood glucose-86 urean-10 creat-0.9 na-136 k-4.3 cl-104 hco3-23 angap-13 04:20am blood alt-19 ast-34 ld(ldh)-321* alkphos-101 amylase-104* totbili-0.5 04:33am blood alt-19 ast-39 ld(ldh)-329* alkphos-124* amylase-78 totbili-0.5 04:33am blood lipase-49 05:30am blood lipase-34 10:00pm blood ctropnt-0.05* 09:18am blood ck-mb-7 ctropnt-0.10* 12:57pm blood ck-mb-8 ctropnt-0.07* 03:19am blood ck-mb-5 ctropnt-0.11* 12:20pm blood ck-mb-6 ctropnt-0.13* 03:01am blood ck-mb-4 ctropnt-0.10* 04:15am blood ck-mb-3 ctropnt-0.09* 10:00pm blood ck-mb-4 04:20am blood ck-mb-6 04:33am blood albumin-2.2* calcium-7.7* phos-2.4* mg-2.1 11:23pm blood calcium-7.5* phos-2.2* mg-2.1 05:30am blood calcium-7.6* phos-2.4* mg-2.1 09:00am blood cortsol-20.7* 04:45am blood cortsol-15.2 04:05pm blood hapto-164 09:35pm blood lactate-1.4 12:21am blood lactate-1.1 11:23am blood lactate-0.9 . ct head (w/o contrast): 1. acute left subdural hematoma with subarachnoid hemorrhage involving the left frontal and parietal sulci, in addition to the sylvian fissure and basal cisterns. there is no shift of normally midline structures at this time. 2. a small hemorrhagic contusion at the superior right frontal lobe as described. 3. more chronic right extraaxial fluid collection. 4. the findings were related to the ed dashboard immediately on interpretation. in addition, the findings were called to dr. . . cxr: no evidence of pneumonia. . ct c-spine: no evidence of cervical spine fracture or malalignment. there is calcification of the posterior longitudinal ligament at the c3/4 level that encroaches on the central spinal canal. . ct head (w contrast): 1. 3 mm focal widening of the left internal carotid artery at the level of the posterior communicating artery. 2. fusiform dilatation of the basilar artery just distal to its formation. 3. new hyperdense focus at the anterior most aspect of right temporal lobe consistent with contusion. 4. stable appearance of right superior frontal contusion, left subdural hematoma, and primarily left subarachnoid hemorrhage since prior exam. 5. multiple areas of arterial narrowing and irregularity, which may represent arteriosclerosis, arterial spasm or both. 6. left parotid tumor. . ct head: 1. minimal increase in size of the left subdural hematoma which now extends more inferiorly and posteriorly than on the prior exam, however, no significant shift of midline structures is demonstrated. 2. relatively stable appearance of right frontal intraparenchymal hemorrhagic contusion and subarachnoid blood. 3. stable appearance of the ventricles. note added at attending review: i believe there has been an increase in the volume of the ventricles since the prior examination. . ct abd/pelvis: 1. patent mesenteric vasculature without evidence of ischemic bowel. the bowel appears nondistended and unremarkable. 2. moderate amount of ascites and periportal edema. 3. small bilateral pleural effusions with bibasilar compressive atelectasis. 4. mildly distended gallbladder with gallbladder wall edema and cholelithiasis. no intrahepatic or extrahepatic biliary duct dilatation is noted. clinical correlation is recommended. hida scan could be performed if there is concern for acute cholecystitis 5. subcentimeter low attenuation lesions within both kidneys, which may represent simple cysts but are too small to fully characterize. 6. sigmoid diverticulosis without evidence of diverticulitis. 7. heterogeneous-appearing and enlarged prostate most likely representing benign prostatic hypertrophy. . ct head: no interval change in the appearance of intracranial hemorrhage and the brain. . cxr: moderate-to-large pleural effusions, right greater than left, increased since . progressive consolidation in left lower lobe could be atelectasis or pneumonia. minimal, if any, interstitial pulmonary edema present. heart size top normal. right internal jugular line tip projects over the svc. feeding tube with a wire stylet in place passes below the diaphragm and out of view. thoracic aorta is tortuous, but not focally dilated. . kub: a portable supine view of the abdomen show gas filled nondilated large and small bowel loops without evidence of intestinal obstruction. there are bilateral pleural effusions. note is made of an ng-tube with the tip in stomach. . cxr: a feeding tube remains in place within the stomach. cardiac and mediastinal contours are stable. again demonstrated are bilateral pleural effusions, moderate on the right and small on the left. the left effusion appears slightly smaller in the interval, but positional differences of the patient may account for this difference. there remains increased opacity in the lung bases adjacent to the effusions, most likely due to atelectasis. no new or progressive abnormalities are evident. . ct of the sinuses without contrast : negative . cxr: 1. interval placement of a left subclavian central line with the tip in the mid svc. no evidence of pneumothorax. 