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: bactrim / remeron attending: chief complaint: respiratory distress major surgical or invasive procedure: endotracheal intubation from /08 through tracheostomy on history of present illness: 85 y/o man with h/o chf, cad, pvd, and chronic atrial fibrillation on who is well known to with multiple admissions who presented to the ed from rehab with respiratory distress/dyspnea. cxr at rehab the day pta with b/l lower lobe pna. he was also noted to be hypotensive in the ed with sbps in the 70s. of note, he was recently admitted to for most of with ftt and dehydration. . ed course: vitals on presentation: t 97.9 hr 104 bp 132/68 rr 27 85% nrb improved to 95% ra then 100% nrb. in the ed, the patient was intubated for respiratory distress and increased work of breathing. he was also hypotension with systolics in the 70s which responded with ivf. he was given ceftriaxone, vanc, and azithromycin. from . he had been dnr/dni but code status was reversed in the ed. past medical history: diastolic chf, most recent ef 60-65%, on lasix at rehab pvd s/p right sfa to at bypass in cad, s/p mi in , s/p nstemi in setting of rapid afib (admission ) chronic atrial fibrillation, had been on in the past, stopped several months ago for unclear reasons, now on asa alone t2dm hypercholesterolemia hypothyroidism. he was diagnosed with hypothyroidism around . he had been taking 12.5mcg synthroid until his recent hospitalization this when his synthroid was increased to 25mcg once daily as his tsh was high at that time. the synthroid was again increased to 50mcg at rehab at unknown day as his tsh was high persistently, according to medical record which was faxed to us from dr. office. so his is taking 50mcg once daily now. recurrent c. diff colitis. post-polio weakness/contracture. he developed polio infection at age of 25 and has bilateral legs weakness and right upper arm weakness. chronic urinary retention to bph multiple prolonged recent hospitalizations: - /07 - admitted for right sfa to dp bypass for severe gangrene of right foot - - atrial fibrillation, c.diff, hypotension - /07 - hypotension, uti, afib with , diarrhea - /07 - pulmonary edema, pneumonia, afib with , placement, cpap, pulm edema requiring thoracentesis and bronchoscopy - /07 - rehab - - , dehydration, acute renal failure and was then transferred to for further management of renal failure, fluid overload. his clinical course was complicated by recurrent c. diff colitis, pseudogout in right wrist and uti. he was discharged to nursing home . - 15/08 - , ftt, hyperkalemia, esbl uti tx with im gent, chronic c.diff on po vanc, pseudogout of right wrist, subacute stroke on asa and plavix, discharged dnr/dni s/p placement concern for depression at recent geriatric visit on , refused to take any antidepressant, tried remeron in the past but didn't tolerate it because of hallucination, also refused megace . social history: sh: home: normally lives with wife at home but has been in rehab. denies tobacco, etoh, and drugs family history: n/c physical exam: ed vitals: t-96 hr 90 bp 137/63 rr 28 sats initially 85% on nrb general: appears malnourished, but in no acute distress. heent: no trauma. extraocular movement are intact. clear conjunctivae. neck: supple. no thyroid nodule palpable. no jvd, no lymphadenopathy. cardiovascular: irregularly irregular heart rate and rhythm. no heart murmur, no gallops. respiratory: distant lung sounds, limited airway movement, no wheezing, no crackle. abdomen: soft, nontender, nondistended. no hepatosplenomegaly. bowel sounds are present in all four quadrants. g- in place. the site of g- is clean and dry. penis retracted pouch in place. there is leakage of urine around the pouch. the skin on scrotum is not erythematous but wet. extremities: no edema, no clubbing, no cyanosis. the extremities are cold secondary to peripheral disease. neuro: alert, awake, and oriented to the place and person. his language is appropriate. speech intact. pertinent results: 07:25am wbc-5.1# rbc-3.29* hgb-9.2* hct-28.9* mcv-88 mch-28.0 mchc-31.8 rdw-14.9 07:25am plt count-482* 07:25am neuts-88.9* lymphs-6.8* monos-3.7 eos-0.5 basos-0.2 07:25am pt-21.5* ptt-41.1* inr(pt)-2.0* 07:25am calcium-8.6 phosphate-6.0*# magnesium-2.1 07:25am ck-mb-10 mb indx-9.9* probnp-* 07:25am ctropnt-0.20* 