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: lisinopril attending: chief complaint: confusion major surgical or invasive procedure: mechanical ventilation via trach history of present illness: 77yo woman with vent dependency, hx of copd, sleep apnea here with increasing confusion at nh. she takes insulin and reportedly oral hypogylcemics in the nh. fs found to be 16 so given 2 amps of d50. also received 2 amps narcan. minimal response although bs up to 146. reportedly still not at baseline. notably recent labs include inr 7.2 on and guaiac neg on , hct 28 on . . spoke with family: they report that she has been increasingly confused and has almost daily episodes of "deep sleep." she had her dobhoff removed 2 wks ago and has been taking very poor po intake. yesterday though she was reportedly more interactive and tolerating better po intake. . pt has been on clinda and levaquin for pna until yesterday then started for "growth in sputum." she also has been treated with po vanco for c diff. . in the ed: vs: hr 88 bp 120/75 o2 100%. exam responds to verbal stimuli. ob negative, head ct neg for hemorrhage or shift. cxr showed stable pleural effusion r>l. labs showed wbc 13 w 89% polys, u/a largely negative, arf (baseline cr 0.6), hct 23 (down from 30s). glucose initially 54. she was given 2 amps d50 and a d5 gtt. gluc fluctuated between 49 to 201. she also received octreotide to try to reverse sulfonyurea. her afib was poorly rate controlled and increased to hr 120s. received iv dilt 10x1 and po dilt 30 x1. bp dropped slightly to 100/50s from 130s/60s and she received total of 1000 ns and 500 cc d5 gtt. also ordered for 2u prbcs for hct of 23. . currently, she appears comfortable but does not verbalize. past medical history: osa - failed cpap at nights agitation, trach placed copd: pfts with fev1/fvc: 131, nl tlc chf: mild symmetric lvh, mild mr cad: documented but no studies on record hyperchol dm2 gout afib on coumadin social history: lives at rehab. denies tobb, etoh. son is hcp family history: noncontributory physical exam: vs: 100.2 hr 117 bp 104/66 100% on fio2 50%, r21 vent: ps 10/5 fio2 50% gen: obese, trach, nonverbal. nad heent: mmm, jvp flat, perrla, cards: irreg, tachy 2/6 systolic murmur lungs: coarse bilat with crackles r>l abd: obese, bs+ nt nd soft no rebound ext: edema. legs equal sized neuro: follows commands: smiles, shrugs shoulders, squeezes hands bilat. cn: perrla, eomi, face symmetric. distal upper strength. access: double lumen picc pertinent results: ekg: afib rate of 87. nl ais, nl intervals. tw flattening v2, otherwise no change. . labs: 144 109 22 -------------< 34 3.4 25 1.4 ck: 19 -> 14 trop-t: 0.03 ca: 8.1 mg: 1.9 p: 4.1 alt: 15 ast: 18 ap: 64 tbili: 0.4 alb: 2.6 : 19 lip: 12 . wbc: 12.7, 90% polys, no bands hct 22.4, mcv 86 plt 241 . pt: 16.5 ptt: 30.5 inr: 1.5 . hct: 22.4 -> 23.8 -> 21.9 . trends: hct: 22.4 - 21.9 - 24 - 26 - 26 wbc: 12.7 - 14.1 - 6.7 inr: 1.5 - 1.4 creatinine: 1.4 - 1.0 na 144 - 147 ck 19 - 14 trop 0.03 - 0.04 . fe 113, tibc 174, ferritin 404 b12 628, folate 12 hapto 383 . blood gases: abg: po2-150* pco2-50* ph-7.31* caltco2-26 abg: po2-67* pco2-63* ph-7.21* caltco2-27 abg: po2-104 pco2-53* ph-7.27* caltco2-25 vbg: po2-40* pco2-49* ph-7.33* caltco2-27 vbg: po2-43* pco2-55* ph-7.30* caltco2-28 . 12:32am blood lactate-1.3 06:51am blood lactate-1.2 . images: cxr: my read: bilat effusions r>l, cardiomegaly, largely stable from previous. . non-contrast head ct: no hemorrhage, hydrocephalus, or shift of normally midline structures. the -white matter differentiation is preserved. no major vascular territorial infarct is apparent. no osseous abnormality is detected. the visualized paranasal sinuses and mastoid air cells which are poorly pneumatized are normally aerated. impression: no hemorrhage. . : ruq u/s: 1. cholelithiasis without evidence of acute cholecystitis. 2. small right pleural effusion. 3. minimal-moderate amount of abdominal ascites. . ct chest: 1. multifocal bilateral pneumonia. 