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: plavix / heparin agents attending: chief complaint: fever, tachypnea, hypotension major surgical or invasive procedure: none history of present illness: 69 y/o f w/ a h/o respiratory failure s/p trach placement and revision , pansensitive tuberculosis on 3 drug regimen, mds with pancytopenia, recently discharged for hemoptysis, trach stenosis, vap and sepsis who was referred to ed intensivist at rehab, dr. , for tachypnea, tachycardia to the 140s, minute ventilation of 16, pancytopenia(unchanged from recent hospitalization), and non-gap acidosis. patient has remained febrile, presumed secondary to medication reaction (see below). also noted that she had a modest amt of hemoptysis (thin, frothy). . recent admission for hemoptysis, inability to ventilate, vap, and septic shock. septic shock presumably secondary to vap and was treated with levophed, ivf, cefepime, and tobramycin (colonized with mdr pseudomonas and initially treated with cefepime but isolated again from sputum now resistent to cefepime). blood cultures remained negative but mdr pseudomonas isolated from sputum. patient then became volume overloaded following fluid resuscitation but responded well to diuresis. plan was to discharge to rehab for a scheduled 14 day course of cefepime/tobramycin to be completed . however, patient had creatinine elevation prior to discharge thought to be due to tobramycin, which was discontinued. patient found to have 80% stenosis of trach tube with granulation tissue. patient intubated from above. ip revised her trach with placement of device and excision of granulation tissue. was then replaced with a permanent customined #7 shiley trach. patient required mechanical ventilation throughout hospitalization with periods of apnea and presumed to have muscle weakness potentially from central process due to h/o cvas. hospitalization complicated by persistent low grade fevers despite appropriate antibiotics thought to be most likely medication related rather than infectious(inh, ethambutol most likely). also complicated by chronic pancytopenia secondary to mds and chronic hemolysis from frequent blood transfusions. . in ed, t104, bp 80s/60s, hr 170s, rr 30-40s, o2 100%. she received tylenol with temp decrease to 101.6. a right femoral cvl was placed. she was volume resuscitated with 7l ns but remained persistently hypotensive so levophed started with sbps to 90s. patient remained tachypneic breathing over vent. labs notable for abg 7.35/20/180. arf with cr 3.3 from last 1.4. pancytopenic but stable from prior discharge without left shift. cxr intially showed improved r middle and lower lung opacities. however, a repeat cxr following volume resuscitation showed blossoming consolidation in r lung. she received cefepime x 1. past medical history: -pulm tuberculosis (pan sensitive) with liver/spleen granulomas s/p r sided vats, r supraclavic ln, liver bx + -h/o +ppd w/o tx -afb on bal -tx continious since 2/1 per prior dc summ -1)diabetes mellitus - diet controlled 2)osa - on bipap 12/8 3)cataract in the left eye 4)cva/tia (positive mri) - right frontal with l arm/hand hemiparesis; etiology likely moderate degree stenosis of the ica in the cavernous region, stable on recent cta 5)asthma 6)hypercholesterolemia 7)seizure- uncertain diagnosis - l arm involuntary movements 8)recent colonoscopy in with single sessile 4-5 mm non-bleeding polyp of benign appearance, s/p removal. mammography yearly unremarkable. 9)sickle trait social history: has been living in rehab macu since getting tx for disseminated tuberculosis. previosly lived alone in . supportive family nearby. remote history of tobacco use. one-two glasses of alcohol per week. retired, used to work in a post office. family history: diabetes in son, sister, and brother. with epilepsy. brother with possible lung cancer. uncle with tuberculosis. physical exam: t: 99.6 bp: 100/52 hr: 115 rr: 30 o2 100% on 0.5 fio2, ac 400x26, peep 5 gen: intubated, sedated, responsive to pain heent: pupils equal and reactive. trach in place. neck: supple. cannot assess jvp. no jvd cv: regular. tachycardic. no mrg lungs: course breath sounds throughout. no rales abd: absent bowel sounds. obese. soft, nt, nd. peg in place ext: wwp, no cce. right femoral cvl oozing blood neuro: reactive to painful stimuli, opens eyes and withdraws. cannot follow commands. gcs 10. pertinent results: 10:39pm glucose-108* urea n-64* creat-2.9* sodium-149* potassium-4.1 chloride-128* total co2-12* anion gap-13 10:39pm alt(sgpt)-29 ast(sgot)-149* ld(ldh)-620* alk phos-103 tot bili-0.3 dir bili-0.1 indir bil-0.2 10:39pm wbc-7.2# rbc-1.87*# hgb-5.7*# hct-17.0*# mcv-91 mch-30.5 mchc-33.5 rdw-16.6* 10:39pm plt smr-very low plt count-52* 10:39pm pt-16.5* ptt-39.7* inr(pt)-1.5* 10:39pm fibrinoge-285 07:57pm rates-26/20 tidal vol-400 peep-5 o2-50 po2-180* pco2-20* ph-7.35 total co2-12* base xs--11 -assist/con 07:00pm urine gr hold-hold 07:00pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-0.2 ph-5.0 leuk-neg 07:00pm urine rbc-21-50* wbc- bacteria-few yeast-rare epi-0-2 trans epi-0-2 07:00pm urine amorph-mod 06:04pm k+-4.0 04:20pm glucose-188* urea n-71* creat-3.3*# sodium-141 potassium-7.4* chloride-119* total co2-13* anion gap-16 04:20pm alt(sgpt)-23 ast(sgot)-109* ck(cpk)-222* alk phos-128* amylase-95 