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: heparin agents / percocet attending: chief complaint: fever and increasing secretions major surgical or invasive procedure: mechanical ventilation history of present illness: 66 year old female with tracheal stenosis s/p trach/peg presenting with hypoxia and increased sputum production and transferred to the micu for significant nursing requirements. her baseline o2 sats are in the low 90s and tends to desaturate with mucus plugging or agitation. also, she has only mild secretions at baseline. on the morning of admission she had an oxygen saturation in the 60s and was cyanotic. she was seen at an osh ed where she was bagged & suctioned and clinically improved immediately. she remained hemodynamically stable with bp 90s/40s and asymptomatic. she had an abnormal but stable cxr and bnp was 251. her temperature was 100.6 and wbc count was 13k with 10% bands. she was started on ertapenem and vancomycin for healthcare associated pneumonia then transferred to . . at , she continued to have profuse tracheal secretions. she ultimately required suctioning every hour leading to desataturations to the 60s with suctioning. her secretions are described as deep tan, thick and intermittently frothy. her abg was: 7.47/38/53 on 70% trach collar and she was placed on 100% trach collar. cxr demonstated an lll infiltrate (preliminary). she required intense nursing and respiratory therapy attention and was then transferred to the micu for further care and monitoring. past medical history: -coronary artery disease s/p cabg in and "recent" pci -left total hip replacement-, elective. complicated postoperative course with post-operative atrial fibrillation wtih rvr requiring cardioversion, sepsis, pseudomonas vap, vre ut, and prolonged intubation leading to trach/peg. discharged to chronic wean facility but unable to decannulate. bronchoscopy revealed tracheomalacia of subglottic region. -supraglottic edema from gerd -bipolar disorder -depression -chronic atrial fibrillation, developed postop from thr, not anticoagulated -chronic constipation -hit during fragmin therapy social history: married. very supportive husband. when she is not hospitalized/in rehab, she lives with him. no etoh or family history: non-contributory physical exam: vitals: 99.9, 93/40, 105, 21, 97% 60% trach collar gen: well appearing female, found asleep, easily arousable, interactive with mouthing words, appropriate heent: eomi. op clear neck: supple. trach collar in place. no surrounding erythema. no jvp seen chest: coarse rhonchi bilat. good air entry. no crackles cv: rrr no m/r/g abd: soft, nt, nd. g-tube in place and site dressing c/d/i and nontender ext: vein harvest scar. no edema. 2+ dp pulses. no clubbing or cyanosis. pneumoboots in place neuro: preserved strength and sensation to light touch pertinent results: outside hospital/pre-admission labs: cbc: 13.3>42<469 86%pmn 11.5%band na 139 k 4 cl 97 co2 30 bun 36 cr 1.7 gluc 208 ua: 1.030 cloudy ph 6, 3+prot, trace ketone, +bili, 3+blood, +nitr, small leuk est, wbc 40/hpf, rbc >100/hpf, gran cast 5, epi 12, amorph moderate, bacteria large bnp 251 (<100 is normal) cxr: diffuse interstitial infiltrates, tracheostomy and prior sternotomy. little change infiltrates from . per my read has increased opacity at left base. . admission labs: 12:45am blood wbc-7.5 rbc-3.70* hgb-11.6* hct-31.9* mcv-86 mch-31.2 mchc-36.2* rdw-17.0* plt ct-322 12:45am blood neuts-83.9* bands-0 lymphs-9.2* monos-3.7 eos-2.6 baso-0.6 12:45am blood glucose-128* urean-26* creat-1.3* na-139 k-3.9 cl-103 hco3-29 angap-11 03:30am blood type-art po2-53* pco2-39 ph-7.47* caltco2-29 base xs-4 03:30am blood glucose-123* lactate-1.2 . other relevant & discharge labs: 06:21am blood gas type-art temp-37.8 rates-/29 tidal v-430 peep-10 fio2-50 po2-65* pco2-43 ph-7.45 caltco2-31* base xs-4 intubat-intubated . 06:56am blood cortsol-23.2* pre-cosyntropin 12:01pm blood cortsol-31.0* 30-min post-cosyntropin 12:38pm blood cortsol-37.2* 30-min post-cosyntropin 08:58am blood probnp-1286* 04:33am blood glucose-119* urean-13 creat-0.7 na-138 k-3.7 cl-104 hco3-29 angap-9 04:33am blood wbc-6.3 rbc-3.31* hgb-9.9* hct-28.0* mcv-84 mch-29.9 mchc-35.4* rdw-16.6* plt ct-312 brief hospital course: the patient is a 66 year old woman with history of respiratory failure & tracheostomy following hip replacement surgery, diastolic chf, cad, admitted for respiratory distress and hypoxia, transferred to the micu for management of her copious secretions. . # respiratory failure: pt has chronic hypoxia with a 40 to 50% trach collar requirement to keep sats in low 90s. pt had acute worsening hypoxia due to healthcare associated pneumonia (and associated copious sputum production). pt initially treated with zosyn/vanc until cultures came back positive for pseudomonas. the pseudomonal sensitivities are as follows: cefepime (sensitive), ceftazidime (sensitive), ciprofloxacin (sensitive), gentamicin (sensitive), imipenem (resistant), meropenem (sensitive), piperacillin/tazo (sensitive), tobramycin (sensitive). she was treated with meropenem & ciprofloxacin for double coverage. she is to complete total of 14 days of antibiotcs (start day = , stop day ). she was also treated with atrovent and albuterol nebs as she had occasional of episodes wheezing. the pt underwent bronchoscopy on which showed some thick secretions. her mucosa was normal and no lesions were seen. during her hospital stay, pt required mechanical ventilation via trach as she became developed more severe hypoxia. she underwent cta chest, which was negative for pe, but did show evidence of pulmonary edema. her bnp was elevated at ~1300. these findings along with her fluid balance of positive 4l for her length of stay suggested that she was likely