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: altered mental status, uti major surgical or invasive procedure: none history of present illness: mr. is an 86 year-old gentleman with a history of pna resulting respiratory failure and eventual trach and peg who was admitted on with altered mental status. per report, patient was alert and oriented on morning of admission, then became more confused and sleepy and later unresponsive. ems was called and patient was brought to ed. in the ed patient was afebrile with hr 66 bp 128/62 with o2 sats 99 % on trach mask. a ua was grossly positive and foley was changed in the ed. he was given ceftriaxone 1 g iv. a head ct showed full mastoids bilaterally. on the patient was transferred to the icu with bradycardia (hr 20s-30s). he was given atropine x 1 and hr eventually came up into 50-60s with questionable of abnormal conduction on multiple ekgs. both metoprolol and digoxin were held and cardiology was consulted; they felt the current rhythm was complete heart block with junctional escape rhythm with rate in high 50s with occasional atrial beats being conducted. also thought that hypothyroidism contributing to bradycardia and potentially potentiating digoxin effect. (tsh was 75 at the time). the cardiology service recommended holding nodal agents, continuing levothyroxine, and said that as long as rates in high 40s-60s and pt asymptomatic that no further intervention would be needed. at the time of transfer back to the floor, the patient was feeling well and without complaints. he denied chest pain or shortness of breath. he felt more clearheaded. past medical history: 1. hypertension 2. hyperlipidemia 3. hypothyroidism 4. recurrent pneumonias 5. osteoarthritis 6. sleep apnea 7. paranoid schizophrenia 8. bipolar 9. gynecomastia 10. bph 11. history of upper gi bleed 12. chronic back pain 13. oropharygneal carcinoma 14. spinal stenosis social history: lives in nursing home ( nursing home; ). has a sister who is hcp and lives in per his report. family history: not relevent in this patient for this admission. physical exam: physical exam on arrival to the floor: vitals: afebrile; sbps ranging 120-130s; hrs 40s-60s; 99% on trach mask general: lying in bed, eyes closed, but easily opens them when asked to eyes: no pallor or icterus heent: trach in place with clear secretions noted; no mastoid tenderness cv: regular and bradycardic; distant sounds; no obvious murmurs pulm: clear anteriorly abd: soft; peg in place; non-tender ext: warm; thin; 1+ edema neuro: alert and oriented x3; able to lift arms and legs off bed equally skin: warm with no rashes pertinent results: labs: blood wbc-6.6 rbc-4.04* hgb-12.6* hct-37.5* mcv-93 mch-31.2 mchc-33.6 rdw-14.7 plt ct-351 pt-12.3 ptt-23.5 inr(pt)-1.0 glucose-111* urean-35* creat-1.1 na-136 k-4.9 cl-98 hco3-28 angap-15 tsh-75* t4-2.7* t3-61* calctbg-1.15 tuptake-0.87 t4index-2.3* wbc-4.9 rbc-3.39* hgb-10.7* hct-31.2* mcv-92 mch-31.4 mchc-34.2 rdw-15.0 plt ct-333 6:30 am urine source: cvs. **final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed skin/genital flora. clinical significance of isolate(s) uncertain. interpret with caution. pseudomonas aeruginosa. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- <=1 s ceftazidime----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s imaging: ecg (): sinus rhythm. left atrial abnormlaity. left axis deviation may be due to left anterior fascicular block and/or possible prior inferior myocardial infarction, although it is non-diagnostic. consider anterior myocardial infarction of indeterminate age. anterolateral lead st-t wave abnormalities are non-specific but cannot exclude ischemia. clinical correlation is suggested. no previous tracing available for comparison. ecg ( at 7:22am): sinus bradycardia rate 44 with single apc atropine given: at 7:43-7:47: sinus rate approximately 60 with high grade av block. accelerated junctional rhythm, rate of 75bpm telemetry from at 9:11am competing sinus and junctional rhythm rates 58 and 60 repectively. ecg (): nsr in 40s-50s. cxr (): within limitations of the study, elevated right hemidiaphragm and no definite evidence of acute cardiopulmonary process. ct head (): 1. no acute intracranial process 2. opacified bilateral mastoids and middle ears suggests otomastoiditis. 3. mild sinus disease. echo (): very limited study. grossly preserved biventricular systolic function. dilated aortic root. ct orbits (): nonspecific opacification of the mastoid air cells and middle ear cavities bilaterally without bony destruction. otomastoiditis is a clinical diagnosis and correlation with the patient's presentation should be made to determine if concern exists for otomastoiditis. brief hospital course: brief summary of hospital course: mr. is an 86 yo man with multiple medical problems including history of atrial fibrillation with rapid ventricular response, recurrent pneumonia s/p trach 7 months ago w/ chronic peg, and indwelling foley catheter who lives in a skilled nursing facility. he was originally admitted on with delirium that was felt to be attributed to a complicated uti related to his indwelling foley catheter. in addition, he was felt to be hypothyroid with a tsh of 75. his hospital course was complicated by bradycardia with symptomatic hrs in the 20-30 range. he received atropine for this and was briefly transferred to the icu for close monitoring. we stopped his lopressor and digoxin. in addition, we increased his synthroid dose. his heart rates improved, he did not develop atrial fibrilation, and his delirium resolved. active problems: 1. bradycardia: thought to be secondary to hypothyroidism, lopressor use, and digoxin use. these were held and his heart rates improved. if he develops atrial fibrillation he may start on low-dose lopressor with monitoring of his heart rate. regardless, he should follow-up with va cardiology as follows: dr. location: 1400 , department: cardiology phone: appointment: tuesday 3:30pm 2. hypothyroidism: on admission the patient's tsh was elevated to 75. he was started on levothyroxine 50. his hypothyroidism may be contributing factor to his delirium and bradycardia. please ensure that his levothyroxine is administered in the morning on an empty stomach, at least 30 minutes before any food is administered to ensure proper absorption. he should have a repeat tsh checked and his levothyroxine adjusted accordingly. 