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 / levofloxacin / phenazopyridine attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation extubation history of present illness: y/o m with pmhx significant for mild diastolic heart failure, copd, atrial fibrillation sent from rehab for respiratory distress, with o2 sats in the 70s. reportedly, he received 240 mg po lasix as well as 4 mg sl morphine at the nh. he was on bipap on arrival. ecg in the ed was difficult to interpret, showing demand pacing with intermittent a.fib with concerning changes laterally (no r waves in v4-v6). on arrival to the ed, the patient's vs were t= 98.2; bp= 115/89; hr= 80s; rr= 30s; o2 sat= 100% on bipap 100%. he was given 40 mg iv lasix and put out 30-40 cc of urine. he was given vanc/cefepime for possible pna on cxr. also, of note, he was tried on a nitro gtt, which initially caused some hypotension. . on arrival to the floor, the patient's vs were t= 97.6; bp= 123/63; hr= 90; rr= 27; o2 sat= 98% on bipap. he was somnolent and was not able to give a history. he did indicate by nodding that he was short of breath. nh records indicated that he was experiencing lightheadedness, sob, doe, orthopnea, poor appetite, mild nausea, and fatigue. per nh records, he was not experiencing chest pain, palpitations, or abdominal pain. past medical history: 1. cardiac risk factors: + hypertension, ? dyslipidemia, - diabetes 2. other past medical history: ddd pacemaker placed for second degree av block coronary artery disease congestive heart failure obstructive sleep apnea hypertension gout lichen simplex chronicus, on zyrtec incisional hernia chronic skin ulcers iron-deficiency anemia s/p prostatectomy s/p appy ventral hernia obesity h/o dvt, on coumadin completed 6m course hypothyroidism chronic renal insufficiency (1.3 - 1.6) basal bronchiectasis ?copd social history: per old records, lives at rehab, denies ever smoking. family history: not able to obtain. physical exam: vs: t= 97.6; bp= 123/63; hr= 90; rr= 27; o2 sat= 98% on bipap general: somnolent; responds to verbal stimuli at times. heent: nc/at. sclera anicteric. neck: jvp of cm. cardiac: rrr, normal s1, s2. no m/r/g. no s3 or s4 appreciated. lungs: no chest wall deformities, scoliosis or kyphosis. decreased air movement; scattered slight crackles throughout on the back. abdomen: obese. soft, ntnd. no masses noted. ventral hernia present. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission labs: wbc-6.8 rbc-4.55* hgb-13.2* hct-43.3 mcv-95 mch-29.1 mchc-30.6* rdw-14.5 plt ct-319 neuts-63.7 lymphs-28.9 monos-5.2 eos-1.5 baso-0.7 glucose-115* urean-39* creat-1.9* na-144 k-4.4 cl-97 hco3-42* angap-9 . cardiac biomarkers: 12:48pm blood ck(cpk)-52 ck-mb-notdone ctropnt-0.09* 03:39am blood ck(cpk)-47 ck-mb-notdone ctropnt-0.09* 07:20pm blood ck(cpk)-63 ck-mb-notdone ctropnt-0.09* . urine: urine color-yellow appear-clear sp -1.009 urine blood-neg nitrite-neg protein-25 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-sm urine rbc-0-2 wbc-* bacteri-few yeast-none epi-0-2 urine hours-random urean-362 creat-54 na-50 osmolal-324 . microbiology: . urine culture site: catheter klebsiella oxytoca. 10,000-100,000 organisms/ml. _______________________________________________________ ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . blood cultures x 2: pnd . : sputum gram stain: >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. culture: rare growth commensal respiratory flora. . : mrsa screen - positive . ekg : ventricular paced rhythm with underlying atrial fibrillation versus irregular supraventricular tachycardia. compared to the previous tracing there is no diagnostic change. . echocardiogram, transthoracic : the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal septal motion/position. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , moderate pulm hypertension is now detected. . cxr (portable ap) : pulmonary edema with left pleural effusion. brief hospital course: y/o m with history of chf, ?copd who was sent to the ed from rehab for respiratory distress. . # respiratory failure - the patient's respiratory failure was thought to be multifactorial, related to congestive heart failure and likely also copd. pneumonia was also considered in the initial differential diagnosis. the patient was treated with nitroglycerin, morphine, oxygen, lasix, nebulizers, vancomycin, cefepime, and bipap. however, he developed progressive hypercarbia, requiring intubation on . the patient was extubated on , after about 30 hours of mechanical ventillation. vancomycin and cefepime were narrowed to cefpodoxime on (to treat urinary tract infection, as pneumonia was thought to be unlikely). on the morning of , the patient became increasingly hypoxemic and tachypneic. a family meeting was held, and the decision was made to treat the patient with medications, and, if necessary, bipap, but not intubation. the patient's symptoms improved with diuresis and nebulizers, and he was discharged on , with a plan for more comfort-oriented care. patient needs q4h monitoring of oxygen saturations.he is on a 10 day steroid taper for his copd during which time he will also be on sliding scale insulin. . # acute diastolic congestive heart failure: the patient presented in respiratory distress. echocardiogram showed lvef >75%, with new pulmonary hypertension, but was otherwise baseline. mi was ruled out with serial cardiac enzymes. the patient was treated with vasodilators, diuresis, and mechanical ventillation, as explained above. the patient was discharged on