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: patient recorded as having no known allergies to drugs attending: chief complaint: l sided weakness, problem with speech major surgical or invasive procedure: central line placement arterial line placement intubation mechanical ventilation history of present illness: ms. an 87 year old woman hx atrial fibrillation on coumadin, right thalamic infarct, who was last known to be well at 8pm on , who was found by a nursing aide at 8am on to be dysarthria and severely phasic. the patient was able to say that she was "cold". she had left-sided weakness. ems was called at 8:15am and patient was taken to . en route, her fs was 221 and she vomited two times. in the ed, her exam was pupils reactive, with eye deviation to the right, not following commands, and non verbal. her arms were drifting down bilaterally. at 9:49am, the patient developed ventricular tachycardia. vitals were bp 175/118 and hr 124. she was given amiodarone 150mg iv once, followed by amiodarone 0.5mg/min drip. patient was intubated and sedated with propofol. her rhythm became atrial fib with rate in the 120's to 140's. her bp decreased to 119/74. ct brain did not show early signs of infarct or bleed. cta did not show cutoff of an intracranial vessel. ct perfusion shows increased mean transit time of the right mca and left aca region. patient was outside the window for tpa or mechanical clot retrieval. she was admitted to the sicu. past medical history: atrial fibrillation cva htn hypercholesterolemia depression anxiety social history: lives alone in independent living facility since her husband died. she has an aide for 12 hours per day, then for 1 hour in the evening. at baseline, 1 assist transfer to wheelchair. 3 sons who live in the area, 1 son is a physician. etoh, tobacco or idu. family history: mother had cva. physical exam: admission physical exam ======================== vs: tc 103.7 bp 175/118 then 119/74 p 185 vtach then 124 r 16-21 02 99% gen: intubated heent: supple neck, no carotid bruits, no lymphadenopathy chest: lungs clear to auscultation bilaterally, no wheezes, rales, or rhonchi heart: irregularly irregular, no murmurs, abd: soft, non-distended, non-tender, no mass, decreased bowel sounds ext: no cyanosis, clubbing, or edema skin: no erythema neuro: ms: opens eyes to verbal, follows commands to wiggle fingers cn: decreased blink to threat on the left, tracks horizontally, pupils 4 to 3mm bilaterally, no obvious facial droop motor: normal tone and bulk of all four extremities, no tremor 3/5 strength of biceps and triceps bilaterally 2/5 strength of legs bilaterally sensory: withdraws with all four extremities to noxious stimuli reflex: t br b k a toes left 2 2 2 2 2 mute right 2 2 2 2 2 mute coord: unable to assess upon transfer to micu: ====================== 97.0 99 121/73 97%ra gen: ill appearing, aphasic heent: poor dentition, dry mucus membranes cv: irregualr, s1, s2, noi m/g/r resp: cta anteriorly, allthough some rhochi laterally abd: soft, nt, nd ext: minimal edema neuro: aphasic, moves all extermities. pertinent results: admission labs: ================ 10:24pm urine color-yellow appear-clear sp -1.010 10:24pm urine blood-lg nitrite-pos protein->300 glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 10:24pm urine rbc-* wbc- bacteria-mod yeast-none epi-0-2 10:05pm pt-29.0* ptt-150 is hig inr(pt)-2.9* 10:03pm ck(cpk)-49 10:03pm ck-mb-notdone ctropnt-0.67* 10:24am glucose-187* lactate-3.5* na+-131* k+-5.0 cl--96* tco2-24 10:10am glucose-210* urea n-14 creat-0.8 sodium-132* potassium-5.0 chloride-97 total co2-22 anion gap-18 10:10am alt(sgpt)-15 ast(sgot)-23 ck(cpk)-53 alk phos-90 tot bili-0.7 10:10am ctropnt-0.11* 10:10am calcium-8.3* phosphate-3.4 magnesium-1.8 10:10am tsh-0.19* 10:10am wbc-10.6 rbc-4.14* hgb-13.3 hct-40.3 mcv-97 mch-32.3* mchc-33.1 rdw-14.0 10:10am neuts-63.5 lymphs-32.8 monos-2.1 eos-1.0 basos-0.6 10:10am pt-17.6* ptt-23.8 inr(pt)-1.6* microbiology: ============= 8:23 pm sputum site: endotracheal gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. heavy growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s 10:24 pm urine urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- 64 i piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r 10:52 am sputum site: expectorated source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. yeast. sparse growth. yeast. rare growth. 2nd type. staph aureus coag +. rare growth. sensitivities performed on culture # 246-1943y(). bcx x 2: negative bcx x 2: negative ucx: negative bcx x 1: negative c. diff: negative ucx: negative bcx x 2: negative ucx: negative bcx: negative dfa negative for influenzae a & b studies: ======== cta head w&w/o c & recons; cta neck w&w/oc & recons impression: 1. ct perfusion findings are consistent with acute ischemia in the right mca and right mca/aca watershed distribution as well as the left aca distribution. possible acute ischemia in the left pca territory. no evidence for intravascular thrombus or intracranial hemorrhage. 2. 