2. stable bilateral pleural effusions and left retrocardiac opacity. . ct cap: 1. large bilateral pleural effusions with bibasilar compressive atelectasis. significant increased in size of these effusions when compared to prior exam (). 2. 8-mm stone within the distal cbd. not significantly changed from prior exam. the common bile duct is upper limits of normal in size, measuring 7 mm. given the patient's recent negative hida scan, there likely is no functional obstruction. however, if clinically indicated, further evaluation can be performed with an mrcp. 3. diffuse ascites and anasarca. 4. no evidence for intraabdominal abscess. . ct head:continued evolution of bilateral subdural and subarachnoid hemorrhage with possible slight interval increase in degree of mass effect of the right subdural hemorrhage. . cxr (post-tap): portable semi-erect ap radiograph of the chest is reviewed, and compared with previous study of . the left subclavian iv catheter terminates in the left innominate vein. a feeding tube terminates in the gastric body. the previously identified bilateral lower lobe opacity has been mproving. there is continued left lower lobe consolidation indicating atelectasis versus pneumonia. there is small bilateral pleural effusion. the heart and mediastinum are within normal limits. the lungs are clear otherwise. there is no evidence of pneumothorax. . cxr pm (prelim): increasing moderate l pleural effusion, small loculated r pleural effusion, bibasilar atalectasis, no pneumothorax. . echo: 1. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). 2. the aortic root is moderately dilated. 3. the aortic valve leaflets (3) are mildly thickened. moderate (2+) aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 5. there is a small pericardial effusion. . eeg: abnormal awake eeg due to diffuse delta slowing as well as background slowing with decreased voltages over the left temporal region, more so than the left convexity. this tracing gives evidence for a cortical and subcortical encephalopathic process with voltage asymmetry consistent with the patient's known subdural hematoma. no epileptiform activity was seen and there was no suggestion of subclinical status epilepticus on this tracing. . cxr: there is a small persistent left pleural effusion but progressive leftward mediastinal shift indicates left lower lobe collapse. small right pleural effusion is present. heart is top normal size. left subclavian catheter tip projects over the svc and a feeding tube ends in the stomach. . cxr: 1. dobbhoff tube is seen, with the tip in the mid esophagus. 2. interval complete opacification of the left hemithorax, which likely represents a combination of an increase in the left pleural effusion with associated left lung atelectasis. . cxr: improving aeration in the right upper lobe. persistent collapse of left lower lobe with likely accompanying large effusion. . cxr: : accounting for positioning differences, no significant interval change without definite evidence for developing pneumonia. . micro: blood culture: ngtd urine culture: negative cath tip: no growth sputum culture: contaminated, culture not done urine culture: negative, fungal negative blood culture: negative urine culture: negative blood culture: negative sputum culture: contaminated, culture not done urine culture: negative blood culture: negative c diff: negative 11/23/2205 c diff: negative rpr: non-reactive blood culture: negative urine culture: negative blood culture: negative c diff: negative blood culture: negative sputum: contaminated, culture not done urine culture: negative (x 2) cath tip: negative blood culture: negative blood culture: negative urine: negative mrsa screen: negative rectal swab: positive for vre mrsa screen: negative sputum: 2+ gnr, 1+ gpr, 1+ gpc in pairs urine: negative blood culture: negative blood culture: negative blood culture: negative blood culture: negative urine: negative ua: >1000 rbc, wbc, few bacteria, neg leuk, neg nitrite . cytology of pleural fluid: negative for malignant cells brief hospital course: neurosurgery course: . pt was admitted to neurosurgery after falling at the rehabilitation hospital he had been discharged to one day earlier after an admission at for a uti. he