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: s/p pulling out peg tube and inability to pass foley major surgical or invasive procedure: picc line placement peg tube insertion egd with cauterization picc line insertion history of present illness: pt is a 76 yo creole speaking male with htn, essential thrombocytopenia, s/p right craniotomy for subdural hematoma, additional admission in for management of sdh, pca stroke, and c. diff colitis, who presents because he pulled out his peg tube and inability to pass foley. pt was started on ritalin last week for being sluggish. he was noted to be delirium over the weekend and ritalin was d/cd on saturday. day of admission, pt was delirius, and pulled out his peg tube. reportedly, pt also with low back pain over the past week and adominal pain which is chronic. past medical history: subdural hematoma hypertension hypercholesterolemia essential thrombocytopenia s/p placement of gj tube infected gj tube insertion site h/o c diff infection (diagnosed in admit) social history: pt is haitian creole speaking. he is married with a son and a daughter. family history: non-contributory physical exam: vs: t: 96.1; bp: 197/70; hr: 50; rr: 16; o2: 98 ra gen: confused laying in bed in nad heent: perrla; sclera anicteric cv: rrr s1s2. no m/r/g lungs: cta b/l anteriorly. abd: +bs. diffuse tenderness without rebound or guarding >er llq and suprapubic areas. g-tube removed. site is not erythematous. ext: no edema. dp 2+ neuro: did not know where he was, or day, or month. ms: upper extremities b/l. le: left flexion , all else . pertinent results: labs on admission: 05:15pm blood wbc-12.2*# rbc-3.74* hgb-11.5* hct-34.6* mcv-93 mch-30.9 mchc-33.3 rdw-15.3 plt ct-746* 05:15pm blood neuts-69.9 lymphs-21.1 monos-8.4 eos-0.3 baso-0.2 05:15pm blood glucose-100 urean-15 creat-1.0 na-140 k-5.0 cl-104 hco3-27 angap-14 05:15pm blood alt-21 ast-26 alkphos-140* amylase-69 05:15pm blood calcium-9.9 phos-3.6 mg-1.7 __________________________ other: 05:15pm blood alt-21 ast-26 alkphos-140* amylase-69 09:05am blood vitb12-690 folate-19.4 09:05am blood tsh-2.8 06:13pm blood lactate-1.1 08:37am blood lactate-1.0 __________________________ labs on discharge: hct: 33.0* hct: 33.1* hct: 32.2* hct: 32.5* ___________________________ micro: - ucx- no growth 12:18 pm urine **final report ** urine culture (final ): pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml pseudomonas aeruginosa | cefepime-------------- <=1 s ceftazidime----------- <=1 s ciprofloxacin--------- 2 i gentamicin------------ <=1 s imipenem-------------- 4 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s rpr -negative , , - c. diff no growth - ucx- no growth _____________________________________ radiology: ct ab/pelvis with and without contrast-1. improved appearance of previously described colitis. 2. no acute abnormality. - ct head without contrast-ct of the brain without intravenous contrast: there is again seen an area of linear density adjacent to the inner table at the location of the right-sided craniotomy, which is unchanged in appearance since , likely post- surgical in origin. no acute intracranial hemorrhage is identified. there is no new mass effect or shift of normally midline structures. the lateral ventricles are symmetric and unchanged in size. the basilar cisterns are patent. stable appearance of old infarct in the right posterior cerebral artery distribution is noted. stable periventricular white matter hypodensity consistent with small vessel ischemic change is seen. elsewhere within the brain, the -white differentiation is preserved. -eeg-: abnormal eeg due to the slow and disorganized background rhythm. this indicates a widespread encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. there were no epileptiform features. -eeg-this is an abnormal routine eeg due to the presence of a slow and disorganized background rhythm in the theta frequency range with occasional intermixed, generalized delta frequency slowing. these findings suggest deep, midline subcortical dysfunction and are consistent with an encephalopathy. common causes include infections, medication effects, and metabolic disturbances. no lateralizing or epileptiform abnormalities were identified. if clinical concern for seizures persists, a repeat study after the patient's mental status improves, may be of benefit to better discriminate focal abnormality that can be obscured by an encephalopathic pattern. sinus bradycardia was noted. mra/mri head-1. new focus of increased susceptibility in the peripheral right cerebellar hemisphere, which may be artifactual, but could represent a small area of hemorrhage. please note that this finding was not seen on the previous examination, but the difference may be due to the present study obtained at 3t, as opposed to the 1.5t study earlier. the higher field strength of the present study could increase the visibility of magnetic susceptibility. 2. no evidence of acute ischemia. 3. stable mra of the circle of compared to . mri gadolidium-1. enhancement of the pachymeninges along the entire right convexity, likely related to previous subdural hemorrhage. 2. developmental venous anomaly in the right frontal lobe, a benign finding. 3. no evidence of acute ischemia. 4. no cerebral masses. brief hospital course: on , pt was noted to be tachycardic, then had decreased in bp from 120's from 150-180's. that same day patient had 2 large melenic stools. ~ 10 point hct drop from 32 on am to 23 on . he was given 2 units of prbc and then was transferred to the micu. micu course: patient had an episode on bloody emesis ~300 cc but hct remained stable. egd was initially attempted but could unsuccessful to visualize bleeding b/o old clot. egd repeated on and showed small ulcer w/ signs of recent bleeding at gastrostomy site. this was injected wtih epinephrine and cauterized. additionally, pt was found to have a pseudomonal uti and mental status improved. then pt had two unresponsive episodes on the floor. the following is by problem of the above: 1. altered mental status/unresponsive- pt was initially pulling at his foley and ivs pulling them out when he was initially hospitalized. he eventually was found to have a pseudomonal uti and was fully treated with zosyn (see below). his mental status cleared to baseline per family where at times he was oriented x 3. thus, his altered mental status when he was in the hospital was attributable to his uti and has now resolved to his previous mental status. pt also had with two episodes of unresponsiveness on and . mri/mra showed ? small amount of hemorhage in right cerebellar hemishphere which could be artifact. mra was fine. repeat mri with gadolidium showed no acute stroke. eeg was repeated and was only consistent with encephalopathy. neurology was consulted on pt who thought that pt may have seizures but it was unclear. was stable for the rest of his hospitalization. b12 was checked (pt with history of b12 deficiency) and it was normal. pt would pull at his tubes/lines frequently but this decreased towards the end of his hospital stay. he was on 1:1 sitters and restraints during hospitalization having the restraints taken off within a few days. the 1:1 sitter was taken off a few days before discharge and pt did well, with no agitation. we held pt's provigil and paxil during altered mental status and avoided sedating medications. 