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: celecoxib / vioxx attending: chief complaint: platelets of 8 major surgical or invasive procedure: none history of present illness: ms. is an 80 yo spanish speaking lady with t2dm, ckd, chf with ef 15-20% (), chronic thrombocytopenia thought to be due to itp, who presented for a platelet count of 8 in the outpatient setting. she saw dr. her hematology oncology physician for a regular follow up appointment. he ordered a routine cbc that showed a platelet count 8 which is below recent baseline of 40-60. she was instructed to come to the ed. she denied any recent episodes of bleeding but did say that she had new petechiae on her upper extremities as well as large bruises on her forearms and lower extremities. she has a diagnosis of myelodysplastic syndrome but also has a history of prior episodes of itp. past medical history: # systolic congestive heart failure (ef estimated at 15-20%) # thrombocytopenia: treated with steroids in the past in setting of asthma exacerbation with clinical response -> likely myelodysplastic disorder as per outpatient heme-onc dr. # asthma # diabetes type ii dx'd ~ # hypothyroidism # hypertension # chronic kidney disease- baseline crt 1.3-1.4; likely secondary to hypertensive nephrosclerosis # anemia # eosinophilia # depression # glaucoma # osteoarthritis # h/o syndrome w/ celecoxib # facial cellulitis tx w/ bactrim in # history of atrial fibrillation social history: from (immigrated ~20yr ago). lives with her son and has a daughter close by. supportive family. has vna coming into the house with rotating family members taking care of her. she does not smoke, does not drink, and does not use drugs family history: her sister had diabetes, brother has heart disease and sister had a stroke physical exam: on admission: general: alert, oriented, no acute distress heent: sclera anicteric, dmm, oropharynx clear neck: supple, no lad, cannot appreciate jvp lungs: clear to auscultation bilaterally, mild end expiratory wheezes but no rales, ronchi cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: multiple echymoses on discharge: heent: petechiae present on buccal mucosa lungs: ctabl, symmetrical chest wall expansion, no wheezes or rhonci skin- multiple petechiae on both u/le, large echymoses on forearms b/l rest of pe unchanged from admission pertinent results: cbc & chemistry admission: 11:10am blood wbc-6.1 rbc-3.26* hgb-10.3* hct-31.5* mcv-97 mch-31.5 mchc-32.6 rdw-14.9 plt ct-8*# 12:15am blood wbc-8.1 rbc-3.12* hgb-9.9* hct-29.5* mcv-95 mch-31.8 mchc-33.7 rdw-15.1 plt ct-7* 12:15am blood hypochr-normal anisocy-occasional poiklo-1+ macrocy-occasional microcy-normal polychr-normal schisto-occasional burr-1+ tear dr 12:15am blood glucose-104* urean-55* creat-1.8* na-138 k-5.8* cl-107 hco3-21* angap-16 12:15am blood ld(ldh)-278* totbili-0.2 dirbili-0.1 indbili-0.1 08:30pm blood ck-mb-2 ctropnt-<0.01 02:20am blood ck-mb-3 ctropnt-0.06* 09:13am blood ck-mb-3 ctropnt-0.12* 03:11am blood ck-mb-2 ctropnt-0.06* 12:15am blood hapto-88 01:37am blood k-6.1* on discharge: 06:23am blood wbc-8.6 rbc-3.49* hgb-10.9* hct-32.0* mcv-92 mch-31.2 mchc-34.0 rdw-15.6* plt ct-38* 06:23am blood glucose-103* urean-47* creat-1.2* na-135 k-4.1 cl-107 hco3-24 angap-8 06:23am blood calcium-8.5 phos-2.5* mg-2.3 urine: 11:44pm urine color-straw appear-cloudy sp -1.015 11:44pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-lg 11:44pm urine rbc-2 wbc->182* bacteri-few yeast-none epi-0 05:38pm urine color-straw appear-hazy sp -1.010 05:38pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 05:38pm urine rbc-1 wbc->182* bacteri-few yeast-none epi-<1 05:38pm urine hours-random urean-468 creat-29 na-42 k-33 cl-41 05:38pm urine osmolal-333 micro: 11:44 pm urine source: catheter. **final report ** urine culture (final ): enterobacter cloacae. >100,000 organisms/ml.. this isolate demonstrates carbapenemase production. consider infectious disease consultation.. sensitivity testing performed by microscan. resistant to cefepime mic => 32 mcg/ml. sensitive to tigecycline mic <= 1 mcg/ml. resistant to sulfa x trimeth mic =>4 mcg/ml. enterobacter cloacae. 