3. recurrent urinary tract infections: he was found to have a uti on admission, culture positive for pseudomonas. during the pre-icu course, the patient was treated with ceftriaxone, however on transfer to the icu, a ua demonstrated persistant pyuria. the patient was swithed to cipro based on culture sensitivities (the pseudomonas had not been tested for ceftriaxone sensitivity). at the time of his transfer out of the icu, it was recommended that he have an outpatient follow-up appt in the va system given he has now had 3 utis and may benefit from suppressive antibiotics and or suprapubic catheter. he should continue on ciprofloxacin with last dose on and follow-up as follows: dr. location: , department: urology phone: appointment: monday 10:40am 4. otitis media with effusion: mr. has a long history of left-sided conductive hearing loss. during this admission a head ct demonstrated fluid in his mastoid, although the patient was asymptomatic. ent was consulted and a dedicated ear exam revealed otitis media with effusion but no evidence of infection. he is recommended to follow-up with ent as follows: dr. gooey location: , department: otolaryngology phone: appointment: thursday 10:20am 5. code status: despite this patient's multiple medical problems, he requested to remain full code during this admission. medications on admission: ophthalmic lubricant to both eyes at bedtime polyvinyl alcohol solution 1 gtt to both eyes daily tylenol albuterol nebs q 6h prn levothyroxine 0.025 mg 1 tab qday metoprolol 12.5 mg ng simvastatin 80 mg ng at bedtime trazadone 25 mg ng qhs chlorhexidine flunisonide inhal nasal 2 sprays each nostril daily mvi peg daily omeprazole 20 mg po qday asa 325 mg peg tube q day digoxin 0.125 mg via peg qday docusate liquid via peg finasteride 5 mg via peg daily heparin 5000 units sc q8h discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : inhalation q6h (every 6 hours) as needed for wheezing. 2. simvastatin 40 mg tablet : two (2) tablet po daily (daily). 3. chlorhexidine gluconate 0.12 % mouthwash : 1-2 mls mucous membrane (2 times a day). 4. aspirin 325 mg tablet : one (1) tablet po daily (daily). 5. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic qhs (once a day (at bedtime)). 7. levothyroxine 50 mcg tablet : one (1) tablet po daily (daily). 8. ciprofloxacin 250 mg tablet : two (2) tablet po q12h (every 12 hours): last dose . 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. therapeutic multivitamin liquid : five (5) ml po daily (daily). 11. acetaminophen 650 mg/20.3 ml solution : one (1) po tid (3 times a day) as needed for pain. 12. tramadol 50 mg tablet : 0.5 tablet po q6h (every 6 hours) as needed for pain. 13. trazodone 50 mg tablet : 0.25 tablet po hs (at bedtime) as needed for insomnia. 14. finasteride 5 mg tablet : one (1) tablet po daily (daily). 15. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po daily (daily). discharge disposition: extended care facility: healthcare center - discharge diagnosis: delirium discharge condition: alert, oriented x 2. conversant. cranial nerves normal. does not ambulate. he is able to describe current symptoms and recent hospital course. he remembers the name of his doctors and previous medical treatments but does not know medications or doses from memory. discharge instructions: dear mr. , you were admitted with confusion and were found to have a urinary tract infection, which is related to your foley. this improved with antibiotics and you should continue on ciprofloxacin with your last dose on . you also developed bradycardia which we think is related to your lopressor and digoxin use. it was probably also related to the fact that you were not receiving enough thyroid replacement and we increased this. we have a number of follow-up appointments for you outlined below. we made the following medication changes: - stop lopressor - stop digoxin - increase levothyroxine to 50mcg daily followup instructions: with: dr. gooey location: , department: otolaryngology phone: appointment: thursday 10:20am with: dr. location: , department: urology phone: appointment: monday 10:40am with: dr. location: 1400 , department: cardiology phone: appointment: tuesday 3:30pm procedure: enteral infusion of concentrated nutritional substances diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia other specified cardiac dysrhythmias urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypovolemia accidents occurring in unspecified place delirium due to conditions classified elsewhere gastrostomy status tracheostomy status infection and inflammatory reaction due to indwelling urinary catheter paranoid type schizophrenia, unspecified unspecified otitis media conductive hearing loss, unilateral 

Answer: The patient is high likely exposed to