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: /diarrhea major surgical or invasive procedure: ij placement history of present illness: 65 year old man with hx of chf (ef 30%), cad (with nstemi on s/p cath on showing 3vd s/p bms to lmca, lad, poba of om), pvd, copd, h/o mesenteric ischemia s/p bowel resection in , mrsa pneumonia, initially p/w /diarrhea on . in the , pt afebrile, but sbp 50s. pt's pressure was responsive to aggressive fluids. pt also had a leukocytosis (wbc 36) and positive u/a, and was started on vanc/levo/flagyl. noted to have rising ces. in the ed, the patient developed vt arrest in setting of sepsis and a mg 0.8. magnesium was repleted, and he received one shock with recovery of normal sinus rhythm. during the code the pt was intubated and sent to the micu. he was subsequently extubated on . of note, ct scan done in ed showed pancolitis. in the micu the pt was noted to have loose stools. he was diagnosed as sepsis/hypovolemia. he was given aggressive fluids via cvl. pt briefly on lidocaine drip from the ed, but never required pressors. c diff from was positive. pt's abx changed to po vanc/flagyl alone. pt extubated on . he required a lasix drip for fluid overload from resuscitation. he was then transfered to medicine for further management. on the medicine floor he became dyspneic with o2 requirement. on lasix was held for hypotension and dyspnea worsened. because of this worsening of dyspnea ce were drawn and showed elevated trop-t to 3.12 and ck of 15 c/w nstemi. heparin gtt was started. on bp stablized and pt has responded with increased urine output to lasix iv bolus with metolazone. he was transferred to today for management of nstemi and better management of fluid status. past medical history: pvd- s/p aorto fem bypass dm bladder ca copd s/p cholecystectomy aorto fem bypass mesenteric ischemia s/p stenting of sma cad with 3 vessel disease on cath duodenal angioectasia respiratory failure mrsa pneumonia social history: pt has 75 pack/year smoking history, quit during last hospitalization, previous etoh use about 6-12 beers/week. he is a retired highway heavy equipment operator, currently lives at . family history: family history significant for cad, brother with mi at age younger than 50. physical exam: micu physical exam: vs- 100/50 98.0 95 20 100% on ps 10/5, 50% fio2 gen- intubated, arousable, not sedated, appears comfortable heent- mmm, anicteric, symmetric, perrl neck- supple, could not assess jvp cor- regular, tachy, distant heart sounds could not apprec. murmur chest- expiratory wheeze with vent sounds. decreased at bases abd- soft, open surgical wound with minimal purulent drainage proximally. pos bs. tender along wound. ext- no c/c/e. pneumoboots on. bounding femoral pulses with scars from prior bypass surgeries. neuro- appears alert , though cannot fully assess orientation due to endotracheal tube. floor: d/c physical exam vitals; 98.8 104/58 88 18 97% on 2l gen: nad, comfortable heent: mmm, no lad, eomi, anicteric neck: supple card: rrr chest: ctab, no wheezing/crackles abd: soft, nt/nd. dressing in place (c/d/i) over open surgical wound ext: no c/c/e. muscle wasting in bilateral lower extremities neuro: alrt, oriented skin: stage 2 sacral decubitus ulcer pertinent results: lab results on admission: 12:49am blood wbc-36.2*# rbc-3.48* hgb-10.8* hct-32.2* mcv-93 mch-31.2 mchc-33.7 rdw-18.5* plt ct-530* 12:49am blood neuts-83* bands-3 lymphs-3* monos-11 eos-0 baso-0 atyps-0 metas-0 myelos-0 04:18pm blood hypochr-2+ anisocy-2+ poiklo-1+ macrocy-2+ microcy-normal polychr-normal burr-1+ 12:49am blood pt-16.4* ptt-30.1 inr(pt)-1.5* 12:49am blood d-dimer-5720* 05:10am blood fibrino-597*# 12:49am blood glucose-43* urean-25* creat-1.5* na-138 k-4.4 cl-103 hco3-19* angap-20 12:49am blood ck(cpk)-22* 12:49am blood ck-mb-notdone ctropnt-0.28* 05:10am blood phos-2.8# mg-0.8* 01:10pm blood type-art fio2-100 po2-440* pco2-42 ph-7.10* caltco2-14* base xs--16 aado2-233 req o2-47 intubat-intubated 03:20pm blood type-art po2-335* pco2-32* ph-7.28* caltco2-16* base xs--10 intubat-intubated 12:38am blood lactate-4.7* 03:45am blood glucose-153* lactate-3.0* 03:20pm blood freeca-1.05* discharge labs: imaging: ct abd: impression: 1. findings consistent with pancolitis, significantly increased in severity and extent compared to the prior study. this could be due to an inflammatory or infectious process, including c. difficile colitis. 2. large bilateral pleural effusions. 3. diffuse anasarca. cxr: impression: 1. appropriate placement of et and ng tubes. 2. increased interstitial opacities bilaterally consistent with fluid overload. 3. more focal airspace opacities involving the right lung may represent asymmetric pulmonary edema or pneumonia. 