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: shortness of breath major surgical or invasive procedure: intubation history of present illness: 84 yo m c significant h/o cad, atrial fibrillation, s/p pacemaker placement for sick sinus syndrome with recent admission in for stemi found to have increasing sob and tachypnea at rehab hospital. he was admitted in for stemi after bilateral knee replacement. catherization at that time showed 100% proximal stent restenosis, diffuse rca disease, and a patent left circumflex stent. a ptca was successfully placed in lad. the catherization was complicated by the development of wide complex tachycardia and hypotension (sbp 80s). as a result, the patient was defibrillated once, given iv lopressor, iv amiodarone, dopamine pressor, an intraaortic balloon pump, and intubated to protect airway. he was treated in the ccu, stabilized, and discharged to rehab. there he was doing well until he developed a pna, found to have rll infiltrate on cxr. he was started on cefuroxime. he had increasing sob over several days, on had increased sob and was given lasix and ativan. he had no chest pain, n/v. he was found down at rehab and then transferred to for further care. in the ed he was found to have severe chf with complicating pna, he was sent to the ccu for further care. past medical history: past medical history: cad -s/p pci to l circ and lad in -s/p mi years ago -: pmibi showed a small fixed inferior defect with slight apical redistribution suggestive of ischemia. - echo showed ef 20% with regional left ventricular systolic dysfuntion, hk basal septum, ak distal septum, lat wall and basal ant. wall atrial fibrillation on coumadin sick sinus syndrome, s/p pacer s/p bilateral total knee replacement s/p umbilical hernia repair social history: denies tobacco, etoh, italian speaking family history: no history of cad physical exam: vs. t 99.6 bp 101/69 pulse 100s a.fib rr 20-30s 92% nrb gen: alert and oriented x3 in nad heent: perrla, mmm, op clear neck: no elevated jvp apreciated lungs: crackles way up bilaterally cv: irregularly irregular, tachycardic, difficult to assess rhythm abd: soft, nt/nd, +bs ext: 2+ edema, no clubbing or cyanosis neuro: a &o x 3in nad, cn ii-xii intact, strenght grossly intact, no change in sensation pertinent results: 11:09pm type-art rates-16/4 tidal vol-650 peep-10 o2-100 po2-127* pco2-48* ph-7.49* total co2-38* base xs-12 aado2-566 req o2-90 intubated-intubated 08:15pm type-art po2-62* pco2-56* ph-7.41 total co2-37* base xs-8 06:40pm type-art po2-55* pco2-60* ph-7.42 total co2-40* base xs-11 06:40pm lactate-2.2* 06:08pm alt(sgpt)-31 ast(sgot)-37 ck(cpk)-146 alk phos-94 tot bili-1.1 06:08pm ck-mb-6 ctropnt-0.16* 05:25pm type-art o2-100 po2-56* pco2-75* ph-7.30* total co2-38* base xs-7 aado2-610 req o2-96 intubated-not intuba vent-spontaneou 01:30pm glucose-152* urea n-22* creat-0.8 sodium-139 potassium-4.6 chloride-98 total co2-32* anion gap-14 01:30pm ck(cpk)-156 01:30pm ck-mb-6 ctropnt-0.12* 01:30pm calcium-6.7* phosphate-3.1 magnesium-1.6 06:51am glucose-153* urea n-22* creat-0.9 sodium-135 potassium-4.7 chloride-92* total co2-31* anion gap-17 06:51am ck(cpk)-146 06:51am ck-mb-6 ctropnt-0.16* 06:51am calcium-8.3* phosphate-3.9 magnesium-1.7 06:51am wbc-15.3* rbc-3.72* hgb-11.4* hct-35.6* mcv-96 mch-30.6 mchc-31.9 rdw-15.5 06:51am plt count-518* 06:51am pt-19.0* ptt-32.9 inr(pt)-2.3 02:06am comments-green top 02:06am lactate-1.3 01:30am urine hours-random 01:30am urine gr hold-hold 01:30am urine color-straw appear-clear sp -1.009 01:30am urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:30am urine rbc-* wbc-0-2 bacteria-rare yeast-none epi-<1 01:20am glucose-161* urea n-22* creat-0.9 sodium-136 potassium-3.9 chloride-93* total co2-32* anion gap-15 01:20am ck(cpk)-123 01:20am ctropnt-0.15* 01:20am ck-mb-5 01:20am magnesium-1.7 01:20am calcium-8.2* phosphate-3.0 magnesium-1.6 01:20am digoxin-0.7* 01:20am wbc-13.5*# rbc-3.68* hgb-11.3* hct-34.9* mcv-95 mch-30.8 mchc-32.5 rdw-15.5 01:20am hypochrom-1+ poikilocy-1+ macrocyt-1+ 01:20am plt count-469*# 01:20am pt-18.6* ptt-30.7 inr(pt)-2.2 ct of the chest without iv contrast: prominent right paratracheal lymph node is present. this is non-pathologically enlarged by ct criteria and is most likely reactive. there are dense multifocal coronary artery calcifications as well as cardiac enlargement. previously evident small pericardial effusion has slightly decreased in size since the prior study. assessment of lung fields again demonstrates findings of congestive heart failure, with evidence of ground-glass opacities and smooth thickening of septal lines. small to moderate bilateral pleural effusions slightly increased in size in the interval. there has been development of areas of organizing fibrosis peripherally with associated bronchiectasis and bronchiolectasis. the airways are patent to the level of the subsegmental bronchi bilaterally. imaged portions of the upper abdomen are notable for vascular calcifications and a left renal cyst. impression: 1) cardiomegaly, coronary artery calcifications, and evidence of congestive heart failure as above, with persistent ground-glass opacities, smooth