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: rigors major surgical or invasive procedure: central line placement history of present illness: mr. is an 88m with cad, chf, dm who presents from home with chills and n/v x1 day. . patient's history is limited, and no family members able to be contact at time of evaluation in micu. per patient, he was feeling well until when he develops rigors and sweats. had n/v and appetite recently poor. has been short of breath for the last month. denies any cough, diarrhea, dysuria, rhinitis, headache, myalgias, sick contacts, trouble swallowing, travel, hospitalizations more recent than . thinks he got the flu shot this year. . in the emergency department, initial vitals were 98 88 110/65 16 96% on room air. he was given vancomycin, ceftriaxone, levofloxacin, zofran, and acetaminophen. tmax in er was 104 rectally; he subsequently became hypotensive to 56/34 despite 3l of ivf. line placed, started levophed. cxr showed right middle lung field infiltrate. ekg with old rbbb. total ivf in ed 5+ l. currently 99.5 81 89/65 26 100% on nrb. . ros: as above. also notes occasional constipation and abdominal discomfort. past medical history: #. cad - s/p 3v cabg in #. chronic diastolic chf - echo , ef>55%. mild-mod mr , mild pulm htn #. obstructive/restrictive lung disease - pfts : fev1 1.49 (66%), fev1/fvc 96 (158%) #. hypertension #. hyperlipidemia #. dm2 #. ckd - baseline cr 1.2 - 2.0 (1.2 x 1 after foley placement) - history of bilateral hydro secondary to bph - seen last by dr. , plan for cysto (not done in omr) #. hx dvt () on anticoagulatioon #. squamous cell carcinoma on lip #. gout #. right eye blindness # bph #. depression #. hx biliary sepsis c/b septic shock #. hx gi bleed #. s/p cholecystectomy social history: the patient lives with his wife and two daughters in . per reports the patient requires a lot of care, and is visited three times a week by a home nurse. his daughter /hcp lives upstairs. tobacco: quit 40 years ago, ppd x 5 years previously etoh: glasses of scotch every saturday night illicits: none family history: non-contributory physical exam: vitals 97.2 82 86/52 25 98% nrb cvp 11 general pleasant elderly man, mildly tachypneic heent sclera white, conjunctiva pale, mmm neck rij in place pulm lungs with few bilateral rales r>l, +egophony cv regular s1 s2 soft systolic murmur at apex. well healed sternotomy scar abd soft nontender +bowel sounds ruq scar extrem warm 1+ bilateral edema and hyperpigmentation rle (site of prior dvt). palpable distal pulses neuro alert and awake, answering appropriately, moving all extremities no gross deficits pertinent results: na 137 / k 4.1 / cl 99 / co2 27 / bun 30 / cr 1.4 / bg 232 alt 65 / ast 54 / alk phos 282 / tuberculosis 1.8 alb 4.1 / ca 8.6 / mg 2 / phos 1.3 wbc 5.1 / hct 43.3 / plt 87 cxr - right lung pneumonia. ruq us - no evidence for biliary ductal dilatation echo - the left and right atrium are moderately dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. 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 to moderate (+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . compared with the prior study (images reviewed) of , septal motion is abnormal (?new ivcd) and overall left ventricular systolic funciton is less vigorous. the severity of tricuspid regurgitation is increased. ct abd/pelvis - 1. pericystic stranding and apparent wall thickening suggests a cystitis. correlate with ua. 2. fluid in the abdomen and pelvis limits the evaluation of the bowel. there is no abscess. 3. bilateral lower lobe opacification suggests pneumonia associated with pleural effusions, loculated on the right. empyema is not ruled out given the appearance. 4. persistent dense pleural plaque on the right. lower extremity ultrasound: wet read right: unchanged chronic partially occlusive dvt in r superficial femoral vein. no sign of new or acute dvt. left: no lle dvt. picc line wet read in place 7:05 pm blood culture klebsiella pneumoniae. final sensitivities. klebsiella pneumoniae | ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). 7:15 pm blood culture site: arm #2. blood culture, routine (final ): klebsiella pneumoniae. identification and sensitivities performed on culture # from . enterococcus faecium. final sensitivities. daptomycin = 2.0 mcg/ml. daptomycin sensitivity testing performed by etest. high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: susceptible to 1000mcg/ml of streptomycin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecium | ampicillin------------ <=2 s ciprofloxacin--------- 2 i daptomycin------------ s erythromycin---------- 2 i levofloxacin---------- 4 i linezolid------------- 2 s penicillin g---------- 2 s tetracycline---------- =>16 r vancomycin------------ <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). gram positive cocci in pairs. aerobic bottle gram stain (final ): gram negative rod(s). , , blood cx pending, no growth to date 9:55 pm urine site: clean catch **final report ** urine culture (final ): gram positive bacteria. >100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. urine cx- negative no urine legionella catheter tip- no growth & - c diff negative brief hospital course: 88yo male with history of coronary artery disease, chf, dm, and prior dvt admitted with septic shock. . 1. septic shock hypotension is likely related to sepsis. the source of his sepsis is likely related to klebsiella and enterococcus found on blood cx, although the source of the gnr and enterococcus is unclear. his blood pressure improved rapidly with broad spectrum antibiotics and was weaned off of pressors within 48 hours. he was originally started on broad spectrum antibiotics which were narrowed early on to ceftriaxone and vancomycin. his enterococcus can back sensitive to ampicillin and he was switch from vancomycin to ampicillin on . his ceftriaxone's last dose is due on . his last dose of ampicillin was due on . . 2. ? pneumonia his chest xray and ct scan were suggestive of pneumonia with possible empyema formation due to effusion with associated loculations. his ct scan also showed a persistent dense pleural plaque on the right. his pulmonary status however has remained stable during this hospitalization and he has improved without further intervention. he had an oxygen requirement earlier in his hospitalization but was weaned off to room air at the time of discharge. he is being treated with ceftriaxone and ampicillin as detailed above. . 