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: no known allergies / adverse drug reactions attending: chief complaint: hypoxia major surgical or invasive procedure: endotracheal intubation history of present illness: 78 year-old man with a history of lung adenocarcinoma s/p lul lobectomy, dvt, afib on coumadin, gi bleed, and nonverbal at baseline from severe dementia who is coming in from a nursing home with worsened altered mental status, fever, and hypoxic respiratory distress. he was recently admitted from /11 for lethargy and fever. he was initially started on vancomycin and zosyn due to concern for sacral decubitus ulcer infection and possible osteomyelitis v. pneumonia. however, the cxr was without clear new infiltrate. the tachypnea was attributed to aspiration pneumonitis v. fever/stress response with the infected sacral ulcer thought to be the primary infectious process. the iv antibiotics were discontinued after 2 days as he underwent surgical debridement, which was felt to be the definitive treatment. he also was found to have c. diff colitis and started on oral flagyl. his mental status improved overall, and he was discharged back to his nursing home. . however, over the past day, he has had worsening altered mental status and shortness of breath. this evening at 7pm, he was found to have o2sats in the 70s on ra and was febrile to 101. he was still hypoxic when ems arrived. they placed him on cpap with improvement to the high 90s and brought him to the ed. . on ed arrival, initially vs were: t 99.1, p 88, bp 112/72, rr 32, o2sat 82% on nrb. he was tachypneic and minimally responsive on arrival so was intubated and sedated with fentanyl and midazolam. in the peri-intubation setting, he went into rapid afib with mild v4-v6 st depressions captured on ekg; the rvr resolved with iv fluids. labs were notable for a wbc 21 up from 12 on discharge (diff...). bnp was 1293 c/w prior admission during which he was not felt to be in chf. ck was 115 but trop mildly elevated at 0.09, consistent with prior admission (0.08-1). post-intubation cxr showed lll infiltrates which were difficult to assess given his post-lobectomy changes. cta chest showed no pe and bibasilar infiltrates mostly at the periphery consistent with pneumonia, less likely aspiration pneumonitis. blood cultures were drawn, and patient started on vancomycin and zosyn. during his ed course, he received a total of 3l ivf with sbps ranging from 79 to low 100s. he remained afebrile. on transfer to the micu, vs were: p 75, bp 105/66, o2sat 100% with abg 7.60/27/130/27 on ac 500/16/5/100%. . on the floor, pt appeared comfortable, intubated and sedated. past medical history: - severe dementia, unable to complete any adl's on his own - s/p lul lobectomy for spiculated mass: 3.3 cm adenocarcinoma with all regional lymph nodes negative, t2a, n0. post op afib. then, l sided effusion s/p thoracocentesis - atrial fibrillation on coumadin, h/o rvr on initial diagnosis - h/o dvt in rle, tx'd with lovenox - h/o tia - colonic adenoma - hypothyroidism - anemia - osteoarthritis, s/p total l hip replacement, s/p total r knee replacement - h/o tibial fracture - spondylosis of the lumbosacral spine - h/o gastric ulcer - h/o urinary retention requiring foleys - h/o gib in , presumed to be lower source, resolved on own. social history: the patient lives at a nursing facility, . his wife visits him, though she still lives at his prior home. remote 10 pack year history. denies current alcohol use, illicit substance use. family history: no family history of lung cancers, prostate cancers or clotting disorders. physical exam: on admission: general: intubated, sedated, not responding to command heent: nc/at, perrla 3mm b/l, intubated and sedated, does not respond to voice or pain, grimaces to deep pain neck: supple lungs: clear to auscultation anteriorly, no wheezing or rales heart: irregularly irregular, ii/vi sem, nl s1-s2. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding, clean stoma with no raw erythema, ostomy in place with soft brown stool; foley in place extremities: wwp, no c/c, trace pretibial edema, with r leg with mild skin darkening and slightly more swelling, 2+ peripheral pulses. skin: no rashes lymph: no cervical lad. neuro: sedated, perrla, withdraws to deep pain rectal: decubitus (stage 4) on left presacral area, wound vac in place with no surrounding drainage . on discharge: gen: arousable, not oriented to self, location, or time, comfortable heent: sclera anicteric, moist mucous membranes, oropharynx clear cv: irregularly irregular, + systolic murmur best at lusb pulm: cta anteriorly; however, exam limited by cooperation abd: soft, non-tender, non-distended, + ostomy with soft, formed stool ext: warm, trace edema, + boots neuro: uncooperative with most of exam; however, strong hand grip b/l, able to move both upper extremeties derm: stage iv decubitus ulcer on left