was found to have a sub-arachnoid sub-dural hemorrhages, and was admitted to the sicu as he required intubation and pressors (for desaturation, tachycardia, and hypotension) to maintain his hemodynamic status. he was evaluated by neurosurgery and trauma who did not feel surgery was required at that time. he was loaded with dilantin for seizure control, and his neuro exam slowly improved throughout his sicu stay with increasing spontaneous movment and awakening. he was weaned off pressors and extubated . repeat imaging of his head revealed that his bleeds were stable. . during the first 3 days of his admission he was noted to have elevated cardiac enzymes, and some ekg changes. his peak troponin was 0.13 and his peak ck was 508 with an mb of 8. cardiology was consulted, and felt that this mild increase in the setting of his intracranial hemorrohage likely represented demand ischemia. per their recommendations, his lopressor dose was adjusted to 25 , and they signed off. . also on admission he was noted to have an elevated temperature, and he was started on levofloxacin and vancomycin. his fevers continued despite antibiotic treatment, and he was transferred to the medicine service for further evaluation and management on , and neurosurgery signed off that day. . medicine course: . # fevers: mr was febrile on admission, and had just been transferred to a rehab facility after inpatient treatment at for a uti, where he received ciprofloxacin. he was initially treated with vancomycin and levofloxacin for a total of 5 days for a presumed uti and possible mrsa exposure in osh or rehab. the vancomycin was then stopped, and flagyl started. the vanco was restarted after being off for 2 days. throughout this time the patient continued to spike to 103 daily, and was pan-cultured multiple times, with no growth of any culture including urine. although his chest xray suggested a possible pneumonia at one point, follow up studies did not support this diagnosis. an echo did not show endocarditis. a diagnostic tap of his pleural effusions revealed no malignant cells, and grew nothing on culture. . the only potential source of infection was that the patient was seen to have gall stones and a stone in the common bile duct with mildly elevated lfts, raising concern for cholangitis. a hida scan was negative for cholecystitis, and surgery did not feel he needed a procedure at that time. finally, after extensive work up, id was consulted. per their recommendations the patient was taken off levofloxacin and flagyl and started on zosyn to complete a 14 day course to cover possible cholangitis. mrcp was attempted but the patient did not tolerate lying flat for the procedure. his fever curve slowly trended down, and after negative cutures of all line tips, the patient was taken of vancomycin as well, having received 14 days of that antibiotic. ercp was considered, but given the patient's improvement, and the risks of the procedure, which would have to be done under general anesthesia, it was decided not to pursue this further at this time. . after he was afebrile for 48 hours he received a picc line , and peg . he has had one febrile spike since that time, on , with negative cultures. at time of discharge he has been afebrile since 1am . he has completed a 14 day course of zosyn on . of note, it may be that the patient will intermittantly spike temperatures due to aspiration of his oral secretions, as he has failed two speech and swallow evaluations (see below). another consideration would be his phenytoin, and he could be transitioned to an alternative medication for seizure prophylaxis if fevers continue, since there has been no strong evidence for continuing infectious source of fevers. . # respiratory: mr. had thick secretions throughout his stay, requiring frequent suctioning, and resulting in mucous plugging with episodes of desaturation. these routinely resolved with deep suctioning and nebulizer treatments. at the time of discharge he has had no desaturations in four days. additionally, he had bilateral pleural effusions on transfer to medicine. the right side was tapped for diagnostic and therapeutic purposes, and has remained resolved. the left pleural effusion resulted in significant left-sided atalectasis, both of which have been resolving with diuresis. as his effusions have resolved his respiratory status has improved. he is still requiring frequent suctioning and close monitoring for mucous plugging at time of discharge. as his status further improves he will be able to transition to a lower level of nursing care. . in addition