thickening of septal lines, and small to moderate bilateral pleural effusions. this process appears to be superimposed upon underlying ards as described below 2) progressive development of areas of organizing fibrosis along the periphery of both lungs. the appearance is consistent with a history of ards with an element of organizing fibrosis. interpretation: findings: this study was compared to the prior study of . left atrium: moderate la enlargement. right atrium/interatrial septum: moderately dilated ra. a catheter or pacing wire is seen in the ra and/or rv. left ventricle: mild symmetric lvh. top /borderline dilated lv cavity size. lv wall motion: regional lv wall motion abnormalities include: mid anterior - akinetic; mid anteroseptal - akinetic; basal inferior - hypo; basal inferolateral - hypo; anterior apex - akinetic; septal apex- akinetic; right ventricle: normal rv chamber size and free wall motion. aorta: mildly dilated aortic root. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild to moderate (+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. mild to moderate +] tr. moderate pa systolic . pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: small pericardial effusion. no echocardiographic signs of tamponade. conclusions: the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. resting regional wall motion abnormalities include anteroseptal, anterior and apical hypokinesis and basal inferior and inferolateral hypokinesis. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic . there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (tape reviewed) of , left ventricular systolic function appears slightly more vigorous. brief hospital course: 1. pulmonary - this 85 year old male with history of cad, s/p recent stemi with cardiac catheterization was admitted with sob and hypoxia. it was felt these symptoms were most likely secondary to pna and chf exacerbation based upon history, examination, and his admission cxr. he was admitted to the ccu for continued care. his enzymes were cycled to rule out ischemia as a cause of his chf exacerbation. there was no evidence of ischemia on ekg. he was treated with antibiotics for presumed infection, he was initially started on levofloxacin. he was also diuresed with lasix. the day after admission vancomycin and flagyl were added for additional antibiotic coverage. on the evening after admission he developed increased respiratory distress. agressive diuresis, morphine, nitro, and bipap were tried with no sucess. he was intubated for respiratory distress, a swan was placed and a head ct was obtained. his swan numbers indicated that he was fluid overloaded so he was diuresed. he continued to spike temperatures despite being on levo, vanco, and flagyl. he was diuresed agressively with lasix and developed a metabolic alkalosis secondary to contraction. he was treated with bumex for a few days. then his alkalosis was treated with a tight kcl sliding scale. he continued to spike fevers and sputum cultures revealed mrsa. his lines were changed. since he continued to spike and have positive cultures despite vanco he was changed to linezolid and the levofloxacin and flagyl were dcd. his wbc count continued to trend down from admission. his respiratory status improved, his wbc count improved, and his cxr improved. based upon good response to a pressure trial he was extubated on hospital day #9. he did well post extubation. he had some diarrhea the evening following extubation which was found to be c.diff positive. he was restarted on flagyl. based upon his improved respiratory status and lack of fevers it was felt he was stable to be discharged from the ccu and sent to the floor. we continued to diurese him but with much less close monitoring than had been occuring in the unit. on hospital day #14 he was found to be very crackly on exam with marked respiratory distress. his antibiotics were broadened to zosyn, flagyl, linezolid. he was transferred up to the ccu with concern that he had become fluid overloaded again. his lt ij was removed and a rt ij placed with swan. the swan indicated that he was fluid overloaded and he was aggressively diuresed with lasix. he was noted to have a swollen wrist and ankle on arrival to the ccu. an attempt was made to remove fluid from his ankle which was unsucessful. that evening he became increasingly hypoxic with sob, he also became hypotensive. he was tried on bipap and given neo then dopamine for bp support. he did not tolerate bipap and was intubated. he continued to require neo for bp support, which was weaned off slowly. he was diuresed with lasix based upon cxr which indicated that he was fluid overloaded. a repeat echo was performed which indicated an improvement in his ef to 30-35%. on hospital day 18 a bronchoscopy was performed and sample sent for culture. he was was eventually exubated in the ccu after aggresive diuresis. bal results came back positive for stenotrophomonas (xanthomonas) maltophilia which was sensitive for bactrim. however at that point patient looked much improved with no recent spike in temperature, respiratory decompensation, or increase in wbc. it was agreed upon to hold off on treating with bactrim and if patient decomensated in future we would treat. however patient never showed any evidence of furter active infection. linezolid and zosyn course were completed while patient was in hospital. patient was transferred back to the floor out of the unit. patient still had crackles on lung exam but based on exam and swan numbers (before swan taken out) patient was dry. a ct chest was ordered which showed resolving ards and fibrosis. patient should have repeat ct scan in weeks. while on floor patient was slowly transitioned from iv lasix dose to po lasix with close monitoring of fluid status. 