presacral area pertinent results: admission labs: =============== 05:35pm blood wbc-21.0* rbc-3.57* hgb-10.9* hct-33.4* mcv-94 mch-30.6 mchc-32.7 rdw-15.8* plt ct-651* 05:35pm blood neuts-85* bands-0 lymphs-10* monos-5 eos-0 baso-0 atyps-0 metas-0 myelos-0 05:35pm blood pt-24.2* ptt-27.7 inr(pt)-2.3* 05:35pm blood fibrino-773* 05:35pm blood esr-122* 05:35pm blood urean-18 creat-0.8 03:42am blood glucose-125* urean-14 creat-0.6 na-143 k-4.3 cl-110* hco3-24 angap-13 05:35pm blood alt-36 ast-26 ld(ldh)-244 ck(cpk)-115 alkphos-72 totbili-0.2 05:35pm blood ck-mb-2 ctropnt-0.09* probnp-1293* 03:42am blood ck-mb-2 ctropnt-0.10* 05:35pm blood albumin-2.8* calcium-8.5 phos-4.7* mg-2.2 06:03pm blood ammonia-29 05:35pm blood crp-102.5* 05:01pm blood vanco-23.6* 05:35pm blood digoxin-0.6* 05:01pm blood digoxin-0.7* 05:35pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . imaging: ======== cxr: 1. endotracheal tube in standard position. 2. left basilar opacity may representing a combination of pleural effusion and adjacent atelectasis, though infection is not excluded. 3. minima patchy opacity in the right lung base could reflect additional area of infection. . cta chest: 1. no pulmonary embolus. 2. post-surgical changes of left upper lobectomy. 3. diffuse peribronchovascular ground-glass nodular opacities compatible with and infectious process. right sided pleural-based nodules and 5-mm nodule in the left lower lobe are likely part and parcel with the infectious process. attention is recommended to these nodules on followup. 4. a 1-cm lymph node in the prevascular space is likely reactive. . cxr: as compared to the previous radiograph, the patient has received a nasogastric tube. the course of the tube is unremarkable. the tip of the tube projects over the middle parts of the stomach. no evidence of complications. tip of the endotracheal tube is visible in unchanged location. unchanged elevation of the left hemidiaphragm with left basal parenchymal opacity. . brief hospital course: 78 year-old man with a history of lung adenocarcinoma s/p lul lobectomy, dvt, afib on coumadin, gi bleed, chronic stage iv sacral decubitus ulcer s/p diverting colostomy and surgical debridement, and mostly nonverbal at baseline from severe dementia who presents with worsened mental status, fever, and hypoxic respiratory distress. . # goals of care: during his stay in the icu, a family meeting was held and code status was changed to dnr/dn-reintubate. they did not wish for escalation of care. the patient was extubated on with understanding that he may decompensate quickly or over several days/weeks and that readmission to the icu or hospital is not consistent with goals. upon transfer to the floor an additional family meeting was held with the help of palliative care and it was decided that goals of care would shift towards being comfort focused. the patient will eat small amounts of food for pleasure. he was discharged back to his extended care facility with transition to hospice care to provide comfort and increased quality of life for his remaining life. the rest of his hospital course is outlined below. . # hypoxic respiratory distress (micu course): on arrival to ed patient had o2 sats of 82% on nrb and was minimally responsive. he was intubated and in post-intubation setting went into rapid a fib with v4-6 st depressions on ecg, which resolved with ivf. wbc elevated to 21 and bnp at 1293 (previous baseline), troponin mildly elevated to 0.09 (also at previous baseline). post-intubation cxr showed bibasilar infiltrates and patient was started on vanco/zosyn for broad hcap coverage given recent hospitalization. on transfer to the micu, vs were: p 75, bp 105/66, o2sat 100% with abg 7.60/27/130/27 on ac 500/16/5/100%. he was maintained on cmv and ultimately weaned down to psv. confirmed with family (nephew who is hcp) that patient is dnr and do not reintubate, and decision was made to extubate patient while accepting risk of subsequent respiratory failure. patient is at great risk of aspiration and decompensation due to pneumonia. sputum showed staph aureus coag + moderate growth, and yeast in sparce growth. he was ruled out for influenza and legionella. family decided to continue antibiotics, but not to further escalate care and not to transfer back to the icu. patient was extubated on and maintained adequate o2 sats on shovel mask. he was transferred to the medical floor for further management. . # health-care associated pneumonia: confirmed on ct imaging. s/p intubation and mechanical ventilation and initially on broad antibiotics (vancomycin and zosyn); however, upon transfer to the medicine floor the regimen was narrowed to vancomycin alone given his endotracheal sputum culture grew coag + staph aureus. his leukocytosis resolved and he remained afebrile. he completed a 7 day course of antibiotics. supplemental oxygen was provided as needed. . # clostridium difficile