07:25am ck(cpk)-101 07:25am glucose-220* urea n-42* creat-1.1 sodium-134 potassium-5.6* chloride-101 total co2-17* anion gap-22* 07:34am lactate-4.4* k+-5.1 10:40am urine color-yellow appear-cloudy sp -1.012 10:40am urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-mod 10:46am o2 sat-80 01:27pm cortisol-28.5* . **** micro **** respiratory viral screen positive for influenza b antigen sputum mrsa 2/19, blood cx pending legionella urinary antigen negative 2/19, urine cx yeast urethral fluid yeast afb smear (-) x3 . ekg atrial fibrillation, average ventricular rate about 100 per minute. borderline low limb lead voltage. complete right bundle-branch block. non-specific st-t wave changes. compared to the previous tracing of no diagnostic change. **** imaging **** cxr single supine view of the chest at 8:30 a.m.: there has been interval placement of an endotracheal , terminating approximately 4.5 cm from the carina. layering pleural effusions are seen bilaterally, left greater than right. increased opacity is seen throughout both lungs, likely due to a combination of mild pulmonary edema, pleural effusions, and basilar atalectasis. cardiomediastinal and hilar silhouettes are unchanged. impression: appropriate position of endotracheal . layering bilateral pleural effusions and mild pulmonary edema. tte the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate to severe global left ventricular hypokinesis (lvef = 25-30 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal with moderate global free wall hypokinesis. the aortic valve leaflets appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , there has been marked/diffuse biventricular systolic dysfunction c/w diffuse process (toxin, metabolic, cannot exclude multivessel cad but less likely as no focality to dysfunction). the left pleural effusion is now much larger. renal u/s 1. no evidence of hydronephrosis or mass within the urinary bladder. 2. a 1.9 cm angiomyolipoma of the right kidney. 3. moderate enlargement of the prostate consistent with bph. picc placed on impression: uncomplicated ultrasound and fluoroscopically guided 5 french double-lumen picc line placement via the right brachial venous approach. final internal length is 45 cm, with the tip positioned in svc. the line is ready to use. : ct sinus/mandible/maxillofacial without contrast: impression: air fluid levels in the sphenoid sinus and in the mastoid air cells. this could be consistent with sinusitis/mastoiditis. clinical correlation recommended. chest ct: impression: 1. probable right lower lobe pneumonia. 2. bilateral pleural effusions, longstanding, with associated compressive atelectasis. non contrast head ct: findings: evaluation is limited secondary to patient motion. allowing for these limitations, there is no evidence for intracranial hemorrhage or mass effect. the ventricles, cisterns, and sulci are prominent secondary to involutional changes. periventricular white matter hypodensities are the sequela of chronic small vessel infarction and area of encephalomalacia in the left occipital lobe indicates prior infarction. there is dense atherosclerotic disease of the cavernous carotid arteries. the visualized paranasal sinuses are clear. there is partial opacification of the mastoid air cells. impression: limited examination secondary to patient motion, there is no evidence of intracranial hemorrhage. mr is more sensitive for the evaluation of acute brain ischemia. brief hospital course: 85 y/o man admitted with respiratory failure and sepsis from influenza a complicated by a mrsa pneumonia. # respiratory failure: pt was dnr/dni prior to this presentation to the ed. upon arrival to the , pt was in mild respiratory distress with hypotension. code status was reversed, pt was intubated & aggressively volume resussitated. pt was found to have influenza a complicated by an mrsa pna, he was also noted to have some e/o demand ischemia. echo revealed a globally depressed ef of 20-30%, cxr revealed bilateral pulm effusions. pt was treated with 10 days of vancmcyin for an mrsa pna. pt was having difficulty weaning with rsbis>100 & low niffs. pt then developped recurrent low grade temps & elevated wbc count. sputum was +klebsiella and pt was started on zosyn for vap & switched to meropenem (for esbl producing klebsiella) to complete a 7 day