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: percocet / codeine / robaxin / lomotil / metoprolol tartrate / linezolid / synercid / rifampin / optiray 300 / percodan / vancomycin / daptomycin attending: chief complaint: sternum biopsy/ suicidal ideation major surgical or invasive procedure: sternal biopsy history of present illness: patient is a 59yo woman w hx breast ca, s/p bilateral mastectomy being treated with carboplatin, taxotere (last ) and herceptin (last ). she has undergone bilateral mastectomy for breast cancer and is currently undergoing adjuvant therapy by you. a recent bone scan showed an abnormality in the sternum. on ct scan, she was noted to have a pathologic fracture involving the superior portion of her sternum. she underwent sternum biopsy on . during admission for sternal biopsy, patient developed suicidal ideation and has been evaluated by psychiatry. plan is for her to be transferred to oncology service to receive resultys of sternum biopsy. past medical history: 1) type i diabetes mellitus 2) cad - cardiac cath: 50% mid lad, 80% distal lcx; stents placed to lad and lcx - pmibi: sob w/o ischemic changes. nl myocardial perfusion - tte: mild la enlargement, mildly dilated ra, lvef >55%, trivial mr, trace ar 3) hypothyroidism tsh 0.78 4) depression/anxiety 5) breast cancer: stage ii infiltrating ductal carcinoma dx - s/p right lumpectomy followed by 4 cycles of adriamycin/cytoxan and 7 weekly taxotere treatments. arimidex since - right mastectomy when mammogram showed new calcifications 6) gerd 7) low back pain s/p placement of neural stimulator 8) right shoulder osteomyelitis: - right humeral fracture s/p orif - mrsa bacteremia from chemo port -> right septic shoulder/osteomyelitis - initially tx with linezolid, stopped due to thrombocytopenia, changed to daptomycin changed to synercid/rifampin due to daptomycin resistance. synercid/rifampin caused pancytopenia, so she was changed to po minocycline. - right shoulder joint and upper humerus removed by dr. at and antibiotic spacer inserted. intra-op cultures grew 1 colony of mrsa --> desensitized to vancomycin and d/c on planned 6 week course of vancomycin prior to shoulder replacement, which would be followed by an additional 4-6 weeks of vancomycin social history: lives with her husband in , ma. smoked 20 pack-years, quit 20 years ago; drinks cocktails per week; no illicit drug use. retired, previously worked with troubled young adults. family history: 1. dm type 1: 2 siblings, both deceased 2. mother d. ovarian ca physical exam: vitals: t: 99.5 96.7 105/61 85 20 100%ra gen: in no acute distress heent: clear op, mmm neck: supple, no lad, no jvd cv: rr, nl rate. nl s1, s2. no murmurs, rubs or gallops lungs: cta, bs bl, no w/r/c abd: soft, nt, nd. nl bs. no hsm ext: no edema. 2+ dp pulses bl skin: no lesions neuro: a&ox3. appropriate. cn 2-12 grossly intact. absent patellar reflexes b/l le. psych: listens and responds to questions appropriately, pleasant pertinent results: 07:10am blood wbc-4.1 rbc-3.23* hgb-10.7* hct-33.5* mcv-104* mch-33.2* mchc-32.0 rdw-16.2* plt ct-129* 04:31am blood wbc-5.1 rbc-2.69* hgb-8.8* hct-27.4* mcv-verified mch-32.8* mchc-32.2 rdw-15.4 plt ct-87* 10:15pm blood pt-14.4* ptt-37.0* inr(pt)-1.3* 04:31am blood pt-16.3* ptt-36.7* inr(pt)-1.5* 07:10am blood glucose-200* urean-15 creat-0.9 na-141 k-4.3 cl-102 hco3-29 angap-14 10:15pm blood glucose-178* urean-28* creat-1.5* na-138 k-3.8 cl-105 hco3-22 angap-15 10:15pm blood alt-12 ast-19 ld(ldh)-246 alkphos-80 amylase-27 totbili-0.3 01:13pm blood calcium-7.6* phos-2.6* mg-1.9 10:20pm urine color-yellow appear-hazy sp -1.018 10:20pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 10:20pm urine rbc-3* wbc-3 bacteri-none yeast-none epi-0 10:20pm urine casthy-20* . abdomen (supine & erect) 10:07 am abdomen (supine & erect) reason: obstruction, free air. medical condition: 59 year old woman with breast ca, abdominal pain reason for this examination: obstruction, free air. history: 59-year-old female with breast cancer, abdominal pain, evaluate for obstruction or free air. comparison: ct abdomen and pelvis . supine and left lateral decubitus abdomen: gaseous distended colon measures up to approximately 9 cm. additionally, significant stool impaction is present within the pelvis. there is no evidence of free intraperitoneal air. a pacer device overlies the right side of the abdomen. osseous structures reveal degenerative changes of the lower lumbar spine. impression: fecal impaction within the sigmoid colon, with a gaseous distended colon. . ct abdomen w/o contrast 2:36 am ct abdomen w/o contrast; ct pelvis w/o contrast reason: assess for toxic megacolon and free air field of view: 38 medical condition: 59 year old woman with abdominal distension & pain reason for this examination: assess for toxic megacolon and free air contraindications for iv contrast: none. indication: 59-year-old female with abdominal distention and pain. please evaluate for toxic megacolon or free air. comparison: . technique: mdct acquired axial imaging of the abdomen and pelvis was performed after administration of oral contrast