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: shortness of breath major surgical or invasive procedure: rij placement in ed midline placement history of present illness: 83 yo m after recent prolonged hospital course for mssa septic prosthetic joint infection and respiratory failure presents from rehab with fever and hypotension after episode of emesis x4 around 12:30 am. an hour later his temp rose to 99.9, his sat dropped to 88-89 on 4l, and he became tachycardic. on exam it was noted he had emesis at his trach stoma site and suction was attempted. of note, his stoma was recently decanulated 3 days ago. in the ed, initial vs were: t 100.7 hr 112 bp 78/45 rr 24 pox71 on ra. patient was given vancomycin 1gm, levofloxacin 750mg, and flagyl 500mg iv. tylenol 650mh x2 was given for fever and levophed was begun for hypotension. lactate of 5.2. a right ij triple lumen was place and confirmed by cxr. he received 3l ns to support his bp and repeat cxr showed prgression in rml infiltrate. on arrival to the micu, patient reporting feeling comfortable on oxygen face mask with occassional cough, chills, and crushing back/sacral pain. he denied further nausea, abd pain, chest pain, diarrhea, or fevers. review of systems: (+) per hpi (-) no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: recent prolong hospitalization for septic prosthetic joint (mssa)requiring skin grafting, prolonged intubation w/ trach and post-pylori g-tube placement, discharged to rehab on htn peripheral neuropathy elevated cholesterol osteoarthritis r tka complicated by above h/o esbl uti social history: he is a retired executive from the emhart corporation. he is a widower. he is a former smoker, smoked up to two packs per day for about 45 years, now quit. after prolonged hospital course, he has been at rehab since . family history: positive for cancer in his brother and in-laws. mother had cardiomyopathy and cardiac hypertrophy, father had a cva, lung disease in a brother, copd. disease in a brother. daughter has skin cancer. physical exam: admission vitals: t:99.9 bp:98/46 p:101 r: 24 o2:93% on face mask general: alert, oriented to place and month, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad, airleak at trach stoma, covered w/ dressing lungs: decreased bs at right base, coarse crackles throughout lower lung fields, no wheezing, good air movement, no accessory muscle use cv: tachy, regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: clean/dry/non-tender g-tube site, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly back: large 10 x8 cm stage iii/vi sacral decub w/ scant tan discharge ext: warm, 1+ pulses, no clubbing, cyanosis or edema . discharge: pe:vs: t 98.2 hr 72 bp 122/70 r 20 94%2l general: pleasant, chronically ill appearing man in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. drymm. op with white lesions in back of throat. neck supple, no lad, no thyromegaly, scar from old trachestomy cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp=6cm lungs: faint crackles at b/l bases but poor inspiratory effort abdomen: peg tube in place, nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 1+ dorsalis pedis/ posterior tibial pulses. skin: no rashes, ecchymoses. scar from surgery on right knee. sacral stage 4 decubitus ulcer. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: admission labs 04:00am blood wbc-22.6*# rbc-3.70*# hgb-10.8*# hct-33.5*# mcv-91 mch-29.2 mchc-32.3 rdw-15.6* plt ct-460*# 04:00am blood neuts-93* bands-0 lymphs-2* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-1* 04:00am blood pt-15.7* ptt-27.0 inr(pt)-1.4* 04:00am blood glucose-107* urean-26* creat-1.2 na-135 k-4.7 cl-100 hco3-19* angap-21* 08:32am blood calcium-7.9* phos-3.6 mg-1.7 . 04:13am blood lactate-5.2* 06:09am blood lactate-1.0 . 04:00am blood ck(cpk)-41 ck-mb-notdone ctropnt-0.10* 03:35am blood ck(cpk)-44 ck-mb-notdone ctropnt-0.11* . bcx ngtd x 2 ucx >100,000 yeast c. diff negative . cxr: rounded retrocardiac opacity is concerning for abscess. recommend pa and lateral radiographs, or chest ct, for further evaluation. . ct chest: 1. bilateral dependent parenchymal consolidations are improved compared to ct chest of . since more recent ct abdomen/pelvis of , consolidation in the right lung base is slightly increased. together with findings on recent chest radiograph, this is likely due to aspiration. these changes may be followed radiographically. no abscess is seen. 2. interval resolution of bilateral pleural effusions since as well as small pericardial effusion. 