4. persistent opacification of the right cardiophrenic angle may represent right middle lobe collapse. ekg: baseline artifact. sinus rhythm. marked left axis deviation. right bundle-branch block. early r wave progression. st-t wave abnormalities. since the previous tracing of st-t wave abnormalities may be improved or there is pseudonormalization echo: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %) with regional variation: the inferior and posterior walls are more hypokinetic than the rest of the left ventricle. there is no ventricular septal defect. right ventricular chamber size is normal. right ventricular systolic function is borderline normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. ct chest: impression: 1. interval worsening in now large bilateral pleural effusions (compared to ct , but similar to ct ), without evidence of loculated component. peripheral interstitial septal thickening suggests congestive failure as part of the cause for the effusions. 2. debris dependently within the trachea. this finding was called to dr. on cxr: findings: in comparison with the study of , there is again moderate-to- severe pulmonary edema with substantial pleural effusions bilaterally and enlargement of the cardiac silhouette. right ij catheter again extends to the lower portion of the svc. echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is inferior akinesis with moderate hypokinesis of the other lv segments, c/w multivessel coronary artery disease or systemic process. overall left ventricular systolic function is moderately depressed (lvef= 30%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: moderate regional and global left ventricular systolic dysfunction. moderate mitral regurgitation. compared with the prior study (images reviewed) of , the findings are similar. c. cath: final diagnosis: 1. three vessel coronary artery disease. 2. systemic hypotension. 3. low filling pressures. 4. successful stening of the lm with a cypher des. complete blood count wbc rbc hgb hct mcv mch mchc rdw plt 06:30am 11.0 3.32* 10.7* 32.4* 98 32.0 32.9 16.5* 393 renal & glucose glucose urean creat na k cl hco3 angap 06:30am 126* 21* 1.1 137 4.5 104 31 7* brief hospital course: 65 year-old man with 3-vessel cad initially admitted for cdiff colitis complicated by polymorphic vt arrest on initial presentation, nstemi and then stemi s/p l main stenting, systolic chf with acute exacerbations, hospital acquired pneumonia with sepsis and gib. . # cardiac arrest / ischemia: in the ed a 'code blue' was called when he became unresponsive and was noted to have a polymorphic vt vs. torsades rhythm. he was resuscitated with defibrillation, epinephrine, and started on a lidocaine drip. the etiology of the arrest is likely due to severe electrolyte derangements, including a magnesium of 0.8 that was in the process of repletion. this was likely complicated by cardiac ischemia from sepsis/hypotension. cardiac enzymes were trended and were markedly elevated as expected after defibrillation and troponin reached a peak of 1.95 and then trended downward. he was initially placed on aspirin , plavix and atorvastatin 80mg and later re-started on metoprolol as tolerated by his blood pressure. the patient was treated in the micu and transferred to the medicine team. while on the medical floor he developed hypotension and dyspnea. cardiac enzymes were again drawn and showed an increased troponin to 3.12, up from 1.52 five days prior. he was started on a heparin drip and transferred to the cardiology service for management on his nstemi and for better managment of his fluid status. troponin peaked at 3.58 and trended down. the heparin drip was stopped after 48 hours. he was chest pain free while on the cardiology service. on , pt had an episode of hypotension with sbp 84. an ekg was done which showed marked twi in v2-v4 and st elevations in ii,iii and avf. pt went to cath lab and underwent successful stening of the lm with a cypher des. pt was hypotensive peri-operatively, and recovered to the ccu for 24 hours. he was briefly on a dopamine gtt but this was quickly weaned. he was then transferred to the cardiology floor and was subsequently stable from a cardiac standpoint. pt needs to continue on aspirin and plavix at all times. on the medicine floor pt had intermitted episodes of increased hr (see atrial tachy below) as well as episodes of hypotension (unrelated to tachyarrythmias), see below. . # afib/atach: pt w/ vt code upon presentation. recurrent runs of atrial tachycardia to 140s/150s, self resolving, but w/ occasional cp. cards c/s, recommended no albuterol to decrease adrenergic drive, aggressive pain control, inc metoprolol to 50 (from 25 tid),and change captopril to lisinopril 10. the metorpolol/lisinopril were subsequently d/ced due to increasing number of episodes of asympt hypotension w/ sbp in 70s. metoprolol currently restarted at 12.5bid, lisinopril restarted . . # asymptomatic hypotension: pt triggered multiple times on floor for sbp 70-80. pts bp tends to be low (85 to 110s). asymptomatic during events. lisinopril decreased and eventually d/ced. metoprolol decreased to 12.5 in an attempt to normalize bp. repeated full workups, last on w/ cxr (improved), blood cx(ngtd), stim borderline (low baseline, but response to cosyntropin). starting on 2d 100 hydrocortisone, then 5mg prednisone daily to continue. had evidence by labs, history, and imaging of a severe c.dif colitis, which was confirmed by laboratory results. he has been treated with po flagyl and vancomycin for a two week course, transitioned to vancomycin po taper. other possible sources could be his uti or his abdominal wound / recent surgery. he was