course of abx. pt was intubated for 16 days with niffs ranging from -1 to -7. rsbis ranging from 80-120. pt has a known h/o post polio syndrome with presumed weak resp muscles and was thought not likely to tolerate extubation. pt had trach placement on , which he toleratd well. his volume status was optimized via lasix and diuresis, and his respiratory status improved. the ventilator was weaned to pressure support, and then tracheostomy collar with blow-by oxygen. upon transfer from the micu, he was tolerating humidified air with good oxygenation and ventilation. after transfer the state lab called, and it was noted that he had a positive afb culture on a negative smear specimen drawn ~1 month prior to admission. infection control was consulted, who felt that the patient could go home once he had ruled out for afbx3 smears, as far as his contagious risk. he had 3 smears which were negative prior to discharge, and cultures were consistent with mac. # bacteremia/fungemia: pt was noted to have low grade fevers & rising wbc count on . blood cultures from were + vre & fungus. pt was started on linezolid for 14 day course for bacteremia. urine culture was +yeast on & . foley was changed out & caspofungin was started for a 14day course treating fungemia & funguria. sputum from & was +klebsiella, pt was treated with a 8 day course of meropenem for presumed vap. patient completed a course of caspofungin and linezolid and subsequently remained afebrile and hemodynamically stable. # atrial fibrillation with labile bp: pt with h/o chronic a.fib was noted to have labile bps thought likely due to agitation & volume. acheived better rate and bp control with metoprolol 100mg tid. diltiazem was added for additional rate control, however, pt had an episode of bradycardia on and diltiazem was stopped. heart rates were generally stable in 80-100's on metoprolol 100mg tid, digoxin 0.125mg & low dose asa 81mg. anticoagulation was held due to hematocrit drop with ongoing bloody secretions from oropharynx, will defer to outpt cardiologist regarding plan for future anticoagulation, although in light of hospice services, it is unlikely to be significantly adjusted. # chronic diastolic and acute systolic heart failures: pt with h/o diastolic chf, found to have globally depressed ef of 25-30% on admission, possible related to viral myocarditis vs sepsis induced cardiomyopathy. echo showed no evidence of regional wall motion abnormality thought pt was noted to have evidence demand ischemia in setting of sirs on admission. lv function was thought likely to recover in 6-8wks, he will likely need follow up echo as outpt. pt was switched from captopril to lisinopril for afterload reduction and developped hyperkalemia despite otherwise normal renal function and the ace-i was discontinued. he was mantained on metoprolol. his lasix was converted to po and a stable daily regimen to maintain euvolemia was established at 120 mg po tid. # oropharyngeal bleed: pt was noted to have increased bloody secretions around ett while on a heparin drip for systemic anticoagulation (for afib). heparin was held & ent was consulted, felt this was likely due to skin breakdown & abrasions under ett after prolong intubation. pt received prbc tranfusions for mild hct drop & bleeding stopped after systemic anticoagulation was held. # delerium: pt was noted to be persistently non-responsive to stimuli after extubation. non con head ct was neg for acute intracran pathology (positive for small vessel dz), vit b12 was wnl & eeg showed slowed background and global encephalopathy. both ethics & the pain/palliative care were consulted, olanzapine 5mg was started for possible underlying delirium. upon clearing his infections, the patient made considerable improvement in his ms. a passy-muir valve was provided for the trach and the patient appropriately answered questions and followed commands. # uti - bacterial: urine cultures from were positive for yeast. pt completed 3 days of amphotericin cbi. repeat uas were +leukocytes & wbcs but no yeast. foley was changed out on & repeat urine cultures have been ngtd. # type 2 dm controlled: pt with a history of type ii dm was covered with humalog insulin sliding scale while receiving tf of nutren pulm at 45cc/hr. # c. diff colitis: pt with h/o relapsing/recurrent c.diff on a slow po vancomcyin