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: heparin agents attending: chief complaint: respiratory distress major surgical or invasive procedure: central line placement history of present illness: 60 yo woman with multiple medical problems as noted below who initially presented with 1-2 days of cough, wheezing, "whole body spasm," confusion, and lethargy. in the ed, she was found to have 22% bandemia and soon developed hypotension (sbp in the 60s) that did not respond to iv fluids. she was started on dopamine and transferred to the icu. given an initial abg of 7.27/72/71 on 3l oxygen by nasal cannula, nippv was attempted but not tolerated, so the patient was intubated. there was a question of seizure activity on , at which point she was loaded with iv phenytoin. following a second episode of fast coarse tremors, the patient was again loaded with iv phenytoin ; she has been maintained on this medication since. further, out of concern for possible baclofen withdrawal, she was restarted on this medication on with good effect (reduction in tremors). past medical history: 1. mrsa bacteremia ultimately complicated by t6-7 osteomyelitis and discitis s/p t6-7 laminectomies and transpedicular decompression of t6, complicated by paraplegia 2. stage iv sacral decubitus ulcer with associated osteomyelitis necessitating diverting colostomy that was re-sited 3. coronary artery disease s/p myocardial infarction 4. hypertension 5. copd (on home oxygen) 6. esbl klebsiella urinary tract infection c/b sepsis 7. polycythemia 8. heparin induced thrombocytopenia 9. possible seizure disorder. 10. cerebellar stroke 11. aneurysms in eca and right mca 12. colocutaneous fistula 13. prior peg tube 14. pneumonia 15. rectovaginal fistula 16. hyponatremia * pertinent past studies: * pft's : fvc-35%, fev1-26%, fev1/fvc-0.55 (75%) tlc-57% * dobutamine tte : no evidence of inducible ischemia (limited study) * tte : ef 60%, normal lv size and function, moderate pulmonary hypertension, likely diastolic dysfunction * abg: baseline paco2 in the 50s social history: lives at home with her husband, who is very supportive and is her primary caregiver. she has a history of tobacco use, but has not used any in 2 years. no h/o etoh abuse. family history: nc physical exam: t-98.6 bp-150/68 hr-115 rr-18 spo2-92% on 4l nc gen: pleasant, comfortable after re-positioning, non-toxic heent: no sinus tenderness, pale conjunctivae, mucous membranes slighly dry neck: soft, supple, no cervical adenopathy cv: tachycardic, regular, no murmurs pulm: moderate crackles halfway up bilaterally, no wheezes back: no cva or spinal tenderness abd: soft, non-tender, non-distended, active bowel sounds, ample loose brown stool in ostomy bag ext: r ankle had just been bandaged and wrapped, 2+ dp pulses bilaterally, multipodus boots over pneumoboots bilaterally, no edema neuro: mild diffuse tremor, bilateral lower extremity spasm (left greater than right) pertinent results: ** admit labs: ** cbc ** 05:00pm wbc-10.7 rbc-5.06# hgb-13.9# hct-41.3# mcv-82 mch-27.4 mchc-33.6 rdw-15.2 05:00pm neuts-72* bands-22* lymphs-3* monos-3 eos-0 basos-0 atyps-0 metas-0 myelos-0 05:00pm plt smr-normal plt count-359 . ** chem ** 05:00pm glucose-104 urea n-19 creat-1.1 sodium-115* potassium-6.5* chloride-74* total co2-28 anion gap-20 05:00pm alt(sgpt)-39 ast(sgot)-108* ck(cpk)-236* alk phos-84 amylase-44 tot bili-0.4 05:00pm lipase-18 . ** cardiac enzymes ** 05:00pm ck-mb-8 ctropnt-0.09* . ** ua ** 06:24pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 06:24pm urine granular-0-2 coarse granular casts 06:24pm urine rbc->50 wbc- bacteria-many yeast-none epi-0-2 . ** abg ** 07:02pm type-art o2 flow-3 po2-71* pco2-72* ph-7.27* total co2-35* base xs-3 intubated-not intuba . ** admit cxr: 1. interval placement of an et tube, with the tip positioned two centimeters above the carina. interval placement of a central venous catheter with the tip positioned in the mid svc. no pneumothorax. 2. prominence of pulmonary vasculature and central hilar vascular engorgement suggests mild chf. 3. left base atelectasis and/or infiltrate. . ** echo: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 60%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the left ventricular inflow pattern suggests impaired relaxation. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . ** chest cta: 1. no pulmonary embolism. 2. extensive patchy airspace opacities. given the additional findings of septal thickening and bilateral pleural effusions, this likely represents congestive heart failure. superimposed infectious process is also possible. . ** head ct: no intracranial hemorrhage or edema is evident. mri is more sensitive for assessment of subtle changes associated with hyponatremia and acute infarction. . ** eeg: abnormal portable eeg due to the slow and disorganized background and due to the bursts of generalized slowing. these findings indicate a widespread encephalopathy affecting both cortical and subcortical structures. metabolic disturbances, medications, and infection are among the most common causes. there were no areas of prominent focal slowing, and there were no epileptiform features. . ** 24-hour eeg: this is a discontinuous 24-hour bedside eeg from that was mildly abnormal due to a somewhat slowed background rhythm in the upper theta and lower alpha frequency ranges. this may reflect excessive drowsiness or possibly an early encephalopathy. common causes of encephalopathy include infection, metabolic disturbances, and medication effect. no lateralizing or epileptiform abnormalities were identified in this recording and of significance, on two occasions, the patient was noted to save tremor or shaking without electrographic evidence of seizure. brief hospital course: 60 yo woman admitted with hypercarbic respiratory failure due to probable pneumococcal +/- klebsiella pneumonia and copd exacerbation with hospital course complicated by klebsiella urinary tract infection, probably seizures, and intermittent hemodynamic instability. . 