resuscitated with ~6l ivf in the ed, and his lactate trended downward. stress dose steroids were started in the icu, d/ced on the floor. he is being treated for the c.diff with po vancomycin to complete a 14 day course free of other abx with vanco taper, 3d at tid, 5d at , 5 d more qdaily prior upon discharge. the hospital course was also complicated by hospital acquired pna w/ + resistant acinobacter now s/p 7d course tobra, 10d course vanc/zosyn. cough/sob resolved. . # left ischemic optic neuropathy-pt reported poor vision in left eye initially and had reported this had been ongoing for the few days prior. however this intial complaint of vision change was in the context of a stemi and pt quickly went to cath; thus upon review of systems when patient came back from cath, pt reported poor vision in both eyes, left>right. patient appeared to have complete loss of vision in the left eye and there was a concern for embolic stroke. an mri/mra was done which did not show evidence of embolic dz or stroke. opthamology consulted and felt pt likely has ischemic damange to optic nerve likely hypotensive episodes. no further intervention was needed other than to maintain a stable blood pressure. the pt will need f/u with neuro-opthamology as outpt. ( . # respiratory failure: patient was intubated during code situation, extubated . extubation c/b acute on chronic chf. subsequent intubation in the context of hospital acquired pneumonia and sepsis. now on 2l o2. stable. needs continous aggressive chest pt. . # chf: acute on chronic chf exacerbation. appeared slightly fluid overloaded in the setting of sepsis. a transthoracic echo revealed an lvef 30% he successfully underwent diuresis with improvement in pulmonary symptoms. euvolemia maintained, autodiuresing, and gentle diuresis/hydration as necessary. home lasix d/ced as pt has not been volume overloaded. hypotension, metoprolol decreased to 12.5 , lisinopril to 2.5mg qdaily . # copd: he has a history of copd with long smoking history. he was on albuterol, ipratropium and systemic steroids. albuterol d/ced cardiac recs that it may be contributing to patients runs of atrial tachycardia. systemic steroids not continued after icu course. acetylcysteine added to regimen, aggressive chest pt and inspirative spirometry. . # dm2: he was on an insulin sliding scale and long-acting insulin. iss continued in hospital (no long acting inconsistent eating habits) with poor control of sugars. restarted low dose lantus on discharge with iss, which will be adjusted at rehab. . # mesenteric ischemia: his small bowel resection was in , and his abdominal wound was closed shortly thereafter. the wound itself appears to okay, though there is some increased purulence at the proximal aspect. dr. team evaluated the wound and thought it was healing well. patient was followed by the wound care nurse throughout his hospital stay. . # gib: pt w/ melanotic stools and known ugi avms, considered likely source. no egd required (unless pt rebleedsand becomes unstable) as unlikely to be of benefit. pts hct remained stable with a plan to transfuse prbcs to hct 30 given recent myocardial ischemia, stools guaiaced (no rebleed) and pt continued on pantoprazole. 1u prbcs on and 12/23 hct<30, with occasional guaiac positive stools. will get cbcs at rehab with prbcs fpr hct<30. . # urinary retention: pt w/ no uop x8hrs s/p foley removal. bladderscan >500cc. foley reinserted. flomax started. +ua, cx positive for yeast. no tx at this time except foley d/ced to pos ua, but reinserted overnight no urine. - continue foley - restarted flomax ; currently unable to transfer to urinal. should d/c foley for trial after pt. increases mobility to maximize chance for success. . . # code: full, long discussions were held with patient. patient is considering dnr/dni status and discussion should be continued. . # fen: soft diet with ensure, patient was given megace and mirtazapine for appetite stimulation with good effect discharged to rehab for more intensive physical therapy deconditioning after long hospital stay medications on admission: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed. 5. tramadol 50 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed. 7. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 9. furosemide 40 mg tablet sig: three (3) tablet po bid (2 times a day). 10. captopril 25 mg tablet sig: two (2) tablet po tid (3 times a day). 11. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day) as needed for constipation. 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 13. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 15. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 16. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 17. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 18. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 19. megestrol 40 mg/ml suspension sig: four hundred (400) mg po bid (2 times a day). 20. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed: 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. . 21. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours). 22. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours). 