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: penicillins / metoprolol / levaquin attending: chief complaint: gross hematuria major surgical or invasive procedure: central venous line placement. history of present illness: y/o man with pmh significant for parkinson's disease, bph, atrial fibrillation, chf, and cri admitted through the ed with gross hematuria, anemia, and hypotension. the patient self discontinued his foley catheter yesterday resulting in traumatic bleeding. today, a moderate amount of blood was noted in the foley catheter bag. in the ed, vs were 95.8 67 106/48 100% ra. labs were significant for a hct of 22.6 (of note, his baseline is between 24-25). an urology consult was obtained in the ed. they placed a 22 french 3-way with continuous irrigation. there was initially some clearing of the urine then it turned more bloody again. the patient was given vancomycin and ceftriaxone. he also was transfused 1 unit of prbc. the patient was kept in the ed for observation. . at 8:00 am the morning of admission, the patient sbp decreased to 70. he was given 1 liter of iv fluids with an increase in his sbp to 90-110. at this time, he is being admitted to the medicine service for further care. . on his arrival to the floor, the patient repeatedly asked for food. he also reported that he was quite tired. denied pain or any other concerns. most of history obtained from his daughters. past medical history: 1. recent admission on for staph aureus and enterococcal bacteremia. at this time, the patient has completed 3 of 6 weeks of vancomycin. 2. acute urinary retention with placement of a foley catheter- 3. pt with recent episodes of hematuria in and . 4. parkinison's disease 5. bph 6. large left hernia 7. s/p appendectomy 8. s/p hernia repair ~20 years ago 9. atrial fibrillation- this was diagnosed in 02/. he is not anticoagulated. 10. chf- tte in showed moderate dilation of the ra, mild symmetric lvj with a lvef of 45 to 55%, rv depression, abnormal diastolic septal motion consistent with rv volume overload. + ar. + mr. 3+ tr. mild pa systolic htn. 11. iron defficiency anemia 12. hypothyroidism 13. ckd- baseline creatinine is 0.9-1.0. 14. left leg wound- vac dressing in place. 15. pna- social history: pt lives at home with his wife and daughter. is retired from work in construction, engineering, and real estate. no etoh, tobacco, or drugs. did occasionally smoke a pipe but quit greater than 20 years ago. the patient's daughter determines what foods he can eat. he will only take hot liquids (tea, coffee) by mouth and these must have thicket in them. family history: father had dm. mother died of heart disease /rythm problems. she was over 90 at her death. daughter (alive at 47) had hodgkins many years ago. physical exam: on admission: vitals: t 101.8 bp 87/57 hr 102-114 r 18 sat 100% ac 450x14, 100%, peep 5; vbg: 7.29/48/48, mixed venous sat 79 gen: ill appearing elderly man, ventilated and sedated heent: ncat, semi dry mm cardiac: distant heart sounds, regular, tachycardic, no m,r,g. pulm: decreased breath sounds rll abdomen: soft. nt. nd. positive bowel sounds. g tube site c/d/i extremities: no c/c/e. bandage on left leg c/d/i with large ulcer down to fascia and clean base; l groin hernia neuro: intubated pertinent results: 03:30am wbc-9.2 rbc-2.82* hgb-7.4* hct-22.6* mcv-80* mch-26.1* mchc-32.6 rdw-18.5* 04:45am pt-12.6 ptt-25.0 inr(pt)-1.1 07:45am urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 09:37am lactate-0.5 06:20pm hgb-7.4* hct-22.5* . -portable cxr- impression: no acute cardiopulmonary abnormality. . -cta: impression: 1. no evidence of pulmonary embolus. heterogeneous flow to basilar segments of collapsed right lower lobe likely physiologic/artifactual. 2. moderate right pleural effusion. likely multifocal atelectasis in the right lung. pneumonia cannot be excluded. 3. near complete resolution of left upper lobe pneumonia. residual left lower lobe minor atelectasis. 4. findings consistent with congestive heart failure. . -renal u/s: impression: limited study demonstrating no hydronephrosis or gross renal calculi in either kidney. . -portable cxr: there has been interval improvement of the right upper lobe opacity most likely representing clearing of consolidation demonstrated on the previous chest ct; the right pleural effusion is increased which could be due to positional change of the patient. the left lower lobe retrocardiac atelectasis is unchanged. no evidence of failure is present. there are no new areas of consolidation. the et tube tip is 2.5 cm above the carina. the right subclavian line tip is in the mid svc. . brief hospital course: this is a y/o