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: fevers to 104 major surgical or invasive procedure: continued intubation history of present illness: 56m s/p recent traumatic c1-4 fracture with subsequent quadraplegia from c4 down with affection of the phrenic nerve on chronic ventilation who presents from with desaturation to 80%, and a fever to 104. . in the ed, he was found to have a multifocal pna and was started on vancomycin and zosyn for vap. a bnp was sent and was found to be elevated. cta was negative for pe. ct abdomen and ct neck was negative for abscess or other infectious source. the patient was hemodynamically stable througout his ed stay. past medical history: dm2, cad, ami , s/p cabg . past surgical history: 1. application of halo. 2. closed reduction c1 fracture. 3. posterior cervical decompression with laminectomy of c3 and c4. 4. posterior cervical arthrodesis c2 to c5. 5. posterior cervical instrumentation segmental c2 to c5. 6. right iliac crest bone graft with application of morselized autograft to posterior cervical spine. 7. right femoral filter (titanium). 8. tracheostomy. 9. gastrostomy. social history: ppd smoker. estranged from wife. kids involved in care. family history: noncontributory. physical exam: vs t:101.4 bp:108/52 hr75 rr22 o2sat:100 on ps10/10, fio2 40, tv 600 gen: nad, aaox3 heent: perrla, mmm neck: no lad, no jvd, halo in place cor: s1s2, regular rhythm, no m/r/g pulm: cta b/l anteriorly abd: + bowel sounds, soft, nd, nt skin: warm extremities, no rash, no open wounds ext: 2+ dp, trace edema/c/c neuro: quadriplegic, perrla pertinent results: imaging: chest (portable ap) 6:29 am the et tube tip remains in unchanged standard position. the right picc line tip terminates in mid svc. the heart size is enlarged but unchanged. the sternal wires are intact. there is some improvement in the previously demonstrated pulmonary edema. the bilateral pleural effusions are grossly unchanged as well as bibasilar atelectasis. . liver or gallbladder us (single organ) port 1:04 pm impression: no evidence of acute cholecystitis. . ct pelvis w/o contrast 5:47 pm impression: 1. limited study without intravenous contrast . 2. no evidence of significant bowel obstruction. 3. small free fluid along the right paracolic gutter inferior to the cecum. 4. no free air. 5. bilateral pleural effusion with bibasilar consolidations, most likely due to atelectasis. 6. high density in ivc, right iliac and common femoral vein worrisome for thrombosis. . ct sinus/mandible/maxillofacial w/o contrast 5:46 pm impression: air-fluid level in the sphenoid sinus on the right and complete opacification of the left sphenoid sinus with aerosolized secretions, most likely representing acute sinusitis. . abdomen (supine & erect) port 9:51 am impression: distended loops of the entire large bowel. diagnostic considerations include a distal obstruction, ileus, and less likely toxic megacolon (given that haustral folds appear normal. . ct neck w/contrast (eg:parotids) 5:56 pm impression: 1. post-operative scan demonstrate a posterior fusion of c2 through c5 with no evidence of abscess. 2. lung apices demonstrate consolidation in the right middle lobe which will be further commented on dedicated chest ct. note added at attending review: the small fluid collection in the surgical site posterior to the spine appears somewhat larger than on the cervical spine ct of . the collection is poorly evaluated on both studies due to overlying artifact from the fusion hardware. it may be better analyzed with mr imaging. however, the apparent enlargement raises a concern of a csf leak or an abscess. there is no evidence of an enhancing rim on this examination. however, this area is so obscured by artifact that enhancement would be difficult to detect if present . ct abdomen w/contrast 5:18 pm impression: 1. no evidence of pulmonary embolus. 2. right upper, mid and bibasilar consolidation concerning for aspiration versus multifocal pneumonia. clinical correlation is recommended. 3. fatty infiltration of the liver. 4. diffuse stranding in the soft tissues consistent with anasarca . chest (portable ap) 4:18 pm impression: left lower lobe opacity which may represent atelectasis or pneumonia, but unchanged. . labs: . microbiology: urine cx: ngtd blood cx: ngtd swab/sputum culture: pansensitive klebsiella oxytoca, pansensitive e.coli . urine legionella antigen; negative mrsa screen: negative vre screen: negative . c. diff negative x 3 . sputum gram stain: gnr . labs on admission: 02:25pm pt-13.3* ptt-36.0* inr(pt)-1.2* 02:25pm plt count-206 02:25pm wbc-9.4 rbc-2.78* hgb-9.1* hct-26.7* mcv-96 mch-32.7* mchc-34.0 rdw-15.3 02:25pm calcium-7.5* phosphate-3.7 magnesium-2.6 02:25pm probnp-1346* 02:25pm alt(sgpt)-31 ast(sgot)-24 alk phos-54 amylase-41 tot bili-0.4 02:25pm glucose-200* urea n-27* creat-0.7 sodium-132* potassium-4.3 chloride-101 total co2-23 anion gap-12 04:34pm lactate-1.7 brief hospital course: 56 yo with quadriplegia from recent mva, ventilator dependent, now p/w multifocal pneumonia. . # sinusitis: although the patient was treated for a full course of antibiotics for vap, he still had refractory fevers. after scanning of the sinuses and abdomen, it was determined that the patient had acute sinusitis that was likely causing temperature spikes. he had his medication changed to levofloxacin and was treated concominantly with afrin and nasal saline. after these measures were taken the patient remained afebrile. . # multifocal pna: the patient was started on broad coverage with vancomycin and zosyn for suspected ventilator associated pneumonia. the patient fever curve trended downward through the course of his hospital stay and he received frequent suctioning to reduce recurrent aspiration. after sputum cultures grew out pansensitive klebsiella oxytoca and pansensitive e. coli, antibiotic therapy was switched to ceftriaxone for a full course. cxrs revealed moderate