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: tetracyclines / zinc attending: chief complaint: hypoxic repiratory failure major surgical or invasive procedure: intubation history of present illness: this is a 66 y/o female well known to with castleman's syndrome, recurrent aspiration pna, htn, who presented to the ed this am with fever and hypoxic respiratory distress. she was recently admitted to the medicine service from to s/p fall x 2 at home. she reportedly fell on while trying to get up from bed and was put back by her hha; she fell again on and was down for approx 3 hours, and was put back into her bed by her hha. ems was then called. no loc. ct of the head, c-spine, b/l hips were unremarkable. fall was felt to be mechanical in nature and sw was consulted re: question of elder abuse/neglect (denied by patient to sw). at midnight that night, she spiked to 102 and was pan-cultured and received tylenol. u/a was unremarkable but urine cx was significant for 10,000-100,000 gnr. cxr was unremarkable. she was further admitted to the medicine service for observation and placement. she was subsequently discharged to home in stable condition yesterday evening. . of note, she was also recently at from to for aspiration pna, fever, and subsequently grew out mrsa (pt has h/o mrsa in sputum in past) and pseudomonas (sensitive to ceftaz/cefepime/meropenem, resistant to levofloxacin). . she was brought to the ed this am by her hha for a temp to 102 at home this am. she was also found to be hypoxic at 80%/ra by ems. on arrival to the ed, she was intubated for hypoxic respiratory distress. her vs in the ed were t 102, bp 150/62, hr 140, rr 26, sao2 80%/ra. she had transient hypotension with sbp's to the 90's, thought to be secondary to per-intubation and received 3 l ns with good response of her sbp to the 110's. sepsis protocol was initiated. she received 1 gm vanc, 500 mg flagyl, 500 mg levofloxacin, ceftaz 2 gm iv, versed/fentanyl gtt, and 1 gm tylenol pr. past medical history: past medical history: 1. castleman's disease (unicentric) s/p splenectomy in . lymph node bx revealed reactive lymph tissue; followed in heme/onc by dr. 2. h/o anaplastic thyroid cancer s/p radical neck dissection; age 15 3. esophageal webs and esophageal dysmotility s/p multiple dilatations (however, per omr notes, nl motility study) 4. recurrent aspiration pneumonias s/p peg (sputum with klebsiella sensitive to meropenem, mrsa, strep pneumo, ) per gi notes, thought to be d/t orophyarngeal dysphagia from prior neck irraditation 5. chronic respiratory disease; bronchiectasis, 's revealed restrictive physiology, ?interstitial lung disease. on 2l home o2 at baseline 6. mrsa osteomyelitis of olecranan s/p multiple debridements 7. bipolar d/o 8. gerd 9. ?seizure d/o (may be in setting of hypoglycemia) 10. hx grave's disease 11. osteoporosis: has broken both hips, left in , right with failed orif and redo at ; s/p short gamma nail fixation of a left hip basicervical fracture 12. h/o zoster 13. htn social history: social history: used to work as a social worker at the va. was at until when she was discharged to home. home health aide 24 hrs/day. no tobacco or etoh. family history: nc physical exam: upon arrival to the vitals: tc 98.3, bp 118/79, hr 92, rr 19, sao2 100%/ac 500 x 15/peep 5/fio2 40% general: very thin, chronically-ill appearing female, intubated, awakens to verbal stimuli heent: nc/at, perrl. intubated. mmm, op without lesions. neck: supple, no jvd chest: diffuse fine crackles at bases, no rhonchi or wheezes cv: rrr, nl s1/s2, 2/6 sem abdomen: soft, nt/nd, + bs. peg in place, site c/d/i. ext: no edema b/l, pulses 1+ b/l, w/w/p neuro: sedated, though arousable pertinent results: 05:05am blood glucose-102 urean-34* creat-1.7* na-138 k-4.7 cl-104 hco3-27 angap-12 06:40am blood glucose-112* urean-24* creat-0.9 na-134 k-4.7 cl-100 hco3-26 angap-13 01:20am blood wbc-21.6* rbc-3.22* hgb-9.8* hct-29.1* mcv-90 mch-30.3 mchc-33.6 rdw-16.3* plt ct-211 01:20am blood neuts-84* bands-3 lymphs-12* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 06:40am blood neuts-55 bands-0 lymphs-20 monos-12* eos-11* baso-0 atyps-1* metas-1* myelos-0 . gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. 2+ (1-5 per 1000x field): budding yeast. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. heavy growth. yeast. moderate growth. pseudomonas aeruginosa. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | pseudomonas aeruginosa | | cefepime-------------- 4 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s =>16 r imipenem-------------- =>16 r levofloxacin---------- =>8 r meropenem------------- 8 i oxacillin------------- =>4 r penicillin------------ =>0.5 r piperacillin---------- <=4 s piperacillin/tazo----- 8 s rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ =>16 r vancomycin------------ <=1 s . admission cxr indication: 66-year-old woman with hypoxia, shortness of breath and fever status post endotracheal intubation and left internal jugular line placement. . portable ap chest dated at 9:37 a.m. is compared to the same examination from two hours earlier. the endotracheal tube terminates 8.1 cm above the carina. again seen is a linear density adjacent to the endotracheal tube which terminates at the thoracic inlet. again this may represent a malpositioned nasogastric tube that perhaps is coiled in the posterior pharynx. it is not seen below the thoracic inlet. there has been interval placement of a left internal jugular central venous catheter which terminates at the brachiocephalic-svc junction. the cardiomediastinal silhouette is unchanged. again, the lung fields show platelike atelectasis within the left mid lung zone. there is no pneumothorax or pleural effusion. the surrounding osseous structures are unremarkable. again, the soft tissue surrounding structures show mild gastric distention. . ct pelvis: findings: several acute fractures are identified. there is a nondisplaced fracture of the left sacrum extending through several sacral ala. there is a comminuted fracture of the anterior column of the left acetabulum with minimal displacement. there is an acute mildly displaced fracture of the left inferior pubic ramus. chronic fracture deformities of the right inferior pubic ramus, right superior pubic ramus, and the right proximal femur are also identified. postoperative changes status post intramedullary rod fixation of the left proximal femur are seen including a proximal gamma nail and femoral neck screw. no hardware-related complication is seen. no additional fracture or dislocation is noted. multilevel degenerative changes of the lower lumbar spine are seen including facet joint hypertrophic changes. a island is seen in the left side of the sacrum. a faint lucent tract in the proximal right femur likely reflects previous hardware. no additional lytic or sclerotic lesions are seen. . soft tissues: a focus of gas is seen in the subcutaneous soft tissues of the anterior abdomen, likely reflecting recent subcutaneous injection. there is a fat-containing umbilical hernia. contrast is seen within the colon. the pelvic soft tissues are otherwise unremarkable. there is a foley catheter in place. . impression: 1. acute nondisplaced fractures of the left sacrum, anterior column of the left acetabulum, and left inferior pubic ramus. 2. chronic fracture deformities of the right proximal femur, left proximal femur, left superior pubic ramus, and left inferior pubic ramus. status post orif of an intertrochanteric fracture of the left proximal femur with no evidence of hardware-related complication . ct neck: findings: the patient has had a radical neck dissection on the right. there is metallic artifact from dental hardware. this obscures a portion of the parotid gland on both sides, however, there are no masses in the visualized portions of the gland. there is no asymmetry in the appearance of the glands. at the level of the hyoid and on the right, there is 1.1 cm soft tissue mass just posterior to the internal carotid artery. this is felt to represent lymphadenopathy in this patient. smaller higher density lymph nodes are seen along the left jugulodigastric chain, not significantly changed since a prior ct of the cervical spine, . however, the lymph node on the right does appear enlarged for this patient and has slightly lower density. this could represent a lymph node associated with the patient's history of castleman's syndrome. this lesion was probably present on the prior ct of the cervical spine, although it is difficult to visualize due to