10,000-100,000 organisms/ml.. 2nd morphology. this isolate demonstrates carbapenemase production. consider infectious disease consultation.. sensitivity testing performed by microscan. resistant to cefepime mic =>32 mcg/ml. resistant to sulfa x trimeth mic =>4 mcg/ml. sensitive to tigecycline mic =2 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | enterobacter cloacae | | cefepime-------------- r r ceftazidime----------- =>32 r =>32 r ceftriaxone----------- =>64 r =>64 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem------------- r r nitrofurantoin-------- =>128 r =>128 r piperacillin/tazo----- =>128 r =>128 r tetracycline---------- =>16 r =>16 r tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- r r fungal culture (final ): no yeast isolated. serology: 6:05 am serology/blood helicobacter pylori antibody test (final ): positive by eia. imaging: cxr-when compared to the prior chest x-ray of the 21st. the apparent increase in size of the heart is probably due to projection alone. some upper zone redistribution may be present, particularly when compared to the two prior chest x-rays and i suspected degree of failure is present. renal u.s.-bilateral renal cysts, as detailed above, slightly increased in size from prior exam. there is no hydronephrosis or renal masses. ekg: sinus tachycardia at 124 bpm, 2 mm ste avr, downsloping std 1-2 mm in leads i, ii, v4-v6. compared to prior these changes are more pronounced. echo ():impression: dilated left ventricle with severe global systolic dysfunction. moderate aortic, mitral and tricuspid regurgitation. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , lv cavity is larger, and both aortic and mitral regurgitation are more prominent. estimated pulmonary pressures are significantly higher. lv systolic function and other findings are similar. brief hospital course: ms. is an 80 yo lady with a significant pmh including t2dm, ckd, chf with ef 15-20% (), chronic thrombocytopenia thought to be due to itp/mds who presented to the hospital for a platelet count of 8. #. melena: on arrival to the floor the patient had an episode of melena. her hematocrit acutely dropped from 28->25, and she became tachycardic with ekg changes and cp,but remained normotensive. cardiology reviewed her ekg, presentation and prior cardiac cath results and determined that these changes were most likely due to demand ischemia not an acute mi. she was transfused prbc and platelets and her hemoglobin and hct remained stable throughout the rest of the admission. she was continued on a pantoprazole drip for this gi bleed and did not have another episode of melena. gi was consulted during this admission but deferred scoping in the setting of cardiac ischemia and thrombocytopenia. it was determined that she could be followed up as an out patient. #. thrombocytopenia: after her bout of melena she was transfused two units of platelets. her plt count rose to the 140s then slowly trended back down to her baseline level of 30-50k. hematology was consulted and recommended she be started on 60mg of prednisone daily. she remained on this regimen throughout her admission. we believe this most recent episode of severe thrombocytopenia is likely due to an ongoing auto-immune process/itp insult on top of myelofibrosis and decreased platelet production. her out patient hematologist dr. was contact and made aware of her current platelet status. he agreed to follow up with her in the near future upon discharge. #. acute renal failure: her hospital course was complicated by acute renal failure with a cr of 1.8 on admission. according to her omr records her renal function has fluctuated over the years and it is unclear as to the etiology of these fluctuations. previous admissions have suggested siadh vs reset osmostat. since admission her cr slowly trended down to 1.2 at the time of discharge with an elevated fena which is suggestive of atn. initially her acei was held due to arf and was restarted prior to discharge as her renal function improved. # asymptomatic urinary tract infection- a urine culture from a specimen obtained from a foley catheter was positive for polyresistant enterobacter cloacae. the patient remained afebrile and asymptomatic during this admission and the decision was made to not start antibiotic therapy. dr. who also is board certified in infectious disease was made aware of this recent finding and agreed with the decision to hold off antibiotic treatment in the setting of no symptoms. he stated that he would follow up on these culture results next week during a follow up appointment. # chronic schf: pt did not appear decompensated during this admission. we held her daily asa 81 given her severe thrombocytopenia and also held her acei due to her arf. her acei was restarted prior to discharge as her kidney function improved. she remained