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: fentanyl / codeine / latex attending: chief complaint: ards major surgical or invasive procedure: intubation at transfer to intubated midline placement picc placement history of present illness: mrs is a 54 yo woman with hx charcot tooth, osteogenesis imperfecta, copd who presented to medical center on after fall, was found to have multiple rib fractures and subsequently developed pna and ards. initially in the ed, she was found to have multiple non-displaced l sided rib fractures involving posterolaterally and 8 through 11 posteriorly, as well as a lll consolidation. she was admitted to the medicine floor and treated for pna and pain control. she developed ams thought hypercapnia and subsequently developed worsening respiratory failure with cxr showing worsening bilateral consolidations requiring icu transfer, bipap and eventually intubation. she was broadend to zosyn, levo, vanc, then subsequently changed to zosyn/linezolid for unclear reasons. course was complicated by arf thought to be atn and hypotension not requiring pressors. plans were made for bronchoscopy and dialysis today, however family requested transfer to tertiary medical center for further evaluation. she was transfered on fent/versed. on arrival to the floor, pt is intubated, sedated on fent/versed, opens eyes to voice. review of systems: unable to obtain past medical history: -charcot--tooth disease -osteogenesis imperfecta -copd -fall in with numerous left sided rib fractures (5-8th posterolaterally and 8-11th posteriorly) complicated by ards requiring intubation -scoliosis -hx osteomyelitis -neuropathy -muscular dystrophy social history: - tobacco: currently smoking 5 cigs daily. - alcohol: none - illicits: none lives with family, on disability, walks with walker, requires assistance with adls. family history: mother with charcot tooth and hx muscular dystrophy in family. physical exam: on admission: vitals: bp:125/60 p:76 r:24 o2:93% general: intubated, sedated, opens eyes to voice but does not follow commands heent: blue sclera, perrl, mmm, intubated neck: supple, jvp not elevated, no lad lungs: rhoncorous throughout, bruising on l thorax cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, mildy distended, hyperactive bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: no edema, r foot cold, 2+ radial/pedial pulses, l foot amputation. on discharge: afebrile for at least several days, tc 97.3 p70-80's 140-160's/60-80's rr 17-29 92-100% on 70-100% face tent and 91-97% with 4l nc pertinent results: osh labs: . 143/ 112/ 50 --------------< 4.2/ 23/ 3.7 . albumin 2.4 alk phos 42 ast 11 alt 13 mg 2.4 wbc 22.6, 91% neuts, 2% bands hct 34.0 plt 148 bnp 1081 . admission labs: 01:57am blood wbc-27.1* rbc-3.83* hgb-11.2* hct-33.5* mcv-88 mch-29.2 mchc-33.4 rdw-15.1 plt ct-153 05:17am blood wbc-16.9* rbc-3.36* hgb-9.9* hct-29.6* mcv-88 mch-29.5 mchc-33.5 rdw-15.0 plt ct-146* 03:53am blood wbc-22.7* rbc-3.13* hgb-9.3* hct-27.3* mcv-87 mch-29.9 mchc-34.2 rdw-14.8 plt ct-164 01:57am blood pt-12.1 ptt-25.2 inr(pt)-1.0 02:11am blood pt-12.9 ptt-27.8 inr(pt)-1.1 11:27pm blood fibrino-574* 01:57am blood glucose-138* urean-62* creat-4.1* na-141 k-4.0 cl-109* hco3-20* angap-16 02:38pm blood glucose-121* urean-68* creat-4.0* na-144 k-3.5 cl-111* hco3-22 angap-15 05:17am blood glucose-111* urean-75* creat-4.3* na-143 k-3.1* cl-110* hco3-21* angap-15 04:00pm blood urean-74* creat-4.4* na-144 k-3.1* cl-110* hco3-17* angap-20 01:57am blood calcium-8.5 phos-3.6 mg-2.5 iron-52 02:38pm blood calcium-8.0* phos-3.7 mg-2.6 01:57am blood caltibc-152* ferritn-476* trf-117* 04:07pm blood hapto-274* 02:53am blood type-art temp-37.3 rates-24/ peep-10 fio2-60 po2-154* pco2-38 ph-7.39 caltco2-24 base xs--1 intubat-intubated 06:07pm blood type-art tidal v-100 peep-10 fio2-60 po2-78* pco2-46* ph-7.27* caltco2-22 base xs--5 intubat-intubated vent-controlled 08:20am blood type-art po2-115* pco2-35 ph-7.37 caltco2-21 base xs--3 06:07pm blood lactate-1.0 08:20am blood lactate-1.2 05:59am blood lactate-0.7 06:07pm blood o2 sat-94 05:47pm blood freeca-1.12 08:05pm blood freeca-1.33* 