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: clotrimazole / augmentin attending: chief complaint: mental status changes, poor po major surgical or invasive procedure: none history of present illness: mr is a 65 year old male with chronic pancreatitis and a long history of multiple intra-abdominal abscesses, s/p multiple drainage procedures with perihepatic collection who presents today with changes in mental status. wife notes symptoms have been going on since monday. s he also notes that he has been increasingly pa.le. legs have been more swollen. he has had poor appetite. he was seen today in clinic, mildly confused and hypotensive to 80s/50s (baseline 90s). hct was noted to be 23 from baseline of 29 five days ago. he was referred to the ed. . pt has a complicated medical history with multiple intraabdominal abscesses with fistulas draing to the skin and bowel. most recently he has had several admissions with details as below: . - : r flank pain and sepsis. ir drainage of perihepatic fluid collection with polymicrobial infection (mrsa and vanco-sensitive enterococcus). ercp/biliary stent placed for biliary leak (empirically) - perihepatic drain continued to drain bilious fluid. no positive cultuers on discharge. discharged on daptomycin, moxifloxacin, and fluconazole. picc placed . . - : admitted for gpcs on bcx from . thought to be due to obstruction of the biliary drain. drain was repaired, fluid culture grew klebsiella and mrsa. picc line was also changed. cultures from ne grew staph epi in bottles from the picc and mrsa from peripheral site. subsequent bcx at were all negative. he was discharged on on same antibiotics to ne where he has continued to have intermittently poor drain function. . . he reports poor appetite. abdomen is generally swollen and tender. r flank hurts constantly. feet are swollen. he denies fevers or chills. . in the ed inital vitals were, 97.8 75 91/61 12 100% ra. in the ed, bp in upper 70s. received 2l ivf, 3rd hanging, with improvement of pressures. wbc 11.3. received vanco and zosyn. surgical consult placed for diffuse abdominal tenderness. ct scan showed pigtail catheter coiled in a perihepatic fluid collection, smaller than previous, severe anasarca and diffuse bowel wall thickening, and extensive pneumonbilia. surgery found no acute surgical process. recommended ir guided drainage if needed. he also received 4mg iv morphine x 2. vital signs on transfer: afebrile, hr 80s, bp 104/62. . on the floor, he denies any symptoms. he reports that he does not want aggressive care. . review of systems: (+) per hpi (-) per pt (who is confused) denies fever, chills. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. multiple polymicrobial fluid collections, status post multiple drain procedures over the past several years. most recently mrsa in new l flank abscess in , past h/o psoas abscess, retroperitoneal abscess, enterocutaneous fistula. 2. ventral hernia repair complicated by severe pancreatitis, leading to a nearly yearlong hospitalization starting at and at the to rehabilitation ending . 3. pancreatic mass per gi notes. endoscopic ultrasound performed twice, most recently showing 2 x 3 cm ill-defined mass to the pancreas. fna was performed. no malignancy was found. 4. cad status post mi 5. diverticulosis. 6. anxiety. 7. hypothyroidism. 8. hypertension. 9. lower extremity dvt status post ivc filter ( or ) 10. portal vein thrombosis. 11. status post fundoplication 16 plus years ago complicated by splenic injury requiring splenectomy. 12. bph. 13. vitamin d deficiency. 14. abnormal lfts intermittently, most recently thought due to augmentin. 15. gynecomastia. 16. cirrhosis - dx in social history: lives in with his wife. is unemployed. - tobacco: smoked <1 ppd for 1 year in the past - alcohol: denies - illicits: denies family history: denies any known family history. physical exam: admission exam: general: alert, oriented to person, place year, no acute distress, emaciated body habitus with wasting of his face, neck and muscles of his chest. anasarca. heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally. reduced breath sounds at bases, poor inspiratory effort. otherwise clear cv: distant heart sounds. regular rate and rhythm. abdomen: soft, diffusely tender. non distended. abs. r abdominal tube in place with drainage fo dark brown liquid. has what appears to be an old drain site with puckering and erythemetous scale consistent with fungal infection. gu: + foley, unable to visualize penis which is retracted within scrotum. ext: warm, well perfused. significant dorsal edema. left leg twice as large as right with pitting edema. discharge exam: general: aaox3, no acute distress, emaciated body habitus with wasting of his face, neck and muscles of his chest. anasarca. heent: sclera anicteric, mmm neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally. reduced breath sounds at bases, poor inspiratory effort. otherwise clear cv: distant heart sounds. regular rate and rhythm. abdomen: soft, diffusely tender. non distended. abs. r abdominal tube in place with drainage fo dark brown liquid. gu: + foley, unable to visualize penis which is retracted within scrotum. ext: warm, well perfused. significant dorsal edema. left leg twice as large as right with pitting edema. pertinent results: admission labs: 12:30pm wbc-11.3* rbc-2.83* hgb-8.7* hct-27.1* mcv-96 mch-30.6 mchc-32.0 rdw-18.5* plt ct-432 12:30pm neuts-86* bands-1 lymphs-8* monos-4 eos-1 baso-0 atyps-0 metas-0 myelos-0 05:27pm pt-14.0* ptt-26.8 inr(pt)-1.2* 12:30pm glucose-79 urean-21* creat-1.1 na-139 k-4.8 cl-112* hco3-20* angap-12 12:30pm alt-16 ast-47* alkphos-357* totbili-0.7 12:30pm lipase-30 12:30pm albumin-1.9* discharge labs: 03:45am calcium-7.9* phos-3.4 mg-1.8 04:33am wbc-7.9 rbc-2.47* hgb-7.5* hct-23.2* mcv-94 mch-30.3 mchc-32.2 rdw-18.6* plt ct-492* 04:33am glucose-88 urean-17 creat-1.0 na-139 k-3.8 cl-116* hco3-15* angap-12 04:33am alt-15 ast-40 ld(ldh)-130 alkphos-297* amylase-35 totbili-0.7 04:33am calcium-7.7* phos-3.3 mg-1.8 iron-pnd imaging: cxr: stable tiny left effusion and basilar atelectasis. interval retraction of picc line with tip residing at the expected location of the left brachiocephalic vein. ct a/p: examination limited by lack of iv contrast and diffuse anasarca/third spacing. 