the lack of iv contrast on that study. . no enhancing masses are identified. there are no fluid collections. there are multilevel degenerative changes in the cervical spine without a definite fracture. there is dental hardware in place. there is scarring at both lung apices. . impression: well-defined soft tissue mass posterior to the carotid, just below the level of the hyoid, in the right neck likely represents an enlarged level iv lymph node. no other lymphadenopathy is identified. the patient is status post right radical neck dissection. portable semi-upright chest radiograph: no significant interval change is seen. there is chronic left hemidiaphragmatic elevation and bibasilar atelectasis. no pleural effusion is seen. the aorta is generally large but no focal or anastomotic dilatation is apparent. surgical staples in the upper abdomen are again noted. impression: no significant interval change. persistent bibasilar atelectasis and left hemidiaphragmatic elevation. study: right knee ct without intravenous contrast. . history: 66-year-old woman with right knee swelling and erythema. evaluate for fracture or focal lesion. findings: multiple contiguous 2.5-mm axial images were obtained through the right knee without the administration of intravenous contrast. subsequently coronal and sagittal reformatted images were obtained. no bony fractures are seen. there are no focal bony lesions identified. the patient is demineralization which is most prominent in the distal femur and proximal tibia. there is a cyst. there is no joint effusion. there is narrowing of the joint space with some subchondral sclerosis in the medial and lateral compartments. small marginal osteophytes are identified. there are some vascular calcifications. the visualized soft tissues are grossly within normal limits. there is some minimal subcutaneous fatty stranding seen within the medial aspect of the knee. impression: 1. osteopenia. 2. no signs for acute bony injury or joint effusion. 3. mild degenerative changes. right knee, three views. there are mild degenerative changes, with slight medial compartment narrowing and small marginal spurs. there is probable diffuse osteopenia. no acute fracture or dislocation is identified. no focal lytic or sclerotic lesion is detected. incidental note is made of some spurring along the proximal fibula posteriorly. no joint effusion is seen. if there is clinical concern for a patellar fracture, then further assessment with an axial image of the patellofemoral joint could help for more detailed assessment. however, no patellar fracture is identified on the current images. patella (ap, lat & sunrise) ri; -77 by different physician reason: r/o fracture medical condition: 66 year old woman with knee swelling reason for this examination: r/o fracture indication: 66-year-old female with knee swelling. comparison: . five views right knee: again seen are mild degenerative changes manifested by medial compartment narrowing and small marginal spurs. there is no knee joint effusion. there is no fracture or dislocation. brief hospital course: hospital course, by problem: #. hypoxic respiratory distress - most likely aspiration event, given her history and cxr findings of no focal infiltrates. baseline requirement of 2 l nc due to underlying restrictive lung disease, and she did well post extubation and was at baseline o2 requirements. in the icu, she was originally covered with broad-spectrum abx (vanc/levo/flagyl/ceftaz), given h/o mrsa/klebsiella/pseudomonas in sputum in past. although she grew mrsa/pseudomonas in her sputum culture, it was felt that these are most likely colonizers given a) the likely aspiration event and b) no focal infiltrates on cxr. while on the floor, vancomycin d/c'd and she was continued on levo/flagyl without recurrent fever, hypoxia, or leucocytosis. she will complete a 14 day courseo of abx for treatment of her aspiration event. given mild chf noted on cxr (nl echo ), she was diursed gently. id followed her on the floor and agreed with the above recommendations. . # l hip pain s/p fall - pelvic ct was obtained per ortho and showed acute nondisplaced fractures of the left sacrum, anterior column of the left acetabulum, and left inferior pubic ramus, along with chronic fracture deformities