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: no known allergies / adverse drug reactions attending: chief complaint: fever, lethargy major surgical or invasive procedure: picc line placement history of present illness: 71 year-old female with a history of dmii, cva with residual lue deficit/facial droop, seizure disorder, copd, and history of multiple infections including c diff on prolonged po vanco taper, mrsa bacteremia, multiple utis, with recent admission in gastroenteritis who presented from nh yesterday fever and hypoxia with sats to 80% and temp of 101.8. in the ed vs were t 98 hr 89 bp 89/40 rr 18 91% on ra. bp dropped to 70's which resolved with 1l ns. she again became hypotensive requiring levofed so she was admitted to the micu. she received an additional 4l ivf and was started on vanc, zosyn and azithro. in the icu she was continued on vanc, zosyn and azithro for concern for hcap. she was quickly weaned off pressors and did well overnight. repeat cxr this mornings shows worsending rll consolidation concerning for pna. her blood cx grew out gnr >100,000 organisms with no speciation yet. her viral screen was legative as was legionella. she was increased to treatment dose of po vanc for her difficult to treat c. diff, toxin pending. on evaluation in the icu, patient reports she is feeling well with no complaints. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: 1. diabetes mellitus, type 2 2. hypertension 3. peripheral vascular disease, s/p l aka () 4. r-mca & pca stroke w/residual lue deficit, left facial droop 5. seizure disorder 6. anemia, microcytic 7. copd/asthma 8. chronic kidney disease 9. hx of mrsa bacteremia 10. s/p tubal ligation 11. gerd 12. recurrent utis 13. multiple admissions for nausea/vomiting 14. recurrent c. diff infections 15. recently admitted in for nausea and vomiting that was thought to be from gastroparesis vs gastroenteritis and she was treated with iv fluid administration, antiemetics and only one dose of antibiotics and it was rec'd she get a gastric emptying study as an outpatient. social history: lives at in . tobacco: former smoker, smoked 1.5 ppd x40 years, quit >10 years ago. etoh: no current use. illicit drugs: no current use or h/o ivdu. enjoys participating in activities and exercises. family history: sister with breast cancer. other sister with diabetes. no family history of gastrointestinal malignancy, inflammatory bowel disease, celiac disease, or liver disease. physical exam: admission: vitals: t: 97.7 bp: 130/48 hr: 81 rr:17 o2sat: 100% 3 l gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: no jvd, right ij in place. + submandibular lmphadenopathy, nontender cor: rrr, distant heart sounds but no murmurs appreciated. radial pulses +2 pulm: lungs inspiratory wheezes on the right base, diffuse rhonchi throughout, no rhales abd: obese, soft, nt, nd, +bs, no sign ext: left aka, left hemiparesis, no right pedal edema, warm and well perfused neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. does not move left side, decreased right patellar reflex skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. dark macule on sole of foot. transfer to the floor and upon discharge: vitals: t: 98.8 bp: 124/67 hr: 78 rr:15 o2sat: 94% on ra gen: well-appearing f in nad heent: eomi, perrl, sclera anicteric, mmm, op clear neck: no jvd, right ij in place with site c/d/i and no erythema cv: regular rate, no mrg appreciated though hs distant pulm: scattered crackles at bases with occasional wheeze abd: obese, soft,nabs, ntnd ext: left aka, left hemiparesis, no rle edema, warm, well perfused neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. l hemiparesis skin: no rashes psych: appropriate mood and affect pertinent results: labs on admission: . 04:04am blood wbc-22.6*# rbc-4.31 hgb-10.6* hct-32.9* mcv-76* mch-24.7* mchc-32.4 rdw-13.6 plt ct-305 04:04am blood neuts-80.2* lymphs-14.1* monos-4.3 eos-1.2 baso-0.3 10:26am blood pt-18.4* ptt-52.7* inr(pt)-1.7* 04:04am blood glucose-227* urean-17 creat-1.1 na-135 k-5.0 cl-100 hco3-27 angap-13 04:04am blood alt-18 ast-36 ld(ldh)-282* alkphos-107* totbili-0.4 04:04am blood calcium-9.2 phos-3.9# mg-1.8 10:26am blood phenyto-9.9* 04:26am blood lactate-2.1* micro: blood cx - negative urine cx - e.coli, sensitive to cefepime legionella ag - negative respiratory viral antigen screen - negative for adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. imaging: cxr (): impression: 1. low lung volumes. 