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: ace inhibitors / iodine / cefepime attending: chief complaint: cough and increased trach secretions - reason for initial micu admission patient with trach on ventilator major surgical or invasive procedure: ????? history of present illness: patient is a 75 year-old woman with history of copd, tracheobronchomalacia, bronchiectasis, mac, diastolic chf, recent hospitalization from - for hcap/sepsis, ultimately requiring tracheostomy and peg placement. patient had recent long, complicated admission from - for hcap (esbl e.coli and mrsa grew in sputum) and sepsis complicated by respiratory failure requiring intubation and later tracheostomy. patient was treated with vanc and meropenem. she had a bal that grew aspergillus and was treated with a course of voriconazole. at that time patient had been intubated and later extubated at osh prior to transfer to . she had persistent stridor at and underwent bronchoscopy showing severe distal tracheal malacia and severe bilateral main bronchi malacia. a tracheostomy was performed on . throughout hospitalization, she required intermittent psv ventilation, but was tolerating trach collar for prolonged periods of time. patient's course was complicated by multiple pneumothoraces requiring several chest tube placements. she underwent pleurodesis by thoracic surgeons on and the chest tube was removed. she later had a recurrent pneumothorax requiring a pig tail chest tube. the chest tube was again removed on and patient did not have any further recurrent pneumonthoraces. patient was discharged on inhaled colistin to supress any future infections. patient was discharged to the macu at rehab on . she had been doing well and had been completely weaned off the ventilator, but since she has had progressive hypercapnia while off the ventilator. she also became progressively tired and dyspnic off the ventilator. as per ip, patient may have recently had trach exchanged for shorter trach; however, this is not documented in rehab records. she also has had some cough and increased secretions. as per her daughter she also ate salty soup one week ago and she had worsenign pedal edema and dyspnea. she is admitted for bronchoscopy and likely trach replacement by ip. on arrival to the micu, patient is comfortable and her breathing is comfortable. she complains of some slightly worsened peripheral edema, but otherwise no complaints. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: tracheal malacia and severe bilateral main bronchi malacia tracheostomy in respiratory failure esbl e.coli and mrsa pneumonia dchf ef > 55% dmii (a1c 6.8 ) mild bronchiectasis anxiety microcytic anemia ?thalassemia trait hypertension gerd hiatal hernia on egd s/p cholecystectomy social history: originally from , moved here from . has 2 daughters (both physcians) one here and one in . her son also lives in us. she is a widow. per family no tobacco, etoh or drug use. family history: her father had copd and asthma, no other respiratory or cardiac history. physical exam: exam upon admission: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact pertinent results: admission labs: 03:56pm blood wbc-6.9 rbc-3.56* hgb-9.0* hct-29.6* mcv-83 mch-25.3* mchc-30.4* rdw-14.6 plt ct-361 03:56pm blood neuts-64.5 lymphs-23.8 monos-7.9 eos-3.5 baso-0.3 03:56pm blood pt-11.2 ptt-27.7 inr(pt)-1.0 03:56pm blood glucose-86 urean-28* creat-0.8 na-138 k-4.2 cl-101 hco3-27 angap-14 03:56pm blood albumin-3.5 calcium-10.6* phos-3.5 mg-1.9 studies: cxr wet read audit # 1 9:27 pm small left pleural effusion with mild bilateral atelectasis and mildly increased central venous pressures. brief hospital course: id: patient is a 75 year-old woman with history of copd, tracheobronchomalacia, bronchiectasis, mac, diastolic chf, recent hospitalization from - for hcap/sepsis, ultimately requiring tracheostomy and peg placement, presenting with worsening hypercarbic respiratory failure and increased ventilator requrirement. # respiratory failure: as per rehab macu notes, patient with worsening hypercarbic respiratory failure. she was previously weaned off vent, but now with increasing requirements over last few days and requiring constant ventilation. differential diagnosis includes worsening tracheobronchial malacia (possibly exacerbated by use of shorter trach), infection - pneumonia vs. flare of bronchiectasis, diastolic