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: percocet attending: chief complaint: fall major surgical or invasive procedure: none history of present illness: this is a 58 year old female s/p witnessed fall down 8 wooden stairs today at approximately 1230. had a 4min loc. when ems arrived she was a&0x3 and was brought into for further evaluation. while in the ct scanner here she vomited x1 while supine, and soon after developed altered mental status. she was subsequently intubated. ct demonstrated diffuse sah. the patient is currently intubated and sedated. past medical history: ++ diabetes mellitus, type 1 - history of insulin pump, but d/c since transplant ++ renal transplant, living related donor (brother) - , secondary to diabetic renal dz ++ pancreatic trasnplant - , dr. - fluconazole, unasyn peri- and pre-operatively - tapered steroids to prednisone; cellcept+prograf ++ hypertension ++ hypercholesterolemia ++ hypothyroidism ++ squamous cell ca - rle, excised ~ 2 years pta ++ chronic foot ulcers - h/o multiple surgeries and antibiotic courses for charcot foot - last hospitalization ++ bilateral fibroadenomas of breast, excised ++ endometrial biopsy ++ h/o vitrectomies, laser surgery, cataract surgery bilat eyes social history: lives in with daughter, and sister and sister's children in same house. functional with basic and most advanced adls. works as a special needs teacher. denies any history of tobacco, alcohol, tobacco use. family history: 2 brothers with diabetes. mother - died at 86yrs of old age father - died at 76yrs, had parkinson's dz physical exam: physical exam: o: t:96.4 bp: 186/82 hr:86 r: 18 o2sats 97t gen: intubated/sedated heent: nc, laceration to r parietal area pupils: surgical, non reactive eoms n/a neck: supple. extrem: warm and well-perfused. neuro: mental status: intubated. off sedation, grimaces and opens eyes to nox. cranial nerves: i: not tested ii: pupils surgical iii, iv, vi: n/a v, vii: n/a viii: n/a ix, x: palatal elevation symmetrical. : n/a xii: n/a discharge exam (pertinent positives) neuro: alert and oriented x 3. patient is interactive, with appropriate attention. strength: ue: symmetric, le r: , l hip flexor/extensor . l thigh flexor/extensor 0/5, l plantar dorisflexion/plantar flexion 0/5. sensation intact bilaterallly. pertinent results: admission: 01:00pm blood wbc-15.4*# rbc-4.22 hgb-12.5 hct-37.4 mcv-89 mch-29.6 mchc-33.4 rdw-14.5 plt ct-385 01:00pm blood neuts-39.6* lymphs-51.6* monos-2.9 eos-4.6* baso-1.4 01:00pm blood pt-11.7 ptt-22.7 inr(pt)-1.0 01:00pm blood glucose-114* urean-36* creat-1.3* na-136 k-4.5 cl-102 hco3-28 angap-11 01:00pm blood alt-24 ast-35 ld(ldh)-189 alkphos-173* totbili-0.2 01:00pm blood ctropnt-<0.01 02:26am blood calcium-8.2* phos-3.6 mg-1.8 04:51am blood tacrofk-3.6* 01:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:36pm blood type-art po2-428* pco2-38 ph-7.44 caltco2-27 base xs-2 01:13pm blood glucose-116* lactate-1.7 k-4.6 discharge: 06:25am blood wbc-11.9* rbc-3.41* hgb-10.0* hct-30.4* mcv-89 mch-29.5 mchc-33.1 rdw-14.6 plt ct-416 03:47am blood neuts-61.2 lymphs-33.2 monos-4.6 eos-0.3 baso-0.6 06:25am blood plt ct-416 12:44pm blood ck(cpk)-63 12:44pm blood ck-mb-4 ctropnt-0.12* 06:25am blood calcium-9.5 phos-2.1* mg-2.1 02:36am blood lactate-1.3 . ct head: impression: small intraparenchymal hemorrhage within the right frontal lobe with subarachnoid hemorrhage in the frontal lobes bilaterally and right temporal lobe. vascular calcifications- correlate for risk factors. dense focus in the left ocular lens- correlate with history and examn. . ct cspine: impression: no fracture. alignment maintained. small lucencies in the cervicalv ertebrae- may relate to cysts/ fat depostis. correlate with any h/o primary malignancy. if there si continued concern for cord, ligamentous/neural injury, mr can be considered if not ci> minimal mucosal thickening/fluid in the mastoid air cells on both sides. small calcified focus in the right pretracheal region-? node/ exophytic thyroid nodule. . ct torso: impression: 1. bilateral atelectasis but no evidence of significant aspiration or pneumonia. no pneumothorax. 2. within the limitations of a non-contrast study, no evidence of acute abdominal or pelvic traumatic process. 