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: aspirin / cefazolin attending: chief complaint: fever x 2 days, chest congestion x 1 week major surgical or invasive procedure: picc placement peg placement history of present illness: history obtained from son and daughter. 80 yo f with severe alzheimer's dementia (non-verbal at baseline) who presents with 1 week of increased respiratory secretions, cough, sob and lethargy. one week ago, pt was started on levofloxacin by her pcp, . . yesterday, pt developed a fever >100. of note pt has multiple areas of skin breakdown as well. . in ed, found to be febrile to 102, tachy to 130s with leukocytosis, elevated lactate consistent with sepsis. pt's code status was discussed with daughter and who confirmed that pt is dnr/dni. given ivf, acetaminophen with some improvement in tachycardia. started on vanco, levo, flagyl empirically for pna, cellulitis, ? osteo. . ros: no n/v/abd pain, diarrhea. no ha. per family, no coughing or choking after eating. family reports pt has pcn allergy- unclear whether this is documented allergy to cefazolin or other allergy. past medical history: severe alzheimer's dementia x 10 years aspiration htn gerd decubitus ulcers h/o gi bleeding secondary to aspirin chronic l lateral malleolus ulcer af social history: lives with daugher in , non-verbal and non-ambulatory at baseline. has 2 pcas who help care for her. per family, sometimes seems to be able to understand commands but not consistently. h/o tobacco (quit 25 yrs ago, only few cigarettes/day before that), no etoh. dnr/dni family history: n/c physical exam: 98.7 138/86 102 22 95% (3l) gen: lying in bed, non-verbal, eyes closed, groans with passive movement, gurgling noises from back of throat heent: dry mm, op clear, no stridor cv: reg, s1, s2, no m/r/g lungs: limited exam, rales at bases bilaterally abd: soft, nt/nd, +bs ext: warm, area of edema over r hip without erythema, fluctuance skin: 6 x 4 cm area of skin breakdown with central and surrounding necrosis over l lateral malleolus. 5 x 3 cm deep ulcer over l elbow with surrounding necrosis. skin tear on r deltoid. healed ulcerations over r hip/buttocks. neuro: non-responsive, groans with passive movement pertinent results: ekg: sinus tach @ 120, l axis, rbbb, inf q waves (old), twi v1-v3 (old), no acute ischemic changes c/w . 03:15pm wbc-16.2*# rbc-5.51*# hgb-13.9# hct-42.9# mcv-78* mch-25.3* mchc-32.5 rdw-17.1* 03:15pm neuts-84.2* lymphs-9.5* monos-5.4 eos-0.3 basos-0.6 03:15pm plt count-464* 03:15pm pt-13.8* ptt-24.9 inr(pt)-1.2* 03:15pm glucose-264* urea n-42* creat-1.3* sodium-150* potassium-4.5 chloride-117* total co2-22 anion gap-16 03:15pm alt(sgpt)-41* ast(sgot)-66* ck(cpk)-3182* alk phos-121* amylase-29 tot bili-0.4 03:15pm calcium-8.8 phosphate-2.7 magnesium-2.4 03:23pm lactate-4.2* 05:53pm lactate-2.3* 03:15pm ck-mb-3 03:15pm ctropnt-0.03* 03:26pm urine color-yellow appear-clear sp -1.026 03:26pm urine blood-tr nitrite-neg protein-tr glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 03:26pm urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi-0-2 cxr : no acute cardiopulmonary abnormality. mild cardiomegaly. l ankle x-ray : soft tissue defect adjacent to left lateral malleolus. indistinct lateral malleolus cortex is worrisome for osteomyelitis. further evaluation with three-phase bone scintigraphy or mri can be performed. , mri lle : 1. edema and enhancement in the distal fibula. although this is a nonspecific finding, it lies immediately deep to the patient's soft tissue ulcer and is therefore concerning for osteomyelitis. no interosseous or deep soft tissue abscess is identified. 2. degenerative splits of peroneus brevis and longus tendons, with minimal associated edema enhancement, which is most likely reactive. 3. ptt tendon degenerative changes. 4. extensive muscle atrophy. . mri lue : 1. edema and associated enhancement in the subcutaneous fat overlying the olecranon and lateral epicondyle and in the anconeus muscle. differential diagnosis includes both edema and cellulitis/muscle infection. 2. no abscess collection, joint effusion, or abnormal marrow signal to indicate osteomyelitis is identified. 3. patient unable to extend arm, arm imaged in flexed position. . cxr : moderate cardiomegaly is longstanding. small opacity just above the eventrated right hemidiaphragm developed between and consistent with pneumonia. when feasible routine radiographs should be performed to exclude the possibility that this is, instead, a longstanding nodular abnormality seen in the lower lungs on an abdomen ct . no appreciable pleural effusion or pneumothorax. tip of the left picc line projects over the junction of the brachiocephalic veins. . cxr : left picc line remains in place. new focal right basilar opacity is without change allowing for patient rotation. there is also a questionable new area of opacity in the left retrocardiac region, which could be due to aspiration or atelectasis. . tte : 1. the left atrium is normal in size. 2. there is mild symmetric lvh. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4. the ascending aorta is mildly dilated. 5. the aortic valve leaflets are mildly thickened. there is mild aortic valve stenosis. no aortic regurgitation present. 6. the mitral valve leaflets are mildly thickenedl. mild (1+) mitral regurgitation is seen. 7. there is moderate pulmonary artery systolic hypertension. 8. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. . cxr : 1. left lower lobe atelectasis-infiltrate, which is recurrent and might be related to aspiration. 2. there is no evidence of congestive heart failure. . ct abd : 1. no evidence of abscess or bowel perforation. 2. improvement in right lower lobe opacities. 3. stable hypoattenuating lesion in the right lobe of the liver most likely representing a cyst. 4. cholelithiasis without evidence of cholecystitis. 5. diverticulosis without evidence of diverticulitis. 6. moderate sized hiatal hernia. 7. soft tissue density opacities in both breasts. correlation with mammography is again recommended. 