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 / demerol / heparin agents attending: chief complaint: failure to thrive at rehab major surgical or invasive procedure: none history of present illness: 80 y/o female with a progressive upper cervical myelopathy who is s/p cervical spine surgery , trach/peg placement , who presented from () with failure to thrive. per daughter, she has had no progression at rehab. she has been immobile. her daughter wanted her re-evaluated and transferred to another rehab facility. the patient is unable to give any history as she is non verbal from this presumed mass. in ed, t101.6, p 106,bp 108/49, rr 16, 96% on trach mask 35% o2. over the course of the evening she had sveral episodes of desats to the 80's requiring frequent suctioning productive of mucous plugs. during one suctioning of a large mucous plug she became hypotensive with an sbp in the 70's. she was started on normal saline and dopamine and her sbp increased to 80'-100s. in the ed she was given a total of 5 l of ns, vancomycin 1 gram, ceftriaxone 2 grams (given before lp sent), tylenol, ativan. she was admitted to the micu with hypotension, fevers, change in mental status and concern for sepsis. she was placed on the must protocol. she received ivf per the protocol to maintain a cvp greater than 8. she was placed on vancomycin, levaquin, and flagyl. her lp did not indicate infection. she only required dopamine for a few hours, and was weaned off. on she was transferred to the floor as she was hemodynamically stable. her neurological history is as follows: she originally presented in with cervical spondylosis, which was treated symptomatically for 3 years. in , she presented to clinic c/o tingling in her hands. at that time she declined mri claustrophobia and was managed symptomatically with physical therapy. in , she returned to their clinic with a significant deterioration. she was quadriparetic and had developed urinary incontinence. mri revealed c1-2 subluxation with a large degenerative pannus (as is seen in rheumatoid arthritis) around the odontoid process, compressing the cervical medullary junction, as well as c3-c4 stenosis. she underwent neurosurgery on , where she had a transoral resection of the odontoid/pannus as well as a posterior occipital cervical decompression. this was complicated by a prolonged intubation and failure to wean. she was extubated on but required reintubation on . at that point she had a trach and a peg placed. per the d/c summary, post-op the pt was able to open her eyes, grip with her hands, move all extremities spontaneous (although decreased in the rue as she was preop) but could not follow commands. she was discharged to rehab at this point. past medical history: 1. s/p c-spine operation (as above) for subluxation with pannus around odontoid 2. tracheostomy 3. peg placement 4. hit, diagnosed 5. ivc filter placement 6. bipolar d/o, on lithium 7. c-section x3 social history: came from rehab, married, husband is also sick at times per daughters, has 2 daughters and 1 son, children very involved. communication: husband/daughter at ( son at ( family history: parents with cad physical exam: t: 98.4 bp: 120/60 p: 75 r: 20 o2 sat 98% on 40% trach mask gen: elderly female in cervical collar, tracks with eyes, following some commands, answers yes/no questions, mouthing words heent: trach in place, perrl, anicteric, mmm cv: rrr, nl s1, s2, ii/vi sem at lsb. lungs: coarse breath sounds throughout but less rhonchorous than on admission abd: +peg, site drsg c/d/i, nt, +bs, approx 5 cm ventral hernia easily reducible ext: no edema neuro: rue dense paresis, otherwise moves ble and lue slightly against gravity, nonresponsive to questions, withdraws to pain. increased tone in rue. pertinent results: 07:40pm blood wbc-12.7* rbc-3.08* hgb-9.7* hct-29.1* mcv-95 mch-31.4 mchc-33.3 rdw-14.3 plt ct-291 08:00pm blood hct-24.3* 06:09am blood wbc-9.4 rbc-3.20* hgb-9.9* hct-29.8* mcv-93 mch-30.9 mchc-33.1 rdw-15.7* plt ct-295 07:40pm blood neuts-85.4* lymphs-10.9* monos-3.1 eos-0.4 baso-0.3 06:09am blood pt-12.9 ptt-23.6 inr(pt)-1.1 06:09am blood glucose-88 urean-13 creat-0.4 na-145 k-3.7 cl-113* hco3-24 angap-12 10:30am blood alt-36 ast-22 ld(ldh)-232 alkphos-107 totbili-0.4 06:09am blood calcium-8.4 phos-2.8 mg-2.3 10:30am blood albumin-2.3* calcium-7.8* phos-2.8 mg-1.9 10:30am blood vitb12-599 10:30am blood tsh-4.8* 08:00pm blood free t4-1.0 10:30am blood cortsol-21.9* 06:09am blood vanco-21.4* 07:46pm blood lactate-1.2 10:31am blood lactate-0.6 d/c labs: 10:32am blood wbc-10.2 rbc-3.33* hgb-10.7* hct-31.1* mcv-94 mch-32.1* mchc-34.2 rdw-15.8* plt ct-382 10:32am blood glucose-128* urean-18 creat-0.4 na-145 k-3.5 cl-113* hco3-28 