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: ancef attending: chief complaint: tx from osh for further management major surgical or invasive procedure: interventional pulmonary adjust/resize of trach interventional radiology: placement of post-pyloric feeding tube history of present illness: hpi: this is a 76 yo m initially presented to osh on with bilateral cellulitis, lower extremity edema on was noted to have respiratory distress failing his routine nightly bipap for osa. at that pt was transferred to ccu for monitoring. . his osh was as follows - cellulitis - was treated with unasyn for 11 days then discontinued on . a leni on was negative for dvt. . - cardiac- his ccu stay was complicated by vt with a code called, which required dopamine pressure. in addition a nstemi (peak trop 7.67 on ) occurred treated with aspirin, plavix, and coreg. apparently heparin was held to bleeding from the tracheostomy. then the beta blocker was held secondary to bradycarida. - respiratory - on transfer to the ccu a "possibly elective tracheostomy at this point" which was performed on . he was started on cpap trach mask trials. he was felt to be fluid overloaded and diuresed. a left sided pleural effusion developed and a thoracentesis was performed on , and he was started on cefazolin. sputum cxs grew out proteus with multiple sensitivies. a lyme cx taken was negative. . - on presentation- the pt is comfortable denies pain, sob, states his (myasthenia ) mg is longstanding causing difficulty with walking/ and breathing at certain pts. otherwise no other complaints. past medical history: #pmhx dm htn obesity myasthenia rhf social history: social - per osh dc summary, married, separated, smoking hx, denies etoh use family history: non-contributory physical exam: vs t 99.4 p76 bp 118/81 rr 21 sa91% fsbs 137 ac 750x12 peep 5 fio2 0.4 gen nad, obese, comfortable heent perrl, op clear, neck supple, thick, trach collar cv distant hs, no mrg chest coarse bs throughout, no decreased bs abd normoactive bs, nt/nd, obese, soft, large pannus noted in lower extremity, no ascites ext : no 2+ pitting edema b/l in lower extremity, warm/erythematous b/l rash in lower extremity calfs, c/w cellulitis, toes also in packing b/l, severe onychomycosis, l hand increased swelling compared with r, o/w picc in r arm neuro aaox3, pertinent results: labs on admission 02:35am blood wbc-7.2 rbc-3.15* hgb-9.7* hct-27.7* mcv-88 mch-30.6 mchc-34.9 rdw-14.6 plt ct-434 02:35am blood neuts-74.5* lymphs-11.9* monos-7.5 eos-5.7* baso-0.5 02:35am blood pt-14.2* ptt-24.6 inr(pt)-1.3* 02:35am blood glucose-119* urean-35* creat-1.2 na-139 k-4.4 cl-92* hco3-40* angap-11 02:35am blood alt-7 ast-38 02:35am blood calcium-8.3* phos-3.2 mg-2.3 iron-20* cholest-127 02:35am blood caltibc-196* vitb12-635 folate-8.3 ferritn-988* trf-151* 02:35am blood triglyc-79 hdl-29 chol/hd-4.4 ldlcalc-82 ldlmeas-81 12:01pm blood type-art po2-98 pco2-56* ph-7.50* caltco2-45* base xs-17 cardiac enzymes 06:03am blood ck-mb-40* mb indx-12.8* ctropnt-1.53* 06:03am blood ck(cpk)-313* 12:45pm blood ck-mb-29* mb indx-11.1* ctropnt-1.74* 12:45pm blood ck(cpk)-262* 10:09pm blood ck-mb-17* mb indx-10.0* ctropnt-1.83* 10:09pm blood ck(cpk)-170 12:00pm blood ck-mb-8 ctropnt-2.70* 12:00pm blood ck(cpk)-107 06:22pm blood ck-mb-notdone ctropnt-2.89* 06:22pm blood ck(cpk)-93 03:45am blood ck-mb-6 ctropnt-3.17* 03:45am blood ck(cpk)-184* 10:20pm blood ck-mb-notdone ctropnt-3.62* 10:20pm blood ck(cpk)-48 03:51am blood ck-mb-notdone ctropnt-3.30 03:51am blood alt-16 ast-28 ck(cpk)-45 alkphos-96 totbili-0.8 cyclosporine levels 10:23am blood cyclspr-61* 03:19am blood cyclspr-121 04:14am blood cyclspr-63* 12:45pm blood cyclspr-57* blood gases 12:01pm blood type-art po2-98 pco2-56* ph-7.50* caltco2-45* base xs-17 01:42pm blood type-art po2-88 pco2-52* ph-7.40 caltco2-33* base xs-5 06:08am blood type- po2-41* pco2-57* ph-7.32* caltco2-31* base xs-0 12:46pm blood type- temp-37.5 po2-39* pco2-54* ph-7.34* caltco2-30 base xs-1 10:42pm blood type- temp-37.2 rates-/30 tidal v-400 peep-5 fio2-50 po2-43* pco2-59* ph-7.31* caltco2-31* base xs-0 intubat-intubated imaging . echo impression: poor echo windows. cannot reliably assess lvef. normal rvef. no pericardial effusion. if clinically indicated a repeat study with echo contrast (definity) may better characterize lvef. . chest portable impression: increased layering of left pleural fluid - positional differences could explain. no new focal consolidations. . -intestinal tube placement (w/fluoro) impression: successful placement of post-pyloric tube in the third portion of the duodenum. 