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: history of present illness: the patient is a 75 year old female from a nursing home who was recently discharged from on , now presenting with mental status changes. her discharge diagnoses from the previous admission consisted of pneumonia and uti. she was discharged back to the nursing home on levofloxacin and flagyl. patient did not improve clinically in terms of her mental status changes and was unable to tolerate p.o. on the day of admission at the nursing home she spiked a temperature and given that her mental status had not improved, she was brought to the e.d. she was found to be hypotensive and tachycardiac to the 140s. she received 3 liters of iv fluids and 20 mg of iv diltiazem times two. her blood pressure improved and her heart rate slowed down to the low 100s. she was also started on ceftriaxone and vancomycin. past medical history: seizure disorder. history of atrial fibrillation which is rate controlled on diltiazem. she is currently not on anticoagulation. osteoarthritis. osteoporosis. history of dementia likely secondary to alcohol abuse. history of lower gi bleed from diverticula. type 2 diabetes mellitus. cerebrovascular accident of the left frontal lobe resulting in ataxia and right hemiplegia. history of fall. history of cataracts. history of decubitus ulcerations on the right buttocks. history of hyponatremia. total abdominal hysterectomy with bilateral salpingo-oophorectomy. allergies: no known drug allergies. medications on admission: diltiazem extended release 120 mg p.o. b.i.d., potassium chloride 20 meq p.o. b.i.d., trazodone 50 mg p.o. q.day, dilantin 450 mg p.o. q.day, phenobarbital 60 mg p.o. q.day, folic acid 1 mg p.o. q.day, glyburide 10 mg p.o. q.day, multivitamin q.day, protonix 40 mg p.o. q.day, calcium carbonate 500 mg p.o. b.i.d., senna q.day, zyprexa 2.5 mg in the morning and 5 mg at night. social history: the patient has a history of alcohol abuse. her smoking history is currently unknown. she lives at the which is a nursing facility. family history: unable to elicit. physical examination: on admission vital signs temperature 101, pulse 140, blood pressure 126/80, respiratory rate 22, oxygen saturation 94 percent on 2 liters of oxygen by nasal cannula. in general, this was an obtunded, elderly female. heent had surgical pupils. lungs had crackles bilaterally at the bases with decreased breath sounds throughout. heart was tachycardiac with an irregular rhythm. abdomen soft, nondistended, nontender with no hepatosplenomegaly and good bowel sounds. on neurologic exam she had right sided hemiparesis. extremities had no cyanosis, clubbing or edema. on rectal exam the patient was guaiac positive. laboratory data: on admission white count was 14.3 with neutrophil predominance of 81.2 percent, hematocrit 37.1, platelets 160. chem-7 sodium 149, potassium 3.9, chloride 118, bicarbonate 21, bun 32, creatinine 0.9, glucose 334. inr was elevated at 1.8, ptt 26.3. alt 11, ast 18, alka phos 108, total bili 0.5. ua was cloudy, moderate leukocytes, large blood, no nitrites, greater than 50 red blood cells, greater than 50 white blood cells, many bacteria, no yeast, 3 to 5 epithelial cells. head ct scan was stable in appearance with no evidence of hemorrhage or edema. chest x-ray showed multifocal air space opacities which have worsened since . the differential diagnosis for these chest x-ray findings is either multilobar pneumonia versus boop versus aspiration pneumonia. ekg showed atrial fibrillation with rvr at 150 beats per minute, lad, st depressions in leads 1, avl, v2 through 6 which are old. hospital course: the patient had a long complicated hospital course, bouncing between the medicine floor, service and the micu. 1. pulmonary. as it was unclear the exact cause of her chest x-ray changes, she was initially started on antibiotics for possible pneumonia. she was treated with vancomycin and eventually cefuroxime was added for further coverage. a pulmonary consult was obtained on following a chest ct which showed multifocal areas of consolidation as well as ill-defined pulmonary nodules and masses, many of which contained air bronchograms. pulmonary consult attributed these chest cat scan changes to either boop versus bronchoalveolar cancer. a trial of steroids was not started initially due to the patient's persistent mental status changes. patient also had multiple episodes of respiratory distress requiring admission to the micu. she was originally admitted to the service of medicine, but required transfer to the micu on for closer monitoring and respiratory distress causing respiratory acidosis. she was again transferred back to medicine to the service on after her respiratory status had improved, but then required another transfer to the micu on for hypoxia requiring bipap. she was transferred back to medicine on the service one final time on after her respiratory status had again stabilized. 2. urinary tract infection. the patient was treated with ceftazidime initially and then switched to vancomycin and gentamicin on . despite these antibiotics, her urinalysis continued to show greater than 50 white blood cells. urine cultures from , , , and all showed yeast. patient was started on diflucan bladder washes in the micu before her last transfer to the medicine service. 3. atrial fibrillation. the patient moved in and out of atrial fibrillation, but was continued on diltiazem and digoxin. 4. congestive heart failure. due to the patient's worsening hypoxemia, the micu team ordered an echo to evaluate cardiac function on . this showed an ejection fraction of 60 percent, 3+ tricuspid regurgitation, 2+ mitral regurgitation. she was started on lasix as it was felt that part of her respiratory distress was due to a chf component. 5. mental status changes. neurology was consulted to further evaluate these mental status changes. eeg showed mild diffuse encephalopathy. csf studies were normal. head ct was negative. neurology believed these mental status changes to be due to a toxic metabolic cause. dilantin levels were adjusted, but she continued to have waxing and mental status. mri showed a focal lesion that did not correlate with physical exam findings. patient was tapered off phenobarbital. at the time of this dictation, she continued to have waxing and mental status of unknown etiology. 6. anemia. the patient had a low hematocrit, but no signs of dic. 7. nutrition. since the patient's mental status did not allow for good p.o. intake, she was started on ng tube feedings. gi was consulted on for possible peg tube placement, but it had not been placed at the time of this dictation. 8. rheumatology. there was a question of whether the patient may have scleroderma due to skin changes on her hand which are consistent with a picture of scleroderma. labs are pending. 9. deep vein thrombosis. lower extremity dopplers showed bilateral dvts and the patient was placed on lovenox. the remainder of the hospital course will be dictated at another time. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified atrial fibrillation other convulsions other specified alveolar and parietoalveolar pneumonopathies other venous embolism and thrombosis of unspecified site 

Answer: The patient is high likely exposed to