on her statin as well as her beta blocker through out the hospital stay. # dm2: she initially was placed on an insulin sliding scale upon admission and then restarted on her home glipizide. her finger stick checks remained in the 110-180 range during this admission. # asthma: she was given albuterol nebs prn during this admission. her lungs remained clear on exam and she did not have any asthma exacerbations. # hypothyroid:she was continued on home levothyroxine during the hospital stay. #social- unfortunately she was informed of her daughters death during this admission. she was discharged in the company of her family who has been updated as to the status of her current health and to the importance of her attending her follow up appointments. #transitional- we have made follow up appointments with dr. concerning her urine culture results and her ongoing thrombocytopenia. we also have made a follow up appointment with gi for investigation of her recent gi bleed. finally a primary care appointment was made for her as well. on admission: -albuterol inhaler 2 puff ih q6h: prn sob -calcium carbonate 500 mg po tid -cyanocobalamin 50 mcg po daily -fluticasone propionate nasal 2 spry nu daily -ferrous sulfate 325 mg podaily -glipizide sr 2.5 mg daily -levothyroxine sodium 88 mcg po daily -latanoprost 0.005% ophth. soln. 1 drop both eyes hs -multivitamins 1 tab po/ng daily -miconazole powder 2% 1 appl tp :prn rash -metoprolol succ 25 mg po daily -omeprazole 20 mg po daily -simvastatin 10 mg po daily -vitamin d 800 unit po daily -furosemide 20 mg daily -asa 81 mg daily discharge : 1. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 2. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: 0.5 tablet po daily (daily). 3. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 5. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 6. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 7. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 11. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 14. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 15. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 16. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 17. outpatient lab work please check cbc on tuesday and fax results to dr. office at ( discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: idiopathic thrombocytopenic purpura gastrointestinal bleed acute renal failure secondary diagnosis: congestive heart failure diabetes mellitus type 2 hypothyroidism asthma 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: it was a pleasure taking care of you at . you were admitted to the hospital because your platelet count was very low and you were at a high risk for bleeding. we placed you on a steriod medication at the present time to treat this. also while in the hospital you experienced a gastrointestinal bleed. we would like you to follow up with a gi doctor inorder to investigate the cause of this bleed further. an appointment was made for you with gi. we also have scheduled a follow up appointment for you with dr. to follow your platelet disorder. please do not take your lisinopril today, but you may restart this medication tomorrow () medication changes: started: prednisone 40 mg daily stopped: furosemide 20 mg daily stopped: aspirin 81 mg daily also please weigh yourself every morning and call your primary care doctor if your weight goes up more than 3 lbs. followup instructions: department: bidhc with: , np when: tuesday at 11:15am phone: building: 545a centre st. (, ma) none campus: off campus best parking: department: div. of gastroenterology when: wednesday at 9:30 am with: , md building: ra (/ complex) campus: east best parking: main garage department: infectious disease when: friday at 1 pm with: , m.d. building: lm campus: west best parking: garage procedure: central venous catheter placement with guidance diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified unspecified glaucoma depressive disorder, not elsewhere classified chronic kidney disease, unspecified myelodysplastic syndrome, unspecified chronic systolic heart failure osteoarthrosis, unspecified whether generalized or localized, site unspecified hemorrhage of gastrointestinal tract, unspecified immune thrombocytopenic purpura helicobacter pylori [h. pylori] diabetes with unspecified complication, type ii or unspecified type, not stated as uncontrolled other nonspecific findings on examination of urine 

Answer: The patient is high likely exposed to