3 right adnexal cyst which is stable in size since at least . . ct head: 1. stable right frontal parenchymal hemorrhage with subarachnoid hemorrhage in bilateral frontal lobes. subarachnoid hemorrhage in the right temporal lobe area is not clearly visualized on this study. 2. hyperdensity within the sulcus at the left frontal vertex may represent artifact; however, could represent a small focus of hemorrhage. . ct head: 1. significant clearance of the predominantly subarachnoid hemorrhage with persistent hyperdensity in the frontal lobes bilaterally and along the falx, which may represent a combination of subdural and subarachnoid blood. 2. no evidence for new hemorrhage. 3. prominence of the subdural space along the right frontal lobe, increased compared to prior; therefore, this may represent a developing right frontal subdural hygroma. 4. central and cortical atrophy, predominantly frontal. . impression: ap chest compared to : mild-to-moderate pulmonary edema is new. mild cardiomegaly is stable. mediastinal vascular distention has increased indicating biventricular cardiac decompensation and/or volume overload. small left pleural effusion is presumed. dr. was paged. . echo the left atrium and right atrium are normal in cavity size. a small secundum atrial septal defect is present. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). doppler parameters are indeterminate for left ventricular diastolic function. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric lvh with hyperdynamic lv systolic dysfunction. positive bubble study consistent with small asd/stretched pfo. indeterminate indices for diastolic function assessment. compared with the prior study (images reviewed) of , bubble study reveals a likely asd/stretched pfo. . portable cxr: history: possible volume overload. findings: in comparison with the study of , there are lower lung volumes. there is some continued engorgement of pulmonary vessels, consistent with volume overload. bilateral pleural effusions with bibasilar compressive atelectasis is seen. widening of the vascular pedicle is again noted. . right foot, three views, at 15:08 hours. history: recent pinning operation. comparison: multiple priors, the most recent dated . findings: there is a dressing over the entirety of the foot. there has been prior transmetatarsal amputation of the fourth and fifth digits. there has also been segmental osteotomies involving the second and third metatarsals. these changes are markedly chronic and stable. there are longitudinal k-pins through the first ray, extending through a truncated distal phalanx and traversing the interphalangeal joint as well as the first metacarpophalangeal joint. extensive bony hypertrophy of the first metatarsal is again present and markedly stable. overall, the alignment has not changed across multiple prior examinations. there is no radiographic evidence of loosening or other hardware compromise. a thin linear metal foreign body again projects within the plantar soft tissues of the foot. . impression: markedly stable appearance of the foot. the longitudinal k-pins in the first ray are stable in position and course. . : le us: impression: no evidence of deep vein thrombosis in either leg. . mri/mra neck/brain impression: 1. a somewhat linear-appearing focus of abnormally slow diffusion in the white matter of the right frontal lobe, subjacent to the known intraparenchymal hematoma. this could represent an acute lacunar infarct, or extension of the blood products. 2. some residual subarachnoid blood noted within the sulci of the left frontal lobe. stable bilateral subdural effusions along the convexities. 3. mra demonstrating moderate narrowing of the cavernous internal carotid arteries, right greater than left, as well as mild irregularity of the proximal mca branches bilaterally, all suggestive of atherosclerosis. 