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: history of present illness: the patient is a 72-year-old gentleman well known to this medical intensive care unit team who was initially transferred from to on after presenting there with pneumonia, hypotension, and sepsis after a 2-day to 3-day upper respiratory infection like prodrome. he was intubated and treated with ceftriaxone, azithromycin, and flagyl for a few days. he was discharged home in good condition on where he developed copious diarrhea, a fever to 106 degrees fahrenheit, mental status changes, and acute renal failure with a creatinine of 2.7. he was intubated for airway protection. lumbar puncture revealed 5 to 10 white blood cells. his culture was negative. he was started on ceftriaxone and vancomycin but developed thrombocytopenia with schistocytes. the patient was transferred to with a question of thrombotic thrombocytopenic purpura. at he was found to have heparin-induced thrombocytopenia with a thrombus in the right internal jugular and subclavian arteries as well as thrombosis and dry gangrene of his left first and third toes. all heparin was stopped, and he was started on coumadin. at that time, cultures from the outside hospital grew back enterococcus. in the setting of enterococcal bacteremia, he underwent an echocardiogram which showed a mobile complex atheroma of the distal aortic arch which was felt to represent endovascular infection, for which he was started on a 6-week course of vancomycin and gentamicin. during the previous hospitalization, he also developed an episode of pneumonia for which he was on a course of cefepime and vancomycin. additionally, over the course of the hospitalization, the patient developed progressive and severe global muscle weakness. an electromyogram was performed which revealed a severe generalized sensory, motor, axonal, polyneuropathy with some demyelinating features which was felt to be consistent with a severe guillain- syndrome; or less likely a severe icu neuropathy. prior to discharge, to rehabilitation, the patient received a 5-day course of intravenous immunoglobulin for suspected guillain- syndrome, to which he had no clear clinical response. it was felt that in his setting intravenous immunoglobulin had a better risk benefit profile than plasmapheresis. the patient's renal function improved to baseline after a short course of steroids. he was not found to be adrenally insufficient. he was discharged to rehabilitation in stable condition with a percutaneous endoscopic gastrostomy tube. he was tolerating tube feedings. on continuous positive airway pressure of 14 to 15. he was afebrile with a left upper extremity peripherally inserted central catheter line, tracheostomy, foley, and percutaneous endoscopic gastrostomy tube in place on . at rehabilitation, he shortly developed a fever and increasing respiratory failure requiring placement on ac ventilation and finally hypotension. he was sent to where he was found to be uroseptic. he was given levofloxacin and flagyl in the emergency department. his blood pressure responded well to approximately 5 liters of fluid boluses. the patient was transferred to the medical intensive care unit for further care. past medical history: (significant for) 1. transient ischemic attacks. 2. hypertension. 3. coronary artery disease (with 70% to 80% right coronary artery lesion and a 40% left anterior descending artery lesion). 4. hyperlipidemia. 5. obesity. 6. chronic lower back pain. 7. sciatica. 8. mild congestive heart failure (with an ejection fraction of 45% and apical hypokinesis). 9. heparin-induced thrombocytopenia with thrombus including right subclavian artery, and internal jugular thrombosis, and left toe gangrene. 10. acute renal failure. 11. ventilator-associated pneumonia. 12. enterococcal bacteremia with endovascular infection. 13. respiratory failure; status post tracheostomy and percutaneous endoscopic gastrostomy tube. 14. diabetes. 15. adrenal hemorrhage felt to be secondary to heparin-induced thrombocytopenia with no evidence of ongoing adrenal insufficiency. 16. seizure in the setting of infection or a questionable emboli to the cas. medications on admission: 1. lansoprazole 30 mg once per day. 2. nystatin ointment. 3. lopressor 75 mg three times per day. 4. coumadin 10 mg at hour of sleep. 