8. umbilical hernia containing small bowel loops without evidence of incarceration. . discharge labs: wbc 13 hct 28.9 plt 568 bun 13 cr 1.0 alt/ast ap 85 tbili 0.2 : esr 113 crp 120 brief hospital course: 80 yo f with severe alzheimers dementia, multiple areas of skin breakdown presents with fever, cough, lethargy and found to have sepsis. hospital course by problem as below: . # sepsis: she was thought to have aspirated, and was started on vancomycin/ levofloxacin/ flagyl. her family refused central line at this time and the patient was admitted to the floor, rather than the icu. she was also noted to have a large ulcer on her left lateral maleolus (decubitus) and left elbow. mri of the left ankle revealed possible osteomyelitis. id was consulted to help with antibiotic regimen. mri of the elbow showed soft tissue changes, but no definitive osteo. id recommended 6 week-course of vanco/levo empirically, since she was not a good candidate for bone biopsy. a peg tube was placed, with family understanding the continued risk of aspiration. . her course was complicated when she developed fever to 103 with transient hypotension and respiratory distress on . blood cultures drawn from picc line grew e. coli (resistant to levo), so she was broadened to zosyn. her fevers and hypotension resolved on this regimen. her picc line was changed over a wire (ir was unable to resite it since she has difficult access). abdominal ct scan did not reveal another source for the bacteremia. she had recurrnt fever and respiratory distress overnight , possibly due to re-aspiration. the likely source of the e. coli bacteremia was aspiration event. her peg tube feeds were stopped. the patient was then changed from zosyn to ceftriaxone once culture data returned. she tolerated the ceftriaxone well and remained afebrile. she was given a 2 week total course of gram negative coverage for bacteremia. she will need a total of 6 weeks coverage for osteomyelitis with vancomycin and ceftriazone/levofloxacin. she will need weekly labs for monitoring. . # anemia: patient had a questionable episode of coffee ground emesis transfer to the icu. she also intermittently had guaiac positive stools, in the setting pf peg placement. her hct fluctuated but overall was stable. iron studies were consistent with anemia of chronic disease. there was thought to be no role of colonoscopy for cancer work-up, as patient is not a treatment candidate. she received one unit of blood during her stay. . # arf: she initially had a bump in her cr, but it improved to a cr of 1.0 on discharge. vanco troughs were checked and she did well with daily dosing. . # fen: the patient had a peg placed on to help with her nutritional status. risks of aspiration were discussed with the family. she was kept npo while in-house. speech and swallow consultants recommended honey-thickened liquids and pureed diet as outpatient, if the family chooses to feed her. her family was trained in peg care. . # wound care: the wound care consultants evaluated her while she was here and made many recommendations management of her ulcers. she was treated with zinc and vitamin c while in house to facilitate wound healing. . # code/communication: she was maintained as dnr/dni during her admission. her contacts are as follows: -granddaughter ; bilingual): -daughter ( ) (hcp): -son : -son ) (cell); medications on admission: mvi levoflox x 7 days tylenol prilosec discharge medications: 1. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 5 weeks. disp:*qs 35 days worth* refills:*0* 2. nutrition tubefeeding: promote w/ fiber (or equivalent) full strength at 45 ml/hr q4h hold feeding for residual >= 100 ml flush w/ 200 ml water q8h # quanitity sufficient for life 3. nutrition kangaroo 324 pump (for tube feeds) #1 4. normal saline flush 0.9 % syringe sig: one (1) injection as directed: flush picc line 5cc ns pre and post vancomycin infusion per picc protocol. disp:*100 syringes* refills:*2* 5. heparin flush 100 unit/ml kit sig: one (1) intravenous as directed below: flush picc with 3cc after antibiotic infusion. disp:*50 synringes* refills:*2* 6. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 7. docusate sodium 150 mg/15 ml liquid sig: fifteen (15) ml po bid (2 times a day) as needed for constipation. 8. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po bid (2 times a day). 9. ascorbic acid 90 mg/ml drops sig: five (5) ml po daily (daily). 10. ipratropium bromide 0.02 % solution sig: one (1) neb treatment inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 11. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 12. ceftriaxone-dextrose (iso-osm) 1 g/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours) for 7 days. disp:*7 grams* refills:*0* 13. levofloxacin 250 mg tablet sig: one (1) tablet po once a day for 4 weeks: please start on . administer via peg tube. disp:*28 tablet(s)* refills:*0* 14. outpatient lab work please draw weekly vancomycin trough, cbc, esr, crp, lfts, bun, cr starting on thursday, . fax results to dr at (phone) discharge disposition: extended care facility: - discharge diagnosis: osteomyelitis, left ankle aspiration pneumonia e. coli bacteremia advanced dementia .. dm htn discharge condition: medically stable, baseline mental status discharge instructions: contact md if patient develops fever/chills, difficulty breathing, or other concerning symptoms. . please take all medications as directed. you have been prescribed 2 antibiotics to take for the next 5 weeks. followup instructions: please follow-up with dr within one week at . procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells diagnoses: anemia of other chronic disease unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified severe sepsis atrial fibrillation pneumonitis due to inhalation of food or vomitus septic shock infection and inflammatory reaction due to other vascular device, implant, and graft alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance dehydration hyperosmolality and/or hypernatremia septicemia due to escherichia coli [e. coli] pressure ulcer, elbow pressure ulcer, ankle unspecified osteomyelitis, upper arm 

Answer: The patient is high likely exposed to