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: procardia / aliskiren attending: chief complaint: altered mental status. major surgical or invasive procedure: none. history of present illness: 72 yo m with hx gbm and ich around mass, who presents to er via ems due to lethargy at facilty today. per the daughter and son, the pt was agitated and was complaining of abdominal pain yeserterday. he did not want to eat and was throwing objects. he had 3 large bms. today pt was more unresponsive, destated to 88% on 6liters nc. ems found pt to have fs of 80 at sceen. . in the er, vs on arrival were hr 63, sbp 80-90, rr 14, 100%, rectal temp 100. pt had a fs of 34 and was given 1 amp d50. he was lethargic and minimally responsive and did not improve with dextrose. pt was intubated after about 20 min for airway protection. prior to this he had intermitent apnea and a wet sounding cough. cxr showed a possible bilaterally pna, and ct head with no new head bleed. hct was found to be 26 from 32 and pt was ordered for 1 unit of blood. trop was elevated to 0.26 with ekg changes concerning for new twave inversions in lateral leads. ekgs were sent to cards. pt was trace guaiac positive on exam. ng lavage was negative. sbp dropped to 77 and pt was started on levophed after at 2.5 liters ivf had been given. pt was given vanco, ctx, and levo. pt given dexamethasone 10mg for stress steriods. on transfer vs were- hr 61, bp 118/58 (levophed 0.12), rr 14, fio2 100%, peep 10, tv 500, sat 100%. past medical history: -right frontotemporal glioblastoma multiforme who grade iv, status post biopsy on , on protocol using hypofractionated involved-field radiotherapy with temozolomide followed by cyberknife boost -ischemic stroke -malignant htn -cad s/p imi -chronic diastolic chf -paf (ed visit ) -type ii diabetes mellitus -anxiety/depression social history: he is a resident of & nursing center in , ma. he is a retired rocket scientist from . he worked for ussr space program and nasa. a former pipe smoker, he quit in . he is a social drinker and he does not abuse illicit drugs. family history: father: type diabetes and hypertension. mother: . brother: type diabetes. physical exam: admission exam: vs: hr 56, bp 130/64, sat 97%, ac fio2 70%, tv 500 rr 14, peep 10 gen: intubated, arousable, russian speaking heent: perrl, ntg tube in place, neck supple resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: abd is distended, nt, +bs ext: no c/c, edema in left le/ankle skin: tinea on right heel, no jaundice neuro: sedated pertinent results: admission labs: 06:45pm blood wbc-7.8 rbc-2.74* hgb-8.8* hct-26.1* mcv-95# mch-31.9 mchc-33.6 rdw-16.5* plt ct-189 06:45pm blood neuts-93.1* lymphs-5.7* monos-1.0* eos-0.1 baso-0.1 06:45pm blood pt-12.7 ptt-25.0 inr(pt)-1.1 06:45pm blood ret aut-2.1 06:45pm blood glucose-83 urean-52* creat-1.6* na-148* k-3.9 cl-108 hco3-27 angap-17 06:45pm blood alt-50* ast-67* alkphos-91 totbili-0.4 06:45pm blood ck-mb-4 06:45pm blood ctropnt-0.26* 10:27pm blood ctropnt-0.20* 03:09am blood ck-mb-5 ctropnt-0.16* probnp-387* 06:45pm blood calcium-8.2* phos-4.9*# mg-2.5 06:45pm blood vitb12-512 05:12am blood triglyc-133 06:45pm blood tsh-0.41 08:47pm blood type- temp-37.8 po2-85 pco2-43 ph-7.42 caltco2-29 base xs-2 intubat-intubated comment-green top 07:00pm blood lactate-1.7 . ct head w/o contrast : impression: no acute change from prior study. right cerebral hypodensity is consistent with known gbm. dystrophic calcification in the right temporal lobe and right basal ganglia reflects either post-treatment change or prior hemorrhage. there is no acute hemorrhage identified. encephalomalacia from prior right parietal and right occipital infarcts is noted. global prominence of the sulci and ventricles is compatible with encephalomalacia. no hydrocephalus. . ct c/a/p : impression: 1. abdominal pneumoperitoneum, which may be due to jejunal ischemia and infarct given abnormal-appearing jejunal loops with wall thickening, possible pneumatosis and mesenteric fat stranding and fluid. evaluation, however, is limited by lack of iv contrast. 2. bibasilar consolidations which may be atelectasis, although pneumonia is not excluded. small effusions. 3. small pericardial effusion. 