3-mm left pca p2 segment aneurysm without evidence for hemorrhage. chest (portable ap) impression: 1. endotracheal tube extending into the left main stem bronchus. repositioning is required. this was discussed with the nurse caring for the patient, , at cell number , at approximately 10:45 a.m. 2. increased opacity of the left lung base, possibly representing aspiration. followup radiographs are recommended. 3. stable cardiomegaly with no evidence of acute congestive heart failure. ekg atrial fibrillation, average ventricular rate 120. left anterior hemiblock. intraventricular conduction delay. non-specific lateral repolarization changes. cannot exclude anterior myocardial infarction of indeterminate age though unlikely. compared to the previous tracing of ventricular response rate to atrial fibrillation is faster, ventricular ectopy is absent, and the late precordial r wave progression (suggesting interval anterior myocardial infarction)is new. chest (portable ap) impression: 1) endotracheal tube abutting the right lateral tracheal wall. the tube should be slightly advanced for more optimal placement. 2) proximal gastric tube, with the side port just below the gastroesophageal junction, might be edvanced 15-20 cm. 3) improving left upper lobe aeration with persistent bibasilar opacities, likely atelectasis. mr head w/o contrast; mra brain w/o contrast impression: no evidence for acute ischemia. extensive small vessel ischemic sequela. aneurysm of the left pca and left posterior communicating artery. portable tte (complete) done the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. overall left ventricular systolic function is severely depressed (lvef= 20 %) secondary to akinesis of the interventricular septum, anterior free wall, and apex. right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. the ascending aorta is mildly dilated. the aortic valve is not well seen. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is now severely reduced, most likely secondary to coronary artery disease and intercurrent myocardial infarction. eeg impression: abnormal portable eeg due to the slow and disorganized background, bursts of generalized slowing, and occasional additional slowing on the right side. the first two abnormalities signify a widespread encephalopathic condition affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there was additional focal slowing on the right, indicating subcortical dysfunction and likely related to the abnormality described on the requisition. nevertheless, there were no epileptiform features. an abnormal cardiac rhythm was noted. liver or gallbladder us (single organ) port liver/gallbladder ultrasound: this evaluation is limited due to lack of patient mobility. the liver is of normal echotexture with no gross focal lesions identified. there is no intra- or extra-hepatic ductal dilatation. the common duct measures 5 mm. the gallbladder is not visualized and likely absent. there is appropriate forward portal venous flow. the pancreas is not demonstrated due to overlying bowel gas. the spleen is incompletely visualized, however, appears to measure 7 cm. there is a small amount of perihepatic fluid. impression: limited examination. small perihepatic fluid. otherwise unremarkable liver gallbladder ultrasound. chest (portable ap) the et tube tip is 3 cm above the carina but note is made that the tip impinges the right tracheal wall, thus it should be repositioned to prevent stricture or malacia. the right internal jugular line tip terminates in distal svc. the ng tube tip passes below the diaphragm with its tip most likely below the inferior margin of the film. the heart size is mildly enlarged but stable. the mediastinal silhouette is unremarkable. bilateral pleural effusions are moderate-to-large, slightly progressed since yesterday although it might be contributed by slightly different position of the patient. no evidence of failure is present. no focal consolidations worrisome for pneumonia are identified although they may be obscured by overlying effusion. portable tte (complete) done the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with akinesis of the septum, mid- and distal anterior wall and distal lv segments/apex, with relative preservation of inferolateral/lateral wall contraction (lvef = 25-30%). right ventricular chamber size is normal. with mild global free wall hypokinesis. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: severe regional left ventricular systolic dysfunction. mild right ventricular systolic dysfunction. mild aortic regurgiation. compared with the prior study (images reviewed) of , biventricular function has slightly improved, although the regional distribution of wall motion abnormalities is similar. severity of mitral regurgitation and pulmonary hypertension has lessened. the other findings are similar. brief hospital course: the patient is an 87m w/ h/o right thalamic bleed and residual left leg weakness, cva in , htn, afib on coumadin who presented from independent living after being found to be nonverbal and have left-sided weakness by her nurse aide. her blood sugar was 221 and she vomited twice on the way to the hospital. soon after arriving to the ed, she went into ?vtach for about 5 minutes and was started on an amio drip after an amio load of 150mgx1. she was intubated and converted back to her native rhythm, afib in the 120s, and put on labetalol for rate control. her last inr before this was 1.5 on . head ct/cta showed evidence of acute right mca/watershed stroke and the patient was admitted to the neuro icu service. she was outside the window for tpa or mechanical clot retrieval. she was febrile to 104 and started on vanc/zosyn. she required pressors (neosynephrine) until at 5pm and was also extubated on . her urine was found to be growing e. coli and sputum to be growing coag+ staph. cardiology was consulted for her vtach and recommended stopping amio and starting diltiazem drip as well as titrating up bb (switching labetalol to metoprolol) and starting acei as tolerated by bp. troponins rose from 0.11 in the ed to a peak of 0.87 . ck peaked at 10 and mbi at 4.0 (last values). tte found ef of 20% 2/2 akinesis of the interventricular septum, anterior free wall, and apex; this is down from 55% in which had normal wall motion. troponin elevation thought to be secondary to increased cardiac demand. mri head done on showed no evidence of acute ischemia. the findings on ct were thought to be possibly artifact per the neuro team. she failed a speech and swallow eval and ngt was recommended, although this was attempted twice unsuccessfully due to patient not cooperating. she was given one dose of coumadin and her inr increased to 6.9. on , she was transferred to the micu service for medical management of her altered mental status and multiple medical problems, including dysarthria, aphasia, elevated troponin, newly depressed ef, coag + staph in sputum and klebsiella in her urine. during her course in the micu, the patient continued to be altered. given newly depressed ef, elevated troponin, vt on arrival to ed, and new wall motion abnormalities, the priamry event for her altered mental status may in fact have been an mi, with hypotension/ischemia exacerbating underlying neurologic deficits. infection with staph in sputum and klebsiella in urine also may have contributed. eeg was negative for seizure. for a presumed nstemi, diltiazem drip was changed to esmolol drip for beta blockade. nitro gtt was later instituted for afterload reduction. she was also started on digoxin daily. for her coag + staph in sputum she was continued on vancomycin for mrsa pneumonia. zosyn was switched to ceftriaxone after ucx sensitivities returned. however, the patient continued to spike fevers despite treatment with vancomycin and ceftriaxone. in the setting of rising wbc, she was switched to cefepime for added pseudomonal coverage. she was pan cultured, which did not show any new source of infection. during her course, she became increasingly tachypneic with cough and was re-intubated for airway protection and increased work of breathing. she remained coagulopathic and received vitamin k and ffp to reverse. dic panel was negative. her inr may have been elevated in the setting of warfarin with amiodarone, antibiotics and malnutrition. her renal function returned to baseline during her course. she also was found to have transaminitis, which was thought to be due to hypoperfusion. in this setting, amiodarone and statin were held. hep serologies negative, and ruq u/s was negative. vascular surgery was consulted for concern for ischemic digits (r fingers > l fingers > toes). she was started on argatroban gtt. towards the end of her hospitalization, the patient required pressor support. after extensive discussion with her hcp and family, the patient was made cmo. she expired shortly after extubation and withdrawal of intensive medical management. medications on admission: lisinopril 5mg daily lasix 20mg daily synthroid 0.15 mg daily diltiazem sr 120mg qam vitamin d 400 units daily oxybutynin 10mg qam labetalol 100mg remeron 30mg qhs lipitor 20mg qhs coumadin 3mg on sunday, monday, tuesday, wednesday and 2mg on thursday, friday, and saturday tylenol #3 prn pain pericolace two tabs lactulose 30cc daily discharge medications: expired. discharge disposition: expired discharge diagnosis: 1. respiratory failure 2. altered mental status 3. non st elevation mi 4. cardiac arrhythmias (atrial fibrillation, ventricular tachycardia) 5. pneumonia 6. urinary tract infection 7. acute renal failure 8. coagulopathy 9. digit ischemia discharge condition: expired. discharge instructions: none. followup instructions: none. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver unspecified septicemia atrial fibrillation subarachnoid hemorrhage paroxysmal ventricular tachycardia pneumonitis due to inhalation of food or vomitus septic shock long-term (current) use of anticoagulants methicillin susceptible pneumonia due to staphylococcus aureus encephalopathy, unspecified acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to