to the above respiratory issues, mr. began breathing several days after transfer to the medicine service with apneic episodes lasting 10-20 seconds and spontaneously resolving. he was placed on an apenea monitor and pulmonary critical care was consulted. they felt this breathing pattern was part of the natural course of his intracranial bleed. the apneic episodes never required intervention for resolution, and have completely resolved - he has had no apneic episodes for 4-5 days at discharge. . # anemia: mr was anemic on admission, likely related to his age, chronic medical conditions, and his poor nutritional status. however, his hematocrit then dropped over two days (11/27-28/05): 31 -> 26.7 -> 25.8 -> 22.7 -> 24.8; with haptoglobin normal, reticulocyte count 1.0, and total bilirubin 0.7; so no clear sign of hemolysis. he was repeatedly guaiac negative, with no sign bleeding elsewhere. this did occur shortly after thoracentesis, so we considered that he could be slowly bleeding there as well. his pleural effusions have been continuing to improve with diuresis however, and there was no sign of new areas on repeat chest xrays. his hematocrit then dropped to 23.4 a couple days later, and he finally received one unit of packed rbcs, with a good response in his hematocrit. on discharge he has stabilized for more than 3 days. . # sah/sdh after fall: per the neurosurgery team, mr. was stable on transfer to the medicine service, and does not require surgery. they suggested a bloob pressure goal of systolic less than 160 per a verbal statement of the neurosurgery pa. on a repeat head ct was done for a change in mr. breathing (see above), and showed no new hemorrhage, but slight increase in mass effect and r to l shift. we contact neurosurgery, and they felt no intervention was needed at that time. they would intervene if >1cm midline shift and his was less. they also suggested keeping his inr < 1.3 and approved sc heparin for dvt prophylaxis. he received a total of 5mg vitamin k subcutaneously for an inr of 1.6, and his inr has been normal since. his inr should continue to be kept below 1.3. his dilantin levels were monitored closely, and were therapeutic. he required one reloading of 300mg, but has been stable for more than a week on his current dose. neurology advised us on his replading dose. additionally there was some qustion of whether he had some facial twitching that might represent seizures. his dilantin was reloaded as descirbed, and an eeg was done 11/27/5, which showed diffuse slowing and activity consistent with his intracranial bleed, and no sign of seizure activity. of note his measured phenytoin levels were adjusted for his albumin level. . # possible heart failure: on transfer to the medicine service mr. had anasarca and bilateral pleural effusions. although he ahd no previous diagnosis of congestive heart failure, there was concern for new onset failure versus poor nutritional status and acute illness with fluid resucitation. an echo showed 2+ ar and an ef > 55%. it is possible his ar in combination with his poor nutritional status underlies his fluid accumulation. his lopressor was continued with frequent ekgs as he has had pvcs throughout his stay. the plan was to stop beta-blocker treatment if his qtc interval increased to > 450, and then start lisinopril instead for afterload reduction. however his qtc interval has remained below 450, and beta-blocker therapy is in place on discharge. of note, his electrolytes are stable, and there is no current therapy required for his pvcs. mr. edema has almost completely resolved at time of discharge, following daily diuresis. . # hematuria/incontinence: mr. had accidental foley removal associated with his fall while at his prior rehabilation facility, with resulting traumatic injury to his urethra/penis, and bleeding. he was seen by urology, who advised keeping the foley in to tampanade bleeding, and further suggested that he should be discharged with foley in place to follow up in urology clinic at a later date. he is scheduled for a follow up appointment. . # hypertension: mr. was normotensive throughout his time on the medical service on his current regimen of lopressor. per neurosurgery we were keeping his sbp < 160 in the setting of his intracranial hemorrhage. in addition to his lopressor, he was written for prn hydralazine, but did not require this as his sbp was did not go above 145. as he recovers further, his beta-blocker dosing could be further adjusted to maintain normal bp. he should continue to be maintained with a sbp < 160. . # fen: mr. failed