tot bili-0.3 04:20pm ck-mb-1 ctropnt-0.13* 04:20pm wbc-3.3* rbc-2.73* hgb-8.4* hct-24.9* mcv-91 mch-30.8 mchc-33.7 rdw-16.6* 04:20pm neuts-53.7 lymphs-39.7 monos-2.7 eos-2.5 basos-1.3 04:20pm pt-14.9* ptt-27.0 inr(pt)-1.3* . ct head: comparison: head ct, . findings: compared to prior examination, there is again evidence of prior right frontal lobe infarct with cortical gyriform calcifications. this is unchanged in appearance. there is also a focal hypodense lesion seen in the region of the right internal capsule, which may represent prior lacunar infarct. this is also unchanged. there are prominent sulci and ventricles with parenchymal volume loss. there is no evidence of hemorrhage, mass effect, shift of normally midline structures, or new areas of infarction. the and white matter differentiation is preserved. there is moderate mucosal thickening of the sphenoid sinus on the left side. there is minimal mucosal thickening of the left mastoid air cells. impression: there is no evidence of hemorrhage or new areas of infarction. . mri head: findings: there is an area of encephalomalacia seen in the right frontal lobe with areas of low signal on susceptibility images indicative of chronic blood products. in this irregular area of encephalomalacia there is a irregular area of high signal on diffusion images with low signal on adc map indicating slow diffusion. given the presence of chronic blood product slow diffusion is most likely related to the blood products. this is unlikely to represent acute ischemia in this location given the appearance. also in absence of vasogenic edema and presence of encephalomalacia an abscess within this location also appears less likely. however, when the patient's condition permit, gadolinium-enhanced mri would help for further assessment. there is mild-to-moderate brain atrophy and changes of small vessel disease are seen. coronal images through the temporal lobe demonstrate medial temporal atrophy without evidence of intrinsic signal abnormalities within the hippocampal regions. impression: large area of encephalomalacia in the right frontal lobe extending to inferior frontal lobe region which could be related to prior trauma or ischemia. irregular area of chronic blood product is seen in this region which demonstrate slow diffusion and which most likely is secondary to chronic blood products. however if patient's condition permit, gadolinium. enhanced imaging would help for further assessment. soft tissue changes, left mastoid air cells. no acute infarct is identified. no mass effect or hydrocephalus is seen. . eeg findings: demonstrated a disorganized and poorly modulated rhythm in the hz frequency range. there were no prominent focal, lateralized, or epileptiform features. there were no repetitive discharges or electrographic seizures. sleep: there were no normal waking or sleeping morphologies seen. cardiac monitor: showed a generally regular rhythm. spike detection programs: consisted mainly of electrode artifacts about the c3 and o2 electrodes. seizure detection programs: there were 31 entries in these files. all were artifactual. pushbutton activations: there were none. impression: this telemetry captured no pushbutton activations. however, this continues to be an abnormal bedside eeg due to the presence of a slow, disorganized, and poorly modulated background rhythm consistent with a severe encephalopathy. medications, infection, metabolic disturbances, and anoxia are among the most common causes but there are others. there were no prominent focal, lateralized, or epileptiform features. however, severe encephalopathies can obscure focal findings. no electrographic seizures were noted on this recording. . . brief hospital course: medical icu course: ms. was admitted to the micu from the ed with acute renal failure and evidence of worsening pneumonia and sepsis, recently discharged after a hospital stay treating hemoptysis, trach stenosis, vap and sepsis. . #. sepsis: her sepsis was presumed secondary to pneumonia seen on cxr. initally her hypotension was unresponsive to aggressive volume resuscitation in ed requiring pressors; however, pressures stablized in icu. prior cultures significant for mdr pseudomonas sensitive to cipro from sputum and mdr e coli sensitive (esbl) to meropenem from sputum . also, vre from cath tip on , started on daptomycin. for the new pna and sepsis, the patient was initially administered vancomycin, ciprofloxacin, meropenem for broad coverage with day 1 of therapy . vancomycin was discontinued on . tobramycin was added on . tobramycin, ciprofloxacin, and meropenem were planned for 14 day course per infectious disease consultants recommendations. the full course of vancomycin and meropenem will be completed on and for tobramycin . of note, during stay flagyl was begun for empiric c. dificle coverage but was discontinued after assays x3 were completed. also daptomycin was begun as a removed catheter tip grew vre; however, daptomycin was discontinued due to negative blood cx on for vre. the patient receive 4 days of daptomycin. . # arf: her baseline creatinine 0.8-1.0. during her last admission creatinine elevation believed to be secondary to tobramycin and antibiotic discontinued at that time. cr 1.4 prior to discharge. this admission her renal failure was thought to be due to atn