23. insulin pt receives nph 12 units at breakfast, 9 units at bedtime, plus fingersticks qid and a sliding scale for coverage discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. vancomycin 125 mg capsule sig: one (1) capsule po every eight (8) hours for as directed days: 125mg po tid for 3 days, then 125 mg po bid for 5 days, then 125mg po qday for 5 days then off. 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). 6. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscellaneous q6h (every 6 hours) as needed for break up secretions. 7. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 8. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours). 9. docusate sodium 50 mg/5 ml liquid sig: one (1) 10 ml po bid (2 times a day) as needed for constipation. 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 11. insulin lispro 100 unit/ml solution sig: as dir subcutaneous asdir (as directed): per sliding scale. 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day): sub cutaneous injection. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 14. megestrol 40 mg/ml suspension sig: four hundred (400) mg po bid (2 times a day). 15. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 16. hexavitamin tablet sig: one (1) cap po daily (daily). 17. tramadol 50 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed. 18. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 19. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 20. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): hold for diarrhea. 21. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 22. oxycodone 10 mg tablet sustained release 12 hr sig: two (2) tablet sustained release 12 hr po q12h (every 12 hours). 23. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 24. magnesium oxide 400 mg tablet sig: two (2) tablet po daily (daily). 25. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 26. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold if sbp<90. 27. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 28. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 29. insulin glargine 100 unit/ml solution sig: five (5) units subcutaneous at bedtime: adjust per finger sticks. 30. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). discharge disposition: extended care facility: country rehabilitation & nursing center - discharge diagnosis: primary diagnosis: c. diff. colitis acute on chronic systolic chf stemi hospital acquired pneumonia and sepsis ischemic optic neuropathy s/p drug-eluting stent placement . secondary diagnoses: pvd- s/p aorto fem bypass dm, on insulin copd mesenteric ischemia s/p stenting of sma discharge condition: good, tolerating pos, minimal diarrhea, satting well on ra, able to sit for 1-2 hours with assist discharge instructions: you have came into the hospital with a bowel infection. you have had a complicated course, developed a pneumonia and were in the icu for several days for treatment of your infections. the pneumonia has been treated, but the bowel infection requires continued antibiotics. you are to continue the po vancomycin on taper as directed with your medications. while in the emergency department you suffered from a cardiac arrest and required a shock. you also have had multiple heart attacks, one of which required catheterization with balloon stenting of the blocked area. please call your primary care doctor or return to the hospital if you have chest pain, shortness of breath, >101.4, or any new symptoms which are concerning to you. please continue with your medications as instructed. please attend all follow up appointments below. followup instructions: please follow up at the following appointments: provider: , md phone: date/time: 3:40 please follow-up in tuesday plastic surgery hand clinic after discharge. you can make an appointment by calling: additionally, please follow up with neuroophthamology. the number is . they have been notified and should call you to make an appointment, but please call to arrange appointment md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified left heart cardiac catheterization coronary arteriography using a single catheter insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart other bronchoscopy other lavage of bronchus and trachea non-invasive mechanical ventilation insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation infection with microorganisms resistant to penicillins peripheral vascular disease, unspecified sepsis pulmonary collapse paroxysmal ventricular tachycardia acute respiratory failure pneumonitis due to inhalation of food or vomitus cardiac arrest septic shock intestinal infection due to clostridium difficile old myocardial infarction unspecified disorder of kidney and ureter other complications due to other cardiac device, implant, and graft retention of urine, unspecified pressure ulcer, lower back angiodysplasia of intestine with hemorrhage acute myocardial infarction of unspecified site, initial episode of care septicemia due to anaerobes glucocorticoid deficiency acute on chronic systolic heart failure disorders of magnesium metabolism ischemic optic neuropathy foreign body in larynx non-healing surgical wound carpal tunnel syndrome 

Answer: The patient is high likely exposed to