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 / codeine / dilantin / erythromycin base / adhesive bandage / tetracycline / vancomycin / nembutal sodium / atropine / gentamicin / sulfa (sulfonamides) / percodan / tetanus attending: chief complaint: altered mental status major surgical or invasive procedure: intubation and extubation, central line placement and removal from right internal jugular vein, picc placement history of present illness: 64f extensive pmh, recently discharged 3 days prior from our medical floor after a pna readmitted with altered mental status, hypotension and possible pna on chest x-ray. . in the ed, initial vs were: temp 101.8, 95 98/53 25 96% 4l. patient was given 2l ns, vanc 1g, levaquin 500mg, tamiflu 75mg x1. foley was placed. transfer vs: 90 121/59 22 96% 4l. upon admission to the icu, the patient was noted to be minimally responsive, diaphoretic and breathing rapidly. . of note, the patient was discharged 3 days prior to admission after a 7 day course of vanc/levo for pneumonia and a concommitant gi bleed. she was reportedly had clear mental status and was otherwise stable at that time. . the patient spent 7d in the micu. intubated on icu day1 for respiratory failure, subsequently extubated to cpap the following day, now satting well on nc with q6h albuterol nebs. she was briefly hypotensive with pressors on arrival but quickly weaned, now borderline hypertensive prior to transfer and labetalol and trandolapril per op regimen re-started. echo demonstrated ef 45-50% with small loculated posterior pericardial effusion w/o evidence of tamponade. the pt also had arf with cr 3.0, now resolving with ivf. in regards to abx- the patient was initially started on linezolid, aztreonam and cipro, she developed a rash thought to be drug reaction- aztreonam was withdrawn and the rash resolved. . upon arrival to the floor, the patient had persistent mild sob and wheezing, improving with albuterol nebs. also has ctd cough productive of yellowish sputum. rash developed on abx involving back and buttocks is improving, minimally pruritic, relieved by sarna lotion. +diarrhea, non-bloody, brownish. denies pain/ha/visual changes/st/cp/n/v/c. past medical history: - colon cancer s/p resection - systemic lupus erythematosus with positive lupus anticoagulants vs. antiphospholipid syndrome (on coumadin with goal inr ). - multiple strokes ( & )and transient ischemic attacks secondary to endocarditis. - seizure disorder, focal motor. - s/p seven spontaneous abortions. - s/p pulmonary emboli on coumadin - mitral valve prolapse. - hypertension. - migraines. - s/p tah - anxiety - obesity - hyperglycemia - ?arrhythmias, per pt, however no record - r meniscal tear social history: married to husband . currently residing in . has phd in american history from . 40 pack year smoking history, but quit 20 year ago. denies alcohol and drug use. family history: mother - cva father - mi three aunts with cvas, one of whom has lupus diabetes in family physical exam: vitals: t: 98.4 bp: 140/66 p: 79 r: 20 o2: 95% 2l nc general: obese, a&o, nad, non-toxic. ambulatory to the bathroom, sitting up in chair. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad. r ij insertion site with sterile bandage- no erythema, edema or exudate. lungs: diffuse expiratory wheezes b/l. good aeration. cv: s1 & s2 regular without murmur appreciated, distant heart sounds. abdomen: obese, ntnd. nabs. gu: foley in place. skin: erythematous rash to back, no obvious areas of skin breakdown ext: cool, pulse present, no edema. pertinent results: cardiology echo the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is mildly depressed (lvef= 45-50%). right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a moderate-sized loculated posterior pericardial effusion. there are no echocardiographic signs of tamponade. impression: mild global left ventricular systolic dysfunction. moderate loculated pericardial effusion without evidence of tamponade. compared with the prior study (images reviewed) of , lv systolic function is not as vigorous. pericardial effusion is slightly larger. the other findings are similar radiology chest (portable ap) impression: 1. stable severe cardiomegaly with prominent hilar contours. 2. persistent left lower lobe opacification may represent continued alectasis and/or pneumonia. 05:37am blood wbc-6.7 rbc-2.61* hgb-7.5* hct-24.3* mcv-93 mch-28.5 mchc-30.6* rdw-16.5* plt ct-283 06:10am blood wbc-7.4 rbc-2.77* hgb-8.0* hct-26.3* mcv-95 mch-28.9 mchc-30.3* rdw-16.0* plt ct-270 05:22am blood wbc-7.4 rbc-2.63* hgb-7.7* hct-24.6* mcv-94 mch-29.3 mchc-31.2 rdw-16.8* plt ct-279 05:22am blood plt ct-279 05:22am blood pt-18.2* ptt-38.9* inr(pt)-1.6* 05:22am blood glucose-105 urean-14 creat-0.9 na-144 k-3.5 cl-108 hco3-30 angap-10 09:53pm glucose-149* lactate-0.6 na+-142 k+-5.1 cl--108 09:53pm hgb-9.3* calchct-28 o2 sat-99 04:25pm alt(sgpt)-26 ast(sgot)-49* ck(cpk)-124 alk phos-133* tot bili-0.3 04:25pm lipase-23 04:25pm wbc-15.1*# rbc-2.94* hgb-8.6* hct-27.8* mcv-95 mch-29.1 mchc-30.7* rdw-15.2 04:25pm blood neuts-90.8* lymphs-4.8* monos-3.0 eos-1.0 baso-0.5 12:01pm blood pt-21.3* ptt-33.9 inr(pt)-2.0* brief hospital course: ms. is a 64 year old f recently admitted with pna and gi bleed now readmitted with altered mental status and r middle lobe pneumonia. her respiratory