1. stable position of right abdominal drain with tip in perihepatic fluid collection which is slightly smaller in size. pocket of air inferior to the right lobe of the liver is similar in size. when viewed in conjunction with the tube check of , this fluid collection and air pocket was confirmed to be in communication with the biliary system. extensive pneumobilia is stable. 2. bowel wall stable thickening, likely secondary to 3rd spacing. however, infection cannot be completely excluded. 3. mild fullness of the right renal collecting system, unchanged. 4. stable small pleural effusions. micro: 4:00 pm culture picc #1. culture, routine (preliminary): gram positive coccus(cocci). in pairs and clusters. anaerobic bottle gram stain (final ): reported to and read back by @ 11:12a . gram positive cocci. in pairs and clusters. 4:10 pm culture picc #2. culture, routine (pending): (ngtd) urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 16 i cefazolin------------- =>64 r cefepime-------------- 2 s ceftazidime----------- 16 r ceftriaxone----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 256 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r 11:09 pm abscess source: abdomen. gram stain (final ): reported to and read back by @ 00:15a . 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 1+ (<1 per 1000x field): yeast(s). fluid culture (preliminary): results pending. anaerobic culture (preliminary): fungal culture (preliminary): yeast. brief hospital course: 65 year old male with chronic pancreatitis and a long history of multiple intra-abdominal abscesses, s/p multiple drainage procedures with perihepatic collection who presents with hypotension and altered mental status in the setting of intraabdominal or urinary tract infection. # hypotension/rule out sepsis: initially thought pt was septic because of hypotension and elevated wbc count. pt was hypotensive to sbp of upper 70s and has had a baseline sbp in the 90s at home. was initially placed on pressors and antibiotics broadened to linezolid/cefepime/flagyl/fluconazole from home regimen of daptomycin/moxifloxacin/flagyl/fluconazole. responded well to fluids, so was quickly weaned off pressors and sbp remained stable ranging 110s-140s off pressors. wbc count came down and pt was never febrile. pt reported poor po intake prior to admission as had very low albumin with new onset le edema. hypotension thought to be secondary to intravascular volume depletion, likely secondary to poor intake plus third spacing. cxr neg for pna. ct showed improvement in abdominal fluid collection and bowel wall edema consistent with third spacing. one of two cultures (2 out of 4 bottles) drawn off same picc were positive for gpcs and this was thought to be contamination because it was not universally positive (as one would expect in the case of bacteremia), plus patient was already on excellent gram positive coverage with daptomycin/moxifloxacin. urine taken from foley grew out a resistant strain of klebsiella pneumoniae which was similar in sensitivities to past cultures. abscess fluid was polymicrobial. since pt recovered so quickly and cultures were not positive for gnrs, urine was thought to be colonization in the setting of a chronic foley, and the abscess is currently being treated with a drain. switched patient back to his home antibiotics (daptomycin/moxifloxacin/flagyl/fluconazole) with plan to broaden should he show signs of decompensation. pt refusing painful or invasive procedures - treatment of uti would require removal of foley, which would likely be painful in the setting of severe scrotal edema (could not visualize penis). pt will follow up with his primary care and id doctor as an outpatient. # le edema: pt admitted with new onset le edema bilaterally but worse on left. per pcp this is new over the past 2 months. obtained le dopplers which showed occlusive dvt on left from common femoral vein down to calf veins. on right there was impaired compressibility that could indicate partially occlusive clot but no definite thrombus. recommend discussion with pcp as to risks and benefits of anticoagulation for palliation of le edema. currently has an ivc filter for pulmonary embolus prophylaxis. # altered mental status: per wife pt was confused at the time of hypotension. pt ruled out for sepsis as above. thought to be volume depletion vs medication effect. pt improved with iv fluids. pcp adjusted pt's medication regimen, stopping all benzos and recommending a max of 15mg po oxycodone and 6mg po dilaudid per day. palliative care recommends spacing out those medications as follows: 5mg oxycodone po q8h standing with 2mg dilaudid po q8h in between; hold if patient is confused or sedated. # pneumobilia: chronic, since ercp. surgery has elected not to perform ccy given patient's high risk abdomen. has been stable with this finding over the last month. surgery has reevaluated in the ed with no indication for acute surgery. # goals of care: pt and wife have