2. prominent bronchovascular markings could be partially due to low lung volumes, however, mild pulmonary edema cannot be excluded. 3. right retrocardiac opacity, which may reflect atelectasis or pneumonia. cxr: there is a right internal jugular line in situ the tip of which lies in the distal svc. the cardiomediastinal contour is normal. there is increased consolidation seen in the right lower lobe. no other abnormality seen. . video swallow : findings: barium passes freely through the oropharynx and esophagus without evidence of obstruction. there is no gross aspiration. mild penetration was only observed during self administration of thin liquid. for details, please refer to speech and swallow division note in omr. impression: mild penetration with self administration of thin liquids. please see speech and swallow note for further details. the study and the report were reviewed by the staff radiologist. brief hospital course: this is a 71 year-old female with a history of copd/asthma, previous utis, c diff, and mssa bacteremia as well as history of stroke and aka initially admitted to micu for sepsis from urine vs. pulmonary source now transferred to floor. . # sepsis: likely source urine with positive cx although unusually the ua was negative. urine culture grew out ecoli - sensitive to cefipime. a cxr also showed a rll infiltrate possibly consistent with aspiration pneumonia. ms. was treated with cefipime iv with good response. given her difficult access and the need for iv abx, a picc line was placed. she will need to complete a 10-day course of iv cefepime (last dose on ), at which time the picc line needs to be removed. another potential source considered was her biliary tract. she has known cholelithiasis and in the past has experienced elevated lfts. for this admission, fortunately, her lfts were not significantly elevated and there was no ruq tenderness. she continued on the oral vancomycin and the dose was increased to treatment dose (q 6 hours) given concurrent antibiotics, which needs to be continued for 2 weeks after completion of the cefepime. at that time, vancomycin can then be slowly tapered over several weeks. . # pna: seen on cxr. given ms. history of cva and appearance of infiltrates, aspiration was considered possible. the nursing staff also noted several episodes of coughing/choking after eating. the swallow team was consulted and video swallow revealed that the patient is at risk for aspiration, but had no frank aspiration. a diet of think liquids with soft food and aspiration precuations were recommended. nebulizers were also given. . # chronic c.diff: started treatment dose increased from tapering dose and needs to be continued at this dose for 2 weeks after completion of cefepime. stool cdiff here negative on . oral vancomycin can be tapered over several weeks after the 2 week course is completed. . # coagulopathy: inr 1.7 on admit now down to 1.4, likely in setting of hypotension and sepsis, possibly nutritional. no e/o dic. trended and labs otherwise stable. #. copd/asthma: minimal wheezing on exam, on room air. - albuterol and ipratropium nebs, as well as her home regimen of fluticasone. # acute kidney injury: upon admission cr peaked to 1.1, secondary to sepsis. improved to 0.7 prior to discharge and lisinopril was restarted (initially held on admission). chem 7 should be followed while at rehab. # dm: continued home fixed dose insulin and ssi. . # htn: bp meds initially held in the setting of sepsis, and slowly restarted. her bb remains half-dose and can be titrated up pending stability of bp. her lisinopril was restarted on . . # h/o cva: continue aggrenox . # hld: continued home statin . # dementia: continued donepazil . # depression: continue ssri and lyrica . # seizure d/o: continue phenytoin and keppra . # code status: full, confirmed in icu . . medications on admission: admission: lyrica 25 mg q day cymbalta 60 mg q day lisinopril 20 mg q day mv q day spiriva 18 mcg q day vanc 125 mg po q day vit d3 400 u q day ferrous sulfate 325 mg q day aggrenox 25-200 mg calcium carb 500 mg dilantin 150 mg docusate 100 mg flovent 110 mcg inh levitiracetam 500 mg metoprolol 50 mg nasal saline tid acidophilus gelcap tid ventolin 90 mcg inh q6h ranitidine 150 mg qhs tylenol w/codeine 300/15mg 2 tabs qhs donepezil 10 mg qhs novolin 8 units breackfast, 6 units lunch, 8 units supper lantus 28 units qam senna 8.6 mg qhs simvastatin 20 mg qhs prochlorperazine 25 mg suppository pr