2. gi bleed-pt had a gib secondary to ulceration at peg tube from pulling it out. he had an egd which showed this and the ulceration was cauterized. he required blood transfusion x 2 initially and then 2 units of prbc when he came back on the floor to bump him up. we initially were checking hct q12 when pt arrived back on the floor and then when hct was stable for a few days qday. we started with protonix and switched to prevacid once g tube was placed. he will get this for one month in total and then to qday. 3. pt grew pseudomonas in his urine which was sensitive to zosyn. he completed a 14 day course of zosyn while in-house. he had negative u/a, ucx after that. his initial delirium was likely due to this, and has now resolved to baseline. foley placement was difficult therefore no voiding trials were done. 4. g-tube displacement- as above. replaced . receiving tube feeds through it. needs speech and swallow evaluation for safety of po intake in setting of baseline delerium. 5. foley placement/ pt had inability to place foley initially and then had a 22 caude placed in the ed. gu saw pt when he was out of the micu and replaced a 22 caude catheter. flomax was started for urinary retention. however, we d/cd it as that was the only change in medications prior to initial unresponsiveness. inability to pass foley is likely foley trauma/acute edema. he will need a voiding trial in rehab and outpt follow up with urology. 6. essential pt was not on his hydroxyurea upon coming in, stopping in in his surgery admission. we restarted hydroxyurea after discussing this with his hematologist, dr. . plavix on hold bleed. pt will need follow up with dr. as an outpatient. please continue to hold plavix (for at least 6 weeks) ; follow outpt hematolgy recommendations. 7. depression- we d/cd paxil in setting of altered mental status. this should be restarted when pt follows up with his pcp. 8. htn- bp meds were initially being held in the setting of acute bleed. we restarted his clonidine and metoprolol at outpt doses. 9. hyperlipidemia- cholestyramine was on hold. we restarted it prior to discharge. 10. c. diff- pt with c. diff positive on prior hospitalizations with persistant diarrhea. we treated him with vancomycin while on zosyn, and have now d/c'd vancomycin. 11. ppx- subcutaneous heparin restarted after gib stable. prevacid. 12. pt had a right fem line in the micu which was d/cd. he had a right arm picc placed by ir which was d/cd when the antibiotic course was finished. he had peripheral ivs otherwise. 13. f/e/ pt was on tube feeds. nutrition consulted for help. electrolytes were checked and repleted prn. speech and swallow evaluation needed for safety of po intake. 14. code status-pt was full code. medications on admission: 1. modafinil 50 mg qday 2. celecoxib 100 3. metoprolol 25 tid 4. lansoprazole 30 qhs 5. cholestyramine 4 g 6. paroxetine 30 mg qday 7. clonidine 0.1 mg q8 hours 8. paroxetine 30 mg qday 9. cholestyramine 4 g 10. dalteparin 2500 units qday discharge medications: 1. docusate sodium 150 mg/15 ml liquid sig: one (1) po twice a day. 2. hydroxyurea 500 mg capsule sig: one (1) capsule po daily (daily). 3. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) sc injection tid (3 times a day). 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. 6. clonidine 0.1 mg tablet sig: one (1) tablet po tid (3 times a day). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 8. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po bid (2 times a day) for 2 weeks: after 2 weeks stop dosing and switch to daily dosing. 9. cholestyramine-sucrose 4 g powder sig: one (1) po twice a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: delirium gastrointestinal bleed urinary tract infection inability to pass foley clostridium difficile secondary diagnosis: hypertension essential thrombocytosis hyperlipidemia discharge condition: pt is doing significantly better. his hct is stable and his mental status has returned to baseline per family. they note that he has had intermittant delerium since sdh in spring, now baseline, does not require inpatient care. discharge instructions: call your doctor or go to the ed if you have change in your mental status, bright red blood per rectum, black stools, have fever >101, chills, nausea, vomiting, chest pain, problems breathing, shortness of breath, or any other health concern. take your medications as prescribed. go to your appointments below. 1.call your pcp . at within the next 7-10 days for follow up. 2. provider: , neurosurgery west where: lm phone: date/time: 2:15 -hematology: dr. - call for appointment -urology: dr. call for appointment: take your medications as prescribed. followup instructions: 1.call your pcp . at within the next 7-10 days for follow up. 2. provider: , neurosurgery west where: lm phone: date/time: 2:15 -dr. - -urology: dr. call for appointment: procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances endoscopic control of gastric or duodenal bleeding transfusion of packed cells replacement of gastrostomy tube insertion of indwelling urinary catheter diagnoses: urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation blood in stool intestinal infection due to clostridium difficile retention of urine, unspecified encephalopathy, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site mechanical complication of gastrostomy other gastrostomy complications chronic ulcer of other specified sites 

Answer: The patient is high likely exposed to