4. normal mra of the neck. the study and the report were reviewed by the staff radiologist . portable cxr : history: aspiration and fever, to assess for worsening pneumonia. . findings: in comparison with study of , the picc line appears to have been pulled back to the axillary region, outside of the hemithorax. there is some increased sharpness of the hemidiaphragm, suggesting decreasing pleural effusion and atelectasis at the left base. . micro: uc: ng -> final bc: ngtd (two pending), remainder ng -> final brief hospital course: 58 yo woman with h/o type i dm s/p pancreas transplant who had a recent surgery of right toe, which needed pinning. after surgery, fell and hit her head after falling down 8 stairs. found to have bilateral sah in the frontal lobes on ct. during the ct she aspirated and has had altered ms since then. she required intubation and sedation in the ed, given her ams. neurosurg evaluated her and did not feel her sah required drainage. . on , after intubation and sedation she was admitted to the sicu for monitoring. she was started on dilantin for seizure prophylaxis. repeat head ct on showed significant clearance of the subarachnoid hemorrhage with persistent hyperdensity in the frontal lobes bilaterally and along the falx. no further hemorrhage was seen. no evacuation was performed. she was extubated on . at that time she was having trouble moving her l arm and l leg, but was able to wiggle her fingers and toes on that side. neurosurgery felt that this weakness was not related to her sah as the sx would not be explained by the location of the bleed. . nephrology was consulted given transplant history and tacrolimus, and they recommended daily tacrolimus levels, especially in the setting of concomitant dilantin therapy, which increases metabolism of tacrolimus. an increased dose of tacro was recommended (4 mg suspension ) with target tacro levels of . . between and she has had a worsening leukocytosis with white count rising to 22. on the night of she had a desaturation event to high 80s on 5 l o2; she briefly required a face mask, after which her saturations improved to mid-high 90s. low grade temperatures overnight to 100.3. chest x-ray done this morning showed an infiltrate in left lower lobe, assumed to be aspiration pna. she was transferred to the medical service for management of her presumed aspiration pneumonia. . on the medical floor the patient was treated with vanc, unasyn, and levofloxacin for aspiration pneumonia. on the evening of the patient became increasingly tachypneic and oxygen requirement increased to 5 liters with oxygen saturation in the mid 90s. cxr bilateral infiltrate concerning for volume overload versus ards. pt given nebs, broadened to vanc, zosyn, and given 20mg iv lasix x2. patient was transferred to the micu. . in the micu she was diuresed and converted to unasyn for her aspiration pna. neurology was consulted for decreased movement on her l side. she also had an echo which demonstrated a pfo. of note, her hypoxic respiratory failure improved and she was transferred to the floor. she underwent an mri/mra of the neck to evaluate for extension of sah vs ischemic stroke. the mri/mra demonstrated extension vs new slow bleed. clinically, however, she continued to improve and started to move her l arm and leg. she was maintained on unasyn and transferred to the floor for further evaluation. . upon arrival to the floor she was hemodynamically stable, and afebrile. she had no respiratory distress and was noted to be moving her left arm, and her left hip, but not her left leg. she was evaluated by podiatry who removed her bandage and noted that the pins were in place. on the morning of she spiked a fever to 101. she had a portable cxr which showed a midline intravenous catheter, but no acute intra-pulmonary process. her effusions were decreased in size at the time of the study. all culture data has been negative to date. her antibiotic coverage was broadened to cefepime, vancomycin, and metronidazole for presumed inappropriate treatment of an aspiration pna. since she has been broadened, she has been afebrile. she was followed by to help adjust her insulin sliding scale. . follow up: - she will need to be seen by neurology on the date listed on page one. - please follow up on a vanc level prior to her next dose at rehab. - her antibiotics course will be completed on . please d/c midline central venous catheter after antibiotics are completed. medications on admission: 1. asa 81mg daily 2. calcium carbonate 3. lasix 20mg daily 4. levothyroxine 150mcg daily 5. lisinopril 10mg daily 6. mvi daily 7. novolog pump 8. pravastatin 40mg daily 9. prednisone 2.5mg daily 10. sulfamethoxazole - t 400mg/80 daily discharge medications: 1. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 2. prednisone 2.5 mg tablet sig: one (1) tablet po daily (daily). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 4. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. levothyroxine 50 mcg tablet sig: three (3) tablet po daily (daily). 7. acetaminophen 325 mg tablet sig: one (1) tablet po q6h:prn as needed for fever. 8. labetalol 100 mg tablet sig: two (2) tablet po tid (3 times a day). 9. tacrolimus 1 mg capsule sig: four (4) capsule po bid (2 times a day). 10. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 11. insulin aspart 100 unit/ml cartridge sig: one (1) please see sliding scale subcutaneous four times a day: please see attached sliding scale. 12. insulin glargine 100 unit/ml cartridge sig: one (1) please see insulin sliding scale for fixed doses subcutaneous once as scheduled dose. 13. sodium chloride 0.9 % 0.9 % parenteral solution sig: three (3) ml intravenous q8h (every 8 hours) as needed for line flush. 14. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 15. mycophenolate mofetil 250 mg capsule sig: one (1) capsule po bid (2 times a day). 16. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 17. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po bid (2 times a day) as needed for constipation. 18. aspirin 81 mg tablet sig: one (1) tablet po once a day. 19. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours). 20. vancomycin 1,000 mg recon soln sig: one (1) intravenous once a day. 21. cefepime 2 gram recon soln sig: one (1) intravenous q12h. 22. calcium carbonate-vitamin d3 600-400 mg-unit tablet sig: two (2) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: sah secondary diagnosis: aspiration pna hypoxic respiratory failure due to pulmonary edema discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. - you were admitted to the hospital after you fell, and then developed a bleed in your brain. your hospital course was complicated by a pna, pulmonary edema (fluid in your lungs), and decreased movement of your left arm and leg which may have been due to an additional bleeding in your brain. you were given antibiotics for your pneumonia, and had several imaging studies to follow the bleed in your brain. you were sent to a rehabilitation facility to help you regain your strength, and help you understand what activities you will be to do at home. you will need to take the following medications at home: added: vanc, cefepime, metornidazole, labetolol, lactulose, senna, colace, bisadocdyl, tylenol changed: lisinopril stopped: none nursing orders for tonight/tomorrow: -please draw a vanc trough prior to the next vanc dosing. goal -if blood pressure is normal on . please md to increase lisinopril dose, and decrease labetolol dose. -please make a note that antibiotics (vanc, cefe, metronidazole) should be stopped on . -if her blood pressure is stable on , please md regarding adding home lasix dose (20 mg po daily) followup instructions: department: podiatry when: thursday at 9:40 am with: , dpm building: ba ( complex) campus: west best parking: garage . 01:00p , , neurology unit cc8 (sb . : 9:30 dr. : neurosurgery. location: of building. please get a head ct on cc3 at 8:45 am prior to your appointment procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization diagnoses: pure hypercholesterolemia unspecified pleural effusion unspecified essential hypertension unspecified acquired hypothyroidism pulmonary collapse acute respiratory failure personal history of other malignant neoplasm of skin pneumonitis due to inhalation of food or vomitus ostium secundum type atrial septal defect accidental fall on or from other stairs or steps hypoxemia pulmonary congestion and hypostasis cerebral artery occlusion, unspecified with cerebral infarction hemiplegia, unspecified, affecting unspecified side subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness cerebral atherosclerosis kidney replaced by transplant pancreas replaced by transplant diabetes mellitus without mention of complication, type i [juvenile type], uncontrolled dysphagia, unspecified 

Answer: The patient is high likely exposed to