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 / bactrim / iv dye, iodine containing contrast media attending: chief complaint: dyspnea major surgical or invasive procedure: intubation bronchoscopy history of present illness: the patient's history was primarily reconstructed from reports from and omr, since she arrived in extremis. the patient has a history of copd, chf, atrial fibrillation (refuses anticoagulation), history of colon cancer, and recurrent pneumonias. the patient had been experiencing 24 hours of worsening acute repiratory distress. the patient further experienced fever, chills, and a cough productive of sputum. her oxygen saturations dropped into the high 60s, so the rehab facility did bag breathing for her overnight. . in the ed, the patient arrived tachypneic to the 40s, using her accessory muscles,and saturating in the 80s. her ekg evidently showed sinus tachycardia. a chest x-ray demonstrated complete opacification of the left lung. the patient had appropriate mental status to be asked her code status; she agreed to be intubated. the patient then nderwent rapid sequence intubation successfully, then was sedated with propofol. during her stay in the ed, the patient spiked a fever to 101.4; because of her already suspected pneumonia, she was started on vancomycin, cefepime, azithromycin. the patient has an operational power picc and peripheral in place for access. her vital signs were hr 89 rr 23 stauration of 97% (ventilator settings not known), bp 101/59. past medical history: 1) diastolic congestive heart failure (nyha class iv) 2) atrial fibrillation (refuses coumadin) 3) symptomatic bradycardia status post vdd pacemaker in 4) obstructive sleep apnea (on cpap at 8-10 cm of h2o) 5) coronary artery disease 6) hyperlipidemia 7) hypertension 8) colon cancer s/p resection 9) copd (on o2 2-4 liters at home) 10) bronchiectasis 11) gerd 12) pulmonary hypertension 13) anemia 14) pneumonia () 15) acute respiratory failure in and again in 16) history of methicillin resistant staphylococcus aureus in her sputum following hernia repair and again in with documented pneumonia . past surgical history: 1) status post hernia repair. 2) status post appendectomy. 3) status post total abdominal hysterectomy. 4) status post back surgery. 5) status post right total hip social history: lives in . worked as a printer many years ago. not married and does not have any children. no family in the area. uses a walker or wheelchair at baseline. patient is quite independent, and she manages her finances, cooks, and cleans herself. she is accompanied to the supermarket. patient quit smoking >25 years ago. drinks one whiskey a week. no illicit drug use. family history: sister has endometriosis and breast cancer physical exam: admission physical exam: vitals: t: 97.3 bp: 106/73 p: 88 r: 18 general: intubate, sedated heent: sclera anicteric, oropharynx clear neck: supple, no lymphadenopathy lungs: bronchial breath sounds on left; clear on right cv: s1, s2, no murmurs auscultated abdomen: soft, non-tender, bowel sounds positive gu: foley catheter ext: warm, well perfused, 1+ pulses . discharge physical exam: vitals: t: 96.8 bp: 142/75 p: 95 r: 20 90% on 4l general: conversant, calm heent: sclera anicteric, oropharynx clear neck: supple, no lymphadenopathy lungs: scattered rhonchi and basilar crackles on right; decreased breath sounds on left. cv: rrr, s1, s2, no m/r/g abdomen: soft, non-tender, bowel sounds positive ext: warm, well perfused, 1+ pulses neuro: cn ii-xii grossly intact; 4-/5 strength in right hip flexor, otherwise 5/5 strength throughout. sensation grossly intact. pertinent results: 03:40pm blood wbc-19.1*# rbc-3.65* hgb-11.7* hct-35.5* mcv-97 mch-32.0 mchc-33.0 rdw-13.8 plt ct-218 03:40pm blood neuts-84* bands-3 lymphs-9* monos-2 eos-1 baso-0 atyps-0 metas-1* myelos-0 04:28am blood wbc-10.5 rbc-2.92* hgb-9.1* hct-27.3* mcv-93 mch-31.2 mchc-33.4 rdw-14.5 plt ct-271 03:40pm blood glucose-217* urean-17 creat-1.0 na-138 k-3.5 cl-96 hco3-25 angap-21* 04:28am blood glucose-101* urean-11 creat-0.6 na-144 k-4.0 cl-110* hco3-25 angap-13 03:52pm blood lactate-7.0* 01:49am blood lactate-1.0 04:10pm urine color-yellow appear-hazy sp -1.023 04:10pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.5 leuks-lg 04:10pm urine rbc-26* wbc-69* bacteri-few yeast-none epi-15 renalep-<1 micro: 8:40 pm urine source: cvs. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. 6:19 pm bronchoalveolar lavage bronchial lavage. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): commensal respiratory flora absent. serratia marcescens. ~1000/ml. piperacillin/tazobactam sensitivity testing available on request. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ serratia marcescens | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s legionella culture (preliminary): no legionella isolated. fungal culture (preliminary): yeast. . imaging: cxr - impression: severely limited examination secondary to motion. complete opacification of the visualized left hemithorax with associated leftward mediastinal shift most compatible with left lung collapse with possible effusion. cxr (after bronch) - ett ends 1.2 cm above the carina and could be retracted by 1-2cm. there is improved aeration in the left upper lobe post-bronchoscopy. extensive parenchymal opacities and left basal opacification persist. r hip - again noted is severe osteoarthritis with marked narrowing of the joint space with subchondral cyst formation, sclerosis, and spurring. on this limited study, i see no evidence of fracture or dislocation. distal femoral internal fixation rod is noted. brief hospital course: this is an 84-year-old woman with a history of copd, bronchiectasis, obstructive sleep apnea, pulmonary hypertension, and diastolic congestive heart failure admitted to the micu with respiratory failure requiring intubation for mucous plugging and pneumonia. # respiratory failure: the patient was admitted in respiratory distress and intubated. based on imaging, the patient has a pneumonia with mucus plugging that took away function of her left lung. she was started on vancomycin and cefepime, with added azithromycin for atypicals. the patient underwent bronchoscopy on day of admission with suctioning of copious secretions. after bronchoscopy, the patient's left lung showed significant improvement on chest x-ray. the patient remained intubated for 2 days with continued suctioning of secretions. secretions diminished and the patient was extubated on day 3 of admission. following extubation, bal