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: bactrim / macrobid / cortisone / codeine / vancomycin attending: chief complaint: epigastric pain major surgical or invasive procedure: : ercp : percutaneous dilational tracheostomy with bronchoscopic guidance history of present illness: the patient is a 67 y.o. f with h/o breast cancer s/p lumpectomy, gallstones who presents with epigastric pain and nausea. + emesis and dry heaves. she presented to an osh where the abdominal ct scan demonstrated diffuse new inflammatory changes surrounding the head of the pancreas with fluid tracking along the anterior pararenal fascia- c/w acute pancreatitis. study was limited to absence of ivc contrast thus +gallstones in the gb but gb unremarkable. pain is similar to a presumed attack of biliary colic that she had 2 years ago which resolved without medical intervention. she was given zosyn 4.5 gm iv, protonix 40 mg iv, zofran 4 mg iv, dilaudid 1 mg iv x 2 along with pepcid 20 mg iv x t, benadryl 25 mg iv x t. she was then transferred to for ercp. in the ed she was given dilaudid 1 mg iv x 1. ros gen: no fevers, chills, + chronic night sweats since menopause, no fatigue, 10 lb weight gain to dietary indiscretion heent: no vision changes, tinnitus, loss of hearing, no dysphagia headache, sinus tenderness, rhinorrhea or congestion. cv: no chest pain resp: no cough, no shortness of breath, no orthopnea, pnd gi: + epigastric pain with radiation to b/l lower abdominal quadrants. + nausea, +vomiting/dry heaves no diarrhea, no constipation, gu: no dysuria, hematuria, hesitancy, or change in frequency, change in bladder habits, vaginal discharge skin: no rashes, lesions, pressure ulcers neuro: no weakness, paresthesias, numbness, headaches, dizziness musculoskeletal: no arthralgias, myalgias psych: no sadness or hallucinations. all other review of systems negative. past medical history: l breast- invasive ductal carcinoma, grade with dcis. er positive pr negative- hypercholesterolemia hypothyroidism osteopenia arthritis. multiple utis psh: - excision of a r breast benign mass - disk surgery on her back in - laser eye surgery for her glaucoma social history: she smoked socially in her 20s and drinks less than five drinks per week. she is not working outside of her home. she lives at home with her husband who has multiple myeloma and is currently undergoing treatment. he seems to have failed a novel therapy and is due to be seen at on monday. she admits to being quite worried about him. family history: breast cancer aunt (age 64), gm (age 55), mother at (age 64) physical exam: vs tm = 98.0 p = 87, bp = 104/58 rr = 16 o2sat = 92% ra general: obese female who appear her stated age. she is currently in a great deal of abdominal pain. nourishment: good grooming: fair. mentation: alert, oriented, good historian. eyes:nc/at, perrl, eomi without nystagmus, no scleral icterus noted ears/nose/mouth/throat: dry mm, no lesions noted in op neck: supple, no jvd appreciated respiratory: lungs cta bilaterally without r/r/w cardiovascular: rrr, nl. s1s2, no m/r/g noted gastrointestinal: soft, markedly diminished bowel sounds. + epigastric tenderness. no rebound or guarding. rectal deferred given patient's discomfort. genitourinary:wnl skin: no rashes or lesions noted. no pressure ulcer extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. lymphatics/heme/immun: no cervical lymphadenopathy noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. -sensory: no deficits to light touch throughout. no foley catheter/tracheostomy/peg/ventilator support/chest tube/colostomy psychiatric: appropriate affect and despite her pain level she has appropriate brightening. pertinent results: 12:25am glucose-157* urea n-19 creat-0.8 sodium-141 potassium-5.6* chloride-106 total co2-27 anion gap-14 12:25am estgfr-using this 12:25am alt(sgpt)-48* ast(sgot)-71* alk phos-40 tot bili-1.0 12:25am lipase-4335* 12:25am wbc-17.5*# rbc-4.25 hgb-13.4 hct-40.5 mcv-95 mch-31.5 mchc-33.1 rdw-13.0 12:25am neuts-94.7* lymphs-2.9* monos-1.9* eos-0.2 basos-0.2 12:25am plt count-199 12:25am pt-13.2 ptt-21.8* inr(pt)-1.1 ecg: sr prolonged qtc osh: wbc = 20 k hct = 38 amylase = 4219 lipase >3000 u/a neg leuk