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: penicillins / tetracycline / sulfa (sulfonamides) attending: chief complaint: unresponsiveness major surgical or invasive procedure: tracheostomy placement tracheal stent placement picc line placement subclavian line placement bronchoscopy lumbar puncture history of present illness: 57-year-old woman with history of tracheobronchial malacia was transferred from after being found unresponsive at home on . she was found to be in acute hypercarbic and hypoxic respiratory failure and was intubated on . she was initially hypotensive, requiring fluid resuscitation and pressors for the first 24 hours. she was found to have a possible lll pneumonia, received 10 days of moxifloxacin, as well as empiric vancomycin for the first 4 days. on she was diagnosed with a uti, with culture pending, and was started on ceftriaxone. also had elevated transaminases in the 6000s which gradually normalized, thought to be due to shock liver. she had , which resolved after ivfs and was also felt to be from low blood pressures. per osh records, she was "ruled in" for nstemi--ck 368, trop (unclear if i or t) 0.54--with "limited management" given her other critical issues. the patient's hypercarbia and hypoxia quickly resolved with mechanical ventilation. her et tube was withdrawn over bronchoscope on , but almost complete airway collapse was witnessed so she remained intubated and transferred to for further management. she had been receiving tube feeds and these have been continued. by discharge from osh, her labs were: wbc 15, hct 31, plts 125, cr 1.1; abg 7.45/35/83. cxr on showed elevated r hemidiaphragm and bibasilar atelectasis. all cultures have been negative to date. . on arrival to , patient was awake, alert, with et tube in but not connected to ventilator; patient was breathing room air. her vitals were stable, and patient denied any pain. . ros: limited as patient was intubated . past medical history: # tracheobronchial malacia: s/p stent placement in then removal in due to persistent secretions # obesity # gerd # avascular necrosis of the l hip s/p l hip replacement in # alcohol abuse # rue dvt in # copd # granulomas in l lung # s/p tah # s/p appendectomy social history: ms. had been a regional manager at insurance company. she lived with boyfriend > 10 years. she had not been in contact with her brother in ~1 year, however, brother has visited her frequently while in the hospital and he is from area and lives at a distance. patient has history of significant alcoholism. unknown cigarrette smoking history as patient unable to give this history. family history: noncontributory physical exam: admission exam: general: middle-aged woman sitting in bed, intubated but awake, alert, able to write, in no acute distress heent: et tube in place cardiac: rr, normal s1/s2, no m/r/g lung: ctab abdomen: soft, nt, nd ext: no c/c/e . exam at time of discharge: date vitals: t 99.6f, bp 141/53, hr 96, rr 20 and o2 sat 99% gen: awake but somnolent, not responding to commands, responds to pain heent: tracheostomy in place, connected to ventilation machine cvs: rrr, s1s2 normal, no m/r/g lung: limited bibasilar crackles, otherwise cta, no rhonchi abdomen: soft, nd, j-tube in place and is nontender and appears clean/dry/intact ext: pedal pulses 2+ bilaterally and no edema present pertinent results: admission labs: 09:18pm wbc-13.0* rbc-3.65* hgb-9.6* hct-29.6* mcv-81* mch-26.3* mchc-32.4 rdw-14.5 09:18pm alt(sgpt)-58* ast(sgot)-13 ck(cpk)-39 alk phos-62 tot bili-0.3 09:18pm glucose-92 urea n-25* creat-1.2* sodium-145 potassium-3.3 chloride-110* total co2-28 anion gap-10 ================= imaging: mr head: 1. no acute intracranial pathology. there are no imaging findings to suggest anoxic brain injury or wernicke-korsakoff syndrome, although given that the possible anoxic brain injury event might have been a few weeks ago, imaging findings can be subtle in these cases.2. nonspecific areas of white matter signal abnormality may reflect the sequela of chronic microangiopathy. . cxr: in comparison with the study of , the respiratory tube tip lies approximately 3 cm above the carina. retrocardiac opacification is consistent with volume loss in the left lower lobe in this patient with low lung volumes. no definite vascular congestion or acute focal pneumonia on this technically limited study. . cxr : as compared to the previous radiograph, the monitoring and support devices are in unchanged position. tracheal wire stent is also unchanged. minimally increasing left pleural effusion with minimal increase of left basal opacity. small area of either atelectasis or small intrafissural effusion at the right lung base. no evidence of pneumothorax. no other relevant changes. . eeg: impression: this is an abnormal portable eeg due to intermittent sharp waves in the l>r mid to posterior temporal regions suggestive of cortical irritability and potential for epileptogenesis. the background rhythm is slow and disorganized consistent with a moderate encephalopathy. medications, toxic/metabolic disturbances and infections are common causes. anoxia is also a possible etiology. if still clinically indicated, would consider 24 hour continuous eeg for further evaluation of the above findings. . ue ultrasound: deep venous thrombosis of the left subclavian, axillary, and basilic veins surrounding the left picc . cta chest: 1. no evidence of pulmonary embolism. bilateral lower lobe collapse with narrowing of left lower lobe and collapse of the right lower lobe bronchus. overall findings are probably due to known tracheobronchomalacia and mucous secretion plugging. status post tracheostomy. slight increase in mediastinal lymphadenopathy. mild splenomegaly. trace free air adjacent to the gastrostomy, presumably related to recent peg placement. . ct abdomen impression: 1. cholelithiasis with no signs of cholecystitis. 