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: lethargy major surgical or invasive procedure: medical icu stay ( - 9/13/ history of present illness: 79 year old man with a history of dementia, crohns, cad who was noted to be lethargic, unable to eat or walk by his caregiver and so was brought in from home by ems. per caregiver, no , fevers or other localizing symptoms other than decreased po intake x few days. . on arrival in the ed, the patient was in moderate distress, hypotensive to the 80s and tachycardic to the 130s. lactate was 11.0, wbc 39.3, sodium 158, creatinine 4.3. a central line was placed. he was given 4 liters of normal saline with improvement of his bp to 110s. cxr was notable for a lingular pna. he was given ctx/levoflox and tylenol in the er. past medical history: #. crohn's disease - history of pancolitis and ileitis - hx of rectal absces - dr. is gi doc #. coronary artery disease - s/p stent to right coronary artery - 20% stenosis of small diagonal artery noted, no intervention #. hypertension #. hypercholesterolemia #. lower extremity edema #. chronic anemia - iron deficiency #. hx of clostridium difficile enterocolitis #. chronic kidney disease - baseline from : bun of 25, creatinine of 1.2 #.depression #. vascular dementia #. hypothyroidism #. scarlet fever as a child . past surgical history: status post stent of right coronary artery. social history: lives with 24 hour caregiver. the patient has been widowed for seven years. he has three children. his daughter lives in , and is his healthcare proxy. another child lives in . past smoking history but quit 40 years ago. independent with feeding, dressing, and toileting prior to present decompensation. family history: the patient's mother had disease. his father abused alcohol and died of complications at a young age. the patient was one of six siblings. four are still living. he reports that one sister died secondary to severe obesity. other siblings have had cardiac issues. physical exam: vitals: 98.6 | 99-120/54-60 | 16-22 | 81-98 | sat 95-99% fm 5l humidified o2 general: confused appearing. alert/oriented x1; nad heent: ncat; perrla; eomi, anicteric; dry mm; very poor dentition neck: jvd 5cm; supple cardiac: rrr. s1, s2. sem rusb pulmonary: scattered course breath sounds bilaterally abdomen: soft;nt/nd, +bs no organomegaly; no mass palpated extremities: b/l 2+ edema calves; dp /pt 1+ bilat skin: bilateral heel eschars; sacral stage iii ulcer 7cm+ diffuse borders. neuro: +palmomental reflexes; grasp reflex; 4/5 strength legs; strenth arms. pertinent results: **admission labs wbc-39.5*# rbc-3.76* hgb-10.3* hct-34.6* mcv-92 mch-27.3 mchc-29.6* rdw-16.7* plt ct-776* neuts-90.3* lymphs-7.6* monos-1.9* eos-0.0 baso-0.2 glucose-146* urean-91* creat-4.3*# na-158* k-4.4 cl-108 hco3-26 angap-28* albumin-2.9* calcium-10.4* phos-5.1* mg-2.9* lactate-11.0* urine cx x 2 & blood cx x 2 from no growth- final . **subsequent labs/discharge labs wbc- steadily trending down to 12.5 at last check on diff steadily improving to neuts-76.6* lymphs-15.3* at last check on renal fxn steadily improving to urean-29* creat-1.0 on lactate resolved to 1.7 on . 07:37am blood probnp-4480* probnp elevated to >4000 after micu fluid resucitation . stool salm, shig, camp negative; c diff antigen not detected sputum gram stain/cx - 2+ gpc in clusters/sparse growth op flora blood cx x 2 - ngtd, pending blood cx x 2 - ngtd, pending ***********pertinent studies****************** ekg - sinus tachycardia at rate 133. right bundle-branch block with left anterior hemiblock. non-specific repolarization changes. overall similar to previous tracing cxr - new infiltrate within the lingular lobe which silhouettes the left heart border. no pleural effusion, pneumothorax, or pulmonary vascular congestion is detected cxr, pa & lat - heart size is enlarged. slight interval worsening in bilateral perihilar and lower lobe opacities is consistent with pulmonary edema. bilateral pleural effusion, left more than right, is present. chest ct- large pleural effusions (l>r) with associated atelectasis/collapse & consolidation bilaterally c/w pneumonia. no empyema, no abscess ct abdomen- 1. bilateral pleural effusion and adjacent atelectasis/consolidation; 2. right small bowel-containing spigelian hernia. there is no evidence of bowel obstruction; 3. colonic diverticulosis without evidence of diverticulitis; 4. diffuse atherosclerotic disease involving the aorta and branch vessels. again note is made of narrowing of the celiac artery origin, unchanged from ; 5. fracture of the sacral tip. new since prior ct from ; 6. small pericardial effusion. brief hospital course: mr. was evaluated in the ed and found to be in severe shock from presumed pulmonary infection. a central venous line was placed in the ed and antibiotic therapy and fluid resucitation were begun immediately. the patient was admitted to the medical intensive care unit where his hypotension and hypernatremia were treated with vigourous iv fluid rehydration without the use of pressors. his pneumonia continued to be treated with broad spectrum antibiotics with levofloxacin and vancomysin. an ng tube was placed to provide continued nutrition during this acute recovery phase of his illness. once he began showing signs of clinical improvement and stability, the patient was transferred to the floor for continued care. over the following days his renal fxn improved to better than baseline, his white count and left shift began resolving, his mental status started to clear, and he became afebrile. at the time of transfer to rehab macu, the patient was still in guarded but stable condition. he is not yet ambulating, not yet tolerating a po diet, and still experiencing episodic delerium. the patient is also still has an oxygen requirement and is undergoing gentle diuresis to improve the pulmonary edema and pleural effusions that developed secondary to his vigourous hydration in the macu. mr. has also been constipated is on a bowel regimen to help him move his stools. a spigelian (abdominal wall) hernia found on ct abdomen could also be explaining his episodic abdominal pain. he was seen and evaluated by the general surgery team who felt this could be handled later once the patient's general functional status was more improved. contact information for follow-up is given in the discharge follow-up instructions. the plan at the time of discharge is to continue antibiotic therapy and gentle diuresis at rehab with slow advances in diet and activity as tolerated. once the patient has improved, arrangements should also be made to see his pcp and the surgical specialists. medications on admission: lipitor 10 mg po qhs seroquel 25mg po qhs seroquel 12.5mg po bid (am and noon) nexium 40mg cap po daily lexapro 10mg po daily thiamine 100mg po daily hydrocholorthiazide 12.5 mg po daily lomotil 2.5mg-0.035mg po tid and prn lotrimin 1% topical cream to feet qhs lotrimin af 2% topical to feet levothyroxin 112mcg poo daily toprol xl 25mg po once daily discharge medications: 1. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 2. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 3. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 4. quetiapine 25 mg tablet sig: 0.5 tablet po bid (2 times a day): please give in am and at noon. 5. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po daily (daily). 7. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day). 11. papain-urea 830,000-10 unit/g-% ointment sig: one (1) appl topical daily (daily): apply to sacral decub. 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. polyethylene glycol 3350 100 % powder sig: one (1) po bid prn as needed for constipation: please titrate to soft bowel movements daily. 15. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for fever. 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 17. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 18. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 19. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 20. furosemide 10 mg/ml solution sig: one (1) injection qam (once a day (in the morning)). 21. vancomycin 750 mg iv q 12h 22. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day. 23. lotrimin 1 % cream sig: one (1) topical at bedtime: apply to feet at bedtime. 24. hydrochlorothiazide 12.5 mg tablet sig: one (1) tablet po once a day. . ****medical management please wean iv lasix as pulmonary, clinical presentation allows. . *****lab work 1. please check vanc trough at 9pm today . one hour prior to 10pm dose. due to change of dose yesterday. 2. follow cbcs daily until white count resolved and stable. then qod until discharged. 3. follow renal fxn with electrolytes daily vs. qod until discharged. . *****radiology per radiology- cxr should be followed to clearing. please cxr once weekly or as clinically indicated until resolved. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: **primary - community aquired pneumonia - hypovolemic shock ** secondary - crohn's disease - coronary artery disease - hypertension - hypercholesterolemia - chronic anemia - chronic kidney disease - depression - vascular dementia - hypothyroidism - aortic stenosis likely due to scarlet fever as a child discharge condition: fair. patient is getting tube feeds at 60ml/hr via ngt with gradual slow addition of honey thick liquids and pureed foods. he is being repositioned from bed to chair for one hour 2-3x daily with nursing assistance. he is not yet ambulatory. discharge instructions: you were admitted to the hospital because you have a community-aquired pneumonia that made you very sick and caused your blood pressure to be dangerously low. you were treated with supportive fluids and antibiotics in the medical intensive care unit for several days before being transfered to the floor. we feel that you are receiving the right treatment since you have been improving on the floor for the past few days. it will probably take you a while to recover from this severe infection so we are sending you rehab for further care. please follow these instructions: 1. please follow the recommended care provided for you at rehab. they will be responsible for making medical decisions/recommendations for you for the rest of your recovery period. 2. we have added two antibiotics to your regular medication regimen; levofloxacin and vancomycin. continue to take these antibiotics as prescribed up through tuesday . this will give you a total of 14 days of medical treatment. 3. we have temporarily switched you from toprol xl to metoprolol tartrate three times a day and added lasix 10mg iv once a day. the doctors rehab will help decide when it is safe for you to swtich back to your normal regimen. 4. we have stopped your lexapro and lomotil for now as these medications can worsen your mental status, especially when you are ill. you can restart these after visiting your primary care doctor once you are well. 5. please make an appointment with your primary care doctor within a week of being discharged from rehab. we have provided their name and contact number for you below. 6. please make an appointment to see dr. . he is a surgical specialist and will help you decide what needs to be done for the hernia that we found you have. **if you experience worsening , shortness of breath, swelling of your feet, severe abdominal pain, chest pain, nausea, vomiting, or any other worrisome symptoms, please talk to your primary care doctor or return to the emergency room.** followup instructions: please report to rehab macu for continued care. continue taking antibiotics as prescribed up through tuesday . this will give you a total of 14 days of medical treatment. please schedule/have rehab staff schedule follow-up with your primary care doctor for within one week of being discharged home. dr. - ( please schedule/have rehab staff schedule a follow-up appointmet with the surgical specialist to help you manage your spigelian (abdominal wall) hernia. dr. - ( procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders personal history of tobacco use depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified constipation, unspecified regional enteritis of unspecified site other shock without mention of trauma septic shock pressure ulcer, lower back iron deficiency anemia, unspecified acute diastolic heart failure pressure ulcer, heel hyperosmolality and/or hypernatremia diverticulosis of colon (without mention of hemorrhage) cerebral atherosclerosis other ventral hernia without mention of obstruction or gangrene mixed acid-base balance disorder vascular dementia, with delirium 

Answer: The patient is high likely exposed to