5. gentamicin 120 mg q.12h. 6. vancomycin 1 gram q.18h. 7. keppra 500 mg twice per day. 8. miconazole powder. 9. diazepam 5 mg three times per day. 10. hydrochlorothiazide 25 mg once per day. 11. captopril 6.5 mg three times per day. allergies: include heparin (heparin-induced thrombocytopenia allergy). social history: no tobacco. no alcohol. he lives with his wife. the patient had been in good health and fully functional prior to the current medical course. code status: he is full code. physical examination on presentation: temperature was 101.3, his blood pressure was initially 90/60 but improved to 118/58 with fluid, and his heart rate was 80. ventilator settings on admission were ac 500 with a tidal volume of 700, respiratory rate of 12, positive end-expiratory pressure of 5, fio2 was 100%, saturating 98%. in general, he was an agitated gentleman shaking his head and nodding appropriately to question. head, eyes, ears, nose, and throat examination revealed normocephalic and atraumatic. the mucous membranes were moist. tracheostomy was in place with some scleral edema. cardiovascular examination revealed a regular rate and rhythm. normal first heart sounds and second heart sounds. no murmurs. respiratory examination revealed diffuse upper airway rhonchi. there were no wheezes or crackles. the abdomen was obese, soft, and nontender. there were positive bowel sounds. gastrojejunostomy tube was clean and well placed. extremities revealed lower extremity edema. sacral decubitus stage 2 necrotic toes unchanged with no erythema or drainage. pertinent laboratory values on presentation: white blood cell count was 10.6, his hematocrit was 28.6, and his platelets were 295. his inr was 2.6. chemistry-7 revealed his sodium was 146, potassium was 3.7, chloride was 113, bicarbonate was 21, blood urea nitrogen was 92, creatinine was 1.1 (up from 0.5 at baseline), and his blood glucose was 107. his anion gap was 12. urinalysis showed moderate leukocytes, greater than 50 white blood cells, many bacteria, and moderate yeast. other laboratories were notable for a creatine kinase of 388 with a troponin of 1.15. his lactate was 1.5. pertinent radiology/imaging: an electrocardiogram revealed a normal sinus rhythm, normal axis, and normal intervals. no st-t wave changes. no changes from prior electrocardiogram. a chest x-ray showed no evidence of pneumonia of congestive heart failure. there was slight haziness at the left lobe thought to represent atelectasis. hospital course by issue/system: 1. pulmonary issues: the patient had increased ventilator requirements likely secondary to increased metabolic demands of sepsis. as his infection was controlled, he was able to be put back to pressure support of between 12 and 20 with a positive end-expiratory pressure of 5. of note, throughout the hospitalization the patient had intermittent episode of tachypnea up into the 40s with a concomitant increase in his ventilation and a respiratory alkalosis. he was found to have a vcs of approximately 42%, and on recent negative maximal inspiratory pressures in three sequential he tries had a nif of 20, 14, and 9; showing severe fatigue. his tachypnea was felt to be a central process. it did not respond consistently to angiolytics nor to changes in ventilation setting. currently, we have allowed him to have these episodes of tachypnea which usually resolve spontaneously in a couple of minutes. he has had decreasing secretions throughout the hospitalization, and has be respiratorily stable. 2. sepsis issues: cultures grew back vancomycin-resistant enterococcus on the second day of his admission. the infectious disease service was consulted. vancomycin and gentamicin were discontinued, and linezolid was started. this was felt to represent a second infection and not re-infection of the mobile complex atheromas in the aortic arch. a repeat echocardiogram was done which showed no change in this. it was recommended that he finish up his 6-week of antibiotics with a 2-week course linezolid to end on . he also had grow out of his urine culture with greater than 100,000 colonies; consistent with funguria. this cleared with two changes of the foley catheter. he was not treated with any antifungal agents. he remained afebrile, and his blood pressure was stable throughout the rest of his hospitalization. 