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 attending: chief complaint: right lower abdominal pain major surgical or invasive procedure: none history of present illness: hpi: 83 year old female with recently complicated medical history, including lengthy admission in for anemia, proliferative pauci-immune glomerulonephritis requiring temporary dialysis, and rle dvt, last admitted /05 for gnr bacteremia, pseudomonal pna (gent resistant, 2 strains, treated with meropenem), and chf, also somewhat vent dependent with trach collar since sicu admission with unclear etiology, now presenting from rehab with rlq abdominal pain x 3 days. ms. was discharged to rehab on after her most recent admission as above. she had been doing well at rehab until 3 days ago when she began complaining of rlq abdominal pain, and was noted to be agitated, pulling out her picc line 1 day prior to admission. her last bm was the day prior to admission and was non-bloody. she has been afebrile, but has been taking tylenol. denies shortness of breath, dysuria. . in the ed her vitals were 97.3, hr 75, 126/50, rr 22, o2 sat 100%. given her history of pelvic abscesses, a ct abdomen was performed in the ed which demonstrated a large r rectus sheath hematoma. she was seen by surgery in the ed who did not feel operative management was necessary. transferred to the for trach management, monitoring of hct. past medical history: 1. respiratory failure: had large pleural effusions and bilateral pneumothoraces, s/p chest tube placement, s/p talc pleurodesis. s/p trach, has been off vent x3 weeks, placed back on it 2 days ago 2. sjogren's 3. glomerulonephritis, proliferative. rx with prednisone and cytoxan, required hd . 4. r popliteal dvt , rx with heparin gtt and coumadin for approx one month (stopped when admitted with gi bleed) 5. chf, ef 55% 6. thrombocytopenia felt cytoxan (nadir at 40, had been in 200s prior to d/c in ) 7. gi bleed adm early : gastritis, esophagitis on egd, proctitis with erythema and small ulcers, diverticulosis on colonoscopy. readmitted with gi bleed later that month, underwent left colectomy, appy, colorectal anastomosis, and gastrostomy. 8. pelvic abscess, adm , s/p drainage by surgery. 9. elevated lfts during hospitalization, unclr etiology s/p extensive w/u 10. hx cdiff colitis, treated with flagyl, oral vanc, linezolid 11. serratia uti (esbl), rx with cefepime 12. adrenal insufficiency 13. raynaud's 14. cryoglobulinemia 15. peripheral neuropathy 16. paget's disease, found incidentally on ct scan 17. secondary hyperparathyroidism social history: lived at home with her 83 y/o sister prior to hospitalization in , has been at since. worked as an administrative assistant, retired . never married, has no children. no hx tobacco. used to drink alcoholic drinks/week. family history: positive for gastric cancer in father, otherwise negative. no autoimmune disease. physical : pe: 96.5, 75, 175/63, rr 20, 100% on ac/ps fio2 30%, vt 400, rr 8 (breathing 20), peep 5, psv 10. gen: slim caucasian female resting comfortably in bed, communicative. heent: conjunctival injection on the r, no discharge. pearl. anicteric sclerae. cor: rr, normal rate, no m/r/g. lungs: cta anteriorly. abd: nabs, marked tenderness to palpation in rlq over area of mass with mild ecchymosis. otherwise, no rebound, no guarding, no rigidity, soft in other 3 quadrants. mutliple ecchymoses at sites of sq heparin injections. extr: 1+ edema of rle to ankle. both feet in multipodous boots. ecchymoses over dorsum of hands b/l. rectal: guaiac negative per ed. pertinent results: 07:45pm wbc-16.1* rbc-3.00* hgb-8.9* hct-27.5* mcv-92 mch-29.6 mchc-32.2 rdw-18.4* 07:45pm plt count-281 08:16am pt-11.9 inr(pt)-0.9 08:15am lactate-1.8 08:10am glucose-97 urea n-122* creat-1.7* sodium-138 potassium-4.6 chloride-101 total co2-25 anion gap-17 08:10am alt(sgpt)-19 ast(sgot)-24 alk phos-102 amylase-69 tot bili-0.2 08:10am lipase-28 08:10am calcium-10.2 phosphate-2.0*# magnesium-1.8 08:10am wbc-13.9* rbc-3.08* hgb-9.0* hct-28.2* mcv-92 mch-29.2 mchc-31.9 rdw-18.5* 08:10am neuts-86.8* lymphs-4.3* monos-6.0 eos-2.6 basos-0.4 08:10am anisocyt-2+ macrocyt-1+ microcyt-1+ 08:10am plt count-293 ct abd : impression: 1. right-sided anterior abdominal wall rectus sheath hematoma. 