4. atherosclerotic disease of the aorta and coronary vessels. . echo : the right atrium is moderately dilated. lvef>55%. the left ventricular inflow pattern suggests impaired relaxation. borderline pulmonary artery systolic hypertension. there is a small pericardial effusion. there is evidence of diastolic dysfunction. . kub : impression: small amount of free air visualized in the left lateral decubitus abdominal radiograph and consistent with persistant pneumoperitoneum. . discharge labs: 09:20am blood wbc-10.9 rbc-3.00* hgb-9.5* hct-29.5* mcv-98 mch-31.8 mchc-32.4 rdw-15.5 plt ct-266 09:20am blood glucose-177* urean-25* creat-0.8 na-143 k-3.6 cl-105 hco3-28 angap-14 04:56am blood alt-20 ast-18 alkphos-71 totbili-0.2 05:12am blood alt-22 ast-14 ld(ldh)-468* alkphos-74 totbili-0.1 06:36am blood calcium-7.8* phos-2.8 mg-1.7 brief hospital course: 72 yo m with hx of ischemic stroke, htn , cad s/p imi, diastolic chf, paf, type ii diabetes mellitus, rec uti??????s and gbm with recent intracranial hemorrhage , who presented with altered mental status with concern for pneumonia, intubated in er due to altered mental status and airway protection. he was admitted to icu where an abdominal ct was obtained for abdominal distention and pneumoperitoneum was found. hypotension due to sepsis was treated with pressors and ivf. he was not a surgical candidate, so the bowel perforation was treated with vanco, 7 days ceftiaxone, and metronidazole (started ). abx changed to cipro with metronidazole for a planned 14 day course, finishing . ceftriaxone also covered a proteus and klebsiella uti. . # pneumoperitoneum with sepsis: managed medically due to poor surgical candidacy. the repeated normal lactate spoke against bowel ischemia as the underlying process. bowel perforation may have been promoted by chronic steroid therapy. hypotension required iv fluids and pressors. patient was intially kept npo than gradually advanced to full diet and tolerated this well. plan is to continue cipro and metronidazole to complete a 14 day course finishing . . # altered mental status: continued delirium. he needed one arm restraint to maintain iv access while getting iv antibiotics. once changed to po, he no longer required iv access or restraints. his family is opposed to any use of anti-psychotics. . # htn: intially off his home , bb, and diuretic as he was strictly npo and hypotensive. after initial hypotension, he developed htn with sbp's to the 180's. he was treated with iv labetolol gtt + clonidine patch. most outpatient meds were re-established: eplerenone, torsemide, labetalol, clonidine, and amlodipine. valsartan 160mg will be added back as an outpatient. . # uti: proteus and klebsiella uti treated with ceftriaxone. . # dmii: volatile blood sugars. insulin glargine and sliding scale increased per. endocrinology consultation. plan to taper dexamethasone to 2mg and further after discharge as discussed with neuro-oncology. . # acute renal failure: resolved. originally cr 1.6 from baseline 1.0, bun was elevated. fena = 0.25% indicating pre-renal azotemia. in the setting of almost normal bnp, this was likely to hypovolemia/distributive shock rather than chf exacerbation with poor forward flow. subsequently after iv fluid and improving renal functions, he started to diurese. he was restarted on his home dose of torsamide 30mg daily as well as eplerenone 50mg daily. . # gbm/intracranial hemorrhage: continued outpatient levetiracetam. tapering dexamethasone. . # asymmetrical leg edema: considering inability to anticoagulate given recent ich and family's wish for no filter, further work-up was not be pursued. . # anemia: stable without transfusions, though was trace guaiac positive in ed. . # cough: controlled with prn benzonatate and ipratropium nebs. . # tinea pedis: continued miconazole cream . . # ekg changes/troponin elevation: due to demand ischemia. chest pain free. continued statin and beta blocker therapy. . # pain/headache: palliative care consulted. acetaminophen tid scheduled. . # fen: regular diabetic diet with thiamine supplement. hypophosphatemia repleted. repleted hypokalemia. . # ppx: pneumoboots. no heparin due to ich history. ppi, bowel meds. . # lines: port. . # precautions: fall. . # code: dnr, but okay to intubate. patient and family are anticipating additional palliative consultation at skilled nursing facility. medications on admission: amlodipine 10mg po daily clonidine 0.3mg/24hr patch qwk labetaolol 400mg po bid epleranone 50mg po daily torsemide 30mg po daily valsartan 160mg po bid simvastatin 40mg po daily levetiractam 500mg po q8hr dexamethasone 3mg po bid omeprazole 20mg po daily docusate 100mg po bid senna 8.6mg po bid buspirone 5mg po daily citalopram 20mg po daily clonazepam 0.5mg po qhs trazadone 25mg q2pm and 12.5mg tid prn agitation insulin glyburide timolol 0.5% 1 gtt ou discharge medications: 1. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 2. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qtues (every tuesday). 3. labetalol 200 mg tablet sig: two (2) tablet po bid (2 times a day). 4. eplerenone 50 mg tablet sig: one (1) tablet po daily (daily). 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. torsemide 10 mg tablet sig: three (3) tablet po once a day. 7. levetiracetam 500 mg tablet sig: one (1) tablet po q 8h (every 8 hours). 8. dexamethasone 2 mg tablet sig: one (1) tablet po q12h (every 12 hours): continue x3 days, then taper to 1mg po bid x3 days, then taper to 0.5mg po bid. 9. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 5 days: finishes . 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days: finishes . 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 13. senna 8.6 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 14. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain not relieved by tylenol. 15. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day). 16. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 17. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day) as needed for rash on heal. 18. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 19. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 20. insulin glargine 100 unit/ml cartridge sig: sixty five (65) units subcutaneous once a day. 21. insulin aspart 100 unit/ml cartridge sig: as directed units subcutaneous qachs: insulin sliding scale, see sheet. discharge disposition: extended care facility: - discharge diagnosis: 1. bowel perforation. 2. altered mental status. 3. hypotension (low blood pressure). 4. urinary tract infection. 5. hypertension. 6. acute kidney failure. 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 for altered mental status (delirium, confusion) and required intubation (breathing machine) in order to protect your airway and keep breathing. while in the icu, ct scan showed a bowel perforation. you were not well enough for surgery, so this was treated with antibiotics. in addition, for very low blood pressure, you needed iv fluids and pressors (medications that increase blood pressure. once your blood pressure returned, you needed blood pressure medication for hypertension. acute kidney failure resolved with iv fluids. you were also treated for a proteus and klebsiella urinary tract infection. your diabetes was difficult to control and the insuline doses were adjusted by the endocrinologist (diabetes doctor). to help manage the very high blood sugar levels, the dexamethasone for the glioblastoma multiforme (brain cancer) was decreased. weigh yourself every morning, md if weight goes up more than 3 lbs. . medication changes: 1. valsartan 160mg 2x a day was held for hypotension, but this can be restarted as the blood pressure increases. 2. dexamethasone dose was decreased from 3mg to 2mg two times a day. after three days, this dose can be tapered further to 1mg two times a day x3 days, then to 0.5mg two times a day. 3. insulin glargine (lantus) dose was changed to 65 units daily. 4. insulin sliding scale was adjusted (see sheet). 5. buspirone 5mg daily was not given during this hospitalization, but can be restarted. 6. citalopram 20mg daily was not given during this hospitalization, but can be restarted. 7. trazadone 25mg q2pm and 12.5mg tid prn agitation was not given during this hospitalization, but can be restarted. 8. acetaminophen 650mg po 3x a day (scheduled) was added for chronic pain. 9. ciprofloxacin finishes . 10. metronidazole finishes . followup instructions: please call your oncologist dr. this week for a follow-up appointment. . department: cardiac services when: wednesday at 10:30 am with: , np building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation perforation of intestine atrial flutter hypopotassemia dysthymic disorder disorders of phosphorus metabolism septic shock old myocardial infarction altered mental status do not resuscitate status hyperosmolality and/or hypernatremia chronic diastolic heart failure hemiplegia, unspecified, affecting unspecified side anemia in neoplastic disease other specified disorders of peritoneum dermatophytosis of foot malignant neoplasm of cerebrum, except lobes and ventricles 

Answer: The patient is high likely exposed to