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 / sulfa (sulfonamides) / levaquin / erythromycin base / ivp dye, iodine containing attending: chief complaint: altered mental status major surgical or invasive procedure: picc placement femoral line placement history of present illness: 66 yo f with multiple medical problems including cad, chf, cirrhosis (and prior encephalopathy), hx dvt's, aspiration, chronic lower extremity ulcers w/cellulitis on abx presented from home with altered mental status. per husband, her ms had been worsening gradually over the past 3 days. she was having cough with some sputum production. she was responsive on the morning of admission but very lethargic and also had incontinence. a fsg showed recording of 34 but was corrected to ~150 with administration of juice. however her ms did not improve with improvement in her fsg. . ed: her bp was around 80's/40's, after 1l -> sbp was >100 (baseline sbp in 90-100). she was dnr/dni but family was okay with lines in the ed. a l fem line was placed as no other access could be obtained. cxr - ?lll pna, left sided effusion. vascular consulted who did not think that the leg was likley source of sepsis. head ct showed sinusitis. she got vanc/. . : upon arrival to icu, i had extensive discussion with the husband who is her hcp. note, patient's functional status had been gradually declining over the last 7 months. the patient and family were frustrated with the fact that the patient had been at home for only 2 weeks of the last 7 months and she had a poor quality of life. the husband did not want any aggressive measures which included no ng tube, no pressors and the goal was to make her comfortable and to try only iv medications if required. . past medical history: 1.type i diabetes mellitus--+nephropathy, no a1c available 2.coronary artery disease 3.congestive heart failure--ef 30%, 2+ tr, mod pa htn per echo in 4.ckd stage iii with baseline cr 1.3-1.9 5.hyperlipidemia 6.gastritis 7.venous stasis 8.allergic rhinitis 9.osteomyelitis 10.rle wound--after trauma, s/p graft 11.cirrhosis--thought to be due to nash; on lactulose, ursodiol and rifamixin in the past 12.hepatic encephalopathy and ?seizures on keppra . social history: lives with husband, who is primary caregiver. lives next door and he and wife wife help with her care. has vna services. needs help with adls. quit smoking in . h/o alcohol abuse. can walk up four steps with assistance. family history: non-contributory physical exam: icu admission vitals: 96.7, 87, 103/46, 100/4l gen: extremly lethargic, open eyes to commands but no verbalization heent: peerl, eomi, anicteric sclera, dry mm chest: clear anteriorly, crackles bilaterally at the bases cv: distant heart sound, rrr, nl s1, s2, ii/vi sem abd: distended nontedner, no rebound or guarding, edematous. unable to appreciate h/s. neuro: extremely lethargic, opens eyes to commands skin: diffuse bilateral erythema, more pronounced in lower ext, has many areas of torn skin and weeping lesions with ulcerations pertinent results: wbc-12.0*# rbc-4.90 hgb-12.4 hct-40.1 mcv-82 mch-25.2* mchc-30.8* rdw-19.9* plt ct-115* neuts-81* bands-9* lymphs-5* monos-5 eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-1* pt-36.7* ptt-54.0* inr(pt)-3.9* glucose-129* urean-102* creat-2.7* na-133 k-3.5 cl-86* hco3-30 angap-21* alt-24 ast-43* ck(cpk)-42 alkphos-343* amylase-44 totbili-1.8* lipase-13 ctropnt-0.05* albumin-2.9* calcium-9.4 phos-6.3*# mg-2.4 cortsol-40.7* crp-52.7* 08:14am vanco-26.3* 03:27pm type-art po2-467* pco2-47* ph-7.45 caltco2-34* base xs-8 intubat-not intuba lactate-3.8* 03:27pm o2 sat-100 ct head w/o contrast 2:12 pm ct head w/o contrast reason: please evaluate for intracranial hemorrhage in this patient medical condition: 66 year old woman with multiple medical problems presenting with altered mental status. reason for this examination: please evaluate for intracranial hemorrhage in this patient on coumadin or any other explanation for her altered mental status. contraindications for iv contrast: none. history: 66-year-old female with multiple medical problems presenting with altered mental status. comparison: ct head of . technique: contiguous axial images through the brain were acquired without iv contrast administration. findings: no evidence of acute hemorrhage, edema, mass, mass effect, or large vascular territory infarction is present. ventricular configuration is not changed. vascular calcifications are noted in the intracranial vertebral arteries and the internal carotid arteries. the patient is status post left cataract surgery. compared to , there is new opacification of some ethmoid air cells and mucosal thickening in the left maxillary sinus. the remainder of the visualized paranasal sinuses and the mastoid air cells are well aerated. no fracture is present. impression: 1. no evidence of acute intracranial hemorrhage. 