esterace, negative nitrites, micro: ucx(final): no growth bcx: no growth ucx(final): no growth mrsa screen(final): negative sputum cx(final): 2+ gnr, sparse growth bcx: no growth sputum cx(final): 2+ gpc pairs; sparse growth mrsa screen(final): negative blood cx no growth sputum: no growth sputum: no organisms urine: negative blood cx: no growth blood cx: no growth iv catheter tip no growth sputum contaminated blood culture - gpc in clusters x 2 bottles, unclear if central line urine negative bcx - no growth sputum - no orgs sputum - gpc pairs and cluster bal - no microorganisms, pmns. ucx -vre uti sensitive to zyvox imaging: ercp: sludge and small stone fragments were extracted. there is no evidence of biliary stricture or ductal dilatation. filling defects within the gallbladder consistent with stones/sludge ct: basilar atelectasis and pleural effusion bilaterally. moderate amount of fluid in peritoneal cavity, strandings in fat surrounding the pancreas and other organs and adynamic ileus are findings compatible with pancreatitis. no free air. cxr: left-sided pleural effusion, basilar atelectasis cxr: ng tube tip passes below the diaphragm, most likely terminating in the stomach. no interval change bibasilar atelectasis cta prelim: interval worsening of peripancreatic inflammatory stranding without evidence yet of pancreatitis-related complication. no definite focal fluid collection observed. anasarca with small left greater than right pleural effusions. cholelithiasis with biliary stent in place. cxr: increasing left basilar atelectasis. minimally improving right basilar atelectasis. cxr: no interval change in et tube is persistently low with tip 1.7 cm above the carina. bibasilar atelectasis with small pleural bilateral effusions are unchanged. cxr: endotracheal tube seen with tip approximately 3 cm above the carina. nasogastric tube coursing over the stomach, tip incompletely imaged. cardiac and mediastinal contours are unchanged. persistent retrocardiac opacity and bilateral pleural effusions, not significantly changed from prior, however, do appear increasing since studies performed in . - cxr post-trach: no pneumomediastinum or ptx. the lung volumes are somewhat improved though there is persistent obscuration of the hemidiaphragms consistent with effusion and atelectasis. - ct abd w/ contrast: . interval evolution of known pancreatitis, with hypo-enhancement in the region of the pancreatic head, and slight increase in parapancreatic fluid collections which have become more loculated in appearance, extending superior to the pancreas as well as inferior to the pancreas, and extending inferiorly along gerota's fascia and the left paracolic gutter. 2. biliary stent in place. 3. interval slight decrease in parahepatic free fluid and increase in pelvic free fluid. 4. interval increase in now small-to-moderate sized bilateral pleural effusions, with related compressive atelectasis in the visualized lung bases. cxr: since , left lower lobe consolidation with complete collapse and left pleural effusion increased. right basilar opacity also increased. mild volume overload is present. cxr: indwelling devices are unchanged in position. improvement in recently described volume overload with minimal perihilar edema remaining. no substantial change in left retrocardiac opacity and adjacent moderate left pleural effusion, but right pleural effusion has decreased in size. cxr: interval increase in the left lower lobe atelectasis most likely completely atelectatic by now. otherwise unchanged portable abdomen: dobhoff tube lies in the stomach. cbd plastic stent overlies right upper quadrant of the abdomen. there are no dilated loops of small or large bowel, without evidence of obstruction or ileus. there is no supine evidence of free intraperitoneal air or pneumatosis. assessment and plan: 67f gallstone pancreatitis s/p ercp, sphincterotomy, stent, intubated for respiratory decompensation brief hospital course: the patient is a 67 y.o. f with h/o gall stones, breast cancer s/p lumpectomy with radiation now on tamoxifen, who presents with presumable gallstone pancreatitis. issues: 1) acute gallstone pancreatitis - per micromedix: a retrospective cohort study of 703 postmenopausal women diagnosed with invasive breast cancer revealed adjuvant tamoxifen therapy is related to a risk in gallstone formation which is most evident after 3 years of treatment. of the 703 patients, 457 received tamoxifen while 246 had not. after a mean follow-up of 4.6 years, the incidence of gallstone formation in tamoxifen-treated patients was 37% compared to 2% in patients not receiving tamoxifen (p less than 0.0001) (akin et , ). 