of the right proximal femur, left proximal femur, left superior pubic ramus, and left inferior pubic ramus. there was no evidence of a hardware-related complication from her prior orif of her left intertrochanteric fracture of the proximal femur. seen by ortho; recommended partial wbat on her left hip. she will follow up with dr. in two weeks as an outpatient for follow-up xr and further plan. pain control was achieved with opioids via peg tube . #eosinophilia: likely secondary to antibiotics. she has no rash to warrant discontinuation of her abx. this should be followed up in clinic. . #resting tremor: on examination, she was noted to have a resting tremor of (b) ue and her jaw with increased rigidity and cogwheeling. neurology was consulted, who felt at the very least she has parkinsonism (had been on long-standing reglan) +/- parkinsons disease. she was started on sinemet in house, and will follow up with neurology as an outpatient. whether this parkinsons disease is the culprit for her orophyarngeal dysphagia is unclear, the neurology team thought that it could be. . #. htn - restarted metoprolol at home dose of 12.5mg . hctz 12.5 mg daily was added but stopped because of hypercalcemia. bp remained well controlled despite this. . #osteoporosis: ca carbonate 500 mg tid was added to her regimen of vitamin d and her bisphonate. # hypercalcemia / primary hyperparathyroidism - she has a h/o primary hyperparathyroidism - seen in the endocrinology clinic/ not an operative candidate. endocrinology was consulted in house and they recommended stopping hctz. vit d levels were ordered and pending at the time of discharge. she was advised follow-up in clinic. . #. chronic pain/depression - continue gabapentin, lamotrigine, effexor. fentanyl patch was increased to 75 mcg/daily to treat her hip pain, along with nsaids/tylenol/oxycodone. # herpes - during the hospital stay, herpetic vesicles were noted on her right knee, confirmed by dermatology who recommended stating valacyclovir. she is to complete a 7 day course. dfa was negative and cultures for zoste and hsv were pending at discharge. # cervical ln - this should be followed with further work-up in clinic. pt evaluated her and recommended dc home with 24 hour supervision. she has , who takes care of her at home. was explained details by pt. medications on admission: 1. tylenol prn 2. vitamin d3 400 u 3. levothyroxine 100 mcg qd 4. atrovent inh 2 puffs q 4 hrs 5. albuterol inh 1 puff qid prn 6. ferrous sulfate 300 mg/5ml qd 7. lamotrigine 100 mg qd 8. lansoprazole 30 mg qd 9. metoclopramide 10 mg qid 10. quetiapine 200 mg qhs prn 11. sodium polystyrene sulfonate 15 g/60ml qd 12. prochlorperazine 5 mg q6 prn 13. oxycodone 5 mg/5 ml q4-6 hrs prn 14. venlafaxine er 150 mg qd 15. lorazepam 1 mg qid 16. metoprolol 12.5 mg 17. fentanyl 50 mcg/hr patch q72 hrs 18. alendronate 70 mg q saturday 19. gabapentin 400 mg qhs 20. polyvinyl alcohol 1.4 % gtt prn discharge medications: 1. docusate sodium oral 2. lansoprazole 30 mg susp,delayed release for recon : one (1) po once a day. 3. morphine 10 mg/5 ml solution : two (2) po q 6 h () as needed for pain. disp:*30 10* refills:*0* 4. ibuprofen 100 mg/5 ml suspension : one (1) po q8h (every 8 hours) as needed for pain. disp:*60 * refills:*0* 5. fentanyl 75 mcg/hr patch 72hr : one (1) patch 72hr transdermal q72h (every 72 hours). disp:*10 patch 72hr(s)* refills:*0* 6. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 2 days. disp:*6 tablet(s)* refills:*0* 7. levofloxacin 250 mg tablet : one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 8. levothyroxine 100 mcg tablet : one (1) tablet po daily (daily). 9. ferrous sulfate 300 mg/5 ml liquid : one (1) po daily (daily). 10. albuterol 90 mcg/actuation aerosol : 1-2 puffs inhalation q6h (every 6 hours) as needed. 11. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 12. lamotrigine 100 mg tablet : one (1) tablet po daily (daily). 13. gabapentin 400 mg capsule : one (1) capsule po hs (at bedtime). 14. alendronate 70 mg tablet : one (1) tablet po qsat (every saturday). 15. polyvinyl alcohol 1.4 % drops : 1-2 drops ophthalmic prn (as needed). 16. venlafaxine 75 mg capsule, sust. release 24hr : two (2) capsule, sust. release 24hr po daily (daily). 17. lorazepam 1 mg tablet : one (1) tablet po qid (4 times a day). 