2. left maxillary and ethmoid sinus disease. chest (portable ap) 10:53 am chest (portable ap) reason: cardiopulmonary process medical condition: 66 year old woman with rhonchi reason for this examination: cardiopulmonary process history: 66-year-old female with rhonchi. comparison: a series of chest radiographs from through . portable supine chest radiograph: since , there has been interval removal of a right picc and dobbhoff tube. there is likely some increase in the moderate-to-large left pleural effusion compared to the study performed nearly a month prior. the left retrocardiac opacity persists, likely representing pleural effusion, associated atelectasis, although underlying pneumonia cannot be excluded. the cardiac silhouette is obscured on the left by the pleural effusion and atelectasis; however, there is likely stable cardiomegaly. prominence of the pulmonary vessels is consistent with pulmonary venous congestion and indistinctness of the pulmonary vessels likely represents interstitial edema. no focal airspace opacities are seen in the right lung or left upper lung. the bony thorax appears intact. impression: vascular congestion with interstitial edema, overall unchanged from . there may be some increase in the left pleural effusion which is now likely moderate to large in size, with associated atelectasis. chest (portable ap) 11:29 am chest (portable ap) reason: interval change, worsening effusion, chf and/or pna medical condition: 66 year old woman with pna, inc sob this am s/p volume resuscitation last night reason for this examination: interval change, worsening effusion, chf and/or pna history: shortness of breath. findings: in comparison with the study of , the degree of vascular congestion has substantially decreased, though there is still evidence of elevated pulmonary venous pressure and a large left effusion. right subclavian catheter extends to the lower portion of the svc. brief hospital course: 66 f with nash cirrhosis, seizure dz on keppra, dvt on coumadin, chronic le ulceration now with altered mental status in setting of multiple medical problems including new pneumonia and sepsis. # sepsis wound infections vs. pna: transiently hypotensive responded to 1l ns in ed; elevated white count with bandemia. hypotensive on night of admissionwith worsening uop to <10cc/hr which trailed off to anuria. treated with antibiotics and gentle fluid hydration without improvement in sepsis. family did not want any life sustaining measures including the use of pressor agents. . # acute oliguric on chronic renal failure: baseline 1.8 until , then increased to 2.3-2.5. increased further to 2.7 after ivf boluses. fena suggested prerenal failure initially, then urine found to have muddy brown casts suggesting atn. dialysis was not in accordance with the wishes of the family or patient. . # altered mental status/delirium: differential included hepatic encephalopathy, sbp, sepsis, seizures, keppra (in setting of arf), cardiogenic shock. hcp did not want any measures including ngt, invasive procedures etc. in this context, home regimen of keppra, lactulose, and rifaximin was continued as patient tolerated po. . # right lower extremity ulceration: started on vanc/meropenem per vascular during last admission and legs improved rapidly. vascular did not think that the leg was the likely source of sepsis with no open ulcers there in the ed on this admission. conservative management with wound care continued during this admission. . # acute on chronic systolic heart failure: pt with worsening wet cough and rales on exam after 6l positive on to maintain sbp and uop and with cold extremities concerning for cardiogenic shock picture. family was offerred trial of dobutamine which was not accepted. . # diabetes: long-standing, covered with insulin sliding scale. . # anticoagulation: on coumadin for dvt, held on admission in setting of supratherapeutic inr. inr reversed for picc placement . . # access: right femoral line placed in ed. in discussion with family, picc was obtained for cleaner access. . # ppx: supratherapeutic inr . # code status: dnr/dni with goal of aggressive measures but no ng tube on admission, changed to cmo on in the setting of new pneumonia, sepsis and acute renal failure. patient remained hypotensive on the evening of and became bradycardic and expired on at 3:45pm. family, pcp, admitting notified. medications on admission: 1. carvedilol 3.125 mg tablet qd 2. white petrolatum-mineral oil qhs 3. camphor-menthol 0.5-0.5 % lotion tid 4. travoprost 0.004 % drops sig: hs 5. b complex-vitamin c-folic acid 1 mg qd 6. acetaminophen 325 mg tablet 2 po q6h 7. levetiracetam 500 mg po bid 8. rifaximin 400 mg tid 9. bumetanide 6 mg 10. miconazole nitrate 2 % powder 11. calcium acetate 667 mg capsule sig: two (2) capsule po tid 12. mupirocin calcium 2 % cream (1) appl topical tid 13. lactulose 30 ml 14. nystatin 100,000 unit/g cream 15. bacitracin-polymyxin b 500-10,000 unit/g ointment 16. lantus 3units qhs 17. insulin ss 18. warfarin 1 mg tablet qhs 19. prilosec 20 mg qd discharge medications: none discharge disposition: expired discharge diagnosis: sepsis pneumonia acute renal failure diabetes mellitus venous statis ulcers discharge condition: expired discharge instructions: none followup instructions: none procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified cirrhosis of liver without mention of alcohol unspecified septicemia severe sepsis polyneuropathy in diabetes other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) cardiogenic shock long-term (current) use of anticoagulants epilepsy, unspecified, without mention of intractable epilepsy acute on chronic systolic heart failure diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled venous (peripheral) insufficiency, unspecified ulcer of calf 

Answer: The patient is high likely exposed to