03:27am blood freeca-1.10* . discharge labs: 03:01am blood wbc-15.0* rbc-3.14* hgb-9.2* hct-26.7* mcv-85 mch-29.2 mchc-34.4 rdw-15.2 plt ct-216 02:24am blood wbc-15.7* rbc-3.20* hgb-9.4* hct-28.0* mcv-88 mch-29.3 mchc-33.5 rdw-15.4 plt ct-233 02:16am blood wbc-19.0* rbc-2.91* hgb-8.6* hct-26.0* mcv-89 mch-29.5 mchc-33.1 rdw-15.2 plt ct-264 02:39am blood neuts-88* bands-0 lymphs-5* monos-6 eos-0 baso-0 atyps-0 metas-1* myelos-0 02:16am blood pt-12.8 ptt-29.2 inr(pt)-1.1 03:01am blood glucose-87 urean-55* creat-3.3* na-139 k-4.2 cl-107 hco3-24 angap-12 02:31pm blood glucose-77 urean-52* creat-3.1* na-134 k-3.8 cl-104 hco3-19* angap-15 02:24am blood glucose-87 urean-61* creat-3.6* na-140 k-4.6 cl-107 hco3-22 angap-16 07:50pm blood glucose-138* urean-62* creat-3.7* na-139 k-4.0 cl-106 hco3-23 angap-14 02:43pm blood glucose-158* urean-61* creat-3.4* na-143 k-2.8* cl-113* hco3-19* angap-14 11:27pm blood ld(ldh)-488* totbili-0.5 03:01am blood calcium-7.9* phos-4.1 mg-2.2 02:31pm blood calcium-7.3* phos-3.7 mg-2.1 02:24am blood calcium-8.7 phos-4.7* mg-2.6 11:27pm blood hapto-322* 03:27am blood type-mix ph-7.37 08:05pm blood type- temp-35.6 ph-7.27* 05:47pm blood type-art po2-59* pco2-45 ph-7.32* caltco2-24 base xs--3 05:47pm blood lactate-1.0 07:58am blood lactate-0.8 03:27am blood freeca-1.10* . micro: ucx negative 12:32 pm bronchoalveolar lavage gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (preliminary): no growth, <1000 cfu/ml. legionella culture (preliminary): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. 5:07 am sputum site: endotracheal source: endotracheal. gram stain (final ): pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): . urine culture : no growth. blood culture negative x4 c. diff ag negative x2 . studies: admission ekg : cardiology report ecg study date of 2:21:42 am artifact is present. sinus rhythm. the p-r interval is short without evidence of pre-excitation. no previous tracing available for comparison. . discharge ekg : cardiology report ecg study date of 8:30:02 am sinus rhythm and frequent atrial ectopy. wandering baseline and baseline artifact. left ventricular hypertrophy and low limb lead voltage. interpretation is limited by poor quality recording. suggest repeat tracing. no apparent diagnsotic interim change as compared with previous tracing of . . tte : conclusions the left atrium is normal in size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef 65%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. . admission cxr : et tube tip is 1.4 cm above the carina, it should be withdrawn a couple of centimeters for a more standard position. ng tube tip is out of view below the diaphragm. the stomach is distended. metallic hardware projects over the spine. cardiac size is normal. there is scoliosis and asymmetry of the ribs bilaterally. . extensive diffuse lung opacities are larger on the right lung. the differential diagnosis is broad and includes the clinical diagnosis of ards but multifocal pneumonia, hemorrhage and pulmonary edema can have the same radiologic appearance. . discharge cxr : findings: as compared to the previous radiograph, there is no relevant change. severe bilateral parenchymal opacities, most severe on the right than on the left. unchanged subtle lucencies suggesting cavitation in widespread pneumonia. additional pulmonary edema cannot be ruled out. the presence of small bilateral pleural effusions is likely. unchanged position of the left picc line. renal u/s : impression: no hydronephrosis is seen bilaterally. trace of ascites. brief hospital course: mrs is a 54 yo woman with hx charcot tooth, osteogenesis imperfecta, copd who presented to medical center on after fall, was found to have multiple left sided rib fractures ( posterolaterally and 8 through 11 posteriorly) as well as a lll consolidation. she was treated there for pna and pain control; then developed ams due to hypercapnia, with subsequent respiratory failure and cxr showing bilateral consolidations concerning for ards. there, she failed bipap and was intubated; course was complicated by arf thought to be due to atn from hypotension (? but did not require pressors?). pt was transferred to for further management. . 