18. quetiapine 200 mg tablet : one (1) tablet po qhs (once a day (at bedtime)) as needed for prn insomnia. 19. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po bid (2 times a day). 20. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po tid (3 times a day). 21. metoprolol tartrate 25 mg tablet : one (1) tablet po bid (2 times a day). 22. carbidopa-levodopa 25-100 mg tablet : 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 23. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 24. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day). 25. acetaminophen 325 mg tablet : two (2) tablet po q8h (every 8 hours) as needed for pain. 26. albuterol sulfate 0.083 % solution : one (1) inhalation q6h (every 6 hours). 27. valacyclovir 1 g tablet : one (1) tablet po three times a day for 2 days: via peg tube. disp:*6 tablet(s)* refills:*0* 28. medications take all your medications via peg tube not by mouth. discharge disposition: home with service facility: caritas home care discharge diagnosis: primary diagnoses 1. aspiration pneumonitis, requiring intubation 2. s/p fall with acute nondisplaced fractures of the left sacrum, anterior column of the left acetabulum, and left inferior pubic ramus 3. resting tremor, ?parkinsonism vs parkinsons disease 4. 1.1 cm r neck lymph note 5. herpetic vesicles right knee) 6. hypercalcemia (h/o primary hyperparathyroidism) secondary diagnoses: 1. castleman's syndrome s/p splenectomy 2. recurrent aspiration pna - s/p peg 3. sputum with pseudomonas/mrsa: likely colonizers 4. anaplastic thyroid ca s/p radical neck dissection - 50 yrs ago 5. bipolar disorder 6. oa 7. htn 8. esophageal webs and ?esophageal dysmotility (nl esophageal motility by dr s/p multiple dilatations 9. chronic respiratory disease; bronchiectasis 10. h/o mrsa osteomyelitis of olecranan s/p multiple debridements 11. ?seizure d/o (may be in setting of hypoglycemia) 12. h/o grave's disease 13. severe osteoporosis: has broken both hips, left in , right with failed orif and redo at ; s/p short gamma nail fixation of a left hip basicervical fracture 14. h/o zoster discharge condition: stable discharge instructions: please contact dr. should you have any fevers, chills, night sweats, difficulty breathing, or any other complaints. it is very important that you follow up with dr. regarding the lymph node in the right side of your neck and elevated eosinophils in blood. you are advised not to eat or drink anything by mouth to avoid the risk of aspiration and lung infections. all your medications should be given thru the peg tube. followup instructions: please make an appointment to follow up with dr within 10 days to follow up the lymph node in your neck and for eosinophilia. please follow up with neurology regarding treatment of your parkinsons diease. someone from their clinic should be calling you to make an appointment. if someone does not call, please call (. provider: xray (scc 2) phone: date/time: 12:20 provider: , md phone: date/time: 12:40 please make an appointment with your endocrinologist, dr . call ( to schedule an appointment to discuss the high calcium levels and also the thyroid medication and to follow-up for the results of lab work done in the hospital. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization transfusion of packed cells replacement of gastrostomy tube diagnoses: anemia of other chronic disease urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified depressive disorder, not elsewhere classified chronic kidney disease, unspecified paralysis agitans acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified enlargement of lymph nodes bipolar disorder, unspecified bronchiectasis without acute exacerbation fall from other slipping, tripping, or stumbling herpes simplex without mention of complication closed fracture of sacrum and coccyx without mention of spinal cord injury hypercalcemia closed fracture of pubis closed fracture of acetabulum attention to gastrostomy postsurgical hypothyroidism personal history of malignant neoplasm of thyroid carrier or suspected carrier of other specified bacterial diseases dyskinesia of esophagus eosinophilia tracheoesophageal fistula, esophageal atresia and stenosis 

Answer: The patient is high likely exposed to