man with pmh significant for parkinson's disease, bph, atrial fibrillation, chf, and cri initially admitted through the ed with gross hematuria, anemia, and hypotension. hospital course summarized below: . of note, the pt was just discharged from on for staph aureus and enterococcal bacteremia (grown in blood and urine). he had completed 3 out of 6 weeks of vancomycin for lle ulcer and empiric endocarditis treatment. his recent history is notable for recent acute urinary retention after hospitalization for sepsis () at which point he was discharged with catheter (14f) in place. he was subsequently readmitted with gross hematuria about one month later; unclear precipitant, no clear trauma, however his catheter had been changed to an 18f pta. he was later found to have a uti, p. aeruginisa, sensitive to cipro and was discharged on this. he returned to the ed with painless hematuria, was irrigated and discharged. . on this admission, the pt had hematuria thought to be due to pulling his foley catheter. the patient self discontinued his foley catheter resulting in traumatic bleeding. he was found to have a hct of 22.6 (bl 24-25), and urology placed a 22 french 3-way with continuous irrigation. in the ed, the patient's bp dropped to sbp 70, and he was given 1l ivf with sbp increasing to 90-110. . since admission to the medicine service, the pts hematuria had resolved. his hct had been stable at 31-33. he received 5 units prbc over 3 days, and he had intermittent wheezing treated with atrovent nebs and prn lasix 10 iv. . on , the pts hr increased from baseline of 100-110, up to 160. his rr also increased to 32. the pt was found to be satting 78% ra. on 100% nrb, his sats only increased to 85% nrb. he was given lasix 10 mg iv x1 and he was intubated given his hypoxia. his sbp then droped to 74/60. he was then cardioverted with shock x1, and converted into nsr. several minutes later he went back into afib with hr in 120s and then again spontaneously cardioverted to nsr upon transfer to the micu. . in the micu, the patient was initially unstable having hypotension and atrial fibrillation with . he received 3 l of ns with initially some effect. antibiotics were broadened to include cefepime and ciprofloxacin (for chronic lle ulcer and empiric endocarditis treatment) and cipro (h/o psuedomonas. he received a levophed bolus in the setting of hypotension, but his hr increased to 210 so levophed was turned off. the pts bp increased with neo and it did not seem to affect his hr. again, his pressures decreased in the setting of , he was given amiodarone 150 mg ivx1, but he had second pauses thereafter. levophed was resumed at a low dose in addition to the neo, and the pts bp stabilized. on hd 2 in the micu, levophed was weaned off. his respiratory status also improved and the patient was extubated on hd 2. the patient remained hemodynamically stable with good respiratory status after this time. he remained afebrile and completed his course of antibiotics. hematuria resolved he was discharged on hd 12 (micu day 8) with two weeks left on his six week course of vancomycin. creatinine trended toward baseline. his mental status was improved but not quite at baseline per the daughter in summary, this is a year old gentleman with parkinson's disease, atrial fibrillation, chf, l leg ulcer, and chronic kidney disease, and recent admission for enterococcal and staph aureus bacteremia. admitted for hematuria believed secondary to traumatic foley. transferred to micu for fever, hypotension, and respiratory failure likely from combination of decompensated atrial fibrillation with and sepsis. briefly intubated and maintained on pressors along with broad spectrum antibiotics. afebrile and hemodynamically stable on discharge with antibiotics completed and maintained on long term vancomycin course. his admission had multple issues and these, along with the plan on discharge, are summarized below. . 1) hypotension/question of sepsis: the etiology of the pts hypotension included septic, hypovolemic, and cardiogenic. given the pts elevated wbc and fever, infectious etiology was believed to be playing a role. he appeared to have a possible rll pna on cta and cxr. cardiogenic cause was less likely given mixed venous sat of 79%. cta showed r pleural effusion and no pe, ?interstitial process. ruled out for mi hree sets of cardiac enzymes were negative for infarction, and he had no ekg changes while in nsr. cefepime was added for broader coverage in addition to vanc ). ruled out for influenza by dfa, blood, sputum, and urine cultures were negative. likely hypotension was secondary to decompensated atrial fibrillation and sepsis with no known source other than possbile rll pna -cefepime and ciprofloxacin antibiotic course completed - continue vancomycin for two more weeks (total six weeks for staph/enterococcus bacteremia . 