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: this is a 64 year old female transferred from hospital to intensive care unit at on . the patient was originally admitted to the outside hospital on , after the acute onset of abdominal pain. the patient was in her usual state of health until this day around 5:00 p.m. when the patient developed the acute onset of epigastric pain and violent nonbloody emesis after eating a meal of macaroni and cheese. the patient states that the pain was ten out of ten, did not radiate to her back, but did radiate to her bilateral flanks. it was associated with increased shortness of breath, no chest pain, light-headedness or syncope. the patient's husband called 911. when she was taken to the outside hospital, her amylase was 3861, white blood cell count 23.0, hematocrit 45.0, normal liver function tests. the patient had temperature of 98.2, blood pressure 135/72, respiratory rate 18, oxygen saturation 98% ? in room air. the patient had an abdominal ct which showed mild acute pancreatitis with no gallstones or other pancreatic complications. the right upper quadrant ultrasound was done that revealed no evidence of gallstones (suboptimal study). the patient then had a repeat abdominal ct on , which showed necrosis of the pancreatic head with peripancreatic inflammatory changes. the amylase had trended down to the 80s over four days and the patient also had significant decrease in her abdominal pain. the patient was transferred to on , for question of endoscopic retrograde cholangiopancreatography as well as for failing respiratory status at the outside hospital. the patient had a chest x-ray that showed bilateral pleural effusions, status post aggressive intravenous fluids. the patient was noted to have increased wheezing on physical examination. she was given 20 mg intravenous lasix with good effect. the patient was also given stress dose steroids of solu-medrol, however, she had hallucinations from this. her pao2 was 61 mmhg. physical examination: temperature is 98.6, pulse 112, blood pressure 134/81, respiratory rate 31, oxygen saturation 88 to 90% on four liters of oxygen via nasal cannula. weight 84.5 kilograms. in general, she is a pleasant female in no apparent distress, speaking full sentences, despite tachypnea. head, eyes, ears, nose and throat examination - mucous membranes are dry. the oropharynx is clear. the pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. anicteric sclera. neck - no jugular venous distention, no bruits, no thyromegaly. pulmonary - diffuse severe end expiratory wheezes with fair air movement, mild bibasilar crackles, increased inspiratory and expiratory ratio. abdomen is soft, positive bowel sounds, nontender, question mildly distended, no rebound or guarding. extremities - no cyanosis, clubbing or edema, 1+ dorsalis pedis pulses. neurologic - the patient is alert and oriented times three. mini mental status examination - 28/30. cranial nerves ii through xii are intact. motor is , right upper extremity. sensation intact. past medical history: 1. chronic obstructive pulmonary disease, ? 2. coronary artery disease, status post non q wave myocardial infarction in , with left bundle branch block. 3. congestive heart failure with a reported ejection fraction of 40% in . peak ck 213 with mb of 18. 4. cardiac catheterization , showed apical hypokinesis, no significant coronary artery disease. 5. left thalamic cerebrovascular accident , with mild right upper extremity greater than right lower extremity weakness. 6. no history of hyperlipidemia, gallstones or alcohol use. medications at home: norvasc 10 mg p.o. once daily. medications here: 1. hydralazine 20 mg intravenous q6hours. 2. enalapril 0.625 mg intravenous q6hours. 3. clonidine 0.1 mg patch. 4. norvasc 10 mg p.o. once daily which has been held. 5. nitroglycerin drip. 6. haldol and ativan p.r.n. 7. morphine intravenous. 8. imipenem 500 mg intravenous q6hours. 9. famotidine 20 mg intravenous q12hours. 10. heparin subcutaneous 5000 units three times a day. 11. the patient had been on gentamicin and zosyn from , to . on , the patient's antibiotics were changed to imipenem. 12. albuterol and atrovent nebulizers q2hours p.r.n. 13. serevent two puffs twice a day. 14. flovent two puffs twice a day. 15. ocean spray nasal solution p.r.n. 16. dulcolax p.r.n. allergies: no known drug allergies. however, solu-medrol has caused hallucinations. social history: the patient is married with three children and lives in and runs a restaurant with her husband. she is a two pack per day smoker for her whole life. no alcohol use or intravenous drug use. family history: questionable history of pancreatic fibrosis in two or three sisters at an early age leading to early deaths. mother with lung cancer. father with hypertension, cerebral hemorrhage. laboratory data: at the outside hospital, white blood cell count 18.0 prior to transfer. arterial blood gases 7.42, 35, 61 and went to 7.41, 43, 68, went to 7.39, 41, 66. blood culture showed no growth to date. on , amylase was 3861, trended down to 94. lipase 862 and trended down to 153. ck 168, mb 2.7, troponin 0.02 but then increased her troponin to 0.18. ck 198, mb 9.5. electrocardiogram - left bundle branch block, pulse 112. laboratory data at included white blood cell count 23.0, hematocrit 40.2, platelet count 258,000, mcv 88. prothrombin time 13.8, inr 1.3, partial thromboplastin time 23.8. sodium 142, potassium 3.3, chloride 106, bicarbonate 28, blood urea nitrogen 14, creatinine 0.6, glucose 135. amylase 68, lipase 27. differential on white blood cell count revealed neutrophils 91%, no bands, 6% lymphocytes, 3% monocytes, 0.1% eosinophils. calcium 8.9, magnesium 2.0, phosphorus 2.5, albumin 3.1. alt and ast 24, total bilirubin 0.4, alkaline phosphatase 126, ldh 496. cholesterol 174, ldl 107, hdl 42. arterial blood gases revealed on five liters nasal cannula 7.46/41/55 with a bicarbonate of 30. lactate 1.3. potassium 3.3, free calcium 1.26. at 7:53 p.m. on 70% face mask, the patient had arterial blood gases of 7.47/38/80, bicarbonate of 28. urinalysis revealed specific gravity 1.005, large blood, negative leukocyte esterase and nitrites, 5 white blood cells, trace ketone, 423 red blood cells, no epithelial