3. cardiovascular issues: (a) ischemia: the patient has known non-intervened on lesions in the left anterior descending artery and right coronary artery. he had a troponin leak in the setting of hypotension with some acute renal failure. these declined with fluid resuscitation and maintenance of his blood pressure. he had no signs of acute coronary syndrome via electrocardiogram. ck/mb was negative. the patient also consistently shook his head "no" to questions about chest pain. it was felt that this was demand ischemia in the setting of hypotension. he will need cardiology followup to assess intervention to these lesions at a future date. (b) pump: the patient had mild congestive heart failure due to fluid overload. he was able to be restarted on his lopressor. will titrate this up and restart the ace inhibitor and hydrochlorothiazide later if needed once ace inhibitor and beta blocker are maximally titrated. the patient was given lasix as needed to control his fluid balance. (c) rhythm: there were no rhythm issues. the patient was in a sinus rhythm versus sinus tachycardia. 4. neurologic issues: the neurology service was consulted again for any further management of his guillain- syndrome. they felt there was no further action to be taken at this time; only physical therapy and supportive care. of note, the patient was showing mild improvement from the last hospitalization with increased alertness and ability to answer questions with shaking and nodding his head to a greater degree. he was to continue keppra for seizure prophylaxis for the near future. 5. hematologic issues: the patient's was transfused 2 units over the course of his hospitalization for a drop in his hematocrit; likely due to phlebotomy and dilution. we kept his hematocrit greater than 28 for his coronary artery disease. also, his coumadin level fluctuated due mostly to antibiotics and needed to be held for a high goal inr. his goal inr is 2 to 3. 6. endocrine issues: we continued his sliding scale of insulin. he was not found to have adrenal insufficiency. 7. renal issues: the patient's creatinine was slightly elevated on admission; likely prerenal due to hypovolemia. his creatinine corrected with fluid resuscitation. 8. fluids/electrolytes/nutrition issues: the patient was continued on tube feeds and nutritional support. we repleted his electrolytes as needed. 9. dermatologic issues: the sacral decubitus on admission improved slightly with wet-to-dry dressing changes twice per day. the plastic surgery service was consulted and felt there was no indication for debridement at this time. 10. gastroenterology issues: continued proton pump inhibitor. no acute issues. 11. code status issues: full code. discharge diagnoses: 1. guillain- syndrome. 2. ventilator dependency due to neuromuscular weakness. 3. heparin-induced thrombocytopenia (with thrombus in the right subclavian artery, and right internal jugular vein, and two toes). 4. vancomycin-resistant enterococcal urinary tract infection. 5. vancomycin-resistant enterococcal sepsis. 6. hypertension. 7. enterococcal endovascular infection. 8. diabetes. 9. hyperlipidemia. 10. seizure disorder. 11. status post acute renal failure. 12. coronary artery disease (with demand ischemia in the setting of hypotension). 13. congestive heart failure (with an ejection fraction of 45%). 14. sacral decubitus ulceration. 15. funguria. medications on discharge: 1. keppra 500 mg twice per day. 2. tylenol as needed. 3. humalog sliding-scale. 4. nystatin ointment. 5. miconazole powder. 6. diazepam 5 mg by mouth q.6h. as needed. 7. lansoprazole 30 mg by mouth once per day. 8. aspirin 325 mg by mouth once per day. 9. zinc. 10. vitamin c. 11. lopressor 75 mg twice per day. 12. polymixin ointment to eyes for one week. 13. linezolid 600 mg intravenously twice per day (until ). discharge disposition: the patient was to be discharged to rehabilitation. condition at discharge: stable. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart closed [endoscopic] biopsy of bronchus therapeutic plasmapheresis transfusion of packed cells replacement of tracheostomy tube injection or infusion of oxazolidinone class of antibiotics diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified candidiasis of other urogenital sites other convulsions ulcer of other part of foot streptococcal septicemia arterial embolism and thrombosis of lower extremity acute infective polyneuritis 

Answer: The patient is high likely exposed to