improvement in his lung fields, although had constant small pleural effusions. . c.diff - the patient was having fevers refractory to ceftriaxone and the patient was also having some abdominal distension. he was started empirically on flagyl and is to finish a 14 day course of this medication. the patient had stool studies obtained and has had 3 negative for c. diff. the abdominal distension was thought to be due to constipation, and this resolved after institution of an aggressive bowel regimen. . fluid collection at surgical site - as the patient was having fevers despite antibiotic therapy, he had a ct that revealed an accumulation of fluid at the surgical site. this was initially thought to be a csf leak or an abscess as his fevers were intermittent, but it was thought that this collections was a likely due to post-operative changes. he had his neck re-imaged and there was no interval change suggestive of a constant csf leak or abscess formation/growth. . # respiratory failure: this patient is ventilator dependent since the mva, and given his phrenic nerve paralysis he is exempt from typical weaning protocol, and the patient was maintained on a peep of 5 while in house. a wean was nonsuccessful and this can be attempted while at rehab. however, the patient was given psv sprints and he was also able to tolerate cuff deflation in order to phonate. . # quadriplegia: the patient was maintained on his current care regimen consisting of pt and skin prophylaxis. these are issues that will need to be continued while at rehab. . # dm: the patient had difficult to control sugars while in house. the patient initially had been on nph with morning dosing of 80 and pm dosing of 60. once his tube feeds were restarted he required constant modification of his insulin sliding scale. consult was obtained and his current sliding scale is in accordance with their recommendations. he will likely require constant modification of this sliding scale dependent on his tf and oral intake. . # fen: the patient was restarted on tube feeds, of which he tolerated without complication. his electrolytes were repleted daily as needed. . # prophylaxis: pneumoboots . medications on admission: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 2. albuterol 90 mcg/actuation aerosol : 1-2 puffs inhalation q6h (every 6 hours) as needed. 3. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation q6h;prn () as needed for wheeze/decreased air movement. 4. docusate sodium 150 mg/15 ml liquid : one (1) po bid (2 times a day). 5. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 6. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 7. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. ranitidine hcl 15 mg/ml syrup : one y (150) mg po bid (2 times a day). 9. glipizide 5 mg tablet : two (2) tablet po bid (2 times a day). 10. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 11. oxycodone 5 mg/5 ml solution : 5-10 mg po q4h (every 4 hours) as needed. 12. acetylcysteine 10 % (100 mg/ml) solution : 1-10 mls miscell. q4-6h (every 4 to 6 hours) as needed for thick secretions/mucus plugging. 13. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q4h (every 4 hours) as needed for constipation. discharge medications: 1. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. paroxetine hcl 20 mg tablet : one (1) tablet po daily (daily). 3. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q6h (every 6 hours) as needed. 4. albuterol 90 mcg/actuation aerosol : 4-6 puffs inhalation q6h (every 6 hours) as needed. 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. oxycodone-acetaminophen 5-325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 7. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 8. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed. 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 10. docusate sodium 150 mg/15 ml liquid : one (1) po bid (2 times a day). 11. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed. 12. ranitidine hcl 15 mg/ml syrup : one (1) 150 mg po twice a day. 13. insulin nph human recomb 100 unit/ml suspension : one (1) 80 subcutaneous qam. 14. insulin nph human recomb 100 unit/ml suspension : one (1) 55 subcutaneous at dinner. 15. levofloxacin 500 mg tablet : one (1) tablet po daily (daily) for 9 days. disp:*9 tablet(s)* refills:*0* 16. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 9 days. disp:*27 tablet(s)* refills:*0* 17. oxycodone 5 mg tablet : one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 18. cyanocobalamin 500 mcg tablet : two (2) tablet po daily (daily). 19. ferrous sulfate 325 (65) mg tablet : one (1) tablet po daily (daily). 20. nystatin 100,000 unit/g ointment : one (1) appl topical qid (4 times a day) as needed. 21. sodium chloride 0.65 % aerosol, spray : sprays nasal qid (4 times a day). 22. ammonium lactate 12 % lotion : one (1) appl topical asdir (as directed). 23. lorazepam 0.5-2 mg iv q6h:prn hold for oversedation 24. lactulose 10 g/15 ml syrup : thirty (30) ml po tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: ventilator associated pneumonia/sinusitis . secondary diagnoses: quadriplegia s/p mva s/p c1-4 fracture and fixation/decompression dm2 cad, ami , s/p cabg discharge condition: afebrile, stable vital signs discharge instructions: you were treated for e.coli/klebsiella pneumonia and sinusitis. you had your surgical staples removed without complication. . 1. please return to if you have any concerning symptoms. followup instructions: as needed procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia aortocoronary bypass status constipation, unspecified old myocardial infarction pneumonia due to escherichia coli [e. coli] diarrhea pneumonia due to klebsiella pneumoniae quadriplegia, unspecified tracheostomy status dependence on respirator, status acute sinusitis, unspecified late effect of spinal cord injury late effects of motor vehicle accident 

Answer: The patient is high likely exposed to