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: history of present illness: mr. is a -year-old gentleman with a history of recent cholecystostomy tube for cholecystitis, chronic obstructive pulmonary disease, and panhypopituitarism who presented from nursing home after being found to be short of breath this morning with oxygen saturations of 77% on 2 liters. the patient was somnolent, tachypneic, and tachycardic on arrival by emergency medical service. emergency medical technician was unable to obtain a blood pressure. on arrival to the emergency department, the patient was responsive only to noxious stimuli and was in respiratory distress. on arrival, his temperature was 100.8 degrees fahrenheit, his blood pressure was 60/20, and his heart rate was 118. the patient was started on dopamine and given antibiotics of ceftriaxone and flagyl as well as intravenous fluids with an improvement in his blood pressure. with improved mental status, the patient reported increased diffuse abdominal pain for two weeks associated with a poor appetite. he reported a precipitous increase in abdominal pain on the day prior to admission. past medical history: 1. panhypopituitarism; status post pituitary adenoma resection. 2. paroxysmal atrial fibrillation. 3. chronic obstructive pulmonary disease. 4. cor pulmonale. 5. obstructive sleep apnea. 6. chronic renal insufficiency (with a baseline creatinine of 1.2 to 1.5). 7. hypertension. 8. dual-mode, dual-pacing, dual-sensing pacemaker for symptomatic bradycardia. 9. benign prostatic hypertrophy. 10. peptic ulcer disease. 11. gastroesophageal reflux disease. 12. history of cholecystitis in ; status post cholecystostomy tube placement which was removed in . allergies: no known drug allergies. medications on admission: 1. hydrocortisone 60 mg by mouth once per day. 2. terazosin 5 mg by mouth once per day. 3. albuterol. 4. protonix 40 mg by mouth once per day. 5. synthroid 50 mcg once per day. 6. amiodarone 200 mg by mouth once per day. 7. insulin sliding-scale. physical examination on presentation: physical examination revealed vital signs with a temperature of 100.5 degrees fahrenheit, his blood pressure was 105/17, his heart rate was 70 (paced), and his oxygen saturation was 100% on 2 liters. in general, alert and oriented times three. an ill-appearing gentleman who was conversant and mildly tachypneic. head, eyes, ears, nose, and throat examination revealed pupils were equal, round, and reactive to light. the mucous membranes were dry. neck examination revealed jugular venous pulsation was flat. cardiovascular examination revealed a regular rate. no murmurs, rubs, or gallops. respiratory examination revealed the lungs were clear to auscultation bilaterally. the abdomen was distended with diffuse tenderness to palpation especially in the right upper quadrant without rebound. positive guarding. a small right upper quadrant scar. extremity examination revealed the extremities were cool. radial pulses were 1+. neurologic examination revealed the patient alert and oriented times three. the patient moved all extremities. pertinent laboratory values on presentation: laboratories revealed his white blood cell count was 19.4, his hematocrit was 39.8, and his platelets were 239. the differential revealed neutrophils of 77%, lymphocytes of 18, and monocytes of 5%. sodium was 144, potassium was 3.4, chloride was 107, bicarbonate was 23, blood urea nitrogen was 29, creatinine was 2.9, and his blood glucose was 95. his amylase was 14, his lipase was 9, alt was 17, ast was 17, alkaline phosphatase was 60, and his total bilirubin was 2.1. creatine kinase was 23. lactate was 4.4. urinalysis revealed small blood, small leukocyte esterase, 0 to 2 red blood cells, 6 to 10 white blood cells, and a few calcium oxalate crystals. arterial blood gas was 7.38/34/98. pertinent radiology/imaging: abdominal ultrasound revealed a markedly distended and edematous gallbladder consistent with cholecystitis and adjacent areas of low attenuation in the liver which were suspicious for extension of abscess of the liver. a chest x-ray revealed bilateral atelectasis. no evidence of congestive heart failure. no acute infiltrate. concise summary of hospital course by issue/system: 1. biliary sepsis issues: the patient was initially on dopamine for pressure support which was changed to norepinephrine with improvement of his blood pressures. the patient had a percutaneous cholecystostomy tube placed by interventional radiology. surgery was consulted. biliary cultures grew methicillin-resistant staphylococcus aureus and enterococcus faecalis. blood cultures grew enterococcus faecalis. the patient was initially started on ceftriaxone and flagyl which were changed to vancomycin and zosyn. once blood cultures were obtained, zosyn was discontinued. the patient was aggressively volume resuscitated with approximately 15 liters of intravenous fluids. his norepinephrine was eventually weaned. the patient was also treated with stress-dose steroids. the patient did well and was eventually called back to the floor. he was discharged to rehabilitation with his cholecystostomy tube in place with plans for a possible cholecystectomy in the future. 