and hemodynamic status were tentative at icu arrival. a brief description of her icu course is described below according to problem: #. respiratory failure: likely d/t worsening hap. the patient's status was tenuous upon arrival. she was diaphoretic and starting to use accessory muscles to breath. she was requiring 100% nrb to maintain sats >90. initial abg showed ph of 7.11. intubation ok with patient's wishes per husband. she was intubated d/t resp distress, but also d/t need to place a central line and inability to lie patient flat. she had a bronchoscopy which did not reveal any mucus plugs or bleed. . she received vanc, cipro and aztreonam (given multiple allegies) and tamiflu. her sputum and blood cultures were negative during her stay. her flu swab and culture were negative as well. . an echo was done to look for cardiac failure as cause of resp distress. her was lv mildly depressed with an ef of 45-50%, mild pa shtn, and a moderate loculated posterior pericardial effusion without signs of tamponade. . patient was diuresed daily depending on physical exam, respiratory status, and respiratory condition. . she was extubated on hd3, but still required bipap for intermittent resp distress. she improved over the next several days and at time of discharge from icu, she was stable on bipap at night for sleep apnea and nasal cannula during the day. . prior to transfer to floor, pt extubated, weaned to cpap in icu, and was satting well on 2l nc on arrival to the floor. she tolerated bipap well o/n, slept well. she received q6h duonebs which gave her symptomatic relief. broncial washings, sputum culture, and blood cultures drawn on admission were all negative, her iv abx regimen of ciprofloxacin and linezolid was continued on the floor through day 10 with the plan to continue the iv regimen for 14 days. at which time the picc can be discontinued. . #. hypotension: her hypotension was likely from sepsis as she had no signs of heart failure. fluid rescussitation was started with fluid boluses. we obtained central access with r ij as we were unable to get peripheral access. she was given vanc, cipro, and aztreonam and levophed to maintain map >65 and uop . the patient was hypertensive prior to leaving icu and was transferred from the floor on labetalol and trandolapril and tolerated the regimen well, with a discharge of bp 113/65 this am. . # arf: the patient's creatinine was elevated markedly above baseline. she had not taken much po for 2-3 days suggesting a pre-renal etiology, but atn was also found as muddy brown casts were seen with urinalsys. rheumatology was consulted and did not believe her to have lupus nephritis given the acute setting. renal was consulted on hd2. she could not receive fluid boluses d/t pulm edema, but renal believed her renal function at this point was mainly atn and to wait on further management to allow kidneys to recover. her cr quickly improved and returned to by hd#7. her cr and uop was monitored throughout icu course. creatinine had returned to baseline prior to transfer to the floor and remained at baseline throughout rest of stay. . # anti-phospholipid syndrome: the patient has a history of strokes and clots and gi bleed. her goal inr is , and her inr was 6.3 upon arrival. she was not given vit k. heme followed patient. her inr went up to 10 on hd#3 and she was allowed to trend down on her own. heme final recs for icu were to allow patient to trend down on own and to start lovenox when inr between 3 and 3.5. her inr drifted below 3 on the day prior to transfer to rehab so sq lovenox at 120 mg was started per hematology recs. she will be discharged on this regimen, after she finishes her course of iv antibiotics/rehab when she is feeling more well it is recommended that she be converted over to coumadin. her hematocrit remained stable in the mid 20's throughout her stay on the floor. . hypertension: on hd 7 she had an episode of hypertensive urgency with sbp in 190's. she was not on her home anti-htn s/t hypotension on arrival, but they were restarted at this time. on hd8 her home diltiazem was stopped and she was started on labetelol 200mg . #yeast infection: patient reported vaginal yeast infection and yeast found in urine. urine yeast could have been contaminant. she was given fluconazole. . #rash: patient was noted to have developed a rash on her back on hd#4. dermatology - recommended chlorhexidine washes and staying off her back as much as possible. given sarna lotion for pruritus. continued to improved thorughout course. . #. seizure disorder: no signs of seizure activity during hospital stay. continued home tegretol, neurontin, carbamazapine with renal dosing. . hyperglycemia- blood glucoses ranged from 100-200, thought to be secondary to acute stress, pt does not have formal dx of diabetes. she received low dose ssi. . fen: continued cardiac diet. . code: dnr, ok to intubate, confirmed with husband . communication: patient; husband (cell), (home). medications on admission: home medications (per omr, confirmed with husband & nursing home list): albuterol neb q6h prn senna prn lactulose prn trandolapril 2mg po daily meclizine 12.5mg po tid atorvastatin 80mg po qhs gabapentin 300mg po q12 colace 100mg po bid oxycodone 5mg po q4 prn pain nystatin-triamcinolone cream tp asa 81mg po daily multivitamin 1 po daily clorazepate dipotassium 3.75mg po bid dipyridamole 150mg po tid carbamazepine 400mg po bid cholecalciferol 800 unit po daily diltiazem hcl 240 mg po daily topiramate 75 mg po daily warfarin 6 mg po daily acetaminophen 325 mg po q6h prn pain discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours): can make prn as patient improves. 