2. large right pleural effusion and small left pleural effusion in the setting of cardiomegaly consistent with moderate chf. 3. possible acute cholecystitis. recommend ultrasound for futher evaluation . ct head: no acute intracranial process. . brief hospital course: 77yo italian speaking woman with hx of osa, obesity, afib, dm here for worsening confusion, poor po intake, and hypoglycemia. hospital course by problem: . # confusion: ddx included hypoglycemia, sedating medications, infection, central neuro process, malnutrition., hypercarbia. initially, mental status improved with minimal intervention. her blood glucose was monitored closely and infectious w/u as below. then on , she developed increased somnulence. repeat head ct negative. abg showed slight increase hypercarbia. repeat blood cx ngtd. we optimized her ventilation by placing her on simv on and her ms improved by back to baseline. we then gradually restarted her antipsychotic medications. . # resp failure: hx of osa and copd now with trach. she is reportedly on 15/5 bipap at night but has been recently on it all day at rehab. in the micu, she was on trach collar on but placed on simv on as above. she then tolerated trach collar for >8h on but returned to simv at night. she had mild hypercarbia but we did not clearly believe this was cause of her delirium. we continued her inhalers and oral care. by , she was tolerating the trach mask well, when awake. she was maintained on simv when asleep at night. she was gently diuresed with po lasix, and will continue this at rehab. . # id: elevated wbc on admission and has recently been treated for many infections. recent cx data from include sputum w stenotrophonomas, acinetobacter, and pseudomonas. she was discharged from on with cefepime and vanco to complete course of pna rx. she then was on levaquin and clinda for pna but switched to on . also has hx of c. diff and mrsa pna. she was also on po vanco for c diff. on presentation, we initially covered her broadly with cefepime, vanco, and po vanco. given stable resp status, we stopped antibiotics within 24h, except we continued cdiff treatment with po flagyl. blood cultures remained negative. - we did attempt thoracentesis of right sided pleural effusion to help guage therapy. this was unsuccessful and we were unable to get fluid. - a sputum culture grew acinetobacter and pseudomonas, with sensitivities similar to what had been obtained at rehab. she had no clear infiltrate on chest ct, but given her initial respiratory failure, we empirically began a 7-day course of meropenem (for the pseudomonas) and tobramycin (for the acinetobacter) for presumed tracheobronchitis. her respiratory status immproved with these antibiotics, and she will complete a 7-day course. ****she will need trough and peak tobramycin levels drawn at rehab to monitor for both therapeutic and toxic levels.**** - we continued po flagyl for her c. diff colitis; she will continue this until 14 days after completion of all other antibiotics. - lactate remained low. . # anemia: baseline hct 30-34, but was down to 21 on presentation. ob neg stool but she has not been on ppi. ngl negative. required 2u prbcs in the emergency dept to maintain hct >22. her hematocrit remained stable in the mid-/high-20s, and no further transfusions were needed. iron studies not c/w iron def anemia. retic count quite low suggestive of marrow suppression. hemolysis labs negative. . # hypotension: baseline appears to be 130s sbp. fluctuating here ranging from sbp 100s to 130s on presentation. we held her lasix and antihypertensives and her bp stabilized within 24h. lasix was resumed one day prior to discharge, with sbps remaining in the 100s. . # chf: right sided failure vs periph edema on exam. previous echo here not with profoundly depressed ef but does have some diastolic dysfunction. diuretics held until given bp as above. then she had good response to lasix. we continued to hold her isordil in order to allow for diuresis with her lasix. . # cardiac; ischemia: no new ekg changes. cardiac enzymes were not indicative of active myocardial ischemia. statin wsa continued. isordil was discontinued, as above. . # atrial fibrillation: we initially held her coumadin in the setting of her low hematocrit, but this was resumed on . her goal inr is 2.0-3.0, and this will need to be monitored daily at rehab until she is therapeutic. he metoprolol was uptitrated since she was having bursts of atrial fibrillation with rvr. . # arf: likely prerenal and intravascularly dry. improved with gentle hydration. . # dm2: as above. no oral agents. given low-dose sliding scale. continued neurontin for neuropathic pain . # hyperlipidemia: no active issues. statin was continued. . # gout: does not report any joint pain at this time, no evidence of acute flair. allopurinol continued. . # nutrition: prior to admission, she had had no tube feeds for 2wks. speech and swallow eval suggested ground, thickened diet, but she was not taking adequate pos. an ng tube was placed so that tube feeds and medications