chf, copd flare. cxr showed no remarkable changes from prior. admitted to the micu and given trial of trach mask which failed so placed on cmv vent settings. continued on baseline colistin nebulizer treatments as well as inhalers. plan for admission was for interventional pulmonary to take pt to or for trach exchange and possible stent placement. during bronchoscopy, there was no trancheomalacia seen. she had increased secretions which were cleared and sent for culture. likely her respiratory failure was due to a bronchiectasis flare with increased secretions. # mac/bronchieactasis: patient with known mac. concern for flare given increased secretions. decision made to wait for cultures to help decide if additional antibiotics needed to be added to baseline colistin. # copd: no wheezing on presentation. continued on albuterol/atrovent nebs # diastolic chf: patient appeared relatively euvolemic on presentation and no edema on cxr. was continued on home dose of lasix (20mg daily) during stay. # seizure disorder: patient developed seizures thought secondary to cephalosporins during last admission (). now on levetiracetam which was continued. - continue levetiracetam 1000 mg # anxiety/depression: stabled. continued on home quetiapine 25 mg qhs. # code: dnr, mechanical ventilation okay # f/u issues: - results of bal from and possible need for antibiotics. medications on admission: medications (list from rehab): acetazolamide 250 mg daily acetylcysteine 100 mg intratracheal albuterol/ipratropium inhaler 6 puffs qid ammonium chloride 486 mg j-tube aspirin 81 mg daily diltiazem 30 mg po q8h docusate sodium 100 mg po bid furosemide 20 mg po daily gentamicin sulfate nebulizer 80 mg q12h heparin 5000 units q12h levetiracetam 1000 mg niacin 50 mg qam quetiapine 25 mg qhs thiamine 200 mg qam acetaminophen 650 mg q6h prn bacitracin topical ointment 1 application q6h levalbuterol 0.63 mg nebs q2h prn miconazole nitrate 2% powder 1 application tid prn sodium chloride 0.65% nasal spray prn discharge medications: 1. acetazolamide 250 mg tablet : one (1) tablet po q24h (every 24 hours). 2. acetylcysteine 10 % (100 mg/ml) solution : one (1) miscellaneous twice a day. 3. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q6h (every 6 hours). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q6h (every 6 hours). 5. ammonium chloride (bulk) granules : four hundred eighty six (486) mg miscellaneous twice a day: into jtube. 6. aspirin 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po once a day. 7. diltiazem hcl 30 mg tablet : one (1) tablet po tid (3 times a day). 8. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day) as needed for constipation. 9. furosemide 20 mg tablet : one (1) tablet po daily (daily). 10. med sulfate nebulizer 80 mg q12h 11. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 12. levetiracetam 100 mg/ml solution : ten (10) po bid (2 times a day). 13. niacin 50 mg tablet : one (1) tablet po daily (daily). 14. quetiapine 25 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 15. thiamine hcl 100 mg tablet : two (2) tablet po daily (daily). 16. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain. 17. bacitracin 500 unit/g ointment : one (1) topical every six (6) hours. 18. levalbuterol hcl 0.63 mg/3 ml solution for nebulization : one (1) inhalation every six (6) hours. 19. miconazole nitrate 2 % powder : one (1) topical three times a day. 20. sodium chloride 0.65 % aerosol, spray : one (1) nasal once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: bronchiectasis tracheostomy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you came to the hospital due to trouble breathing. you received a bronchoscopy and bronchealveolar lavage by interventional pulmonology. they found that you do not have tracheomalacia. your shortness of breath was likely due to a flair of your bronchiectasis. cultures of your sputum were sent and if they grow bacteria, we the doctors at your rehab will start you on antibiotics. followup instructions: please follow up with your pulmonary doctors rehab as needed. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and chronic respiratory failure epilepsy, unspecified, without mention of intractable epilepsy do not resuscitate status chronic diastolic heart failure gastrostomy status tracheostomy status bronchiectasis with acute exacerbation 

Answer: The patient is high likely exposed to