1. hypercarbic respiratory failure: her hypercapneic respiratory failure was ultimately attributed to a combination of pneumococcal pneumonia, copd exacerbation, and congestive heart failure. she was therefore treated with a course of antibiotics (initially vancomycin (5 days followed by an additional 3 days ) and levofloxacin (3 days), followed by piperacillin/tazobactam (8 days), metronidazole (6 days), and finally meropenem (day today)), steroids, and nebulizers; she was also gently diuresed as tolerated by her blood pressure. she gradually improved, and on she self-extubated. she initially tolerated extubation on significant, non-invasive ventilatory support, and her steroids were tapered to off on . she was ultimately reintubated for hypercapneic respiratory failure (paco2 131) on , at which point stress-dose steroids were restarted. she was successfully extubated and was transferred to the floor on nasal cannula, meropenem, 60 mg of prednisone and standing nebs. she completed a 14-day course of meropenem and continued to improve, requiring less frequent suctioning and remaining stable on her home level of 2l of o2. . 2. hypotension: her hypotension was attributed to sepsis and resolved with treatment of her infections (pneumonia as well as esbl klebsiella urinary tract infection); she was quickly weaned off of pressors and was aggressively volume resuscitated up front. she did well hemodynamically until , when she again became hypotensive, and transiently required pressors. her sbp remained in the 100s-110s throughout the remainder of her hospital course. . 3. urinary tract infection: urine culture grew esbl klebsiella that likely has been adequately treated with ten days of meropenem. repeat urinalysis was clean with a negative culture. . 4. hyponatremia: present on admission, likely due to hypovolemia; resolved with hydration. of note, baseline na is between 133-136. . 5. sinus tachycarida: etiology not entirely clear. it has been attributed to intravascular volume depletion, agitation, and anxiety. concern for pulmonary embolus was alleviated with a negative ct scan. . 6. pressure ulcers: both the sacral decubitus ulcer and the right ankle ulcer were potential portals of entry for infection, although both sites appear clean with good granulation tissue. she continued zinc and vitamin c. . 7. seizure activity: transient episode of hand shaking/myoclonus on without further events. head ct and eeg negative. differential diagnosis includes seizure (prior questionable history of seizure disorder) or baclofen withdrawal. neurology was consulted and recommended starting dilantin and baclofen. dilantin levels were stable and pt will follow-up with neurology as an outpatient. . 8. coronary artery disease: pt was continued on asa and lipitor. ace-i was not added due to borderline low bp and can be added as an outpatient. . 9. f/e/n: speech and swallow evaluated the pt after extubation and cleared her for a regular diet. she tolerated food well without any signs of aspiration. medications on admission: 1. albuterol, one to two puffs q 6 hours. 2. fluticasone, two puffs b.i.d. 3. ipratropium bromide, two puffs q.i.d. 4. salmeterol xinafoate, one ih b.i.d. 5. gabapentin, 400 mg po t.i.d. 6. diltiazem, 60 mg po q.i.d. 7. lactulose, 20 grams b.i.d. 8. famotidine, 20 mg po b.i.d. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. lactulose 10 g/15 ml syrup sig: thirty (30) ml po three times a day. 3. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily) for 10 days. disp:*10 capsule(s)* refills:*0* 4. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day). 6. dilantin 100 mg capsule sig: one (1) capsule po three times a day. disp:*90 capsule(s)* refills:*2* 7. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 8. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation three times a day. 9. salmeterol xinafoate 50 mcg/dose disk with device sig: one (1) puff inhalation three times a day. 10. gabapentin 400 mg capsule sig: one (1) capsule po q8h (every 8 hours). 11. prednisone 20 mg tablet sig: two (2) tablet po daily (daily): take 2 tabs from , 1.5 tabs from , 1 tab from and 0.5 tab from . disp:*15 tablet(s)* refills:*0* 12. prevacid 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 13. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation three times a day. 14. atrovent 18 mcg/actuation aerosol sig: one (1) puffs inhalation three times a day. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: 1. pneumococcal pneumonia 2. hypercarbic respiratory failure 3. copd on home oxygen 4. klebsiella uti 5. seizure disorder 6. sinus tachycardia 7. paraplegia due to mrsa osteomyelitis 8. hyponatremia secondary diagnosis: 1. cad s/p mi 2. hit 3. colocutaneous fistula 4. rectovaginal fistula 5. aneurysms discharge condition: good, stable on 2l nasal cannula discharge instructions: please take all medications as prescribed. we have started you on dilantin for seizures. you will follow-up with neurology and dr. . followup instructions: we have made you an appointment to see dr. on thursday, at 12:30pm we have also made you a follow-up appointment with neurology: , md where: neurology phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization infusion of vasopressor agent diagnoses: urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site hyposmolality and/or hyponatremia severe sepsis obstructive chronic bronchitis with (acute) exacerbation other convulsions acute and chronic respiratory failure other specified cardiac dysrhythmias other specified septicemias pressure ulcer, lower back pneumococcal pneumonia [streptococcus pneumoniae pneumonia] acute diastolic heart failure encephalopathy, unspecified paraplegia pressure ulcer, ankle fistula of intestine, excluding rectum and anus digestive-genital tract fistula, female skeletal muscle relaxants causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to