2. respiratory issues: the patient was in respiratory distress upon admission, requiring noninvasive positive pressure support. this was felt to be multifactorial in nature; although volume overload secondary to aggressive intravenous fluids was felt to have played a significant role. a renal service consultation was obtained. they recommended continued aggressive diuresis with lasix with metolazone and diuril as needed. the patient slowly diuresed over his hospitalization and was eventually doing well on room air with no complaints. an echocardiogram was requested prior to discharge and was pending at the time of this dictation. this may need to be done as an outpatient for evaluation of the patient's systolic function, and the possibility for an ace inhibitor, and congestive heart failure treatment as needed. the patient was felt to be euvolemic to slightly dry at the time of discharge, so diuresis was discontinued. 3. chronic obstructive pulmonary disease issues: the patient was continued on his home nebulizers and inhalers. 4. mental status change issues: this was felt secondary to acute illness and resolved over his hospitalization. 5. paroxysmal atrial fibrillation issues: the patient was on no anticoagulation. at the time of admission, his amiodarone was secondary to hypotension. this was restarted on the day of discharge at a maintenance dose. 6. hyponatremia issues: the patient was hyponatremic throughout his medical intensive care unit course. this was felt to be secondary to an inability to take in free water. he was free water bolused in his total parenteral nutrition and defervesced. 7. nutritional issues: the patient has a history of being unable to swallow with straws. a bedside swallow evaluation was done which the patient failed. a video swallowing study was then performed. finally, the patient was safe to take pills with purees, thin liquids, and have soft solids. basic aspiration precautions were maintained. the patient observed to alternate between bites and sips and swallow twice between bites and sips. 8. panhypopituitarism issues: the patient was continued on repletion with stress-dose steroids which were weaned to his regular outpatient dose. 9. anemia issues: the patient's iron studies were consistent with anemia of chronic disease. stools were guaiac-negative. it was felt that his anemia was stable and secondary to his chronic renal insufficiency. 10. infectious disease issues: the patient had several urine cultures growing yeast despite foley catheter changes. given his multiple medical problems at this time, and treatment with vancomycin, it was decided that antifungals would be held and this would be addressed again as an outpatient. discharge status: discharge status was to rehabilitation. condition at discharge: condition on discharge was good. discharge diagnoses: 1. biliary sepsis. 2. volume overload with pulmonary edema. 3. chronic obstructive pulmonary disease. 4. panhypopituitarism. 5. anemia of chronic disease. medications on discharge: 1. amiodarone 200 mg by mouth once per day. 2. pantoprazole 40 mg by mouth once per day. 3. multivitamin one tablet by mouth once per day. 4. levothyroxine 75 mcg by mouth once per day 5. hydrocortisone 40 mg by mouth twice per day. 6. vitamin d 400 international units by mouth twice per day. 7. vitamin c 500 mg by mouth twice per day. 8. ipratropium meter-dosed inhaler 2 puffs inhaled q.4-6h. as needed. 9. albuterol 1 to 2 puffs inhaled q.4h. as needed. 10. albuterol ipratropium 1 to 2 puffs inhaled q.4h. as needed. 11. insulin sliding-scale (as at home). 12. terazosin 5 mg by mouth once per day. 13. ipratropium nebulizer q.4-6h. as needed. discharge instructions/followup: the patient was instructed to follow up with dr. in rehabilitation. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization percutaneous aspiration of gallbladder diagnoses: acidosis acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified atrial fibrillation chronic obstructive asthma, unspecified hyperosmolality and/or hypernatremia streptococcal septicemia acute and chronic cholecystitis panhypopituitarism 

Answer: The patient is high likely exposed to