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 / ceftriaxone / clindamycin attending: chief complaint: cc: major surgical or invasive procedure: intubation history of present illness: 62-year-old male with past medical history of multiple sclerosis, subdural hematoma s/p craniotomy, copd, multiple admissions for pneumonia including recent admission for respiratory distress and clostridium difficile infection who presents with respiratory distress. . the patient was recently admitted on for aspiration pneumonia. at that time he was treated with vancomycin, levofloxacin and piperacillin/tazobactam for a short coarse which was narrowed to levofloxacin. he was also diagnosed with c. diff and started on metronidazole at that time. . the patient was discharged to rehab where he was at his baseline state of health (aox0, minimally interactive) until the day of presentation when he was noted to be more lethargic and increased work of breath with copious secretions. a wbc was checked and returned elevated to ~25. given concern for pneumonia ambulance was called and he was transported to ew for further evaluation. . upon ems arrival, patient was tachypneic, labored breathing and saturating mid 80s on room air. he was placed on supplemental oxygen and transported to . . initial vitals at were: t 98.7, hr 86, bp 99/56, rr 30, sao2 91% 4l. he had repeat labs which showed wbc 21 (uptrending since last admissions), . a cxr showed which showed lll infiltrates. he was started on levofloxacin, metronidazole, vancomycin, methylprednisolone, albulterol and ipratropium. he had significant work of breathing and was near intubation, however, ultimately improved. abg was 7.49/38/87. vitals on transfer were: hr 84, bp 114/63, rr 21, sao2 99%. . currently, appears uncomortable and in respiratory distress. loud upper airway sounds. past medical history: - multiple sclerosis with left sided hemiparesis - depression - copd - iron deficiency anemia - h/o dvt in lower extremity - osteoporosis - subdural hematoma s/p left frontal temporal parietal craniotomy() - dysphagia - h/o steriotactic brain biopsy () - h/o respiratory failure social history: currently lives in home. denies tobacco, alcohol, illicit drugs. guardian - (, , h: , w: ). currently undergoing re-evaluation of guardian status. date pending. family history: unknown. has estranged brother who previously lived in . physical exam: general appearance: thin, anxious eyes / conjunctiva: perrl, conjunctiva pale head, ears, nose, throat: normocephalic, poor dentition cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: 2+), (left radial pulse: 2+), (right dp pulse: 2+), (left dp pulse: 2+) respiratory / chest: (expansion: symmetric), (percussion: resonant : , dullness : dull left lower lobe), (breath sounds: crackles : bibasilar, bronchial: left lower lobe, no(t) wheezes : ), extensive upper airway noise abdominal: soft, non-tender, bowel sounds present, g-tube in place extremities: right lower extremity edema: none, left lower extremity edema: none, no(t) cyanosis, no(t) clubbing musculoskeletal: muscle wasting, le atrophy skin: warm neurologic: follows simple commands, responds to: not assessed, movement: not assessed, tone: not assessed, able to track with eyes, nod yes/no pertinent results: 04:58am blood wbc-10.7 rbc-2.96* hgb-9.5* hct-28.8* mcv-97 mch-32.1* mchc-33.0 rdw-17.4* plt ct-554* 05:35am blood wbc-9.5 rbc-2.82* hgb-9.0* hct-27.6* mcv-98 mch-31.8 mchc-32.5 rdw-17.0* plt ct-548* 06:07am blood wbc-13.8* rbc-2.56* hgb-8.1* hct-25.0* mcv-97 mch-31.8 mchc-32.6 rdw-16.0* plt ct-641* 01:55pm blood wbc-16.7* rbc-2.57* hgb-8.4* hct-25.2* mcv-98 mch-32.6* mchc-33.3 rdw-16.2* plt ct-630* 03:45am blood wbc-15.2* rbc-2.37* hgb-7.5* hct-23.3* mcv-98 mch-31.5 mchc-32.0 rdw-16.1* plt ct-565* 05:25pm blood wbc-21.4* rbc-2.81* hgb-8.9* hct-27.0* mcv-96 mch-31.7 mchc-33.1 rdw-16.3* plt ct-632* 04:58am blood neuts-73.8* lymphs-19.5 monos-5.7 eos-0.6 baso-0.4 05:25pm blood neuts-90.1* lymphs-7.1* monos-2.6 eos-0 baso-0.1 04:58am blood pt-12.3 ptt-23.9 inr(pt)-1.0 05:25pm blood pt-14.2* ptt-24.7 inr(pt)-1.2* 04:58am blood glucose-118* urean-19 creat-1.0 na-137 k-4.3 cl-100 hco3-30 angap-11 05:25pm blood glucose-120* urean-37* creat-1.5* na-147* k-4.2 cl-111* hco3-26 angap-14 03:26am blood alt-34 ast-22 ld(ldh)-187 alkphos-88 totbili-0.3 03:45am blood alt-34 ast-28 ld(ldh)-217 ck(cpk)-99 alkphos-94 totbili-0.3 01:55pm blood ck-mb-4 ctropnt-0.07* 03:45am blood ck-mb-4 ctropnt-0.07* 05:25pm blood ctropnt-0.11* 04:58am blood calcium-9.7 phos-2.8 mg-2.6 05:25pm blood calcium-9.2 phos-3.9 mg-2.5 09:38pm blood triglyc-42 06:07am blood vanco-15.3 imaging: cxr: impression: left basilar opacity concerning for pneumonia. . ct head: impression: 1. no acute hemorrhage. 