only. iv contrast was not administered due to elevated creatinine. multiplanar reformatted images were obtained and reviewed. ct abdomen: there is dependent opacity at the lung bases bilaterally, right greater than left. this appears more than would be expected for simple atelectasis, and there is likely a component of pneumonic consolidation or aspiration as well. absence of intravenous contrast limits evaluation of the abdominal parenchymal organs and vasculature. diffuse anasarca has worsened, and there is a moderate amount of ascites now seen throughout the abdomen. there is evidence of portal venous gas within the liver, and there is markedly abnormal appearance to the entire colon. there is moderate wall thickening in the cecum and ascending colon, and there is pneumatosis intestinalis extending from the transverse colon just distal to the hepatic flexure to the uppermost portion of the descending colon in a segmental distribution. pneumatosis in the mid transverse colon is most severe, without evidence of mucosal sloughing. the descending colon appears intact. a few borderline distended loops of contrast opacified small bowel, with small air-fluid levels are seen in the mid abdomen, but small bowel loops are otherwise unremarkable. the liver is unremarkable except to note portal venous gas as described above. the gallbladder is mildly distended, but there is no wall thickening or pericholecystic fluid. pancreas, spleen, adrenal glands, and kidneys have normal non-contrast appearance. there is no free intraperitoneal air, or abnormal intra-abdominal lymphadenopathy. ct pelvis: there is a moderate amount of ascites within the pelvis. pelvic loops of small bowel are unremarkable. note is made of spinal stimulator device in the right abdominal wall. the uterus and adnexa appear unremarkable. osseous structures: mild multilevel degenerative changes, including t12 compression deformity, and multiple old rib fractures are unchanged. impression: 1. pneumatosis intestinalis in a territorial distribution involving mainly the transverse colon from the hepatic flexure to the descending colon. moderate amount of free fluid, and mesenteric and portal venous gas. these findings are highly concerning for mesenteric ischemia, though vascular etiology cannot be evaluated on this non-contrast scan. watershed ischemia is also a consideration, given the patient's reported recent history of hypotension. 2. moderate wall thickening and pericolonic inflammatory change in the cecum and ascending colon may also represent early ischemic change, with probable lesser amounts of pneumatosis around small amounts of stool. 3. bibasilar atelectasis, with increased right basilar consolidation, concerning for superimposed pneumonia or aspiration. brief hospital course: . #)breast cancer: patient had recent bone scan with new lesion identified on sternum. she was therefore scheduled to undergo a sternal biopsy. the day of the sternal biopsy, the patient developed suicidal ideation and was therefore admitted to the hospital with a 1:1 sitter for closer monitoring. she was followed by psychiatry daily. the patient recieved one dose of herceptin on , and a second dose on . . #)abdominal pain: the patient reported new onset of abdominal pain the morning of . the patient had diffuse abdominal tenderness, along with rebound tenderness. kub was performed which showed stool filled and distended colon. her distension was thought secondary to fecal impaction, and she was given two soap suds enemas followed by a small bowel movement. the patient reported mild relief with the bowel movement. she spiked a fever to 101.5 and was begun on levofloxacin/flagyl. abdominal ct was postponed because the patient had a history of acute renal failure with iv contrast, and nausea was preventing her from taking oral contrast. later in the day the patient had a second large bowel movement with further relief of symptoms. later inthe day the patient developed hypotension, with blood pressures 77/40. she was bolused with 4l of normal saline with increased blood pressures to 96/60. given her increased fluid requirements to maintan blood pressure, she was transferred to the . she had a ct scan which revealed severe colitis, so was taken to the emergency room emergently for ex lap and subtotal colectomy with mucus fistula. she actually tolerated the procedure quite well, and was transferred to the floor on pod 3. her cdif toxin came back positive so she was started on po flagyl and vancomycin per her mucus fistula. she regained bowel function and was advanced to regular diet. her staples were dc'd prior to discharge. she was given a prescription for 2 additional weeks of po flagyl. . #)diabetes mellitis i: patient with difficult to control blood sugars. was placed on standing lantus and humalog insulin sliding scale. the service followed daily. she was directed on how to count carbs and calculate a correction factor at home. #)depression: psychiatry consult was called and she was treated with antidepressants. she was quite tearful immediately postoperatively, but as her condition improved she actually became quite