volume overloaded. pt was diuresed w/ iv lasix. she may need further diuresis once at rehab; dosing of lasix should be done at the discretion of the rehab physician. discharge, the pt required frequent suctioning for her thick tracheal secretions. she was tolerating periods of trach mask (up to six hours on the day before discharge) followed by time on the vent. it is believed that as pt recovers from her pneumonia and pulmonary edema resolves she should again tolerate full time trach mask. until then, may need the vent for short periods of time. . # airway stenosis: patient found to have severe supraglottic edema from likely gerd as well as subglottic stenosis/?tracheomalacia. she has been followed by dr. , who recently referred the pt to otolaryngologist dr. (# ). the pt was seen by ent during her stay. the recommended optimizing her ppi therapy given evidence of severe gerd. her ppi was changed to twice daily dosing. they also recommended follow-up with dr. (scheduled for at 1pm). in the future, she will likely need rigid bronchoscopy. . # atrial fibrillation: not currently on rate controlling medications as her rate is well controlled w/o meds (70-80 bpm). not on anticoagulation (reason unclear). pt was in sinus for the duration of her hospital stay. . # depression/anxiety: pt needs frequent re-assurance regarding her care and clinical status. she was treated with prn lorazepam, which she required frequently, and standing klonopin. . # acute renal failure: baseline creatinine of 0.7 to 1.0. was 1.7 on admission. due to pre-renal etiology. it improved with ivf. discharge crt 0.7. . # anemia: likely anemia of chronic disease given significant medical issues over the last few months. iron studies done last month revealed elevated ferritin, normal iron and normal tibc. . # yeast in urine: pt had u/a on w/ wbc. yeast grew in culture. because of this pt had her foley changed on . . # fen: peg tube feeds given with supplemental protein powder (probalance at 45cc/hr; 1296 kcals) # prophylaxis: ppi, pneumoboots. no heparin as history of hit. # access: pt had picc line placed on # code: full # contact: (husband) ; (son) medications on admission: *aspirin 81 mg po daily *olanzapine 5 mg po bid *paroxetine hcl suspension ten (10) mg po daily *therapeutic multivitamin 1 cap po daily *docusate sodium 100 mg po bid (2 times a day). *lactulose 30 ml po bid *furosemide 40 mg po bid *klonopin 0.5 mg *lorazepam 1 mg po q4h prn *zolpidem 10 mg tablet po hs *spironolactone 25 mg 1 *pyridium 100 mg tid x3 days *zegerid 40 mg *protein powder 1 scoop tid *senna 8.6 mg 2 tabs hs *kcl 20 meq daily discharge medications: 1. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. albuterol 90 mcg/actuation aerosol : 4-6 puffs inhalation q4h (every 4 hours) as needed. 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 4. ciprofloxacin 250 mg tablet : two (2) tablet po q24h (every 24 hours): stop day . 5. clonazepam 0.5 mg tablet : one (1) tablet po bid (2 times a day). 6. docusate sodium 50 mg/5 ml liquid : two (2) ml po bid (2 times a day). 7. ipratropium bromide 17 mcg/actuation aerosol : 4-6 puffs inhalation q4-6h (every 4 to 6 hours) as needed. 8. lactulose 10 g/15 ml syrup : thirty (30) ml po bid (2 times a day). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 10. lorazepam 1 mg tablet : one (1) tablet po q3h prn () as needed for anxiety. 11. meropenem 500 mg iv q8h day 1 = 12. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 13. therapeutic multivitamin liquid : five (5) ml po daily (daily). 14. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po tid (3 times a day) as needed. 15. olanzapine 2.5 mg tablet : two (2) tablet po bid (2 times a day). 16. paroxetine hcl 10 mg tablet : one (1) tablet po daily (daily). 17. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 18. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 19. spironolactone 25 mg tablet : one (1) tablet po bid (2 times a day). 20. zolpidem 5 mg tablet : one (1) tablet po at bedtime as needed for insomnia. 21. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 22. furosemide 40 mg tablet : one (1) tablet po twice a day. discharge disposition: extended care facility: - discharge diagnosis: primary: -pseudomonal pneumonia -volume overload/diastolic heart failure -supraglottic edema and subglottic stenosis -chronic respiratory failure with tracheostomy . secondary: -history of -anxiety/depression -coronary artery disease -atrial fibrillation -status post total left hip replacement () discharge condition: awake, alert, tolerating trach mask with 50% fi02. sbp 90's to 120's. discharge instructions: please suction as needed. pt may need time on the vent if she tires. . please continue ppi twice a day--this is a change for pt. . please follow-up with scheduled appointments . please avoid heparin products as pt has been hit positive in recent past. -pt has contact precautions followup instructions: you have a follow-up appointment scheduled with dr. of ent on at 1pm. phone: . . a phone message was left with dr. office (interventional pulmonary) to schedule a follow-up appointment in the next month. they may call pt's home # to schedule. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances other lavage of bronchus and trachea diagnoses: anemia of other chronic disease congestive heart failure, unspecified acute kidney failure, unspecified candidiasis of other urogenital sites atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status dysthymic disorder hypotension, unspecified pneumonia due to pseudomonas diastolic heart failure, unspecified gastrostomy status chronic respiratory failure tracheostomy status other diseases of trachea and bronchus stenosis of larynx edema of larynx 

Answer: The patient is high likely exposed to