2) respiratory decompensation/failure s/p tracheostomy 3) presumed vap 4) maculopapular abdominal rash - suspected drug rash, resolving 5) vre uti sensitive to zyvox . chief complaint: gallstone pancreatitis . events: transferred from osh for ercp for presumed gallstone pancreatitis. ercp performed. increasing abdominal pain o/n, hypotension treated with multiple 1l boluses, kub at 6am shows ?free air under diaphragm. to ticu, intubated ngt, po/iv contrast ab ct, right ij triple lumen placed, esophageal balloon placed - peep increased to 24, t=102.3 - sent bld,urine,sputum cx, changed abx to vanco/zosyn, on tpn, bladder pressure peaked at 28 insulin drip started due to elevated bs lasix gtt began with slow success; rising white count decreasing peep cta abdomen : some meds changed to po, increasing fever and wbcs, continuing to diurese. tpn, albumin w/lasix gtt, peep at 8 rij d/c'd left subclavian cvl placed, transfused 2 uprbc - tolerating cpap well, daily sbts, diuresed >3l, hct holding after transfusion - tolerating ps well, sbt @6am, diuresing 1-2l net, albumin added to hydration regimen, clonidine patch aadded to improve bp control; . overnight spiked 102, pancx. failed sbt in am pt with persistent rash in groin extending onto flank. rsbi 44 but failed sbt again, continue weaning; worsening lower abdominal maculopapular rash, with blistering over mons, and progression to back and bilateral flanks. spiked t 102, recultured. - failed sbt again, attempted to continue wean; still persists on cpap/ps 5+10, cultures pending, continued rash spread seems to be atopic in nature, rsbi+sbt in am, treated with benadryl for continued rash -failed sbt again today and was extubated transiently. as patient was agitated, she was given propofol for sedation. - trach @ bedside today, then started weaning. gen ordered ct abd w/ contrast to eval for interval change. - neuro status waxing and , weaned off fent gtt, started on fent patch + oxycodone po, slowly weaned off benzo (ativan 0.5mg q8hrs x 2 days, then q12hrs, then qdaily, then off). - concern for increased secretions and clinical discomfort on ventilator concern for infectious process; cxr shows interval infiltrate from , pt started on linezolid/zosyn - had bronchoscopy. had one episode of emesis: 15 cc's of yellowish emesis, nonbloody, nonbilious, following coughing episode. given zofran. further attempts to wean ativan and fentanyl and replace with propofol. - bal from no growth. vre uti sensitive to zyvox. foley changed. low grade temps during the day. on tcm >12 hours until pt complains of fatigue, placed back on cpap 5/5/35% @ mn for rest, plan for longer tcm . neuro status much improved, aao x 3, answering questions appropriately. - rehab screen to be pursued, dobhoff placed, started on a clonidine patch for persistent hypertension, failed speech and swallow - to be re-evaluated over next two days; remained off ventilator all night : neurologic: neuro checks q: 4h pain: oxycodone po atc, fent patch 25mcg/hr, iv dilaudid prn breakthrough sedation/benzo withdrawal tx: ativan and haldol prn, on sl zyprexa , clonidine patch, pt much more alert. . cardiovascular: hd stable. on lopressor 75mg tid po. still remains tachycardic with stable bp. pulmonary: - s/p trach . initially tolerated tcm x 48 hours but subsequently needed vent support. again on tcm trials. - continue nebs/combivent treatment . gi / abd: abdomen exam improving tf started , at goal, tpn stopped. monitor for residuals. . nutrition: on tf. . renal: foley, follow uop, to maintain euvolemia. . hematology: hct stable. . endocrine: - insulin ss for labile blood sugars secondary to pancreatic inflammation - hypothyroid - tsh 3.0 on , maintain levoxyl 25mcg po. id: - vre uti - on zyvox for