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 (sulfonamide antibiotics) / levaquin / allopurinol / rituxan / droperidol / doxycycline / bacitracin attending: chief complaint: hypotension major surgical or invasive procedure: sinus debridment history of present illness: 69 yo m w/ cll, h/o parkinson's disease, recurrent pulmonary infections and chronic sinusitis who is s/p endoscopic sinus surgery (sinusectomy) on to prevent recurrence of mrsa pneumonia. on he started to develop fevers, was seen by ent on and given inhaled vancomycin and betamethason as or cultures were positive for mrsa. he was then admitted from and started on vancomycin with goal trough of 10. during that admission his anc dropped to 0 and was started on neuopgen by his oncologist, dr. . on he underwent debridment by dr. with minumal purulent discharge. on he began to develop fevers to 103 with rigors and fatigue. he was admitted on . in the ed, labs were notable for wbc 51.9 hct 25 plts 104, sodium 132 (was 27 on ). cxr without infiltrate. his floor course was c/b several runs of afib with rvr to the 150s with systolic blood pressures as low as the 80s. he was started on cefepime to converage grown on nasal swab for pseudomonas on . since then his fever curve has declined. today at 7am he was in afib wtih rvr to 150 blood prssure briefly at 70/52. he was given 3l ns followed by 0.25mg of digoxin. ekg was similar to above. pt remained asympomatic throughout without chest pain, palpitations, shortness of breath, or light headedness. shortly after digoxin, hr reduced to 80s-100, bp improved to 90s. he was transferred to the micu for monitoring and for increased nursing requirements. past medical history: past medical history: -cll (dx ) s/p rituximab, fludarabine in . -hypogammaglobulinemia (iga, igm) treated with iv ig 2x/month (last ) -recurrent pna with mrsa, pseudomonas, m. gordonae (likely contaminant) -bronchiectasis -recurrent sinusitis -rectal ca in s/p resection, radiation, 5-fu -parkinson's dz dx -htn social history: the patient is married, lives with his wife in . he has two daughters, both healthy. he is a retired phd in economics, still working minimally as a professor. . no tobacco. no ivdu or illicits. family history: stroke and parkinson's disease, congestive heart failure, prostate cancer, glaucoma. physical exam: admission physical exam: vitals: t:98.2 bp:95/69 p:101 r:20 o2:94% ra general: alert, oriented, no acute distress heent: sclera anicteric, perrl, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: few basilar rales. otherwise clear, good airmovement. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, enlarged spleen gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: perrl, no facial assymmetry, + cogwheel rigitidity, alert and oriented, responds appropriately to questions. pertinent results: 11:55am gran ct-355* 11:55am plt smr-low plt count-86* 11:55am hypochrom-1+ anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 11:55am neuts-1* bands-0 lymphs-98* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 11:55am wbc-35.5* rbc-2.76* hgb-8.4* hct-25.1* mcv-91 mch-30.5 mchc-33.5 rdw-15.3 12:45pm pt-13.3 ptt-25.8 inr(pt)-1.1 12:45pm plt smr-low plt count-104* 12:45pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 12:45pm neuts-1* bands-0 lymphs-99* monos-0 eos-0 basos-0 atyps-0 metas-0 myelos-0 12:45pm wbc-51.9* rbc-2.74* hgb-8.4* hct-25.1* mcv-91 mch-30.7 mchc-33.6 rdw-15.9* 12:45pm lactate-0.9 12:45pm estgfr-using this 12:45pm glucose-123* urea n-17 creat-1.0 sodium-132* potassium-4.1 chloride-98 total co2-24 anion gap-14 01:30pm urine rbc-0 wbc-0 bacteria-mod yeast-none epi-0 01:30pm urine blood-neg nitrite-neg protein-25 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:30pm urine color-yellow appear-clear sp -1.021 08:25pm plt smr-low plt count-84* 08:25pm wbc-39.3* rbc-2.54* hgb-7.7* hct-22.9* mcv-90 mch-30.5 mchc-33.8 rdw-15.9* 08:25pm vanco-9.5* 08:25pm ck-mb-1 ctropnt-<0.01 08:25pm ld(ldh)-135 ck(cpk)-18* 08:25pm glucose-155* urea n-17 creat-1.1 sodium-132* potassium-3.5 chloride-97 total co2-25 anion gap-14 02:52am blood gran ct-1780* 04:00am blood gran ct-720* 11:55am blood gran ct-355* 12:03pm blood tsh-2.5 05:47am blood wbc-34.3* rbc-2.44* hgb-7.4* hct-22.5* mcv-92 mch-30.4 mchc-33.1 rdw-17.3* plt ct-54* 05:47am blood glucose-91 urean-16 creat-1.1 na-140 k-4.2 cl-103 hco3-32 angap-9 11:30 am swab site: sinus **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. heavy growth. of two colonial morphologies. sensitivities: mic expressed in mcg/ml ______________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ 4 s meropenem------------- 0.5 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s 12:10 pm tissue source: middle meatus. **final report ** gram stain (final ): reported by phone to @ 630pm . 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). tissue (final ): pseudomonas aeruginosa. heavy growth. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ 2 s meropenem-------------<=0.25 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s anaerobic culture (final ): no anaerobes isolated. potassium hydroxide preparation (final ): no fungal elements seen. fungal culture (final ): no fungus isolated. blood culture, routine (final ): no growth. urine culture (final ): no growth. blood culture, routine (final ): no growth. urine culture (final ): no growth. blood culture, routine (final ): no growth. urine culture (final ): no growth. blood culture, routine (final ): no growth. .........................imaging................... echo the left atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: normal global and regional left ventricular systolic function. borderline dilated and hypokinetic rv. mild mitral regurgitation. moderate pulmonary artery systolic hypertension. ct chest here is no evidence of pulmonary embolism. small bilateral pleural effusionsand associated bibasilar atelectasis are new. bronchiectasis and bronchialwall thickening involving the anterior segment of the right upper lobe (2:28)is unchanged since . allowing for the limitation of significant respiratory motion artifact, multiple poorly defined nodules in the left upper lobe: a 5-mm perifissural nodule (2:17) in the apical posterior segment, and two other ground-glass opacities in the anterior segment of the left upper lobe measure 5 mm each (2:18 and 20). a 3-mm noncalcified left apical posterior segment nodule on act of is now calcified (2, 19), suggesting that it is a granuloma. a 5-mm noncalcified superior segment of right lower lobe nodule is stable since (2:25). extensive adenopathy in the superior mediastinum, bilateral axillae, anterior mediastinum, tracheobronchial stations and the para-aortic space are again present: the largest right hilar node measures 18 x 26 mm compared to 13 x 21 mm on the prior study (3:46). confluent prevascular adenopathy has also increased in size and number (3:31). conversely enlarged axillary and periaortic lymph nodes have decreased in size: a right axillary node measures 20 x 24 mm (2:20) compared to 22 x 32 mm on the prior study, the largest paraaortic posterior mediastinal node now measures 41 x 42 mm compared to 41 x 45 mm on the prior study (2:45). a left upper extremity peripherally inserted central venous catheter tip terminates in the distal left brachiocephalic vein. the cardiac size is normal without pericardial effusion. the airways are patent to the subsegmental level. the proximal esophagus is mildly dilated and contains food debris, possibly a mechanical effect of the extensive posterior mediastinal adenopathy. the study is not tailored for subdiaphragmatic evaluation, only to confirm extensive para-aortic and retroperitoneal soft tissue masses which are incompletely visualized and stable perinephiric fat stranding. upper and lower thoracic spine osteophytosis are moderately severe. impression: 1. no evidence of pulmonary embolism. 2. new small bilateral pleural effusions with associated atelectasis. 3. mixed interval change in size of extensive axillary, hilar, superior and posterior mediastinal adenopathy. there is enlargement of the mediastinal and hilar adenopathy with slight interval reduction or stability of the axillary and posterior mediastinal masses. 4. three new left upper lobe poorly defined nodules, in the setting of recent surgery could represent aspiration or infection. 5. stable mild right middle lobe bronchiectasis and bronchial wall thickening. brief hospital course: assessment & plan: a 69 yom with pmh paroxsymal afib, cll, parkinson's disease, chronic sinusitis and mrsa pneumonia admitted for pseudomonas sinusitis and called out of micu after 4 day stay for afib with rvr. #. sinusitis: on admission, was febrile to 103, most likely source was sinuses given recent debridment. blood cultures and urine cultures were negtaive. he was empirically treated with cefipime while pseudomonas cultures were speciated. culture data showed sensitivity to cipro and cefipime, however patient is allergic to fluroquinolones. he was treated with cefipime and vancomycin, given history of mrsa sinusitis. ent followed the patient in house and performed repeated debridments of sinuses. he was discharged with a picc line and a plan for outpatient iv cefipime and vancomycin to complete a total of 14 days of antibiotic therapy. followup with ent and pcp was arranged. #: micu course: on hd 4, he developed a fib with rvr and hypotension to sbp 70, he was transfered to the micu where he was treated with fluid resussication and rate controlled with amiodarone and digoxin, he converted to sinus rhythm and both were discontinued and metoprolol 12.5mg was started. cta chest was performed which was negative for pe, echo showed borderline hypokenetic rv and normal lv systolic function. moderate pulmonary artery systolic hypertension was noted. # afib: following transfer from micu, patient remained in sinus rhythm and was continued on metoprolol 12.5 mg tid. # cll: patient has not been treated since as there have been no acute indications to do so. he is followed by dr. as outpt. on admission his neutrophil count was 790 and he received one dose of neuopgen to correct this. he was given an appointment for follow up with dr. on discharge. # parkinson disease: patient has slow scanning speech and a shuffling gait, no resting tremor appreciated on exam. throughout admission, patient was maintained on home regimen of carbidopa/levodopa, rasagiline 0.5 mg daily and ropinirole 3 mg qid. medications on admission: -rasagiline 1 mg tablet sig: one (1) tablet po daily () as needed for parkinsons. - ropinirole 1 mg tablet sig: three (3) tablet po qid (4 times a day). -amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). -alprazolam 0.25 mg tablet sig: three (3) tablet po qhs (once a day (at bedtime)). -nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day) as needed for groin rash. -guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (). -psyllium packet sig: one (1) packet po tid (3 times a day) as needed for constipation. -vancomycin inhaled treatment (pt to take home medication) -betamethasone oral -acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain or fever. -carbidopa-levodopa 25-100 mg tablet sig: two (2) tablet po qam (once a day (in the morning)) as needed for at 7 am. - carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po daily (daily) as needed for 10:30 am. 16. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)) as needed for 2 pm. -carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)) as needed for 5:30 pm. -vancomycin in d5w 1 gram/200 ml piggyback sig: 250 ml intravenous q 12h (every 12 hours) for 16 days. disp:*80 grams* refills:*0* -carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po daily (daily) as needed for 10:30 am. disp:*45 tablet(s)* refills:*0* - neupogen sig: three hundred (300) mcg subcutaneous once a day. discharge medications: 1. cefepime 2 gram recon soln sig: one (1) recon soln injection q8h (every 8 hours) for 22 doses: final full day of abx: . disp:*22 recon soln(s)* refills:*0* 2. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 6 doses: final full day of abx . disp:*6 gram* refills:*0* 3. acetaminophen 650 mg tablet sig: one (1) tablet po every six (6) hours as needed for fever: do not exceed 4000mg in 24hrs 4. ropinirole 1 mg tablet sig: three (3) tablet po qid (4 times a day). 5. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 6. alprazolam 0.25 mg tablet sig: three (3) tablet po qhs (once a day (at bedtime)). tablet(s) 7. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day): groin rash. 8. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po twice a day. 9. psyllium packet sig: one (1) packet po tid (3 times a day) as needed for constipation. 10. carbidopa-levodopa 25-100 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). 11. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po daily 2pm (). 12. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po daily 17:30. 13. carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po daily 10:30. 14. betamethasone 0.6 mg/5 ml solution oral 15. rasagiline 0.5 mg tablet sig: one (1) tablet po daily (daily). 16. mupirocin 2 % ointment sig: one (1) appl topical every hours: 3 inches of mupirocin mixed in saltaire bottle (420ml), use 2 squirts in each nostril . 17. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 18. outpatient lab work please check cbc with differential and fax to dr. at , and dr. at discharge disposition: home with service facility: northeast home care discharge diagnosis: primary diagnosis pseudomonas sinusitis secondary diagnoses: paroxsymal atrial fibrillation cll (dx ) s/p rituximab, fludarabine in . hypogammaglobulinemia (iga, igm) treated with iv ig 2x/month (last ) recurrent pna with mrsa, pseudomonas, m. gordonae (likely contaminant) bronchiectasis recurrent sinusitis rectal ca in s/p resection, radiation, 5-fu parkinson's dz dx discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure taking care of your in your hospitalization at . as you know, you were admitted for pseudomonas sinusitis. you were seen by ear nose and throat who performed debridments of your and flushings of sinuses. you were treated with iv antibiotics with good result. you are being discharged with visiting nurse service to help administer your antibiotics. in your hospital stay, you developed atrial fibrillation and were admitted to the intensive care unit for low blood pressure related to atrial fibrillation. your heart rhythm returned to and you were started on metoprolol to prevent return of atrial fibrillation. we recommend that you follow up with your primary care doctor to discuss the length of treatment with metoprolol. we noted that you are anemic (low blood), although not in a dangerous range, we recommend that you have your blood checked in one week and follow up with dr. to discuss your red blood cell level. we have arranged for the visiting nurse to draw your blood. we made the following changes to your medications: - start metoprolol 12.5mg three times per day - start iv cefipime three times per day - start iv vancomycin twice per day followup instructions: please call dr. from ear nose and throat to arrange follow up for this thursday () or friday (). dr. friday at 11:20am ipswitch department: hematology/bmt when: wednesday at 2:00 pm with: , md and dr. building: sc clinical ctr campus: east best parking: garage procedure: sinusectomy, not otherwise specified sinusectomy, not otherwise specified diagnoses: thrombocytopenia, unspecified anemia, unspecified unspecified septicemia hyposmolality and/or hyponatremia atrial fibrillation sepsis paralysis agitans methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site bronchiectasis without acute exacerbation personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health splenomegaly chronic lymphoid leukemia, without mention of having achieved remission insomnia, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site chronic maxillary sinusitis neutropenia, unspecified acute sinusitis, unspecified hypogammaglobulinemia, unspecified personal history of methicillin resistant staphylococcus aureus personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus 

Answer: The patient is high likely exposed to