2. scattered air-space opacities at the left lung base. clinical correlation is recommended. _________________________ cxr : impression: interval resolution of pleural effusions and pulmonary parenchymal opacities. no pneumonia. __________________________ cxr : a tracheostomy tube and left picc line remain in place. cardiac silhouette is upper limits of normal in size. a bilateral central alveolar pattern shows some interval improvement. there is mild volume loss in the right upper lobe, which is also improved. bilateral pleural effusions, right greater than left show slight improvement on the right, and no significant change in the left. there may be a subpulmonic component of the right effusion. impression: improving perihilar pulmonary edema and right upper lobe volume loss. ___________________________ echo findings: left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. left ventricle: normal lv wall thickness, cavity size, and systolic function (lvef>55%). normal regional lv systolic function. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. aortic valve: mildly thickened aortic valve leaflets (3). mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. moderate mitral annular calcification. moderate (2+) mr. lv inflow pattern c/w impaired relaxation. tricuspid valve: mild to moderate +] tr. moderate pa systolic hypertension. pericardium: no pericardial effusion. conclusions: 1. the left atrium is mildly dilated. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 3. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. 5. there is moderate pulmonary artery systolic hypertension. 6. compared with the findings of the prior report (tape unavailable for review) of , the severity of mitral regurgitation has increased. brief hospital course: 83 year old female with multiple medical problems, and multiple recent admissions, last discharged to rehab on , presenting with rlq pain, found to have large rectus sheath hematoma, acute on chronic renal failure. . 1) rectus sheath hematoma: likely secondary to sq heparin injections plus possibly uremic platelets. inr < 1.0, hct relatively stable, currenlty stable at 25 for 3 days. surgery was consulted at the ed and recommended no surgical intervention at the present time. patient is status post transfusion of 4 units of prbcs to keep hct above 25. suggest checking labs qd or qod, and transfuse prbcs if hct drops below 20. pain was well controlled with prn percocet and morphine. platelets wnl. patient had very poor iv access so ir was consulted and placed a picc line in the l arm. . 2) acute on chronic renal failure: as above, etiology of chronic renal failure unclear. appears to have returned to creatinine of 0.9 in , last found to be 1.1 in , now up to 1.7. bun also elevated, suggesting pre-renal, however bun possibly also elevated from hematoma resorption. most likely pre-renal in the setting of blood loss, and fena of 0.8. renal was consulted on the patient and recommended hydration in addition to placing the patient on qod epo injections in the setting of chrnoic renal disease. patient's steroids (for h/o glomerulonephritis) were continued during her stay in the icu. patient with hx of pauci immune glomerulonephritis treated with steroids/cytoxan. baseline cr. 0.9. last value here was 1.6. in addition bun>>cr, likely secondary to degradation of hematoma. . 3) ventilator dependence: it is unclear what caused the patient to be intubated to begin with - occurred during a long sicu course in the setting of bilateral pleural effusions and pneumothoraces, s/p talc pleurodesis and tracheostomy formation. has been on pressure support 10 for the most part, peep of 5 tolerating intermittent trach mask with fio2 28%. she even tolerated a spontaneous breathing trial on trach mask for > 6 hours. however, patient had several episodes of desaturation down into the 80s during her icu stay, thought to be due to 1. fluid overload in the setting or worseing mr (as revealed by the echo performed during this hospital stay); 2. pneumonia due to gr- rods found in her