a 14 day course - bal negative, zosyn d/c'ed after discussion with primary team. . lines/tubes/drains: right radial aline inserted , lsc cvl triple lumen, piv x 1, trach, foley, dobhoff medications on admission: atorvastatin - (prescribed by other provider) - 10 mg tablet - tablet(s) by mouth once a day levothyroxine - (prescribed by other provider) - 50 mcg tablet - 1 tablet(s) by mouth once a day tamoxifen - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day trimethoprim - (prescribed by other provider) - 100 mg tablet - 1 tablet(s) by mouth once a day medications - otc aspirin - (prescribed by other provider; otc) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day calcium + vitamin d - (prescribed by other provider; otc) - 600 mg (1,500 mg)-200 unit tablet - 2 tablet(s) by mouth once a day glucosamine-chondroitin - (prescribed by other provider; otc) - dosage uncertain multivitamin - (prescribed by other provider; otc) - tablet - 1 tablet(s) by mouth once a day discharge medications: 1. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 2. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed. 3. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 4. hydromorphone (dilaudid) 0.5-2 mg iv q4h:prn 5. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 6. oxycodone 5 mg/5 ml solution sig: ten (10) ml po q6h (every 6 hours) as needed. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal prn (as needed) as needed for constipation. 8. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day). 9. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 10. haloperidol 0.5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for agitation. 11. lorazepam 1 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for anxiety. 12. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 13. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 15. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 16. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qtues (every tuesday). 17. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 12 days. 18. levothyroxine 25 mcg tablet sig: one (1) tablet po once a day. 19. insulin regimen insulin sc (per insulin flowsheet) sliding scale fingerstick qachs insulin sc sliding scale: breakfast lunch dinner bedtime regular glucose insulin dose 0-50mg/dl 4 oz. juice 51-150mg/dl 0 units 151-200mg/dl 2 units 201-250mg/dl 4 units 251-300mg/dl 6 units 301-350mg/dl 8 units 351-400mg/dl 10 units > 400mg/dl notify m.d. discharge disposition: extended care facility: and discharge diagnosis: gallstone pancreatitis, acute respiratory failure & ventilator dependence discharge condition: stable discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications on discharge from rehab and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to ambulate several times per day. followup instructions: provider: phone: date/time: 9:00 provider: , md phone: date/time: 10:30 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances endoscopic sphincterotomy and papillotomy non-invasive mechanical ventilation percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus endoscopic insertion of stent (tube) into bile duct transfusion of packed cells dilation of esophagus diagnoses: pneumonia, organism unspecified hypocalcemia pure hypercholesterolemia unspecified pleural effusion urinary tract infection, site not specified unspecified acquired hypothyroidism infection with microorganisms resistant to penicillins personal history of malignant neoplasm of breast unspecified glaucoma pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure disorders of phosphorus metabolism calculus of gallbladder without mention of cholecystitis, without mention of obstruction other and unspecified complications of medical care, not elsewhere classified other specified antibiotics causing adverse effects in therapeutic use personal history of irradiation, presenting hazards to health acute pancreatitis disorder of bone and cartilage, unspecified dependence on respirator, status arthropathy, unspecified, site unspecified family history of malignant neoplasm of breast personal history, urinary (tract) infection 

Answer: The patient is high likely exposed to