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: admission history of present illness: the patient is a 49-year-old woman admitted to the micu for hypercarbic respiratory failure in the setting of question sepsis. the patient was intubated two times in the sicu first for possible fungemia with what grew out to fungemia, parapsilosis and second time for , postextubation laryngeal edema. per the emergency room report, the patient was a 49-year-old woman with a history of chronic nausea, vomiting, and headache. the patient reports nausea and vomiting x3 days prior to admission. she developed a temperature of 102 the night prior to admission. she also continued to develop a headache which was dull, bifrontal and improving without meningitic signs or photophobia. at the time of admission, she denied chest pain, shortness of breath, abdominal pain, or dysuria. in the emergency room, her temperature was 101.6, her blood pressure was 104/56, heart rate 110, respiratory rate 18, and o2 saturation is 95% on room air. she was given dilaudid, flagyl, and phenergan, 1 gram of vancomycin and levaquin iv in the emergency room. she experienced hypercarbic failure on the floor on , and was intubated but is now extubated. past medical history: 1. chronic nausea and vomiting with multiple admissions thought secondary to bilious reflux from her j limb efferent, causing accumulation into the gastric remnant. the surgery on was unsuccessful. 2. tpn dependent status post multiple infections including , mrsa and fungemia. 3. question of crohn's disease on steroids intermittently. 4. intervertebral fractures with chronic back pain. 5. femoral fractures. 6. status post hip replacement. 7. peptic ulcer disease status post billroth ii. 8. status post microperforations leading to microadhesions. 9. anemia of chronic disease. 10. pulmonary vasculitis. 11. episode of alveolar hemorrhage. 12. lung biopsy with cement and bone marrow emboli. 13. ruptured vertebroplasty. 14. pulmonary function tests demonstrate restrictive defect. 15. history of mild asthma on prn inhalers. 16. chronically elevated lfts. 17. chronic hypokalemia. 18. status post appendectomy. 19. status post cholecystectomy. 20. j-tube placement. 21. status post revision of roux-en-y anastomosis in . she has peptic ulcer disease status post billroth ii, roux-en-y, status post microperforations, abscess, chronic tpn, status post j-tube feeds. medications on transfer: 1. ondansetron 4 mg iv. 2. tylenol. 3. miconazole. 4. fluconazole. 5. fentanyl patch. 6. metoclopramide. 7. lorazepam. 8. midazolam. 9. diphenhydramine. 10. midazolam hcl. 11. albuterol. 12. hydromorphone. 13. captopril. 14. metoprolol. 15. promethazine. allergies: sulfa causes rash, aspirin unknown. family history: prostate cancer, father. coronary artery disease in the mother. social history: she has a history of being a state representative, no tobacco and no alcohol use. physical examination: performed on on transfer to the micu floor, subjective: no complaints, no chest pain, no shortness of breath, positive back pain. vital signs: temperature 99.2, blood pressure 128/88, heart rate 80, respiratory rate 20. heent: oropharynx clear. pupils are equal, round, and reactive to light. extraocular movements are intact. neck is supple. cardiovascular: regular, rate, and rhythm without murmurs, rubs, or gallops. lungs are clear to auscultation. abdomen positive bowel sounds, soft, nontender, nondistended, positive j tube, minimal erythema around j tube site, multiple abdominal scars. extremities: no edema, cyanosis. left arm is in a sling. neurologic: alert and oriented. cranial nerves ii through xii intact. general: the patient is emaciated, ill appearing. laboratories: on admission to the medicine floor, white blood cell count 5, hematocrit 28.3, platelets 284, sodium 134, potassium 3.8, chloride 97, bicarb 31, bun 11, creatinine 0.2, platelets 104. lfts: alt 34, ast 13, alkaline phosphatase 132, t bilirubin 3.1, lipase 14. on ck rule out: ck 54, 47, and 50 respectively. on ........... 223, .......... 1.1 to 21 to 23. on haptoglobin 212. a lipid panel: triglycerides 100, hdl 42, cholesterol 33, ldl 77. blood cultures no growth, blood cultures no growth, blood cultures no growth. oropharyngeal shows pseudomonas. , her vitamin d is less than 7. a a chest x-ray shows collapse of the left lower lobe, lesser degree atelectasis at the right base. a ct scan of the neck shows a left shoulder comminuted, slightly inferior displaced left humeral head. a ct scan of the abdomen shows no evidence of abscess or draining, persistent ........... of efferent loop to point bowel anastomosis with question of low grade obstruction at this site and mild intrahepatic biliary duct dilatation, bilateral pleural effusions or thickening of the bowel wall, question of crohn's, extensive ........... suggestive of anasarca. a electrocardiogram: sinus rhythm, poor r-wave progression, nonspecific st wave changes. a echocardiogram: left atrium mildly dilated, left ventricular moderate global left ventricular hypokinesis, overall left ventricular systolic function depressed, improved mr . a echocardiogram tr