04:05am blood wbc-8.7 rbc-3.22* hgb-9.6* hct-28.7* mcv-89 mch-29.9 mchc-33.5 rdw-16.6* plt ct-292 03:23am blood neuts-73.7* lymphs-14.9* monos-5.3 eos-5.7* baso-0.4 04:05am blood pt-15.1* ptt-27.1 inr(pt)-1.4* 04:05am blood glucose-90 urean-32* creat-1.0 na-144 k-4.5 cl-107 hco3-28 angap-14 04:05am blood alt-18 ast-27 alkphos-86 totbili-0.9 04:05am blood calcium-8.4 phos-3.6 mg-2.2 05:01pm blood type-art fio2-50 po2-102 pco2-58* ph-7.33* caltco2-32* base xs-2 brief hospital course: 76 yo male with pmhx significant for morbid obesity, osa, trach'd p/w cellulitis with course complicated by nstemi. . 1. cellulitis- at outside hospital was started on unasyn, then transitioned to ancef but developed an abx rash, and was changed to vancomycin by arrival to . he was noted to have bilateral cellulitis with increased lower extremity swelling and was to finished a 14 day antibiotic course, and monitor for resolving infection. he otherwise was treated symptomatically with aquaphor ointment, and did not spike a fever during his hospital course. he has residual b/l le erythema that has been stable with no other signs of infection. . 2. hypoxia- the patient arrived with a tracheostomy from an osh, on ac ventilation, when a trach mask trial was attempted, he developed increasing tachypnea, anxiety, and chest pain, which was not cardiac in nature. with a history of mg a nif was performed which demonstrated low values, but his limited ability for successful trach mask trial, was likely multifactorial, a sputum culture grew swarming proteus and he was started 8 day course of levaquin, he was to have daily nifs as there are rare exacerbations of mg with levaquin, he remained stable. he otherwise was maintained on duonebs, and fluticasone was added. in addition fluid overload was another potential component of his inability to be weaned from the vent, and he was actively diuresed with 40mg lasix , but his creatinine became elevated to 2.2 from 1.1 baseline likely secondary to overdiuresis as his fena suggestsed a prerenal acute renal failure. he was administered fluid boluses to maintain urine output. otherwise ip was consulted for a tracheostomy adjustment and felt he was maintaining appropriate oxygenation and ventilation and adjustments were not required. he tolerated weaning to pressure support with mmv at times but during his hospital course developed additional hypoxia associated with a rll infiltrate, he was continued on levaquin started for a proteus positive sputum culture. a bronchoscopy was performed which did not reveal gross abnormalities, 2 bals were taken and grew 3+gnrs, speciated as stenotrophomonas. for the remainder of his course the patient remained stable. based on daily assessment he was placed on trach mask trials or pressure support as tolerated. he tolerated up to 8 hours of 50% trach mask, but became anxious and tachypneic and was restarted on cpap 8/5 with 40 % fio2. at he was satting 94-97 % on cpap 8/5 and 40 % fio2. . 3. cv -he was transferred from the outside hospital after having an nstemi, not tolerating heparin secondary to bleeding from the tracheostomy site. he was transferred on a betablocker, aspirin, plavix. his lipid profile was checked while inpatient, and hot found to be elevated. he otherwise had an echocardiagram which demonstrated elevated pa pressures of 29, otherwise a suboptimal study without ef calculation, also an moderately dilated aortic root, which was not seen on previous outside hospital echos, he was to follow up as an outpatient for management of his dilatation. he was strted on lisinopril 5 mg po qd 2 days prior to which he tolerated well. nstemi- he had an episode of supraventricular tachycardia self limiting without associated hypotension. an ekg at that time demonstrated lateral lead st depressions, with an associated 1mm st elevation in v1. cardiac enzymes were cycled and noted to be elevated, likely secondary to demand ischemia. he was started on heparin, a betablocker, aspirin, plavix, and a statin were administered. cardiology was consulted and recommended continuing medical management. the patient will need to be on plavix for 9-12 months and should follow up with a cardiologist as an outpatient. . 4. dm- the patient's sugars were well controlled on a riss . 