returned positive for serratia species. her antibiotic coverage was narrowed to ceftriaxone and she should continue on this antibiotic alone until . blood cultures remained negative from but were still pending at time of discharge. she will likely need aggressive pulmonary toilet at rehab if she were to mucous plug again potentially including chest pt, saline neb treatments, in/exsufflation, or nasotracheal suctioning. # urinary tract infection: the patient was admitted with urinalysis suggestive of infection, with pyuria and large leukocyte esterase. urine culture was not checked, but given that the patient improved clinically it is felt that the patient likely did not have a true uti. if the patient develops symptoms c/w uti a ua and urine culture should be checked. # copd: the patient's home regimen includes albuterol, advair, and tiotropium. albuterol and ipratroprium were used in the icu while intubated. # diastolic heart failure: the patient is nyha class iii, but with preserved ejection fraction. the patient's home spironolactone and torsemide were held on admission given possible sepsis picture. on day 3 of admission, the patient was restarted on her home dose of torsemide. on discharge she was restarted on her home dose of spironolactone. . # coronary artery disease: the patient was continued on aspirin and simvastatin therapy throughout admission . # right leg pain - chronic. however, there was new concern for the degree of pain while the patient was intubated. patient underwent right hip x-ray that showed severe oa, with no evidence of fracture or dislocation. she was started on morphine 2mg iv q4hrs prn pain and fentanyl patch at home dose of morphine. pain improved. #code status: full code medications on admission: 1. albuterol sulfate 1.25 mg/3 ml solution for nebulization sig: one (1) inhalation every four (4) hours as needed for shortness of breath or wheezing. 2. azelastine 137 mcg aerosol, spray sig: two (2) sprays nasal twice a day. 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone 50 mcg/actuation spray, suspension sig: two (2) sprays nasal once a day. 5. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. gabapentin 400 mg capsule sig: two (2) capsule po tid (3 times a day). 7. morphine 60 mg tablet extended release sig: one (1) tablet extended release po twice a day. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po twice a day. 10. primidone 50 mg tablet sig: two (2) tablet po at bedtime. 11. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 12. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 13. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 14. torsemide 20 mg tablet sig: two (2) tablet po daily (daily). 15. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: two (2) tablet, chewable po daily (daily). 16. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 18. multivitamin tablet sig: one (1) tablet po daily (daily). 19. ferrous gluconate 240 mg (27 mg iron) tablet sig: one (1) tablet po once a day. 20. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 21. cefepime 1 gram recon soln sig: one (1) gram injection q12h (every 12 hours) for 9 days: to finish on . 22. vancomycin 500 mg recon soln sig: five hundred (500) mg intravenous q 12h (every 12 hours) for 9 days: to finish on . 23. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for wheezing. 3. azelastine 137 mcg aerosol, spray sig: two (2) sprays nasal twice a day. 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. fluticasone 50 mcg/actuation spray, suspension sig: two (2) sprays nasal once a day. 6. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: two (2) tablet, chewable po q 24h (every 24 hours). 7. advair diskus 100-50 mcg/dose disk with device sig: one (1) inhalation inhalation twice a day. 8. gabapentin 800 mg tablet sig: one (1) tablet po three times a day. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. primidone 50 mg tablet sig: two (2) tablet po at bedtime. 11. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 12. spironolactone 25 mg tablet sig: one (1) tablet po once a day. 13. ceftriaxone 1 gm iv q24h 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 16. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 17. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 18. morphine sulfate 2-4 mg iv q4h:prn agitation/pain hold for somnolence or rr<10 19. multivitamin tablet sig: one (1) tablet po daily (daily). 20. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 21. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 22. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 23. torsemide 20 mg tablet sig: two (2) tablet po daily (daily). 24. 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. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: respiratory failure requiring intubation mucous plugging serratia pneumonia urinary tract infection 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 to for further evaluation of respiratory distress, productive cough, and fevers and found to have a pneumonia, mucous plugging, and a urinary tract infection. you needed to be placed on a breathing machine to help your breathing while your pneumonia was being treated and needed a procedure called a bronchoscopy to help clear out some mucous from your lungs. you will be discharged to rehab where your breathing can continue to be monitored and you can finish your antibiotic course. you should continue all of your previous medications in addition to a course of iv antibiotics (ceftriaxone daily until ). followup instructions: please follow-up with all of your outpatient appointments listed below: department: medical specialties when: tuesday at 10:30 am with: , md building: campus: east best parking: garage department: cardiac services when: wednesday at 10:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 11:00 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube closed [endoscopic] biopsy of bronchus diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux pneumonia due to other gram-negative bacteria urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation other and unspecified hyperlipidemia acute respiratory failure personal history of malignant neoplasm of large intestine cardiac pacemaker in situ chronic diastolic heart failure hip joint replacement acquired absence of both cervix and uterus other diseases of trachea and bronchus osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh bronchiectasis with acute exacerbation 

Answer: The patient is high likely exposed to