3. transaminitis the patient had mildly elevated transaminases and total bilirubin. priors from were within normal limits. there is concern that he could have mild hepatic congestion given his chf. his transaminitis may also reflect systemic infection. these should be redrawn to ensure that they normalize. on ct scan his liver showed two stable hypodensities which were likely cysts. his ceftriaxone could be contributing to his increased ap. . 4. thrombocytopenia on review of omr, he had prior plts in the low 100's. his platelets nadired at 73 and were 123 on the day of discharge. . 5. leukopenia during his admission, his white blood cell count declined from 12 to 3. the etiology of this decline was thought likely related to sepsis or medication effect given the multiple different antibiotics he received. his leukopenia normalized prior to discharge. his wbc count should be drawn again in 1 week. . 6. chf, chronic, diastolic: his b-blocker and lasix were held in the setting of hypotension. they were restarted prior to discharge. . 7. cad please review echo findings in result section. he was continued on his asa and statin. his b-blocker was held as detailed above and then restarted. he had mildly elevated troponins which was consistent with prior troponins present in our records. . 8. dm his home glipizide was held while in the hospital and restarted upon discharge. he is being discharge on a humalog sliding scale. he should be started on an ace as an outpatinet. . 9. cri & cystitis his creatinine was at his baseline of 1.1. a ct of the abdomen showed pericystic stranding and apparent wall thickening suggests a cystitis. a ct scan also showed multiple bilateral renal hypodensities measuring to 4.2 cm on the right, containing fluid- attenuating material, likely benign cysts . 10. bph foley was placed with the help of urology to monitor urinary output. his tamsulosin was continued. . 11. prophylaxis he was continued on heparin sc. . 12. code status: dnr/dni medications on admission: bupropion 150mg sr asa 81mg daily simvastatin 20mg daily tamsulosin 0.4mg daily lasix 60mg daily metoprolol 12.5 mg glipizide 2.5mg daily . discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 8 days: last day . 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation: hold for loose stool. 4. ampicillin sodium 2 gram recon soln sig: one (1) recon soln injection q6h (every 6 hours) for 8 days: last dose . 5. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) syringe intravenous prn (as needed) as needed for line flush. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: hold for loose stool. 7. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 8. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: do not exceed 4grams in 24hrs. 12. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 13. insulin sliding scale please use attached sliding scale 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection three times a day: can discontinue when patient is ambulating regularly. 15. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). 16. insulin please see attached scale 17. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for sbp<100 and hr<55. 18. glipizide 5 mg tablet sig: 0.5 tablet po daily (daily). 19. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day): apply to area in groin, pls keep area dry. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: -pulmonary and urosepsis . secondary diagnosis: -cad s/p 3v cabg in -chronic diastolic chf ef>55%. mild-mod mr , mild pulm htn -obstructive/restrictive lung disease -hypertension -hyperlipidemia -dm2 -ckd -history of bilateral hydro secondary to bph -history of dvt , now off anticoagulatioon -squamous cell carcinoma on lip -gout -right eye blindness -bph -depression -history of biliary sepsis c/b septic shock -history of gi bleed -stauts post cholecystectomy -thrombocytopenia since -chronic lle > rle edema discharge condition: stable. alert and oriented x3. severe rash in groin that needs to be kept dry. discharge instructions: you were admitted to the intensive care unit for fever and very low blood pressure. you were given intravenous fluids and started on antibiotics. we took blood cultures and you were found to have bacteria in your blood. your antibiotics were narrowed so they specifically treat the bacteria in your blood. you also had a pneumonia and a possible urinary tract infection which could have caused the bacteria to get into your blood. you are being discharged on 2 antibiotics which you will finish on . you had to have a picc line placed for antibiotic administration. it was difficult to place so we sent you down to radiology to have it placed under image guidance. your home blood pressure medications were held while you were in the hospital but we have restarted these. we took pictures of the veins in your legs which have an old clot but no new clot. you have a rash in your groin consistent with a yeast infection. we started you on an antifungal powder for this and it is very important to keep that area dry. . please take all medications as directed on attached sheet. . please seek immediate medical attention if you experience fevers, chills, chest pain, shortness of breath, diarrhea, dizziness, nausea, blood in your stool, black stool, or any new concerning symptom. followup instructions: when you are discharged from rehab please call to make a follow up appointment with dr. . procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified congestive heart failure, unspecified severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status chronic kidney disease, unspecified other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) right bundle branch block septic shock other septicemia due to gram-negative organisms other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled streptococcal septicemia chronic diastolic heart failure leukocytopenia, unspecified cyst of kidney, acquired nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] other specified causes of urethral stricture profound impairment, one eye, impairment level not further specified cystitis, unspecified 

Answer: The patient is high likely exposed to