2. limited study for evaluation of mass lesion due to lack of iv contrast. however, no definite liver lesion was visualized to explain the transaminitis on the non-contrast study. 3. splenomegaly. 4. unchanged wedge compression deformity of the lower thoracic vertebra . cxr: chest, ap: lung volumes are low, but stable. increased linear opacities at the right lung base may represent atelectasis or consolidation. left lower lobe atelectasis is unchanged. tracheostomy and tracheal y stent are in standard position. a right picc again terminates in the right atrium. there is no pneumothorax or pleural effusion. the cardiomediastinal and hilar contours are normal. impression: increasing right basilar atelectasis or consolidation. . ekg - hr 80s. baseline artifact. sinus rhythm with first degree a-v block. non-specific st-t wave abnormalities. compared to the previous tracing of no diagnostic change. no qt prolongation. . : bun 10, cr 0.6, na 145, k 3.8, cl 105, hco3 33, hct 28.7, plts 256, wbc 7.4, mg 1.9, ca 8.3, phos 3.2 . : ast 17, alt 36, alp 195 ( down from 371) , total bili .2 inr 1.3, pt 15, ptt 32 . lactate .4 h.pylori serology negative . hepatitis b panel negative micro data: c.difficile pending - urinalysis negative - urine culture pending - c.difficile negative - blood cultures x 2 negative - blood cultures negative - blood cultures x 2 negative -blood cultures negative -blood cultures negative 12:20 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited . bal results - 11:00 am bronchial washings left lower lobe. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in clusters. 1+ (<1 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): budding yeast. respiratory culture (final ): ~3000/ml commensal respiratory flora. yeast. 10,000-100,000 organisms/ml.. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): fungal culture (final ): yeast. potassium hydroxide preparation (final ): test cancelled, patient credited. this is a low yield procedure based on our in-house studies if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). . 8:31 pm csf;spinal fluid source: lp. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. fungal culture (preliminary): no fungus isolated. viral culture (preliminary): no virus isolated so far. brief hospital course: 57-year-old woman with history of tracheobronchial malacia was transferred from after being found unresponsive at home on and subsequently intubation who has had difficulty weaning from the ventilator machine despite y-stent placement and will need long-term weaning at rehab facility. . # severe tracheobronchial malacia: patient is status post y-stent placement . due to inability to wean from ventilator she tracheostomy placement . since then, she has been able to be weaned to just a sole trach collar at night time when she sleeps due to desaturations. thus, she has been kept on trach during daytime hours from 7am to 9pm (approximately), but is placed on pressure support at the following settings overnight : ps --> 10 cm/h2o peep: 5 cm/h2o fio2: 50 %. she has tolerated this regimen for at least 1 week prior to discharge and has been doing very well with this routine. the goal is to decrease hours of pressure support to eventually have her on the trach alone x 24 hours. per interventional pulmonology team the long term goal is also to have her recannulized, stent removed, and eventual surgery. she will be followed by interventional pulmonary for this on an ongoing basis. full follow-up and appointments outlined below in discharge planning. overall settings on her mechanical ventilation during daytime: cpap w/ & w/o ps. as above, on pressure support levels at night: 10 cm/h2o peep: 5 cm/h2o fio2: 50 % settings. . # agitated delirium: likely related to long icu stay coupled with anoxic brain injury and seizures. she lp which was negative for infectious sources. she was seen by psychiatry who recommended starting haldol prn and qhs. agitation significantly improved. she was followed by psychiatry during her hospitalization and was recommended to be on standing and prn haldol (with ekgs checking for qtc prolongation). by disharge, her delirium was under control with haldol po 0.5mg in am, 0.5mg in afternoon, and 2mg qhs. she as also written for 1mg po bid prn agitation. she was off restraints by time of discharge. she should be written for ekgs when given additional haldol doses to make sure qtc<0.5. continue redirection over the course of the day, maintain sleep/wake cycle. . # fevers/ventilator associated pna: only positive bal