1. respiratory failure: unclear if initially pt was hypoxic or hypercarbic, however initiaing event appears to be pna. pt also with underlying structural abnormalities including scoliosis and numerous left sided rib fractures as above. pt transferred with persistent bilateral infiltrates on cxr, and with no evidence of heart failure on echo, was most suspicious for ards, and was ardsnet ventilated. . she was given mdi's, but no steroids as copd not suspected. pt was diuresed with iv lasix to address minimal volume overload. she was on the ventilator until when she was extubated. she initially did have some increased wob and discussion of whether she would desire re-intubation was discussed with her and her family; she did desire re-intubation if that were felt necessary. however, through the next couple days we kept a close eye on her and she improved over time with decreased wob and respiratory status overall much improved, and she was satting well on 40-50% facetent (shovel mask) and 4l nc by discharge. . she had increased sputum production and desaturations with minimal amounts of exertion and would benefit from continued pulmonary pt. would also recommend standing albuterol/ipratropium inhalers q6 and additional albuterol prn. of note, her cxr continued to show bilateral patchy infiltrates by discharge, but she had clinically much improved. . 2. lll consolidation: noted at where she was started on vanc/zosyn/levaquin (briefly on linezolid instead of vanc but switched back to vanc on admission) and she completed a course for hap (unclear exact duration, but was > 7-10 days). she was admitted with wbc count 27.1 which improved to 15.0 by time of discharge. last fever was 100.7 on at 4am. sputum and bal cultures did not grow anything either here or at (see below, leukocytosis) . 3. acute renal failure: creatine at osh 3.7, with unclear prior baseline, and was 4.1 on admission to . concern for atn given ? history of hypotension; however did not seem to be prolonged based on notes. renal was consulted and sediment seemed consistent with atn. renal u/s showed no signs of obstruction. a 24 hr urine cr collection showed a calculated gfr of 26. she was not anuric and had normal electrolytes, and in fact then entered in the polyuria phase of atn, with a large volume of uop. she was briefly given 1/2 ns to keep up with sodium losses to prevent hypovolemia per renal recs, and would benefit from frequent electrolytes checks at least initially until they are seen to be stable. uop should also be carefully monitored, and our goals were to keep her ins and outs even. . creatinine was trended, peaked to 4.8, and continue to downtrend to 3.1-3.3 by discharge, again with unclear baseline. *** she will need follow up with our renal department within 1 month to reassess her renal function *** . 4. leukocytosis: most likely due to pulmonary infection +/- recent steroid use (she was not given steroids at , unclear if given at osh). treated for hcap as above. cultures from blood, sputum, bal, and cdiff were all negative. her initial wbc count of 27 downtrended to a persistently elevated wbc count of 15 by discharge, but she continued to be afebrile and was clinically much improved. . also of note, micro lab was contact and sputum was consistent with respiratory flora, blood cultures were negative, and urine culture negative. . 5. rib fractures: trauma surgery was consulted, who felt it unlikely that the rib fractures would pose a threat to breathing, and unlikely to be flail chest. recommended supportive treatments, and pt was started on oxycodone for pain control after extubation. . 6. anemia: unclear baseline. her hct was 33.5 on admission and downtrended through admission, and was 26.7 on discharge. no signs/symptoms of bleeding, hemolysis labs negative; iron studies were consistent with acd. . 7. lue skin tear: wound care with mepilex. . 8. hypernatremia: very mildly to na 147 for a couple days, then trended down to normal na 139 by discharge. . 