2) af with : likely exacerbated by infection, pe ischemia unlikely cause. -continue aspirin - may consider outpt cardiology eval for rate control. pt rate controlled adequately on discharge -hold on bb given history of block low bp -hold on using amiodarone given pauses and hypotension seen with bolus given in hospital. . 3) hypoxic respiratory failure: suspect combination of pna and possible flash edema in the setting of afib/. the pt was intubated on the floor and maintained on ac. on micu day 2, he was successfully extubated . 4) hematuria, largely resolved: pts hct remained stable s/p 5 units prbc. bl hct is 25, was 28 on dischage. per daughter still had occasional clots passing through foley. -pt discharged on 22 foley, will maintain for now to ensure any residual clots can pass, can change to 16 coude after -outpt urology follow up to be scheduled, per daughther she may have the pt's foley changed by urologist . 5) left le wound: patient with an ulcerated stasis wound on his left lower leg. had a freecom vac in place but the battery died in the ed. was followed by plastics and wound care nurse using hospital vac equipment (different equipment from that at home). some confusion regarding best management of wound vac dressing changes, with differing plans from plastics, wound care, and the patients daughter. acute issues arose from the le wound and there were no signs of infection on examination of the wound . the wound vac dressing was last changed , the pt was discharged with dressing in place and vacuum to resume on arrival to home. the following day, the wound vac dressing would be changed by vna services using the freecom system. the patient also had a l superficial ulcer on dorsum of l foot. on discharge, this did not appear infected. aquacel was placed on the wound and dressing was placed. -continue wound vacuum care -continue zinc complete course of vancomycin. . 6) hyperkalemia: resolved s/p kayexalate. ddx included and adrenal insufficiency. stim wnl . 7) : pt is oliguric. bl cr is 1.1, cr rose to 2.3. causes include poor forward flow, atn, hypovolemia. pts cr rose s/p hypotension and iv contrast for cta, so in part cause could be contrast related atn as well as hypotension-related atn. renal us negative for obstruction. cr 1.3 on discharge --renally dosed vancomycin --monitor cr one week after discharge . 8) elevated inr/decreased plt: pts plt decreased from 300s to 150 on . his inr increased from bl of 1 to 1.9 on . all heparin products were held and hit ab was sent. dic labs were negative. . 9) ileus: pts pills were being regurgitated up through his g tube. axr c/w stool in colon, lactulose and bowel regimen given -pt tolerating tube feeds by discharge, ileus resolved -continue outpt bowel regimen . 10) parkinson's disease:the patient's neurologist is dr. . --continued carbidopa/levodopa, comtan,and mirapex. --of note, of note, family wanted it to be known that pt received 2 out of the three antiparkinson's medications on an incorrect schedule. all medications were supposed to be schedule at 8 am 2 pm and 8 pm; however, for two days the patient received two of three medications at 10 pm instead of 8 pm. the other medication were received at the regular schedule. after this, medications maintained on regular schedule until discharge . 11) bph: continued finasteride; hold on alpha blockers . 12) hypothyroidism: continued levothyroxine. . 13) gerd: continued lansoprazole . 14) skin lesions: pt with nodule on l shoulder which will needs dermatology biopsy as outpatient. . 15) fen: tube feeds with probalance as before . 16) prophylaxis: lansoprazole, colace, sc heparin . 17) access: picc; quadruple r subclavian placed, removed on discharge . 18) disp: home with services. . code status remains full. medications on admission: 1. carbidopa-levodopa 25-100 mg, 1.5 tablets po tid 2. levothyroxine 12.5 mcg qd 3. zinc sulfate 220 mg qd 4. furosemide 20 mg qod 5. pramipexole 3 mg tid 6. finasteride 5 mg qd 7. tamsulosin sr 0.4 mg qhs 8. aspirin 81 mg qd 9. lansoprazole, rapid dissolve 30 mg qd 10. entacapone 200 mg tid 11. docusate tid 12. senna 8.6 mg, 2 tabs 13. enulose qd 14. brimonidine 0.15 % drops : one (1) drop ou 15. xenaderm 90-87-788 unit-mg-mg/gram ointment tid 16. miconazole nitrate 2 % powder topical discharge medications: 1. entacapone 200 mg tablet : one (1) tablet po tid (3 times a day). 2. finasteride 5 mg tablet : one (1) tablet po qam (once a day (in the morning)). 