gradient shows an ejection fraction of 25-30%, left ventricular systolic function depressed, mr 2+/3+ tr. hospital course by system: pulmonary: the cause of the patient's respiratory distress was unclear. the patient was treated for sepsis initially because she was hypercarbic breathing at a rate of over 40 and not hypoxic when initially intubated. her chest x-ray was consistent with possible congestive heart failure. her cta was negative for large pulmonary embolus and the patient was easily extubated and improved the next day on without diuresis. on the evening of , the patient started to respond to racemic epinephrine and improved. on , the patient experienced focal wheezing over neck and then progressive tachypnea, hypercarbia, and lactate up to 10. the patient continued to wheeze and have symptoms of chf that did not improve with lasix. the patient's symptoms were discussed with interventional pulmonology and postextubation laryngeal edema was suspected. the patient was intubated and then extubated in the sicu again. of note, the patient has a history of restrictive pulmonary function tests and therefore, the question of pulmonary vasculitis was raised. there was also the possibility of aspiration. on the medical floor, the patient's respiratory status was stable. a repeat x-ray was performed. the x-ray showed minimal bibasilar atelectasis with no pneumonia. id: the patient presented initially with fungemia. she continued on fluconazole and a repeat echocardiogram. per recommendations, the patient should not wear artificial nails. also ophthalmology examination and a re-echo were done, further evaluation and were negative. fever/leukocytosis: in the sicu, the patient finished six days of broad coverage of linezolid and flagyl given the question episode of sepsis. she finished a seven day course of ceptaz for pseudomonal urinary tract infection, although this was felt likely due to possible colonization, and continue on fluconazole on . she will be discharged with a course of one additional month course of fluconazole for fungemia. repeat ct scan of the abdomen was negative on showing no abscess or fluid collection. cardiology: patient with a history of congestive heart failure. echocardiogram was performed and showed a depressed ejection fraction of 25% with mr . this, however, continued to improve throughout the hospitalization, and repeat echocardiogram was performed prior to discharge and showed an ejection fraction of 50-55%. renal/fen: patient's history presented with initial metabolic acidosis which turned into alkalosis and was improving. nutrition: the patient was placed on tpn. prior to discharge, we advanced her tube feeds at 10 cc per day. the patient's tube feeds should be advanced over extremely gradual and prolonged course. gi: patient was efferent limb distended and reflux of bile into the stomach causing nausea and vomiting. the long-term plan is to surgically fix this problem. this should be followed up in the gi service. pain: patient with chronic back, abdominal, and shoulder pain. she will be discharged on a pca pump, however, this should be slowly weaned. heme: patient with a history of anemia. it is likely of chronic disease. endocrinology: the patient originally received stress dose for sepsis. she was switched to dexamethasone. ........... stim was negative. rheum/ortho: the patient was followed by orthopedics for fracture. she should be followed up with orthopedics, dr. in weeks. line: the patient has a right picc line for tpn and antibiotics. communication: husband has proxy and power of attorney at phone number . prophylaxis: the patient was maintained on heparin subq and h2 blockers and tube feeds. code: full. discharge: the patient will be discharged to rehabilitation. condition on discharge: fair. discharge followup: the patient will follow up with pcp and gastrointestinal physicians within 2-4 weeks. discharge medications: 1. mirtazapine 45 mg po hs. 2. lorazepam 0.5-2 mg po q1-2h prn. 3. hydromorphone pca. 4. promethazine hcl 25 mg iv q6. 5. metoprolol 12.5 mg po bid. 6. captopril 12.5 mg po tid. 7. albuterol nebulizers one nebulizer 1h q6 prn. 8. thiamine 25 mg po q day. 9. fioricet 1-2 tablets po q4-6h. 10. diphenhydramine 25 iv q6. 11. midazolam hcl 1.5-2 mg iv q2 prn. 12. metoclopramide 15 mg po/iv qid prn. 13. fentanyl patch 200 mcg/hour tp q72h, hold for sedation. 14. fluconazole 400 mg iv q24 start and . 15. miconazole powder application around j tube site. 16. tylenol prn. 17. ondansetron 4 mg iv q6h. discharge planning: the patient needs pt, ot. patient needs tube feeds as well as tpn. the patient is on dilaudid pump. the patient should receive psychiatry followup. dr., 12-899 dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances injection or infusion of oxazolidinone class of antibiotics diagnoses: cellulitis and abscess of trunk congestive heart failure, unspecified unspecified septicemia hypopotassemia pulmonary collapse acute respiratory failure disseminated candidiasis infection and inflammatory reaction due to other vascular device, implant, and graft infection of gastrostomy 

Answer: The patient is high likely exposed to