could be administered. she will continue the tube feeds at rehab until she is able to sustain her nutrition by mouth. . # ppx: bowel regimen, ppi, sq heparin . # access: picc line . # communication: son - () who is health care proxy/power of attorney . # code status: full, discussed at length on admission w son . # dispo: she is being discharged to rehab for continuation of her above antibiotics, continued respiratory support for her chronic obstructive sleep apnea, and for continued nutritional and physical support, as above. medications on admission: allopurinol 300mg daily vit c 500mg atorvastatin 20mg daily calcium carbonate 1250mg colace advair lasix 60mg neurontin 300mg qhs riss isosorbide dinitrate 10mg tid meropenem 500mg x1 on linezolid 600mg () lopressor 50mg tid mvi zyprexa 2.5mg potassium prn risperdal 0.5mg senna qhs tiotropium daily po vanco 125 qid (-planned until ) warfarin 2.5mg qhs tylenol prn albuterol prn asa 81mg daily bisacodyl prn lactulose prn magnesium prn ntg prn trazodone 25mg qhs . allergies: nkda discharge medications: 1. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 2. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 3. atorvastatin 40 mg tablet sig: 0.5 tablet po daily (daily). 4. insulin regular human 100 unit/ml solution sig: as directed units injection asdir (as directed): per sliding scale. 5. meropenem 1 gram recon soln sig: five hundred (500) mg intravenous q8h (every 8 hours) for 6 days. 6. pantoprazole 40 mg recon soln sig: forty (40) mg intravenous q12h (every 12 hours). 7. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 9. furosemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). 10. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 20 days. 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 13. hexavitamin tablet sig: one (1) cap po daily (daily). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 16. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours) as needed. 17. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation qid (4 times a day). 18. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 19. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 20. risperidone 0.25 mg tablet sig: one (1) tablet po bid (2 times a day). 21. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 22. calcium carbonate 250 mg tablet, chewable sig: five (5) tablet, chewable po twice a day. 23. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation inhalation once a day. 24. outpatient lab work please check daily inr until patient is therapeutic on coumadin (goal inr ). 25. outpatient lab work please draw peak and trough level for tobramycin and adjust dose apprpriately. 26. tobramycin sulfate 40 mg/ml solution sig: one hundred (100) mg injection q8h (every 8 hours) for 6 days. discharge disposition: extended care discharge diagnosis: primary diagnoses: hypoglycemia delirium respiratory failure anasarca secondary diagnoses: obstructive sleep apnea, status-post tracheostomy chronic obstructive pulmonary disease chronic diastolic congestive heart failure atrial fibrillation anemia hyperlipidemia discharge condition: stable discharge instructions: you were admitted to the hospital with confusion and low blood sugars. your confusion resolved with repletion of your blood sugar, and your blood sugars have remained normal. we have started you on a course of iv antibiotics for treatment of suspected tracheobronchitis; you will complete a 7-day course. you received a blood transfusion to treat your anemia, and your blood counts have remained stable. you have been receiving nutrition through a nasogastric tube. as you continue to recover, your rehab facility can attempt to give you nutrition by mouth. it is very important that you continue to use the ventilator when you're asleep at night. you can use the trach collar during the day. as you regain your strength, the nasogastric tube can eventually be removed as you are able to take food and pills by mouth. followup instructions: you should call the office of your primary care physician, . , at to schedule follow up within the next 2 weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified pure hypercholesterolemia unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified gout, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled intestinal infection due to clostridium difficile long-term (current) use of anticoagulants chronic diastolic heart failure chronic respiratory failure tracheostomy status 

Answer: The patient is high likely exposed to