colitis: c diff toxin positive on last admission on . currently on 14 day course of flagyl. clinically, wbc improved and stool well-formed in colostomy. he was continued on flagyl 500 mg tid (last day ). . # stage iv sacral decubitus ulcer: clinically probes to bone. on prior admission there was no xray evidence of osteomyelitis; however, mri was not performed. he is s/p i&d, diverting colostomy, surgical debridement, antibiotic therapy, and repeat debridement last in 5/. wound vac was removed in the icu. wound care consult provided recommendations regarding care. given his current goals of care, surgical consult was deferred. -contie wound care recs . # altered mental status: severe underlying dementia exacerbated by toxic-metabolic encephalopathy in the setting of infection. digoxin level low. mental status improved after transfer out of the intensive care setting. . # afib with rvr: most likely stress response in setting of sepsis; rvr resolved with ivf. coumadin was held given therapeutic inr on admission and initiation of antibiotics. given change in goals of care, anticoagulation was discontinued. . # elevated troponin: stable from prior admission with normal ck. represent mild demand in the setting of afib with rvr. initially continued asa 81 mg, simvastatin 20 mg and metoprolol; however, given change in goals of care to focusing on comfort measures these medications were discontinued. . # colostomy: appears to be working appropriately, no evidence of infection around stoma, and patient making normal stool. currently underway on 2-week course of flagyl for positive c diff with resolution of symptoms. medications on admission: -aspirin 81 mg daily -simvastatin 20 mg daily -senna 8.6 mg -metoprolol succinate 200 mg daily -diltiazem 240 mg daily -digoxin 125 mcg daily -warfarin 5 mg daily -tamsulosin 0.4 mg qhs -divalproex 250mg -acetaminophen 650 mg q6h prn pain -multivitamin 1 tab daily -metronidazole 500 mg q 8h discharge medications: 1. other ok to screen and admit to hospice 2. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 3 days: last day is . disp:*9 tablet(s)* refills:*0* 3. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: five (5) mg po q1h as needed for mild pain. disp:*30 cc* refills:*0* 4. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: ten (10) mg po q1h as needed for moderate pain. disp:*30 cc* refills:*0* 5. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: fifteen (15) mg po q1h as needed for severe pain. disp:*30 cc* refills:*0* 6. lorazepam intensol 2 mg/ml concentrate sig: 0.5 mg po every four (4) hours as needed for agitation/restlessness. disp:*30 cc* refills:*0* 7. lorazepam intensol 2 mg/ml concentrate sig: one (1) mg po every four (4) hours as needed for agitation/restlessness. disp:*30 cc* refills:*0* 8. atropine-care 1 % drops sig: two (2) drops ophthalmic every four (4) hours as needed for excess secretions. disp:*30 cc* refills:*0* discharge disposition: extended care facility: discharge diagnosis: health-care associated pneumonia clostridium difficile colitis chronic stage iv sacral decubitus ulcer chronic indwelling foley atrial fibrillation coronary artery disease dementia discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dear mr. , you were initially admitted to the icu (intensive care unit) for treatment of worsening respiratory status, likely secondary to a pneumonia. we provided you with antibiotics and you improved. we had a family meeting and all agreed that it is best to focus our goals on improving the quality of your life. you are being discharged back to your extended care facility where you will be able to receive hospice services. . we are making a few changes to your current medication regimen. we are discontinuing medications that are not necessary and we are adding medications to address your symptoms and focus on providing comfort. followup instructions: you will be followed by providers at the extended care facility . the following appointments were scheduled in our system. you may cancel the ones you do not wish to attend. department: general surgery/ when: thursday at 1:30 pm with: acute care clinic building: lm bldg () campus: west best parking: garage department: radiology when: monday at 10:15 am with: cat scan building: campus: east best parking: garage department: hematology/oncology when: tuesday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified toxic encephalopathy unspecified septicemia severe sepsis unspecified acquired hypothyroidism atrial fibrillation personal history of malignant neoplasm of bronchus and lung other persistent mental disorders due to conditions classified elsewhere acute respiratory failure intestinal infection due to clostridium difficile long-term (current) use of anticoagulants pressure ulcer, lower back do not resuscitate status pressure ulcer, stage iv colostomy status 

Answer: The patient is high likely exposed to