cells. chest x-ray - mild cardiomegaly, interstitial markings with congestive heart failure. hospital course: 1. pancreatitis - the patient with history of necrotizing pancreatitis of unclear etiology. normal liver function tests, amylase and lipase and hematocrit of 40.2. unclear family history of childhood pancreatic fibrosis but at the time of presentation, the patient is 64 years old and this may be unrelated acute event. the patient may have passed a gallstone given her age, gender, clinical history with acute onset of severe pain after a fatty meal. the patient was continued on imipenem for necrotizing pancreatitis which was discontinued on . the patient was kept npo except for most medications and ice chips. she did not require placement of nasogastric tube. the patient initially was able to tolerate gradually increasing diet including sips which was then advanced to full clears and soft solids. however, on , the patient noted epigastric tenderness to light palpation after eating and the patient was again made npo. the patient continued to do well after she was made npo with a goal of restarting clears on . the patient was continued on tpn throughout her hospital course with the long term plan being that the patient will likely need tpn for at least seven to ten days postdischarge in order to meet her full nutritional needs assuming that she will be able to tolerate gradually increasing p.o. the patient continued to have amylase and lipase that were within normal limits. however, her ldh and alkaline phosphatase did remain elevated at 465 and 173, respectively. the patient's hematocrit was 38.5 on . long term plans for gastrointestinal follow-up would include touch base with the gastroenterology service to assess length of tpn as well as question of endoscopic retrograde cholangiopancreatography at some later date as an outpatient once acute episode of pancreatitis has resolved. 2. pulmonary - the patient initially had bilateral pleural effusions likely secondary to congestive heart failure and volume overload as well as potential third spacing of fluid from her pancreatitis. the patient never required intubation and was maintained on mask ventilation and eventually titrated down to nasal cannula and currently saturating 94% in room air with no subjective shortness of breath. 3. congestive heart failure - the patient had an echocardiogram which showed an ejection fraction of 55% with 1+ mitral regurgitation, no evidence of pericardial effusion. 4. hypertension - the patient continued to have labile hypertension throughout her hospital course. the patient was started on a regimen of metoprolol and norvasc which were gradually titrated. however, while the patient was npo, the patient's norvasc was held and metoprolol was continued and is currently at a dose of metoprolol 100 mg p.o. three times a day. however, once the patient is able to tolerate p.o. she should be restarted on her norvasc 10 mg p.o. once daily. both of these medications can be titrated down to maintain a good blood pressure. 5. ileus - the patient has an ileus, however, she gradually had an improving abdominal examination, positive flatus and then began to pass stool with ability to tolerate her p.o. medications. 6. infectious disease - the patient had an increased white blood cell count that was persistently elevated in the 20s and remained relatively stable, however, gradually started to increase to 26 and 25. the patient had a clostridium difficile toxin sent as she had been experiencing significant loose stools and it was positive for evidence of clostridium difficile. the patient was then started on flagyl 500 mg p.o. three times a day. this was started on . the patient will need a full fourteen day course for this infection. the patient had complete resolution of her diarrhea after the start of flagyl. she remained afebrile. 7. psychiatry - the patient had intensive care unit delirium and required p.r.n. haldol while she was in the intensive care unit. she did not require any restraints and was not receiving any narcotics at the time. after transfer to the medicine floor, the patient did quite well and had no further episodes of delirium. 8. access - the patient had a right ij that was placed on , at the outside hospital. this was discontinued on . the patient had a picc line placement for long term tpn. 9. disposition - the patient is full code. her family is quite involved including her husband and her children. family can be reached at . in addition, her primary care physician, . , is also very available and involved in her care. the patient was seen by physical therapy who deemed that she would need rehabilitation. the patient is in the process of being screened and referred to various facilities. the patient will require tpn at the time of discharge for at least one week most likely. condition on discharge: stable. the patient is not at her functional baseline, however, with resolution of her acute medical condition, it is likely that she will improve to her baseline functional status. medications on discharge: 1. sodium chloride 0.65% nasal spray for dryness. 2. flomax 110 mcg two puffs twice a day. 3. tylenol rectal suppository p.r.n. fever or pain. 4. dulcolax 10 mg rectal suppository q.h.s p.r.n. constipation. 5. nicotine 14 mg a day patch. 6. miconazole powder 2% to groin once daily. 7. norvasc 10 mg p.o. once daily if the patient on p.o. 8. metoprolol 100 mg p.o. three times a day. 9. benadryl 25 mg p.o. q6hours p.r.n. rash. please discontinue this medication if the patient is not still experiencing rash. 10. flagyl 500 mg p.o. once daily for a full course of two weeks. this was started on and it should be completed on . discharge diagnoses: 1. necrotizing pancreatitis. 2. labile hypertension. 3. respiratory distress secondary to congestive heart failure and bilateral pleural effusions from volume overload. , 12.adf dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances thoracentesis diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified pleurisy with effusion, with mention of a bacterial cause other than tuberculosis acute respiratory failure paralytic ileus diastolic heart failure, unspecified acute pancreatitis 

Answer: The patient is high likely exposed to