discussed his current state and multiple episodes of acute on chronic infection. would prefer to avoid aggressive care in respect to measures that would cause him additional pain and prolong his suffering. reviewed icu consent with wife who does not want large needles or tubes in body, no ivs in neck including ej. had family meeting with pcp and id doc in which he re-affirmed his dnr/dni status but was not ready for cmo or hospice yet and asked to continue to treat infection and send to long term care facility. # elevated lfts/cirrhosis: pt has cirrhosis with some element of obstruction that is chronic, but lfts are reduced compared to previous hospitalizations. no action taken. # anemia: likely secondary to chronic disease; appears to have been dropping steadily since end of . checked iron studies which were pending at the time of discharge. # hypoalbuminemia: pt has very severe malnutrition which is contributing to his anasarca. likely contributing to gut wall edema. requested recommendations from nutrition. # pancreatitis: stable. continued creon # ckd: at baseline. held sevelemer and neutraphos and rechecked electrolytes, which were stable, so restarted on discharge. # hypothyroidism: continued levothyroxine # skin rash: continued miconazole powder, desenex # cad: continuedasa # chronic pain: continued lido patch, standing tylenol max 2gm daily, prn zofran. held narcotics while in house and can restart as above as outpatient # anxiety: stopped ativan. transitional issues: - follow up cultures - monitor for hemodynamic decompensation - may need to broaden antibiotics if so - follow up iron studies - discuss anticoagulation with patient for palliation of le edema in the setting of dvt - pain control medications on admission: levothyroxine 25mg qday lipase-protease-amylase 5,000-17,000-27,000 2caps tid w/meals miconazole powder tid asa 81mg daily lidocaine patch 5% daily tylenol 1000 prn sevelamer 1600 tid w/meals colace senna dulcolax daptomycin 400mg iv q48hrs omeprazole 40mg daily moxifloxacin 400mg daily fluconazole 200mg daily zofran prn nephrocaps daily mvi zinc 220mg daily ativan 0.5 mg qhs prn prosource no carb 30ml daily roxicodone 5mg q6h desenex 2 % tid discharge medications: 1. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 2. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: two (2) cap po tid w/meals (3 times a day with meals). 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 hours on, 12 hours off. 6. acetaminophen 500 mg tablet sig: two (2) tablet po three times a day as needed for fever or pain. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. daptomycin 500 mg recon soln sig: four hundred (400) mg intravenous q48h (every 48 hours). 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 12. moxifloxacin 400 mg tablet sig: one (1) tablet po once a day. 13. fluconazole 200 mg tablet sig: one (1) tablet po once a day. 14. zofran odt 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 15. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 16. multivitamin capsule sig: one (1) capsule po once a day. 17. zinc-220 220 (50) mg capsule sig: one (1) capsule po once a day. 18. terbinafine 1 % cream sig: one (1) appl topical (2 times a day). 19. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 20. oxycodone 5 mg tablet sig: one (1) tablet po every eight (8) hours. 21. dilaudid 2 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain: between doses of oxycodone. hold for confusion or sedation. 22. sevelamer hcl 800 mg tablet sig: two (2) tablet po three times a day: with meals. discharge disposition: extended care facility: northeast - discharge diagnosis: primary diagnosis: dehydration medication side effect secondary diagnosis: abdominal abscess chronic foley discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: thank you for letting us take part in your care at . you were brought to the hospital because you were confused and your pressure was low. you were given ivf and your pressure and mental status improved. you were also given additional antibiotics to protect you from infection. your cultures did not indicate that there was an infection in your , you were placed back on your home antibiotics. you improved so you were sent home. you should drink plenty of fluids and avoid certain medications (below) which can lead to confusion. the following changes were made to your medications: 1. you should avoid benzodiazepines. 2. you should not take more than 15mg oxycodone (short-acting) per day 3. you should not take more than 6mg dilaudid per day followup instructions: department: when: monday at 1:45 pm with: , md building: sc clinical ctr campus: east best parking: garage md procedure: injection or infusion of oxazolidinone class of antibiotics diagnoses: anemia of other chronic disease other chronic pain coronary atherosclerosis of native coronary artery urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site cirrhosis of liver without mention of alcohol unspecified septicemia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified anxiety state, unspecified septic shock old myocardial infarction rash and other nonspecific skin eruption personal history of venous thrombosis and embolism other ascites do not resuscitate status other disorders of plasma protein metabolism dehydration chronic pancreatitis peritoneal abscess diverticulosis of colon (without mention of hemorrhage) other specified diseases of pancreas nutritional marasmus personal history of methicillin resistant staphylococcus aureus other specified disorders of intestine hypertrophy of breast 

Answer: The patient is high likely exposed to