sputum (speciating and sensitivities pending). as a result, her ventilator setting had to be turned up: pressure support, peep, and fio2 were increased, though intermitently. the patient was already treated with imipenem (for resistant kliebsiella uti, see below), so no futher gram negative coverage was needed. in addition, she was aggessively diuresed with lasix gtt, and aggressively afterload reduced with isordil, hydralazine, and verapamil. her labetalol and amlodipine were thought to be suboptimal in managing her heart failure with fluid overload and were discontinued. on the day of discharge, the patient was back on her vent settings of pressure support 5/peep 5, 30% fio2 and diuresing >200cc/hr on 4mg/hr lasix gtt. she should be weaned off lasix drip and transitioned to standing lasix pending the resolution of pulmonary edema on her cxr. her afterload reduction should be adjusted based on her blood pressures. . uti: resistant kleibsiella was cultured from her urine. sensitivies were as follows: klebsiella pneumoniae | ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- r ceftazidime----------- =>64 r ceftriaxone----------- r cefuroxime------------ =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s nitrofurantoin-------- 64 i piperacillin/tazo----- 8 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r . she was started on imipenem based on her h/o of allergies to b-lactams. imipenem was thought to have least incidence of x-reactivity, and the patient tolerated the treatment well. she has received 4 days of treatment, and should be continued on the same regimen for 10 more days (20 total doses). repeat cultures of her urine and of her sputum should be obtained. . . 4) leukocytosis: chronic since , possibly secondary to steroids. in addition, see infections as above. on the day of discharge, the wbc count was 15.5, similar to admission hct. appears to be at recent baseline, patient afebrile, without complaints other than abdominal pain attributed to hematoma. mild neutrophilia, chronic, c/w steroid effect. . 5) anemia: chronic, baseline appears to be around 29. iron studies c/w anemia of inflammation in the recent past, repeated in house as well. has required numerous transfusions in the past, as well as epo. also with h/o gi bleed, guaiac negative here. re-started on epo while in house. . 6) history of adrenal insufficiency: continued on outpatient dose of prednisone. . 7) atrial fibrillation: history of af, patient has been in sinus while stayin in the icu. patient coumadin was held in the setting of recent bleed, but was restarted at a lower dose due to h/o popliteal dvt in . she should be kept on coumadin qhs and titrated to inr of .. . 8) hypertension: patient's medication were changed to verapamil, isordil and hydralazine. regimen should be optimized at your discretion. blood pressures stayed between 100-140/50-70 during her stay. . 9) fen: we continued her j-tube feeds. recs as per discharge worksheet. . 10) ppx: we held the subq heparin due to recent bleed, but maintained the patient on pneumoboots, giving her intermittent breaks for comfort. 11) access: r piv. . 12) code: dnr. confirmed with patient and her sister, who makes the majority of medical decisions for her. phone no. . . 13) communication: , sister, . 14) dispo: will return to rehab when hematoma stabilized. icu while in house for resp care. likely to go to rehab on tuesday, . medications on admission: 1. prednisone 20 mg po daily 2. lansoprazole suspension 60 mg po bid 3. ursodiol 300 mg po bid 4. ascorbic acid 90 mg/ml drops 5 po daily 5. lorazepam 0.25 mg po q4-6h prn 6. polyvinyl alcohol 1.4 % x 1-2 drops ophthalmic prn 7. heparin sodium 5,000 unit tid 8. nystatin 2.5 ml po tid 9. acetaminophen 320 ml po q4-6h prn 10. regular insulin sliding scale 11. labetalol 400 mg po tid 12. amlodipine 10 mg po daily 13. morphine 2 mg q4h as needed for dressing change. 14. gabapentin 200 mg po qhs 15. tramadol 25 mg q4 prn 16. quinine 325 po qhs 17. albuterol nebs q4 hours, q2 hours prn 18. epo 19. senna 10 ml po qhs 20. mirtazapine 7.5 mg po qhs 21. simethicone 80 mg po qid 22. ferrous sulfate 300 mg po tid 23. folic acid 1 mg po qday 24. zinc 220 mg po qday 25. bisacodyl 10 mg po qday 26. mvi 27. lactulose 20 grams po daily discharge medications: 1. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 2. gabapentin 100 mg capsule sig: two (2) capsule po hs (at bedtime). disp:*qs capsule(s)* refills:*2* 3. tramadol 50 mg tablet sig: 0.5 tablet po q4-6h (every 4 to 6 hours) as needed. disp:*qs tablet(s)* refills:*0* 4. quinine sulfate 325 mg capsule sig: one (1) capsule po hs (at bedtime). disp:*qs capsule(s)* refills:*2* 5. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. disp:*qs qs* refills:*0* 6. albuterol sulfate 0.083 % solution sig: one (1) inhalation q4h (every 4 hours). disp:*qs qs* refills:*2* 7. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). disp:*qs tablet(s)* refills:*2* 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*qs tablet(s)* refills:*0* 9. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 10. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). disp:*qs qs* refills:*2* 11. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 12. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4-6h (every 4 to 6 hours) as needed. disp:*qs ml(s)* refills:*0* 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. disp:*qs qs* refills:*0* 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*qs tablet, delayed release (e.c.)(s)* refills:*0* 15. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 16. morphine sulfate 1-2 mg iv q4h:prn only for use if percocet not effective 17. imipenem-cilastatin 500 mg iv q12h 18. dolasetron mesylate 12.5 mg iv q8h:prn 19. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*qs capsule, delayed release(e.c.)(s)* refills:*2* 20. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 21. simethicone 80 mg tablet, chewable sig: 0.5-1 tablet, chewable po qid (4 times a day) as needed. disp:*qs tablet, chewable(s)* refills:*0* 22. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 23. hydralazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 24. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po qmo, we, fri (). disp:*qs tablet(s)* refills:*2* 25. epoetin alfa 3,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). disp:*qs qs* refills:*2* 26. isosorbide dinitrate 10 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 27. furosemide 10 mg/ml solution sig: 4mg/hr gtt injection infusion (continuous infusion). disp:*qs qs* refills:*2* 28. warfarin 2.5 mg tablet sig: one (1) tablet po daily (daily): titrate up to inr of . disp:*qs tablet(s)* refills:*2* 29. verapamil 120 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*2 tablet(s)* refills:*2* discharge disposition: extended care facility: & rehab center - discharge diagnosis: rectus sheath hematoma kliebsiella urinary tract infection respiratory failure due to pulmonary edema and fluid overload acute on chronic renal failure anemia of chronic inflammation discharge condition: stable, on pressure support ventilation, good o2 sats, good urine output discharge instructions: -please take all medications as directed -please monitor urine output and change foley catheter as needed -continue imipenem 500 iv q12 for two weeks for resistant kliebsiella uti -continue pressure support ventilation, 5 pressure support, 5 peep, fio2 30%. wean as tolerated -continue afterload reduction with isordil, hydralazine and verapamil followup instructions: provider , . call to schedule appointment procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: anemia of other chronic disease urinary tract infection, site not specified long-term (current) use of steroids acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation mitral valve insufficiency and aortic valve insufficiency rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease secondary hyperparathyroidism (of renal origin) anticoagulants causing adverse effects in therapeutic use chronic respiratory failure tracheostomy status other disorders of muscle, ligament, and fascia status of other artificial opening of gastrointestinal tract sicca syndrome chronic glomerulonephritis with lesion of proliferative glomerulonephritis 

Answer: The patient is high likely exposed to