results were for yeast in sputum per bronchial washings. also yeast in urine. we believe this represents colonization. given fever in setting of being on ventilator she was treated with 10 day course of vancomycin and cefepime which was changed to meropenem and this antibiotic regimen was finished on and central line pulled out prior to discharge. . # esophagitis/gastritis/reflux: patient found to have coffee ground emesis . an egd revealed gastritis. she also had issues with reflux of bilious materials which was followed by gi. she was maintained in iv protonix and po ranitidine . she may still have occasional reflux/nausea of 50-100c or less (written for prn iv zofran) but is on reglan and has gi followup for gastric motility/impedence studies. please call clinic for any concern for increased reflux to have her seen in clinic earlier (workup for this happens as outpatient). current tubefeed schedule/levels outlined below is diet instructions and patient's j-tube site remains clean, dry and in tact and is working well. . # concern for anoxic brain injury: patient initially found down for unknown length of time. lumbar puncture done during this hospital course and csf was unrevealing. given her altered ms on this admission she mri which did not demonstrate any acute intracranial pathology. she eeg which did show some epileptiform activity. agitation has been well controlled with haldol regimen as outlined in medication list. she was seen by the psychiatry service to help with adjustments in her haldol dosing. she had been on olanzepine briefly but did this medication had limited effects. . # seizures: given concern for altered ms eeg which revealed epileptiform activity. she was loaded with dilantin and started on a maintenance dose. her outpatient bupropion stopped given concern for lowering sz threshold. she will need neurology follow-up as an outpatient. . # niacin deficiency: found to be completely deficient of niacin which was thought to be playing a role in depressed mental status. patient was repleted with oral niacin 100mg qid. a level following repletion is pending. . # new atrial fibrillation: unclear etiology. normal tsh. she was started on diltiazem which was uptitrated to 80mg qid by time of discharge. she responded to bolus doses of iv diltiazem for breakthrough ectopy but this has abated for at least 3-days prior to discharge. as noted below she is currently be anti-coagulated for dvt for lovenox. when anti-coag for dvt complete she only needs to be on asa given chads 0. . # lue dvt: swelling was noticed so a follow-up us of lue on showed a deep venous thrombosis of the left subclavian, axillary, and basilic veins surrounding the left picc. this was felt to be secondary to picc line which was then pulled. patient had cvl placed for better access. she was started on warfarin with lovenox bridge and she will now need a total of 3 months of anticoagulation (see course in medication section). . # nutrition: peg tube placed which was converted to g-j given that patient was vomiting intermittently mostly when she was coughing on secretions. she is currently at goal on her tube feeds and tube site is clean. she was followed by the gi service and will need additional outpatient follow-up as outlined above. . # copd: on admission was taking methylprednisone iv 40mg daily that was tapered off. she is now continued on ipratropium and albuterol nebulizers. full ventilation settings outlined above for recent respiratory failure. . # hypernatremia: improved with ~1.5l free water daily. should be less of a problem now that her tube feeds have been at goal. should be monitored at least weekly. . #recent diarrhea: patient has had some loose stools x 3 days which may be secondary to her tube feedings. multiple prior c.difficile studies were negative. a repeat c.difficle sample sent prior to discharge which is now pending and will need to be followed up on. # code: full code status / confirmed with hcp and brother ( ) # contact: boyfriend , brother medications on admission: azithromycin pantoprazole omeprazole 40 mg qday tussionex prn cough bupropion sr 150 mg po qday ipratropium inh lorazepam prn discharge medications: 1. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for wheezing. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 4. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 5. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for rash. 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain. 7. hydrocortisone acetate 1 % ointment sig: one (1) appl rectal (2 times a day): to hemorrhoids. 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours) as needed for wheezing. 9. phenytoin 125 mg/5 ml suspension sig: 100mg po tid (3 times a day). 10. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 11. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous q12h (every 12 hours): cont until inr therapeutic () for 48 hrs. 12. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm: monitor inr daily. goal is . 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 14. acetylcysteine 20 % (200 mg/ml) solution sig: 3-5 mls miscellaneous (2 times a day) as needed for thick secretions. 15. diltiazem hcl 90 mg tablet sig: one (1) tablet po qid (4 times a day): hold for sbp<95. 16. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 17. haloperidol 1 mg tablet sig: half tablet po as directed (): haloperidol 0.5 mg po as directed (morning and afternoon: 8am and 3pm) . hold for qtc>500 . 18. haloperidol 1 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for agitation . 19. haloperidol 1 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for agitation: patient needs daily ekg with review of ho before haldol given that day. confirm qtc<0.5. 20. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 21. lidocaine (pf) 10 mg/ml (1 %) solution sig: 2.5 mls injection q12h (every 12 hours) as needed for cough. 22. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane prn (as needed) as needed for ng tube. 23. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 24. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 25. metoclopramide 10 mg tablet sig: one (1) tablet po tid (3 times a day). 26. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea. 27. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary: hypercarbic and hypoxic respiratory failure tracheobroncheomalacia ventilator associated pneumonia deep venous thrombosis / upper extremity esophagitis gastritis delirium seizure disorder discharge condition: mental status: mental status at recent baseline, responding appropriately but unable to speak (trach in). level of consciousness: awake, alert and oriented to person/place/time activity status: bed-bound . discharge diet: tubefeeding: start after 12:01am; vivonex ten full strength; starting rate:10 ml/hr; advance rate by 10 ml q6h goal rate:65 ml/hr residual check:q4h hold feeding for residual >= :200 ml flush w/ 250 ml water q4h discharge instructions: you were admitted with respiratory failure. you had a tracheal stent placed and because we could not wean you from a ventilator we had to perform a procedure called tracheostomy placement which is another opening in your airways that lead into your lungs to allow you to have assisted breathing that helps you to have appropriate oxygenation. your course was complicated by seizures, pneumonia, deep venous thrombosis, delerium, and some mild irritation of your stomach leading to bleeding. on discharge, you have been able to tolerate the trach collar during the day and have been placed on pressure support at night which is with a ventilation machine. the goal is for you to work towards being on the trach collar 24 hours a day at rehab, which may take several weeks to months. in addition, you have a better regimen for delirium with a medication called haldol. . you had a lab study ordered for recent diarrhea called a c.difficile stool study. you also had a urine culture that was pending at the time of your discahrge. this was communicated to your rehab facility prior to your discharge. . based on your complicated hospital course as described above, you have been set up with neurology, pulmonary and gastroenterology appointments as an outpatient. these details are all listed below. . discharge diet: tubefeeding: start after 12:01am; vivonex ten full strength; starting rate:10 ml/hr; advance rate by 10 ml q6h goal rate:65 ml/hr residual check:q4h hold feeding for residual >= :200 ml flush w/ 250 ml water q4h followup instructions: provider: clinic interventional pulmonary (sb) phone: date/time: 11:30 provider: intake,one rooms/bays date/time: 1:30 provider: , md phone: date/time: 2:00 . you have an appointment with dr. from gi at 3pm on wednesday in 1 buildling. ( - call if acute issues arise. the plan is to followup on your reflux and do studies on your gastric motility and impedance studies. . you have a follow-up appointment with dr. in the neurology clinic on at 8:30am on the of the building. . md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances other endoscopy of small intestine fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other intubation of respiratory tract other intubation of respiratory tract temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus replacement of tube or enterostomy device of small intestine diagnoses: subendocardial infarction, initial episode of care anemia, unspecified esophageal reflux candidiasis of other urogenital sites atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation other convulsions pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus anoxic brain damage other acquired absence of organ other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants paralytic ileus candidiasis of lung other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diarrhea obesity, unspecified acute bronchitis hyperosmolality and/or hypernatremia ventilator associated pneumonia delirium due to conditions classified elsewhere leukocytosis, unspecified other and unspecified alcohol dependence, continuous hip joint replacement acquired absence of both cervix and uterus other esophagitis other diseases of trachea and bronchus dependence on respirator, status dysphagia, oropharyngeal phase history of fall other specified gastritis, with hemorrhage acute venous embolism and thrombosis of superficial veins of upper extremity pellagra 

Answer: The patient is high likely exposed to