3. several prominent mediastinal lymph nodes are slightly larger than that seen on and could represent reactive change. attention to these is recommended on followup studies. 4. upper lobe predominant emphysema. 5. aortic valvular calcifications. 6. narrowed right subclavian vein with opacification of multiple chest wall collaterals. . 06:10am blood wbc-10.1 rbc-3.32* hgb-9.7* hct-29.7* mcv-90 mch-29.1 mchc-32.5 rdw-15.9* plt ct-257 05:42am blood wbc-8.4 rbc-3.07* hgb-8.9* hct-27.8* mcv-90 mch-28.8 mchc-31.9 rdw-15.6* plt ct-230 02:20am blood wbc-9.4 rbc-2.96* hgb-8.7* hct-25.9* mcv-88 mch-29.4 mchc-33.5 rdw-16.1* plt ct-243 03:35am blood wbc-12.5* rbc-2.52*# hgb-7.4*# hct-22.4* mcv-89 mch-29.5 mchc-33.2 rdw-16.1* plt ct-270 02:20am blood pt-15.9* inr(pt)-1.4* 04:00am blood pt-15.7* ptt-27.0 inr(pt)-1.4* 06:10am blood esr-82* 06:10am blood glucose-107* urean-15 creat-0.6 na-143 k-3.4 cl-112* hco3-23 angap-11 05:42am blood glucose-118* urean-17 creat-0.6 na-143 k-3.0* cl-111* hco3-24 angap-11 02:20am blood glucose-102 urean-21* creat-0.7 na-137 k-3.2* cl-107 hco3-21* angap-12 03:35am blood glucose-86 urean-23* creat-0.7 na-137 k-4.0 cl-107 hco3-21* angap-13 05:00pm blood glucose-118* urean-28* creat-0.9 na-135 k-4.4 cl-104 hco3-21* angap-14 08:32am blood glucose-113* na-137 k-4.7 cl-108 hco3-20* angap-14 04:00am blood glucose-107* urean-26* creat-1.2 na-135 k-4.7 cl-100 hco3-19* angap-21* 05:42am blood alt-12 ast-20 alkphos-99 totbili-0.5 08:32am blood ld(ldh)-199 06:10am blood calcium-8.6 phos-2.3* mg-1.9 05:42am blood calcium-8.3* phos-2.7 mg-1.9 08:32am blood calcium-7.9* phos-3.6 mg-1.7 03:35am blood hapto-266* 06:10am blood crp-87.0* . 4:49 pm urine source: catheter. **final report ** urine culture (final ): yeast. >100,000 organisms/ml.. brief hospital course: # shock: likely aspiration pneumonia v. pneumonitis; may have also had infectious component from osteomyelitis at sacral decub. pt on vanc/zosyn to cover hap as from rehab. picc line pulled and cultured. he remained afebrile with resolution of leukocytosis. pressors were able to be weaned off after first night in micu. cx neg to date other than yeast in urine which was treated. foley changed. c. diff negative. cont vanc/zosyn x 7 days for tx of pna. . # fungal uti: foley changed to condom cath but had urinary retention so repleaced. started on fluconazole for 7d course per id. . # hypoxia: developed in setting of recent aspiration event. treated for pneumonia as above and weaned off face mask to nasal cannula. discharged on 2lnc. cont vanc/zosyn to complete 7 days course. . # sacral decubitus c/b osteomyelitis: developed on last hospitalization and worsened at rehab. had been started on vanc/zosyn on (day prior to admission) at rehab for worsening appearance. ct l-spine with evidence of osteomyelitis; able to probe to bone. seen by wound nurse , who recommended wound care and nutritional support. cont vanc/zosyn for at least 6 week course. . # h/o mssa right knee prothestic joint arthritis: followed by id as outpatient. outpatient rifampin 300mg po daily being held initially but resumed prior to discharge. f/u with id and ortho as outpatient. . # anemia: unclear source. no evidence of hemolysis. transfused 2 units prbc with hct bump of only 2 pts but stable hct overnight. noted to have trace guaiac positive stool. trend hct daily which was improving upon discharge. . # romi: pt with rate-related ekg changes which resolved on subsequent ekg when rate controlled. cardiac enzymes cycled and negative. . # mediastinal lymph nodes: noted to have several prominent mediastinal lymph nodes on ct chest that are slightly larger than those seen on and could represent reactive change. attention to these is recommended on followup studies. . # general care: fen: restarted on tube feeds. (npo), access: midline on right, ppx: pneumoboots, sq heparin, h2 blocker, communication: patient, daughter/hcp( ), son is physician, status: dnr/dni, confirmed w/ daughter/hcp & family. disposition: rehab medications on admission: acetaminophen 975mg q8h acetylcysteine 200mg q8h ascorbic acid 500mg po daily calcium carbonate 650mg po bid cholecalciferol 1000units daily citalopram 20mg daily cyanocobalamin 50mcg daily ferrous sulfate 325mg daily insulin humalog ss ipratropium neb q4h lactobcacillus 2 tabs daily lisinopril 5mg po daily metoclopramide 10mg q8h mvi daily nystatin 5cc tid swish and spit omperazole 440mg po daily zosyn 4.5mg iv q6h (started ) potassium chloride 40 meq daily rifampin 300mg po daily saliva substitue 2.4ml tid swish and swallow vancomycin 1gm iv q12h (started ) oxycodone 5mg po q4h prn oxycodone 10mg po q4h prn discharge medications: 1. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 2. heparin flush (10 units/ml) 2 ml iv prn line flush mid-line, heparin dependent: flush with 10 ml normal saline followed by heparin as above, daily and prn per lumen. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection q8h (every 8 hours). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. metoclopramide 5 mg/5 ml solution sig: ten (10) mg po q 8h (every 8 hours). 8. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid sig: one (1) po daily (daily). 9. vancomycin 1,000 mg recon soln sig: one (1) g intravenous twice a day: please continue through . 10. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours): continue through . 11. morphine 2 mg/ml syringe sig: 0.5 mg injection q6h (every 6 hours) as needed for pain. 12. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 13. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. 14. rifampin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 15. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 16. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 17. vitamin a 10,000 unit capsule sig: two (2) capsule po daily (daily) for 6 days. 18. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily) for 6 days. 19. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for fever or pain. 20. calcium 600 600 mg (1,500 mg) tablet sig: one (1) tablet po twice a day. 21. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 22. celexa 20 mg tablet sig: one (1) tablet po once a day. 23. cyanocobalamin 50 mcg tablet sig: one (1) tablet po once a day. 24. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 25. multivitamins tablet, chewable sig: one (1) tablet, chewable po once a day. 26. artificial tears drops sig: one (1) ophthalmic four times a day. 27. aspirin 81 mg tablet sig: one (1) tablet po once a day. 28. ascorbic acid 90 mg/ml drops sig: five hundred four (504) mg po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary - aspiration pneumonia - sacral decubitus complicated by osteomyelitis - fungal urinary tract infection secondary - right tka complicated by mssa septic prosthetic joint - hypertension - peripheral neuropathy - hypercholesterolemia - osteoarthritis - h/o esbl uti discharge condition: vital signs stable, moves all 4 extremities but bedridden discharge instructions: you were admitted with septic shock in the setting of an aspiration event. you required some medications to help your blood pressures initially but improved with treatment of your infection. you were also started on antibiotics to treat your aspiration pneumonia and infection of the bone in your sacrum. . there is evidence that your sacral decubitus ulcer has progressed to osteomyelitis, an infection of underlying bone. you will required at least 6 weeks of antibiotics to treat this. . the following changes were made to your medication regimen: discontinued omeprazole. started famotidine. started vancomycin and zosyn for your infection for the next 6 weeks. . please take all medications as prescribed. call your doctor or 911 if you develop chest pain, difficulty breathing, fever > 101, dizziness, worsening confusion, bleeding, inability to tolerate food/liquids, inability to pass gas/stools, or any other concerning problems. followup instructions: please follow up with your pcp, . , within 1 week of discharge from rehab. his office number is . . provider: , md phone: date/time: 1:30 provider: surgery clinic phone: date/time: 2:00 provider: , md phone: date/time: 11:00 procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: anemia, unspecified pure hypercholesterolemia other postoperative infection urinary tract infection, site not specified unspecified essential hypertension unspecified protein-calorie malnutrition unspecified osteomyelitis, other specified sites pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot pressure ulcer, lower back surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation nonspecific abnormal findings in stool contents knee joint replacement gastrostomy status pressure ulcer, stage iv other and unspecified mycoses other respiratory abnormalities shock, unspecified infection and inflammatory reaction due to internal joint prosthesis late effect of complications of surgical and medical care 

Answer: The patient is high likely exposed to