3. lactulose 10 gram/15 ml solution sig: 15-30 ml po every eight (8) hours as needed for constipation. 4. trandolapril 2 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po at bedtime. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. gabapentin 300 mg capsule sig: one (1) capsule po twice a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 9. multivitamin tablet sig: one (1) tablet po once a day. 10. carbamazepine 200 mg tablet sig: two (2) tablet po bid (2 times a day). 11. topiramate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 12. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for pruritus. 13. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 14. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, headache. 15. linezolid 600 mg/300 ml parenteral solution sig: six hundred (600) mg intravenous q12h (every 12 hours): 14 day course; day 1 = . 16. ciprofloxacin in d5w 400 mg/200 ml piggyback sig: four hundred (400) mg intravenous q24h (every 24 hours): 14 day course; day 1 = . 17. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours): this is a new medication. 18. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po once a day. 19. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 20. labetalol 100 mg tablet sig: two (2) tablet po bid (2 times a day): this medication was started while inpatient. 21. enoxaparin 120 mg/0.8 ml syringe sig: one y (120) mg subcutaneous q12h (every 12 hours). 22. clorazepate dipotassium 3.75 mg tablet sig: one (1) tablet po twice a day. 23. outpatient lab work morning glucose monitoring. patient required only minimal insulin while inpatient (approximately 2u humalog daily) which was started while she was acutely ill. please monitor am fingersticks. if consistently > 126 would consider further diabetic therapy. 24. picc line care picc line care per protocol; please discontinue once patient has completed 14 day course. 25. outpatient lab work patient with final lab work as stated in discharge summary. please obtain cbc, liver function tests and coagulation panel each week for monitoring given on going antibiotics. first draw on . 26. dipyridamole 75 mg tablet sig: two (2) tablet po three times a day. 27. anticoagulation patient on lovenox given systemic lupus with associated hypercoaguable state. plan to transition back to warfarin once medically improved. goal inr 2.5 - 3.5. would contact dr. about this transition. discharge disposition: extended care facility: northeast - discharge diagnosis: primary: hospital acquired pneumonia, respiratory failure, sepsis, acute renal failure secondary: systemic lupus erythematosus with positive lupus anticoagulants vs. antiphospholipid syndrome; seizure disorder; hypertension discharge condition: hemodynamically stable and afebrile. discharge instructions: you were admitted with difficulty breathing. you were intubated and required a breathing machine given your breathing problems. were successfully taken off the breathing machine. you will continue to be treated for pneumonia at your care facility. please take all medications as prescribed. your care facility has been given a list of the medications you should be on. the following medications were stopped: - meclizine 12.5mg po tid - oxycodone 5mg po q4 prn pain - nystatin-triamcinolone cream tp - diltiazem hcl 240 mg po daily - warfarin 6 mg po daily the following medications were started: - linezolid - ciprofloxacin - lovenox - labetolol please keep all outpatient appointments. seek medical advice if you notice fever, chills, difficulty breathing, abdominal pain, confusion or any other symptom that is concerning for you. followup instructions: you have follow-up scheduled with your primary care physician . on at 10:00am. please contact if you are unable to keep this appointment. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization closed [endoscopic] biopsy of bronchus injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified acidosis systemic lupus erythematosus obstructive sleep apnea (adult)(pediatric) mitral valve disorders acute kidney failure with lesion of tubular necrosis unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia sepsis other and unspecified hyperlipidemia anxiety state, unspecified unspecified disease of pericardium acute respiratory failure long-term (current) use of anticoagulants late effects of cerebrovascular disease, hemiplegia affecting unspecified side personal history of venous thrombosis and embolism primary hypercoagulable state obesity, unspecified internal hemorrhoids with other complication migraine, unspecified, without mention of intractable migraine without mention of status migrainosus epistaxis localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy osteoarthrosis, unspecified whether generalized or localized, lower leg candidiasis of vulva and vagina dizziness and giddiness benign neoplasm of rectum and anal canal other and unspecified nonspecific immunological findings 

Answer: The patient is high likely exposed to