lasix 80 mg po bid. . # rhythm: the patient presented in a demand-paced rhythm with underlying atrial fibrillation. he also had a supraventricular tachycardia that was thought to be avnrt, and a wide-complex tachycardia (with rate around 100) that was thought to be an accelerated idioventricular rhythm versus slow ventricular tachycardia. the patient is on coumadin for atrial fibrillation. this was briefly held in the setting of supratherapeutic inrs, for the the patient received vitamin k. coumadin was restarted on . the patient will need to have his inr followed after discharge. . # hypotension: the patient briefly required a dopamine infusino for hemodynamic support. . # hypothyroidism: continued levothyroxine. tsh was within normal limits. . # copd: pt with reported history of copd. initially treated with bronchodilators alone, then with bronchodilators, plus prednisone taper. . # acute on chronic renal insufficiency: on admission, the patient's creatinine was 1.9, from baseline 1.4. the patient's creatinine ranged from 1.7 to 2.1 during this admission. the etiology of the patient's acute on chronic renal failure was thought to be prerenal, related to the patient's heart failure. he also had a uti which he is being treated with cefpodoxime for a 7 day course # urinary stricture: he has a history of urethral stricture for which he is s/p dilation. he was seen by urology post dilation, with recommendation for intermittent catheterization with a 16 fr catheter if he has difficulty voiding. . # code status: the patient was full code on admission. he was admitted to the ccu, where he was intubated and briefly required pressors. on , a meeting was held with the patient and his family. at that time, the patient decided to change his code status to dnr/dni, no pressors. medications on admission: morphine oral concentrate - dexacidin/maxitrol eye ointment - warfarin 5-6 mg daily - artificial tears - furosemide 80 mg po bid - lorazepam 0.75 mg po q4 prn - nystatin topical qam - levothyroxine 75 mcg daily - cholecalciferol 1000 units daily - senna 8.6 mg prn - acetaminophen 650 mg q4 prn - tropicamide 1 drop to each eye per shift - albuterol - ipratropium - calcium carbonate 1300 mg daily - guaifenesin - bacitracin topical discharge medications: 1. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 2. artificial tears ophthalmic 3. furosemide 80 mg tablet sig: one (1) tablet po twice a day. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every four (4) hours as needed for wheezing/dyspnea. 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 8. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 9. calcium carbonate 1,000 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 10. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 11. cefpodoxime 100 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 10 days. 12. nystatin 100,000 unit/g powder sig: one (1) spray topical twice a day: to affected areas. 13. bacitracin 500 unit/g packet sig: packet topical at bedtime: apply to each eye at bedtime. . 14. tropicamide 1 % drops sig: one (1) drop ophthalmic twice a day: to both eyes. 15. cefpodoxime 100 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. tablet(s) 16. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: please check inr on wednesday and call results to provider. 17. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection twice a day. 18. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 19. calcium 500 500 mg (1,250 mg) tablet sig: two (2) tablet po at bedtime. 20. omeprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day: please give while pt receiving prednisone only. 21. prednisone 10 mg tablet sig: six (6) tablet po once a day: please taper by 10 mg every 2 days. total of 10 day course, first day , last day . . discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary - acute on chronic diastolic heart failure hypercarbic respiratory failure klebsiella urinary tract infection secondary - chronic kidney disease hypothyroidism discharge condition: mental status: confused - sometimes level of consciousness: alert and interactive activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to the hospital due to difficulty breathing. you required help breathing briefly and were placed briefly on a ventilator. you were given medications to help remove fluid and improve your respiratory status. we are treating you for a urinary tract infection with antibiotics. we have restarted your warfarin at your previous dose. weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. medication changes: 1. you are being treated for a urinary tract infection with cefpodixime. . followup instructions: follow up with your primary care doctor at your rehabilitation center. , j. . cardiology: dr. and dr. phone: date/time: monday at 8:40 am. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: obstructive sleep apnea (adult)(pediatric) abnormal coagulation profile coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, unspecified acute respiratory failure incisional hernia without mention of obstruction or gangrene iron deficiency anemia, unspecified cardiac pacemaker in situ personal history of venous thrombosis and embolism obesity, unspecified anticoagulants causing adverse effects in therapeutic use bronchiectasis without acute exacerbation ulcer of other part of lower limb lichenification and lichen simplex chronicus personal history of methicillin resistant staphylococcus aureus urethral stricture, unspecified 

Answer: The patient is high likely exposed to