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: sepsis major surgical or invasive procedure: intubation history of present illness: this is an 84 year old male with a history of emphysema, atrial fibrillation, type ii diabetes, and history of aaa repair who presents from hospital with hematuria, hematemasis and elevated lactate. history is taken per the patient's family. he presented twice to cape code hospital within the past 24 hours. his initial presentation was for hematuria for which he was prescribed ciprofloxacin. he presented again with hematemasis and respiratory distress. he was found to be tachypnic and unresponsive and was intubated. he had a foley catheter placed which was subsequently palpable in the patient's scrutum. he received methylprednisolone, albuterol, atrovent, succinylcholine, etomidate, propofol and zosyn. he had a ct abdomen and pelvis, the results are pending. he was transferred here for further management. . in the ed, initial vs were: t 97.2 p 116 bp 106/76 r 25 96 o2 sat, vent settings not listed. noted to have new renal failure and elevated lactate. the patient underwent a urology evaluation, cystoscopy and foley placement attempt. he received levaquin, versed and propofol. head ct here wnl. abdominal ct initially concerning for free air in abdomen. also of note, the patient was found to have unequal pupils r (surgical) pupil 5mm, l pupil 1mm, that resolved after a negative head ct. . on arrival to the icu, the patient is intubated and sedated. when sedation is lightened, the patient is non responsive. urology is present and attempting to replace the patient's foley catheter that does not appear to be in place. . a discussion with his wife reveals recent hematemesis for the past 24 hours with hospitalization, the details of her story were unclear. additionally, she reports a medical history of only "aneurysms down the front" which have been repaired by a dr. on . . review of systems: unable to obtain past medical history: atrial fibrillation s/p pcm emphysema dvt from trauma cad, htn, hld hematuria bph urosepsis dm2 h/o cva s/p aaa repair s/p appy s/p ccy social history: lives with wife, unclear past habits. son and wife unaware of patients wishes regarding end of life. family history: father with stomach ca, mother unknown physical exam: vitals: t: 93.1 bp: 130/62 p: 118 r: 31 o2: 100% on invasive ventillation general: cachetic intubated man, not responsive to any stimuli. heent: r surgical pupil, equal and reactive. dry mucous membranes. neck: jvp not elevated lungs: wheezing and crackles throughout all lung fields. cv: s1 & s2 fast and irregular, no murmur appreciated. abdomen: thin/rigid, bowel sounds not present. gu: foley in place with blood at meatus, draining bloody urine ext: cold, no edema, 1+ distal pulses. pertinent results: 10:56am 7.28/43/204/21 na:135 k:4.8 cl:98 glu:>500 freeca:1.03 lactate:10.5 hgb:10.0 calchct:30 o2sat: 99 . 05:27a k:5.8 lactate:7.7 140 102 47 -----------< 221 5.6 19 2.4 estgfr: 26/31 (click for details) ck: 56 mb: notdone mg: 2.3 p: 5.7 alt: 26 ap: 179 tbili: 1.0 ast: 36 tprot: 7.3 dig: 1.7 . 12.7 32.5>---<291 13.7 291 43.2 n:93 band:2 l:1 m:4 e:0 bas:0 poiklo: 1+ macrocy: 1+ tear-dr: 1+ . pt: 11.7 ptt: 27.3 inr: 1.0 cxr: cardiac size is normal. ng tube tip is out of view below the diaphragm but likely in the stomach. right ij catheter tip is in the upper svc. left transvenous pacemaker lead terminates in unchanged position one in the right atrium and the second one could be just at the entrance of the right ventricle. moderate to large right pleural effusion has minimally increased in size. right ij catheter tip in the cavoatrial junction. bilateral pulmonary enlargement is stable. the lungs are hyperinflated due to emphysema. right apical opacity likely related with past tuberculosis and fibrotic changes is stable. left apical pleural thickening is also stable. asymmetric opacification of the lungs that is mild, greater on the right side has increased on the right mid lung and suggest a new area of infectious process. otherwise mild edema is stable. ue us: no evidence of deep vein thrombosis in the right arm. the right cephalic vein could not be identified. cta head: impression: no significant abnormalities on ct angiography of the head. ct head: impression: 1. no evidence of acute hemorrhage or vascular territorial infarction. 2. evidence of remote infarction, possibly embolic. tte: left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. the pulmonic valve leaflets are thickened. there is moderate pulmonic valve stenosis. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures. impression: hyperdynamic lv systolic function. there is an increased gradient seen along the right ventricular outflow tract. this could be from infra-pulmonic, supra-pulmonic or pulmonic valve stenosis. there may be extrinsic compression of the rvot/proximal pulmonary artery causing this gradient. no other valvular abnormality seen. no evidence of endocarditis (cannot exclude). small anteriori pericardial effusion without evidence of tamponade. ct cystogram/pelvis: 1. the foley catheter is within the urinary bladder. there is no evidence of contrast leak. multiple bladder diverticula are seen. 2. minimal amount of free air as well as small volume of free fluid within the deep pelvis (subperitoneal), consistent with history of recent foley trauma. cxr (official read): 1. et tube and ng tube as described above. the ng tube should be advanced. 