9. diarrhea: before discharge she was noted to have some diarrhea. she had had 2 negative cdiff's and was afebrile, with decreasing wbc count by discharge so low suspicion for infection. would continue to monitor. . 10. social: of note, pt had noted during admission that her husband is an alcoholic and she did not want to see him right now. her daughter (number below) was called just before the pt was discharged and we confirmed that the pt would be discharged to ltac. . 11. access: she had a lue picc line placed, and a 22g piv. she was given subq heparin for dvt prophylaxis. . 12. communication: , , ; sr, husband, , , daughter ; dr. at southshore was contact . 13. full code . 14. dispo: the pt will be discharged to ltac for further rehabilitation. . 15. medication reconciliation: of note, unable to fully reconcile home medication list. med list stating pt taking ? 150 mg and 120 mg ; however while admitted to was given 30 mg and 50 mg hs. oxycontin and percocet on home med list were held for now but could be restarted if appropriate. klonopin also currently being held. medications on admission: home meds (per osh records): - 120 po daily -trazodone 150 (? 3 tabs??) at bedtime -klonopin 1 mg po bid -oxycontin 40 mg po tid -percocet 5/325 1 tab q 4 . medications on transfer: -combivent 8 puff qid -versed 2-4 mg q 30 hrs -fentanyl 50-100 mcg q 30 min -albuterol 8 puffs q 2 hrs -protonix 40 mg iv daily -colace 100 mg daily -solumedrol 80 mg q 8 hrs -heparin 5000 mg sq q 8 - 30 mg daily -trazodone 450 mg q hs -linezolid 600 mg iv bid -zosyn 2.25 q 8 hrs discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 4. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 7. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 8. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for skin redness. 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnoses: 1. ards 2. hospital acquired pneumonia 3. acute renal failure from acute tubular necrosis secondary diagnoses this admission: -charcot--tooth disease -osteogenesis imperfecta -copd -scoliosis -hx osteomyelitis -neuropathy -muscular dystrophy 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 from , where you presented after having had a fall and breaking many of your left sided ribs. you were also found to have a pneumonia and were treated with an antibiotics course. there, your respiratory status worsened and you developed acute respiratory distress syndrome, which required that you be intubated and put on a breathing machine. you slowly improved and were able to come off the breathing machine. you were also found to have kidney damage but did not require dialysis; this is improved but must be watched carefully in the days to weeks to come. you are being discharged to , a long term acute care facility where you can continue to rehabilitate and strengthen your lungs. the following changes were made to your medication regimen: 1. it was unclear if you were taking 30 mg daily or 120 mg daily , you are continued on 30 mg for now but could increase after clarification 2. start albuterol and ipratropium nebs 3. start ultram for rib pain 4. start oxycodone for rib pain 5. start subcutaneous heparin 6. it was also unclear what dosage of you were taking, so we continued on 50 mg at hs until this can be clarified. 7. start fluticasone/salmeterol 8. stop oxycontin 40 mg tid for now -- this was held while you were intubated but could be restarted when appropriate followup instructions: please follow up with your primary care doctor , p. by calling to schedule a follow up appointment in the next month. it is very important that you follow up with nephrology for your acute renal failure. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified anemia, unspecified tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified septicemia chronic airway obstruction, not elsewhere classified sepsis hyperosmolality and/or hypernatremia scoliosis [and kyphoscoliosis], idiopathic fall from other slipping, tripping, or stumbling home accidents closed fracture of eight or more ribs osteogenesis imperfecta peroneal muscular atrophy hereditary progressive muscular dystrophy 

Answer: The patient is high likely exposed to