5. htn- initially admitted with lopressor, which was held after noting irregularity on ekg, his pressures remained in good range off lopressor. his lopressor was restarted and was titrated up to 37.5 mg with hrs on 50s-60s. additionally and ace-i was added once his creatinine stabilized and his pressures were stable in 120s-130s. 6. anemia- normocytic, likely secondary to chronic disease, iron/folate/b12 studies were suggestive of chronic disease, tranfused to a hct>30 after determination of his nstemi. hct was stable at . . 7. mg- stable continued on mestinon, neoral. discussed with outpatient neurologist, maintained on outpatient regimen, monitored csa levels for toxicity. he had decreased mental status during his hospital course, and neurology was consulted for evaluation of exacerbation. neurology did not feel that his mg was contributing to his delta ms as much as perhaps icu delirium. he was continued on his outpatient regimen. he will need to establish care with a new neurologist. . 8. anxiety- maintained on zoloft, and ativan prn . 9. fen: a post pyloric tube was placed by ir for feeding, but it was d/c'd accident;y x2. at the patient was tolerating softs solids, and therefore the tube was not replaced. . 10. ppx: heparin sc, lansoprazole, bowel regimen . 11. access: picc placed at osh on , cxr confirming placement. a postpyloric feeding tube was placed by fluoroscopy. . 12. code: full . 13. contact: daughter + hcp (h) (c), (office) . pcp neurologist upender (left practice) medications on admission: lopressor 25mg free h20 150cc q8h ancef 2gm q8h (d6/10) (although dc summary states vanco) benaprotein 2pkt zoloft 25mg qd alb/atrovent q4hr lotrimin cream to groin asa 325 qd aquaphor ointment ble plavix 75mg qd prevacid 30mg qd mvi 15cc ft qd vit c 500mg zinc sulfate 220mg qd neoral 75mg mestinon 180mg tid insulin protocol lasix gtt 20mg/hr lovenox 40 sc qd lidocain patch qd dilaudid 1mg iv q3h prn medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. sertraline 50 mg tablet sig: 0.5 tablet po daily (daily). 4. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. multivitamin capsule sig: one (1) cap po daily (daily). 9. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 10. pyridostigmine bromide 60 mg tablet sig: three (3) tablet po q8h (every 8 hours). 11. insulin regular human 100 unit/ml solution sig: three (3) injection asdir (as directed): sliding scale per protocol. 12. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 13. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 14. ipratropium bromide 17 mcg/actuation aerosol sig: 6-12 puffs inhalation qid (4 times a day). 15. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 16. cyclosporine modified 100 mg/ml solution sig: seventy five (75) mg po q12h (every 12 hours). 17. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 18. hydromorphone 0.5-2 mg iv q3-4h:prn 19. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 20. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 21. lorazepam 0.5-1 mg iv hs:prn hold for rr <12 22. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 23. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 24. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. disposition: extended care facility: northeast - diagnosis: primary diagnosis 1. nstemi 2. respiratory failure . secondary diagnosis ttpe 2 diabetes htn obesity myasthenia rhf condition: hemodynamically stable, hrs 50- 60s, satting 94-97 % on cpap 8/5 40 % fio2. instructions: you are being discharged to another care facility where they can take care of your respiratory care. information about your hospital stay has been communicated to the physician assuming responsibility for your care. followup instructions: you should follow up with your primary doctor from rehab. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus transfusion of packed cells insertion of (naso-)intestinal tube insertion of (naso-)intestinal tube diagnoses: anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified anxiety state, unspecified acute respiratory failure other specified cardiac dysrhythmias cellulitis and abscess of leg, except foot long-term (current) use of insulin hyperosmolality and/or hypernatremia other and unspecified complications of medical care, not elsewhere classified proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site dependence on respirator, status attention to tracheostomy myasthenia gravis without (acute) exacerbation 

Answer: The patient is high likely exposed to