prn nausea loperamide 2 mg prn maalox prn trazodone 25 mg prn insomnia diabetic tussin prn transfer: senna 1 tab po bid:prn constipation heparin 5000 unit sc tid duloxetine 60 mg po daily pregabalin 25 mg po/ng daily albuterol 0.083% neb soln 1 neb ih q6h:prn wheeze ipratropium bromide neb 1 neb ih q6h:prn wheeze vitamin d 400 unit po/ng daily ferrous sulfate 325 mg po/ng daily dipyridamole-aspirin 1 cap po bid docusate sodium 100 mg po bid phenytoin infatab 150 mg po/ng fluticasone propionate 110mcg 2 puff ih med ranitidine 150 mg po/ng hs acetaminophen w/codeine tab po hs:prn leg pain @ 0945 donepezil 10 mg po/ng hs @ 0945 simvastatin 20 mg po/ng hs @ 0945 levetiracetam 1000 mg po/ng @ 0953 vancomycin oral liquid 125 mg po/ng q6h dextrose 50% 12.5 gm iv prn hypoglycemia protocol @ 1108 glucagon 1 mg im q15min:prn hypoglycemia protocol @ 1108 insulin sc (per insulin flowsheet) sliding scale & fixed dose @ 1255 acetaminophen 650 mg po/ng q6h:prn pain @ 1451 trazodone 25 mg po/ng hs:prn insomnia cefepime 2 g iv q24h day 1 = vancomycin 1000 mg iv q 12h day 1 = azithromycin 250 mg po/ng q24h day 1 = metoprolol tartrate 25 mg po/ng discharge medications: 1. pregabalin 25 mg capsule sig: one (1) capsule po daily (daily). 2. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 3. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours). 4. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 5. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 6. dipyridamole-aspirin 200-25 mg cap, multiphasic release 12 hr sig: one (1) cap po bid (2 times a day). 7. phenytoin 50 mg tablet, chewable sig: three (3) tablet, chewable po bid (2 times a day). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for loose stool. 9. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 10. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 11. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 12. simvastatin 10 mg tablet sig: two (2) tablet po hs (at bedtime). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day): if pt not ambulatory. 14. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 15. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 16. ranitidine hcl 150 mg tablet sig: one (1) tablet po hs (at bedtime). 17. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 18. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 19. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100 and hr<60. 20. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 21. ventolin hfa 90 mcg/actuation hfa aerosol inhaler sig: inh inhalation every six (6) hours as needed for shortness of breath or wheezing. 22. acetaminophen-codeine 300-30 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for leg pain. 23. cefepime 2 g iv q24h day 1 = 24. insulin continue 28 units of lantus at bedtime and humalog sliding scale as described on attached sheet. discharge disposition: extended care facility: the discharge diagnosis: pneumonia, hcap urinary tract infection htn seizure disorder dm type ii pvd 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: you were admitted with a severe infection from pneumonia and a urinary tract infection. you were treated with iv fluids and iv antibiotics. you will need to complete this course of iv antibiotics over the next three days (last day ). your picc line should be removed after completion of the antibiotics. based on a speech and swallowing study, you are at risk for aspiration and should maintain a diet of thin liquids and soft solids to prevent against aspiration. medication reconcilication: 1. start cefepime 2 grams daily for 3 more days (last dose on ) 2. decrease metoprolol to 25 mg twice daily; this can be slowly uptitrated as blood pressure remains stable 3. increase vancomycin to 125 mg q6 hours while on antibiotics for pneumonia and continue this course for 2 weeks after completion of antibiotics. the vancomycin can then be tapered slowly over several weeks. followup instructions: please follow-up with pcp at . md procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified anemia, unspecified urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other convulsions peripheral vascular disease, unspecified depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified other late effects of cerebrovascular disease chronic obstructive asthma, unspecified above knee amputation status other late effects of cerebrovascular disease, facial weakness 

Answer: The patient is high likely exposed to