2. left lower lobe peribronchiolar opacity concerning for possible aspiration. follow up radiograph is recommmended. 3. biapical pleural scarring, fibrosis and volume loss. mild right cp angle blunting. likely due to granulomatous infection (tuberculosis). the chronicity of this findings is unknown, follow up is recommended. ct abdomen/pelvis: . malpositioning of the foley catheter. the tip of the foley catheter is seen outside of the urethra in the soft tissues of the left hemipelvis with surrounding subperitoneal fluid, representing a mixture of urine and hemorrhage. the balloon of the foley catheter is inflated in the prostatic portion of the urethra. 2. trabeculated bladder with multiple large bladder diverticula as described above. 3. no free intra-abdominal air. 4. status post aorto-biiliac bypass. 5. compression fracture of l1 of indeterminate age. ct head: mpression: no evidence of hemorrhage. note at attending review: the hypodensity, likely representing chronic small vessel infarction, is most evident in the right frontal periventricular white matter. osh head ct: head ct: encephalomalacia is noted within the r frontal lobe, prior infarct, no hemorrhage. head ct: impression: no evidence of hemorrhage. note at attending review: the hypodensity, likely representing chronic small vessel infarction, is most evident in the right frontal periventricular white matter. brief hospital course: an 84 year old gentleman admitted from hospital with respiratory failure, hematuria, and urosepsis with enterococcus and strep viridans in urine. . #sepsis: on presentation appeared to have urosepsis w/ positive ucx requiring pressors, though all blood has been negative. pt has had multiple previous uti??????s, and had a traumatic foley placement at osh. osh cultures positive for gpc??????s. and was started on ampicillin but spiked higher temps and coverage was broadened to vanc/cefipime/cipro when enterococcus and strep viridans grew out in urine. he was on ampicillin but subsequently had coverage broadened to vanc/cefepime/cipro on day 2 due to fevers and hypotension, and respiratory distress (believed to be from ventilator associated pneumonia - see below). patient improved and had pressors weaned off, extubated successfully (see below for description of respiratory distress). patient was continued on a 14-day course of vanc/cefepime/cipro, but was then switched back to ampicillin after he clinically stabilized and after cultures were negative for 48 hours. is currently completeing a 14 day course of ampicillin (currently day on day of discharge). currently afebrile and significantly improved mental status and respiratory status with negative cultures. picc line in place. . #respiratory failure: initially intubated for respiratory failure due to most likely vap given fevers, but did not have positive cultures. ct scan showed severe emphysema. cxr showed possible left sided infiltrate. patient was started on broad spectrum abx as above (vanc/cipro/cefepime), and respiratory status improved, was sucessfully extubated and place on face tent, then face mask. cxrs showed subsequent improvement but did show pulmonary edema. pt received lasix with improvement of respiratory status. pt also received albuterol and ipratropium nebulizers during his hospital stay. the patient aspirated during a repeat speech and swallow evaluation on the day of anticipated discharge, and had a transient oxygen desaturation. he was monitored overnight in-house with po2 in the mid- to high 90's subsequently without evidence of infection. the patient was instructed to take lasix if he develops shortness of breath, and to return to the hospital if shortness of breath does not improve. . # leukocytosis: no evidence of infection, may be reactive aspiration the day prior to discharge but no fever and no evidence of infection, po2 high 90's. patient had c. diff sent also, though no diarrhea. will f/u with physician in rehab. if patient develops diarrhea, given that he has been on antibiotics, low threshold to test for c.diff and start appropriate treatment. . #atrial fibrillation/pvcs: patient s/p pacemaker for unclear underlying rhythm, although hospital notes history of atrial fibrillation. he was monitored on telemetry, and was in sinus tachycardia with pvc??????s, intermittent conduction block, and his current rhythm is paced and tachycardic. digoxin level was normal, and patient was started on home digoxin. patient on full-dose aspirin. the possibility of anticoagulation was discussed, but this will have to be discussed further with his primary care provider given his high risk of falls but history of cva. . # neck soreness ?????? appears msk due to position, extubation, etc. used warm compresses and wrote for standing tylenol and morphine liquid elixir drops on tongue (failed speech & swallow). . #altered mental status: initially had altered mental status, likely multifactorial due to infection and toxic/metabolic from medications. cta of head and neck did not reveal abnormalities. improved with resolution of urosepsis. . # right upper extremity edema: mild right upper extremity edema without pain ?????? ue us ruled out thrombus. edema self??????resolved. . #acute renal failure: initially in likely pre-renal acute renal failure in the setting of sepsis, also possibly with component of atn and initially post-renal obstruction. foley catheter was successfully