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: please see previous dictation covering dates to , as dictated by dr. , regarding further information pertaining to the patient's initial hospital course. briefly, this is a 60 year old female with a complex past medical history including hepatitis c, status post liver transplant times two with last transplant complicated by hepatic artery stenosis, status post stent, respiratory failure, status post tracheostomy and multiple transfers to the medical intensive care unit for secretion management, chronic renal insufficiency, diabetes mellitus type 2, hypertension and chronic anasarca. she was admitted on to the medicine service for mental status changes and hypoxia. the patient improved after deep suctioning after transfer to the medical intensive care unit for more aggressive pulmonary nursing care. sputum culture eventually grew out pseudomonas and multidrug resistant klebsiella. all of these were likely colonizers. she was treated with zosyn. while in the medicine intensive care unit she failed several attempts to wean her ventilator. she was transferred to the regular medicine floor. she was doing well on the floor until when she was found lethargic and pulseless. a code was called. she was resuscitated after deep suctioning. it was felt that the patient had a pea arrest secondary to mucous plugging. of note she had had increased nasal secretions around her nasogastric tube. amoxicillin was added to her medication regimen out of concern for sinusitis. while in the medical intensive care unit, she was continued on a regimen of deep suctioning and aggressive pulmonary toilet. she did well with this regimen and was deemed stable for transfer back to the medicine floor in the evening. please see the rest of this dictation from this admission for specific details concerning her past medical history, social history, medications prior to admission and family history. physical examination: physical examination upon transfer, vital signs showed temperature of 98.6, blood pressure 152/84, heart rate 88, respiratory rate 22, oxygen saturation 99% on 70% oxygen via tracheostomy collar. general appearance was that of a well developed, obese african american female who is comfortable, mouthing words in no acute distress. head was normocephalic, atraumatic. pupils were equal, round and reactive to light. sclera were anicteric. mucous membranes were moist. a nasogastric tube was in place with thick secretions around her nares. neck was remarkable for a tracheostomy as well as a tracheostomy collar delivering oxygen. neck was supple with no masses or lymphadenopathy. there is no jugulovenous distension. lungs had coarse breath sounds anterolaterally with no rhonchi, rales or wheezes. cardiac examination was regular rate and rhythm. cardiac examination was regular rate and rhythm with s1 and s2 heart sounds auscultated. no murmurs, rubs or gallops. abdomen was soft with mildly diffuse tenderness, moderately distended. there were positive normoactive bowel sounds. no rebound or guarding. extremities demonstrated no clubbing or cyanosis but were remarkable for a 3+ lower extremity edema to mid thigh bilaterally. of note, the patient also had a 5 by 3 cm sacral decubitus ulcer with necrotic tissue on her lower back. laboratory data: laboratory data on transfer was remarkable for the following, complete blood count demonstrated white blood count of .1, hematocrit 26.0, platelets 453. chemistry showed sodium 139, potassium 4.0, chloride 107, bicarbonate 27, bun 59, creatinine 0.7, glucose 116. liver function tests showed alt 44, ast 83, alkaline phosphatase 1542, total bilirubin 0.7. coagulation profile showed pt 13.8, ptt 34.3, inr 1.3. a chest x-ray from , showed a stable right effusion with patchy left lower lobe lingular infiltrates concerning for pneumonia. sputum culture from , demonstrated greater than 25 polymorphonuclear cells, 2+ gram negative rods and 1+ gram positive cocci in pairs. eventually these organisms would be identified as multidrug resistant klebsiella and pseudomonas. addendum to hospital course: 1. respiratory distress/failure - the patient continued to have thick secretions resulting in episodic mucous plugging and respiratory distress. she was continued on an aggressive regimen of pulmonary toilet with chest physical therapy and suctioning to prevent recurrent plugging. she received oxygen via tracheostomy collar with it weaned down to oxygen saturation greater than 90%. she received lasix 40 mg p.o. q.d. to avoid pulmonary edema secondary to volume overload and low albumin state. she received scheduled mucomyst and albuterol nebulizer treatments q. 6 hours with metered dose inhalers as needed for shortness of breath and wheezing. pulmonary service was consulted regarding possible nosocomial pneumonia and right upper chest x-ray demonstrating a left lower lobe and lingular opacity as well as the increased quantity of the patient's sputum. she underwent a bedside bronchoscopy on which demonstrated copious thick viscous secretions with purulent appearance. she had sputum suctioning and pulmonary toilet via the bedside bronchoscopy and then had a repeat bronchoscopy the following day for a bal and lavage sampling. the patient's sputum eventually grew out multidrug resistant klebsiella and pseudomonas. she was evaluated by the infectious disease service and was started on zosyn. ultimately a plan must be developed between the liver staff, pulmonary service, and otorhinolaryngology service regarding the best way to manage the patient's colonization with pseudomonas and klebsiella as well as means of diminishing her mechanical aspiration and recurrent aspiration pneumonia. 2. status post liver transplant - the patient was continued on aspirin and plavix status post hepatic artery stent to maintain patency of stent. the alkaline phosphatase was persistently elevated. as questioned, this was related to her immunosuppressive therapy, however, to rule out thrombosis, she underwent a right upper quadrant ultrasound which demonstrated patency of the portal vein, hepatic vessels and the previously placed hepatic artery stent as well as normal flow. she was continued on tacrolimus and imuran, the dose was adjusted appropriately based on levels. 3. sinusitis - while on the medical intensive care unit, early in this admission, the patient was noted to have increased nasal secretions around her nasogastric tube. she completed a three day course of amoxicillin and aspirin for sinusitis. 4. sacral decubiti - the patient was evaluated by the plastic surgery and wound care services with dressing changes per their recommendations. she was continued on vitamin c and zinc for increased wound healing. 5. diarrhea - the patient has had a problem with persistent diarrhea during the course of this hospitalization. it is felt to be likely osmotic in nature as all culture data was negative and the patient demonstrated a dramatic decrease in her level of diarrhea after discontinuation of her tube feeds. therefore she was maintained on total parenteral nutrition as well as cholestyramine. 6. hypertension - the patient was continued on lisinopril and norvasc titrated for blood pressure control. 7. diabetes mellitus 2 - she was continued on regular insulin sliding scale with q.i.d. fingersticks. 8. tachycardia/bradycardia syndrome - earlier in this hospitalization the patient was seen by the cardiology service. per their recommendations, beta blocker was being held. 9. anemia - iron studies demonstrated this to be an anemia of chronic disease. hematocrit was followed serially and the patient was transfused for a hematocrit less than 25. 10. pain - the patient experienced significant pain from her sacral decubiti which was treated with oxycodone. additional events regarding the hospital course, discharge events, diagnoses, medications and follow up plans will be dictated as a separate addendum to this report. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances closed (percutaneous) [needle] biopsy of liver other bronchoscopy closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine transfusion of packed cells replacement of tracheostomy tube diagnoses: unspecified pleural effusion urinary tract infection, site not specified unspecified septicemia chronic airway obstruction, not elsewhere classified sepsis acute respiratory failure liver replaced by transplant pneumonia due to klebsiella pneumoniae 

Answer: The patient is high likely exposed to