2. subacute on chronic right cerebral hematoma. . cxr: impression: ap chest compared to through : bibasilar consolidation is continuing to clear. there may be residual bronchiectasis. upper lungs are clear. no pleural effusion or evidence of central adenopathy. heart size normal. normal mediastinal and pulmonary vasculature. brief hospital course: 62-year-old male with past medical history of copd, aspiration pneumonia, clostridium difficile who presents with respiratory distress and leukocytosis. . # respiratory distress: likely secondary to aspiration pneumonia. increasing lll infiltrate. abg relatively good, however, copious secretions with poor management. will need intubation for excessive secretions. the patient was given vanc, levo and metronidazole in ew. hcap would broaden coverage with piperacillin/tazobactam. other etiologies considered were pneumonitis, pe, pulm edema. most consistent with pneumonia at this time. pt was initially on vanc, levo, zosyn. this was narrowed to zosyn only only sputum cx revealed gnrs, then e coli and proteus. blood cx remained neg. cxr showed improvement. clinically also, pt improved with less o2 requirement (was briefly intubated) to now satting well on ra. pt does require frequent sucitoning to manage pulmonary secretions. pt completed a full course of zosyn and thus is off all iv abx now. . # goals of care: pt's nonrelative guardian wishes to change pt's code status to dnr/dni. legal department has all the necessary paperwork to assist in this process. the process is pending at time of discharge. . # c. difficile: appears to have worsening leukocytosis since last admission. unclear based on transfer records whether stool output has improved. based on worsening leukocytosis would favor po vancomycin for now for possible refractory c. difficile. pt was maintained on po vancomycin during this hospital course and will need to complete 5 more days after being off all other abx, starting on . pt can be started on probiotics when able to tolerate. bowel regimen shoudl be used with caution. . # leukocytosis: likely secondary to pneumonia. c. difficile may be contributing. leukocytosis resolved with treatment with iv antibiotics and pt has remained afebrile. . # copd: the patient has no evidence wheezes or imaging suggestive of obstructive process. not retaining co2. did not receive steroids. maintained pt on alb and ipratropium nebs for goal sats in 90-93%. . # : likely prerenal in setting of infection. recent baseline is 1.2 although has been higher in past. cr was 1.5 on admission but trended down to 1.0 with hydration and tfs. pt's tube feeds were held on day of transfer and pt's urine output decreased to 10-30cc/hr (likely dehydration), which should be monitored once tube feeds are resumed. . # anemia: at baseline, required no transfusions. remained hemodynamically stable. consider work up or deferral to outpatient. . # thrombocytosis: likely reactive. remained stable. . # multiple sclerosis: appears to be at baseline. was continued on home meds. . # altered mental status: aox0 at baseline. appears to understand and responds with one word answers sometimes. . # pt was initially npo then started on tube feeds. pt had a picc for iv abx which was removed upon completion of course. pt was on heparin sc for dvt ppx. pt is full code currently however pt's guardian is going to court to change it to dnr/dni. medications on admission: - ranitidine hcl 15 mg/ml syrup sig: ten (10) ml po daily - amantadine 50 mg/5 ml syrup sig: twenty (20) q12 hours - levetiracetam 500 mg tablet sig: two (2) tablet po bid - methylphenidate 10 mg tablet sig: one (1) tablet po bid - duloxetine dr 40mg twice daily - mirtazapine 15 mg tablet sig: one (1) tablet po hs - calcium-vitamin d 600-400 mg-unit tablet sig: - docusate sodium 50 mg/5 ml liquid sig: one hundred mg - tiotropium bromide 18 mcg capsule daily - albuterol sulfate 2.5 mg /3 ml (0.083 %) q4hr prn - acetaminophen 325 mg tablet sig: 1-2 tablets q6 prn pain - bisacodyl 5 mg tablet sig: two (2) tablet po daily prn - milk of magnesia 1-2 doses daily prn constipation - fleets enemas prn constipation - jevity 1.2 continuous at 75ml/hr with 150ml h20 flushes q8hrs discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 5 days. 3. levetiracetam 100 mg/ml solution sig: 1000 (1000) mg po bid (2 times a day). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob, wheezing. 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day). 8. methylphenidate 5 mg tablet sig: two (2) tablet po bid (2 times a day). 9. amantadine 50 mg/5 ml syrup sig: two hundred (200) mg po bid (2 times a day). 10. duloxetine 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po bid (2 times a day). 11. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 12. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po bid (2 times a day). 13. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 15. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: aspiration pneumonia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive though cannot verbalize except for one word answers activity status: bedbound. discharge instructions: dear mr. , it was a pleasure taking care of you here at . you were admitted because you had another episode of aspiration pneumonia. you were treated with a course of iv antibiotics. you improved and were then transferred to a rehab facility for further monitoring and care. the following changes were made to your medications: stop ranitidine start po vancomycin for 5 days starting stop milk of magnesia stop fleets enemas titropium inhaler was changed to ipratropium nebulizers followup instructions: please follow up with your primary care doctor dr. after discharge from the rehab facility. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified intestinal infection due to clostridium difficile iron deficiency anemia, unspecified personal history of venous thrombosis and embolism multiple sclerosis hyperosmolality and/or hypernatremia leukocytosis, unspecified hemiplegia, unspecified, affecting unspecified side essential thrombocythemia dysphagia, unspecified 

Answer: The patient is high likely exposed to