placed, ivf administered, cr resolved currently at baseline. . #traumatic foley placement: patient transferred after concern that foley may be placed in scrotum. initial ct concerning for intraabdominal placement, but then believed pt has a bladder diverticulum. urology did cystoscopy to placed a foley. they recommended to keep foley in place, do not remove without asking urology first, keep secure to thigh with 2 catheter secures, f/u with urology when acute illness over. the patient was instructed not to remove the foley catheter until he saw urology. . #elevated blood sugars: initially had elevated blood sugars in the 500s on arrival to the micu and started on insulin gtt. hyperglycemia resolved, insulin gtt discontinued. . #coronary artery disease: details were unclear, continued home aspirin 81mg daily. . #hyperlipidemia: continued home lipitor 10mg daily. . #fen: tubefeeds per dobhoff. . code: dnr, dni. communication: wife medications on admission: lipitor 10mg po daily aspirin 81mg po daily pyrimidine, cipro (recent for uti) calcium carbonate 1250mg po daily prilosec 20mg po daily multivitamin 1 tab po daily digoxin 0.25mg po daily ? coumadin discharge medications: 1. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 2. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 3. calcium 500 500 mg (1,250 mg) tablet : one (1) tablet po once a day. 4. multivitamin tablet : one (1) tablet po once a day. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for wheeze. 6. ampicillin sodium 1 gram recon soln : one (1) recon soln injection q6h (every 6 hours). 7. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 8. acetaminophen 650 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for fever/pain. 9. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 10. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed for thrush. 11. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day). 12. morphine 2 mg/ml syringe : 0.5-2 mg injection q4h (every 4 hours) as needed for pain: must have droplets on tongue, as pt is high aspiration risk and must be strict npo. 13. aspirin 325 mg tablet : one (1) tablet po daily (daily). 14. lansoprazole 15 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr twice a day. discharge disposition: extended care facility: - discharge diagnosis: urosepsis ventilator associated pneumonia discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you presented to from hospital for bloody urine, bloody vomit, difficulty breathing, and abnormal lab tests. you had a breathing tube placed at the outside hospital for difficulty breathing, and also had a foley catheter placed at hospital which had extended into your scrotum. a ct scan at showed this was likely due to an open fistula between your bladder and scrotum. the urologists placed a foley catheter in the operating room to ensure it was in the correct position, and you should follow up with them prior to having anyone remove your foley catheter. . while in the hospital, you were treated with antibiotics for your urinary tract infection, and also required medications to keep your blood pressure elevated. you also had pneumonia requiring antibiotics. you subsequently improved, and the breathing tube was removed and the medications to increase your blood pressure were able to be discontinued. . if you develop shortness of breath, you should take lasix 20mg iv to help your shortness of breath. if your shortness of breath does not improve with lasix, speak to your doctor and return to the hospital. . the following changes were made to your medications: - ampicillin was started for a total of fourteen days. you received this in the hospital, and will need one more day of the antibiotic after leaving the hospital. - aspirin was increased to 325mg daily . if you develop any difficulties breathing, fever, nausea/vomiting, or other concerning symptoms, please call your doctor and return to the hospital. followup instructions: you will be seen by the doctor at the rehabilitation center. please also follow up with your primary care doctor once you leave the rehabilitation center. . you will need to see a urologist once you leave the rehabilitation facility to follow up on your foley catheter, which you had placed in the hospital. do not remove the foley catheter until you see the urologist. . your blood test (white blood cell count) was abnormal when you left the hospital, but you did not have a fever and had no signs of infection. you had a stool test sent but you should return to the hospital if you develop fevers, cough, confusion, or other concerning symptoms. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances arterial catheterization other cystoscopy other cystogram insertion of indwelling urinary catheter diagnoses: pneumonia, organism unspecified acidosis anemia, unspecified coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis atrial fibrillation other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis septic shock other emphysema pressure ulcer, lower back cardiac pacemaker in situ personal history of venous thrombosis and embolism personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidents occurring in residential institution cervicalgia edema other premature beats body mass index less than 19, adult pressure ulcer, unstageable mechanical complication due to urethral (indwelling) catheter diverticulum of bladder 

Answer: The patient is high likely exposed to