angap-8 10:32am blood calcium-8.7 phos-3.0 mg-2.2 lp results: tube 1: (csf) wbc-49 rbc-* polys-98 lymphs-1 monos-1 tube 4: (csf) wbc-0 rbc-68* polys-64 lymphs-36 monos-0 (csf) totprot-36 glucose-62 gram stain neg for polys or bacteria ua lg blood, neg nit/leuk, rbcs, 3-5 wbcs, few bact, urine cx no growth (final) sputum cx with 4+ oropharyngeal flora ekg : sinus rhythm, nonspecific inferolateral t wave flattening cxr : bibasilar patchy and linear opacities with slight worsening at left lung base. this may be due to atelectasis or aspiration. infectious pneumonia in left lower lobe is not excluded. brief hospital course: 1. hypotension: this had resolved by the time she arrived on the floor, and at that point she actually became hypertensive. her antihypertensives were restarted. her original hypotension was felt to be secondary to sepsis given her fever and infiltrate on cxr. her cortisol was normal and so it was not likely due to adrenal insufficiency. 2. fever: this was likely due to an aspiration pneumonia. her urine, csf, and blood cultures all remained negative. she was originally treated with vanc/levo/flagyl, but the vanc was discontinued on hd3 as she appeared to have an aspiration pneumonia. she will be treated with levaquin and flagyl for a total 14 day course, last day . 3. altered mental status: her ams resolved while in the icu. her tsh was mildly elevated (not a helpful test in the acutely ill) with a normal t4. her lfts, b12, and lp were wnl. her lithium was continued and her ativan was restarted on a lower dose, prn basis. neurosurgery followed her while she was an inpatient and did not feel she had any acute issues related to her recent surgery. 4. fen: on hd3, she appeared to develop abdominal pain, with abdominal tenderness on exam which was not present 2 minutes later while the patient was asleep. she was having bowel movements and had normoactive bowel sounds. her ventral hernia was nontender and easily reducible. because of this, her tube feeds were held. they were restarted later and she tolerated this well. she was placed on aspiration precautions. on hd3, respiratory therapy gave her a pessy-muir valve, which she tolerated for only a few minutes at a time. 5. rue edema: initially on exam she had some rue edema, which was concerning as she had a r subclavian central line in place. an u/s was done, which ruled out dvt. 6. guaiac pos stool: she was guaiac pos. in the icu. her hct actually increased from 29 to 31 when she reached the floor. it was felt this may be due to her peg tube, and her hematocrit remained stable. 7. ppx: she was on lansoprazole, pneumoboots (no heparin as has hit)/ivc filter while an inpatient. medications on admission: metoprolol 50 mg daily hydralazine 10 mg q 6 hours levaquin 500 mg daily colace bisacodyl prevacid 30 mg daily estrogen 0.3 lithium carbonate 300 mg daily ativan 0.5 mg q 4-6 hours prn tylenol prn isosource medications on transfer: metoprolol 12.5 mg metronidazole 500 mg gt tid levofloxacin 250 mg gt daily lithium 300 mg daily vancomycin 1 g iv daily lansoprazole 30 mg daily bisacodyl colace discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain, fever. 4. lithium carbonate 300 mg capsule sig: one (1) capsule po qd (). 5. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 9 days: last dose . disp:*9 tablet(s)* refills:*0* 6. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 9 days: last dose . 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100 or pulse <60. 8. conjugated estrogens 0.3 mg tablet sig: one (1) tablet po daily (daily). 9. hydralazine hcl 10 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp <100. 10. docusate sodium 150 mg/15 ml liquid sig: ten (10) ml po bid (2 times a day). 11. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. discharge disposition: extended care facility: - discharge diagnosis: aspiration pneumonia discharge condition: stable discharge instructions: please call your pcp or return to the ed if you experience fevers, lightheadedness, chest pain, shortness of breath, increased secretions from your trach, greenish secretions from your trach, abdominal pain, nausea, vomiting, diarrhea, or swelling in your legs. followup instructions: provider: where: lm phone: date/time: 10:00 please f/u with your pcp 1 week. md procedure: spinal tap incision of lung enteral infusion of concentrated nutritional substances transfusion of packed cells infusion of vasopressor agent diagnoses: unspecified septicemia sepsis pneumonitis due to inhalation of food or vomitus bipolar i disorder, most recent episode (or current) unspecified gastrostomy status tracheostomy status cervical spondylosis with myelopathy 

Answer: The patient is high likely exposed to