2. cad - he had a history of cad, on this admission further ischemia was ruled out by enzymes. he was continued on aspirin, lipitor, and plavix throughout his hospital stay. he was started on beta-blocker and ace-i once bp could tolerate. his ekgs remained unchanged. 3. pump - his ef prior to admission was documented as 20%. on admission a cxr showed evidence of chf most likely due to pna c/b a.fib with rvr. he was agressively diuresed as mentioned above. he was continued on his digoxin. his ace-i was given when his pressure was able to tolerate it. a repeat echo on showed and ef of 30-35%. it also showed: "anteroseptal, anterior and apical hypokinesis and basal inferior and inferolateral hypokinesis, mild (1+) aortic regurgitation, mild to moderate (+) mitral regurgitation." 4. rhythm - he had a history of a.fib with pacer placed for sss. on admission his rhythm was a.fib with lots of pvcs and short runs of nsvt on telemetry. he was initially continued on beta-blocker and amiodarone. his beta-blocker was held when his blood pressure could tolerate it, and then restarted once he improved. his amiodarone was discontinued on with concern for amiodarone induced lung toxicity. he was anticoagulated throughout his hospital stay with heparin iv or coumadin. 2. id - he was treated for pna with various antibiotics as mentioned above. he had a c.diff positive stool for which he was treated with flagyl. sputum cultures grew mrsa treated with vancomycin then linezolid. bal samples were sent for culture and results mentioned above. repeat c. diff toxin came back negative. patient was kept on flagyl until other antibiotic courses were completed and he should continue on flagyl for two more days since his zosyn was discontinued on the day of discharge. 4. s/p fall - he had a fall at the nursing home prior to coming to the hospital. his neuro exam showed no deficits on arrival. head ct showed old lt temporal infarct, no new infarcts. he had some increased confusion after sedation but had no focal neurologic deficits. 5. psych - all out-patient psych medications were held. medications on admission: haloperidol 0.5 mg q 1700 lorazepam 0.25 mg po q 8hrs prn aceotminophen 650 mg po q 4 hours prn furosemide 40 mg iv metop 50 mg po lansoprazole 30 mg ppo q d insulin digoxin 0.125 mg qd quetaiapine fumarate 25 mg po qhs haloperidol 1 mg p q4h pr im haloperiodl 1 mg po q 4 hrs coumadin 1 dose? bisacodyl 10 mg qd mgoh 30 mg laactulose 20 mg qd senna colace lisinopril 5 mg qd atorvastatin 80 mg qd amiodrarone 400 mg qd clopidogrel 75 mg qd aspirin 325 mg qd cefuroxime 500 mg po bid discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary pnemonia-mrsa congestive heart failure (ef 30 to 35%) c difficile colitis questionable amiodarone pulmonary induced toxicity. secondary: coronary artery disease atrial fibrillation on coumadin sick sinus syndrome, s/p pacer s/p bilateral total knee replacement s/p umbilical hernia repair discharge condition: good, afebrile, tolerating po intake and sating comfortably on 3l nc. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. fluid restriction: 1500 cc please return to the emergency room or your pcp if you experience shortness of breath, chest pain or light headedness or increasing weight gain not relieved by lasix. it is very important to weigh yourself every day and call your physician if you experience any weight gain. followup instructions: please call your pcp doctor, dr. at to make a follow up appointment in one week. provider: breathing tests where: pulmonary function lab phone: date/time: 12:45 provider: exam room is (no charge) where: is (no charge) date/time: 1:00 provider: , .d. where: medical specialties phone: date/time: 1:00 please have your son accompany you to assist in translation. you have an appointment for a chest ct the morning of . you will be called about the time. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus pulmonary artery wedge monitoring transfusion of packed cells transfusion of other serum injection or infusion of nesiritide injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other pulmonary insufficiency, not elsewhere classified atrial fibrillation infection with microorganisms resistant to penicillins long-term (current) use of insulin intestinal infection due to clostridium difficile methicillin susceptible pneumonia due to staphylococcus aureus cardiac pacemaker in situ subendocardial infarction, subsequent episode of care effusion of joint, ankle and foot effusion of joint, forearm 

Answer: The patient is high likely exposed to