two swallowing evaluations, and therefore received enteral feedings through an ngt. these were intermittantly stopped to accomodate procedures and/or acute decompensations in his condition. he was able to reach his goal feeding of probalance full strength at 55cc/hr. prior to discharge a peg tube was placed to provide access for long-term enteral nutrition. he should continue to receive tubefeeds, and his albumin should be monitored for improvement. his electrolytes should continue to be monitored and repleted as needed. they have been stable throughout his stay, requiring little to no repletion. of note, his calcium levels have been normal when adjusted for his albumin level. mr. received small fluid boluses at times throughout his stay for low uop. largely however, he did not receive many supplemental iv fluids, as he was quite fluid overloaded, receiving a significant volume of iv medications, and we were required to diurese him to improve his edema a respiratory status. . # prophylaxis: mr was on protonix for ulcer prophylaxis, and sc heparin for dvt prophylaxis after cleared by neurosurgery. . # disposition: mr. was discharged for further nursing care and physical therapy as he continues to recover from his fall, intracranial hemorrhage, and sepsis. he may finally require chronic care in a lower level nursing facility, depending on the level of his recovery from this acute injury. . # code: full code: multiple family meetings were held with the medical team, dr. , dr. , and mr. wife and children to discuss his current medical status and prognosis. it was explained many times that dnr/dni does notmean withdrawing care, but rather sets limits on the extent of care pursued in case of acute decompensation. mr. full family met and finally decided they want to keep him full code and pursue all treatment options at this time. medications on admission: norvasc 10mg po daily aspirin 325mg po daily pravachol 10mg po daily ciprofloxacin discharge medications: 1. albuterol sulfate 0.083 % solution sig: one (1) nebulizer treatment inhalation q3-4h (every 3 to 4 hours) as needed. 2. ipratropium bromide 0.02 % solution sig: one (1) nebulizer treatment inhalation q3h (every 3 hours) as needed. 3. acetaminophen 650 mg suppository sig: one (1) suppository rectal q4-6h (every 4 to 6 hours) as needed for fever or pain. 4. papain powder sig: 5-10 mls miscell. prn (as needed) as needed for indigestion. 5. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 6. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for yeast infection. 7. pravastatin 10 mg tablet sig: one (1) tablet po daily (daily). 8. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 9. phenytoin 100 mg/4 ml suspension sig: one y (150) mg po q8h (every 8 hours). 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for heart rate less than 60 or systolic blood pressure less than 100. 11. furosemide 20 mg tablet sig: one (1) tablet po once a day: via peg tube. 12. hydralazine 20 mg/ml solution sig: twenty (20) mg injection q6h (every 6 hours) as needed for hypertension for 5 days: please give for systolic blood pressure greater than 160 only, hold for systolic blood pressure less than 140. discharge disposition: extended care facility: - discharge diagnosis: primary: subdural hemorrhage, subarachnoid hemorrhage, sepsis secondary: dementia hypertension acute coronary syndrome fluid overload poor nutritional status discharge condition: stable: afebrile, decreased supplemental oxygen requirement, tolerating enteral feeding, seizure-free, with no signs of further intracranial hemorrhage. discharge instructions: please inform your doctor if you have worsening breathing, temperatures greater than 101 farenheit, nausea & vomiting, diarrhea, seizures, or any other health concern. followup instructions: please follow with the primary doctor at your skilled nursing facility. . provider: , m.d. urology, phone: date/time: 8:30 . provider: , neurosurgery west phone: date/time: 9:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells diagnoses: anemia, unspecified unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension unspecified fall other persistent mental disorders due to conditions classified elsewhere pneumonitis due to inhalation of food or vomitus cholangitis subdural hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness acute pancreatitis subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness calculus of bile duct without mention of cholecystitis, without mention of obstruction foreign body in larynx 

Answer: The patient is high likely exposed to