taper as outpatient. pt was given treatment dose po vancomycin at 125mg q6hr while on broad spect abx. his outpatient taper was re-started on the last day of systemic antibiotics, . # left shoulder dislocation: this was noted incidentally on early admission cxr, per ortho, they deferred management until medically stable to tolerate mri. repeat shoulder films unable to confirm dislocation, pain was managed with po morphine. #afb (+) cultures cultures at state lab were positive from prior admission. as such he was ruled out with 3xafb smears which were all negative, and on day of discharge the state lab's cultures were read out at mac rather than mtb. medications on admission: levothyroxine 100 mcg po daily diltiazem hcl 30 mg po qid aspirin 81 mg po daily miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed. simvastatin 5 mg po mwf clopidogrel 75 mg tablet : 0.5 tablet po daily (daily). prilosec 20 mg po daily calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po bid (2 times a day). cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 12. insulin insulin per sliding scale qid. acetaminophen 325 mg tablet : two (2) tablet po every six (6) hours. vancomycin 125 mg capsule : one (1) capsule po every other day: last day . metoprolol tartrate 25 mg po tid 16. gentamycin gentamycin 50mg intramuscular q12 hours. six doses, first dose given on at 4pm. megace 200 mg po bid levaquin 250 mg po x 7 days, started on ciprofloxacin 500 mg po bid x 7 days, started on milk of mag bisacodyl lantus mvi colace (per family, not on transfer records) discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. levothyroxine 100 mcg tablet : one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 4. simvastatin 10 mg tablet : 0.5 tablet po qmowefr (monday -wednesday-friday). 5. albuterol 90 mcg/actuation aerosol : 6-10 puffs inhalation q4h (every 4 hours) as needed for sob. 6. ipratropium bromide 17 mcg/actuation aerosol : 4-6 puffs inhalation q4h (every 4 hours) as needed for sob. 7. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po tid (3 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 9. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 10. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. 11. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 12. olanzapine 5 mg tablet : one (1) tablet po bid (2 times a day). 13. metoprolol tartrate 50 mg tablet : two (2) tablet po tid (3 times a day). 14. docusate sodium oral 15. morphine 10 mg/5 ml solution : one (1) po q4 hours (). 16. morphine 10 mg/5 ml solution : one (1) po q3h (every 3 hours) as needed for respiratory distress or discomfort. 17. acetaminophen 325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for fever. 20. vancomycin 125 mg capsule : one (1) capsule po q8h (every 8 hours) for 14 days, then decrease to 125mg q12hrs for 14 days, then decrease to 125mg once a day for 2weeks then decrease to 125mg every other day for 2weeks then stop. discharge disposition: home with service facility: hospice of the good discharge diagnosis: respiratory failure s/p prolonged intubation & tracheostomy mrsa pna klebsiella vap atrial fibrillation candidal uti ms changes discharge condition: stable discharge instructions: you were admitted with sepsis due to influenza, this was complicated by an mrsa pneumonia. you were also treated for a ventilator assoc pneumonia. you have had a prolonged icu course including intubation & tracheostomy placement. you will need to continue with vent weaning at the . followup instructions: pls call his pcp . at for follow up appointments. 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 temporary tracheostomy diagnoses: pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis unspecified acquired hypothyroidism candidiasis of other urogenital sites atrial fibrillation infection with microorganisms resistant to penicillins acute respiratory failure septic shock intestinal infection due to clostridium difficile methicillin susceptible pneumonia due to staphylococcus aureus unspecified accident other and unspecified complications of medical care, not elsewhere classified pneumonia due to klebsiella pneumoniae influenza with pneumonia acute on chronic combined systolic and diastolic heart failure closed dislocation of shoulder, unspecified 

Answer: The patient is high likely exposed to