stable and happy. her 1:1 sitter was discontinued several days prior to discharge, and she continued to do well on her own. she was cleared for discharge to home by dr. prior to discharge. medications on admission: atenolol - 25 mg tablet - one tablet(s) by mouth once a day atorvastatin - 10 mg tablet - 1 tablet(s) by mouth once a day clonazepam - (prescribed by other provider) - 1 mg tablet - tablet(s) by mouth at bedtime exemestane - 25 mg tablet - one tablet(s) by mouth once a day fosamax plus d - 70-2,800 mg-unit tablet - 1 tablet(s) by mouth weekly after arising first thing in the am, with a full glass of water, nothing else to eat or drink for 30 minutes. furosemide - 40 mg tablet - 1 (one) tablet(s) by mouth once a day gabapentin - 600 mg tablet - 1 tablet(s) by mouth 3 times daily insulin aspart - (prescribed by other provider) - 100 unit/ml solution - to use with insulin as directed lactulose - (not taking as prescribed: not needed during chemotherapy) - 10g/15ml syrup - 30cc by mouth every day as needed for constipation levothyroxine - (prescribed by other provider) - 125 mcg tablet - 1 tablet(s) by mouth once a day lidocaine-diphenhyd--mag- - 400 mg-400 mg-40 mg-25 mg-200 mg/30 ml mouthwash - use swish and swallow three times a day as needed for mouth sores lorazepam - 1 mg tablet - one tablet by mouth three times daily meloxicam - 15 mg tablet - 1 tablet(s) by mouth once a day take with food omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth twice a day ondansetron hcl - 8 mg tablet - 1 tablet(s) by mouth q 12 hours as needed for nausea - no substitution prochlorperazine edisylate - 10 mg tablet - 1 tablet(s) by mouth q 8 hours as needed for nausea take tid on day 2 following chemo. then take as needed - no substitution valsartan - 40 mg tablet - 1 (one) tablet(s) by mouth once a day venlafaxine - 150 mg capsule, sust. release 24 hr - 1 capsule(s) by mouth three times a day wellbutrin sr - 150mg tablet sustained release - one by mouth three times a day medications - otc aspirin - 325mg tablet - one by mouth every day calcium-vitamin d3-vitamin k - (otc) - 500 mg-100 unit- mcg tablet, chewable - 2 tablet(s) by mouth once a day docusate sodium - (otc) - 100 mg capsule - 1 capsule(s) by mouth three times a day multivitamins-ca-iron-minerals - (otc) - 27 mg-0.4 mg tablet - 1 tablet(s) by mouth once a day senna - (prescribed by other provider) - dosage uncertain discharge medications: 1. exemestane 25 mg tablet sig: one (1) tablet po qd (). 2. gabapentin 300 mg capsule sig: two (2) capsule po tid (3 times a day). 3. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. wellbutrin 100 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 6. venlafaxine 100 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 7. clonazepam 0.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). disp:*30 tablet(s)* refills:*0* 8. lorazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. disp:*1 bottle* refills:*2* 11. insulin glargine 100 unit/ml solution sig: twenty two (22) units subcutaneous qam: with breakfast. disp:*10 ml* refills:*2* 12. insulin lispro 100 unit/ml solution sig: one (1) unit subcutaneous qachs: carb count: i/c cf: 1:40 mg/dl. disp:*10 ml* refills:*2* 13. insulin syringe microfine 0.3 ml 28 x syringe sig: one (1) syringe miscellaneous qachs: for insulin administration. disp:*100 * refills:*3* 14. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 2 weeks. disp:*42 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: 1. cdiff colitis 2. asthma 3. anxiety 4. depression 5. metastatic breast cancer 6. hypothyroidism 7. diabetes mellitus 8. hypertension 9. gerd discharge condition: good discharge instructions: 1. please call office or go to er if fever/chills, nausea/vomiting, abdominal pain or distention, drainage or redness around incision, significantly decreased or increased output or bleeding from ostomy. 2. resume medications as directed. 3. follow-up as directed. diet: you may resume a diabetic diet activity: you may resume your normal activity. no heavy lifting > 10 lbs. followup instructions: please call dr. office () to schedule appointment. please call at ( to schedule a followup appointment for 1 week. provider: felt, rn phone: date/time: 1:00 provider: , md phone: date/time: 2:30 provider: felt, rn phone: date/time: 4:00 procedure: other and unspecified partial excision of large intestine colostomy, not otherwise specified other permanent ileostomy biopsy of bone, scapula, clavicle, and thorax [ribs and sternum] diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified acquired hypothyroidism pulmonary collapse long-term (current) use of insulin intestinal infection due to clostridium difficile major depressive affective disorder, single episode, unspecified other ascites diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled acute vascular insufficiency of intestine disorder of bone and cartilage, unspecified pathologic fracture of other specified site other specified disorders of peritoneum malignant neoplasm of other specified sites of female breast suicidal ideation 

Answer: The patient is high likely exposed to