3. levothyroxine 25 mcg tablet : 0.5 tablet po daily (daily). 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. brimonidine 0.15 % drops : one (1) drop ophthalmic (2 times a day). 7. acetaminophen 160 mg/5 ml solution : one (1) tab po q4-6h (every 4 to 6 hours) as needed. 8. pramipexole 1 mg tablet : three (3) tablet po tid (3 times a day). 9. papain-urea unit-mg/g ointment : one (1) appl topical (2 times a day). 10. vancomycin in dextrose 1 g/200 ml piggyback : one (1) g intravenous q48h (every 48 hours) for 2 weeks. disp:*7 bags* refills:*0* 11. outpatient work please check vancomycin trough tomorrow. 12. pramipexole 1 mg tablet : three (3) tablet po tid (3 times a day). 13. acetaminophen 500 mg tablet : two (2) tablet po asdir (as directed): please given 2 hours prior to dressing change. 14. zinc sulfate 220 mg capsule : one (1) capsule po qam (once a day (in the morning)). disp:*90 capsule(s)* refills:*2* 15. heparin lock flush (porcine) 100 unit/ml syringe : two (2) ml intravenous daily (daily) as needed: 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. . disp:*100 ml(s)* refills:*3* 16. 10 ml normal saline please flush picc catheter daily and prn. follow saline flush with heparin flush. 17. entacapone 200 mg tablet : one (1) tablet po tid (3 times a day). 18. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 19. docusate sodium 150 mg/15 ml liquid : fifteen (15) ml po tid (3 times a day). 20. enulose oral 21. miconazole nitrate 2 % powder : one (1) appl topical (2 times a day) as needed. 22. carbidopa-levodopa 25-100 mg tablet : one (1) tablet po tid (3 times a day): given at 8 am, 2 pm, and 8 pm. 23. probalance 6 cans a day for tube feeding. 24. outpatient work please check blood chemistries, bun and creatinine next week 25. lasix 20 mg tablet : one (1) tablet po every other day: hold for systolic blood pressure less than 100. 26. outpatient work please check complete blood count next week discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: 1. hematuria secondary to traumatic foley 2. atrial fibrillation secondary diagnoses: 1. acute blood loss anemia 2. chronic lle venous stasis ulcer 3. parkinson's disease 4. bph 5. hypothyroidism 6. gerd discharge condition: stable, afebrile with vital signs within normal limits. oxygen saturation nl on room air. alert, vocalizes but doesnt form comprehensible words, intermittently follows commands. pt not yet returned to mental baseline per family. of note, family wanted it to be known that pt received 2 out of the three antiparkinson's medications on an incorrect schedule. all medications were supposed to be schedule at 8 am 2 pm and 8 pm; however, for two days the patient received two of three medications at 10 pm instead of 8 pm. the other medication were received at the regular schedule. discharge instructions: weigh patient regularly. . please make the follow-up appointments as detailed below. dr the primary care physician, be seen shortly. also make an appointment with urology to assist you with issues regarding the foley. . continue the vancomycin for two more weeks. . the vna will change the wound vac dressing tomorrow. . maintain the 22 foley catheter for now. after it should be safe to change this foley to a 16 gauge cudahy catheter. . call your pcp or return pt to the ed if you have: *fever/chills/night sweats *decreased urine output *increased blood in the urine *blood in the stools/dark stools *chest pain/difficulty breathing followup instructions: you should make a follow-up appointment within one week with your pcp . by calling . . you will also need to follow-up with dr. in the urology clinic; you can make an appointment at your convenience by calling . they will help you with issues regarding the indwelling foley. . provider: surgery clinic phone: date/time: 3:00 . provider: , md phone: date/time: 9:30 . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances transfusion of packed cells application of other wound dressing replacement of indwelling urinary catheter diagnoses: pneumonia, organism unspecified hyperpotassemia thrombocytopenia, unspecified esophageal reflux congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia unspecified acquired hypothyroidism atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) sepsis chronic kidney disease, unspecified paralysis agitans acute respiratory failure hypotension, unspecified cardiac arrest paralytic ileus unspecified accident injury to bladder and urethra, without mention of open wound into cavity acute upper respiratory infections of unspecified site varicose veins of lower extremities with ulcer 

Answer: The patient is high likely exposed to