given her history of hypotension, noting a possible contribution of tobramycin to renal failure; the benefits of tobramycin in treating infection were felt to be greater than their contribution to her renal failure. her renal function improved during her icu stay and her creatinine at discharge was 2.4 (3.3 on admission. . # respiratory failure: she was tachypneic on admission and has chronic respiratory failure s/p trach placement. she could not be weaned from ventilator during recent admission or this current admission. abg showed respiratory alkalosis with concomitant metabolic acidosis, which could be primary non-gap acidosis due renal failure or respiratory compensation for metabolic acidosis due to sepsis with baseline chronic respiratory alkalosis due to increased central drive (bicarbonate less than expected for acute, but bicarbonate values perhaps consistent with chronic pc02 drop). upon discharge her respiratory status was ventilatory dependent and stable. . # anemia: the patient required multiple blood transfusions this admission to keep her hematocrit above a tranfusion goal that ranged from 21-25. thigh bleeding was noted on exam in the region of a femoral line, which was removed secondary to question of possible art stick initially. retroperitoneal bleed was ruled on imaging. cvl was re-sited. her hematocrit was 22.0 upon discharge and stable. . # altered mental status: her gcs was 9 upon discharge (nonverbal, withdraws to pain, eyes open). per her family, the patient had decreased alertness and orientation during this admission. the neurology service was consulted and followed the patient throughout admission. anoxic brain injury was suspected given recent history of hypotension/hypoventilation. a ct head showed no interval change, old r frontal stroke. eeg results as above. mri results as above. . # fever: no leukocytosis or left shift was noted during stay but has h/o pancytopenia. she was intermittently febrile during recent admission which could have been in part secondary to medication (inh, ethambutol most likely as was thought during her last admission). however, medications cannot be stopped. her current pneumonia/sepsis likely also contributed to her intermittent fevers. urine cultures were negative. sputum cultures grew culture pseudomonas, sensitive to ciprofloxacin, tobramycin, resistant to meropenum. a catheter tip grew vre although blood cultures were negative. more recent blood cultures are currently pending but show no growth to date. . # tachycardia: hr was systolically in 170s on admission and had appearance of sinus tach on ekg though it was doubtfully sinus given patient's age and level of tachycardia. tachycardia was likely secondary to hypotension and a pe was unlikely as oxygenating well. . # disseminated tuberculosis: pan sensitive tuberculosis with liver and spleen granulomas on inh, ethambutol, pyrazinamide since 2/. pt is s/p r sided vats, r supraclavicular ln, and liver bx positive. recently ruled out for active tuberculosis w/ 3 negative sputums last admission . continue inh, ethambutol, pyrazinamide with complete course not finished until at the earliest; id to be reconsulted again before discontinuing tuberculosis antibiotics in the future. no respiratory precautions were observed given negative sputum x 3 for tuberculosis. . # pancytopenia: she has a h/o mds seen on bone marrow biopsy with borderline transformation to aml. however, no blasts on peripheral smear during recent admission to raise concern for progression. counts improved since recent discharge. counts were as low as 1.0 but have increased again, wbc up to 4.0 today, on neupogen. she was given final dose of neupogen x1 today with plans to not continue neupogen in rehabilitation. . # diabetes mellitus: reasonable bg control currently. lantus at half dose while npo and insulin sliding scale controlled sugars reasonably well during admission. . # h/o cva: h/o r ica with residual l arm/hand hemiparesis and aphasia. neuro exam cannot be assessed secondary to patient's clincial status. gcs currently 9(eyes open, withdraws/localizes to pain, nonverbal). ct head and mri during this admission showed no new cva. please see ct/mri study results as above. . # asthma: no evidence of obstruction on abg in ed. albuterol/atrovent mdi prnwere administered. . # hypercholesterolemia: statin was held given mild lft elevation. . # fen: tube feeds were administered at goal. lytes repleted lytes as necessary. g-tube in place. . # ppx: - no heparin give h/o +hit. pneumoboots. - ppi, sucralfate - colace, senna, lactulose, bisacodyl for bowel regimen, but holding bowel regimen now given diarrhea. . # access: picc. piv x2. . # code: full . # comm: ( health care proxy ) , . medications on admission: acetaminophen 325 mg po q6h as needed for pain/fever. albuterol 90 mcg/actuation aerosol 6-8 puffs inhalation q4h (every 4 hours) as needed for wheezing/sob. bisacodyl 10 mg po daily (daily) as needed. docusate sodium 100 mg po bid ethambutol 1200 mg po daily insulin glargine(15) units subcutaneous at bedtime. insulin regular human subcutaneous four times a day: 4 units for fsbs 150-200, and 2 units for every additional 50 fsbs points over 200. ipratropium bromide(2) puff inhalation qid isoniazid 300 mg po daily lactulose 20 gm po q6h lansoprazole 30 mg po daily pyrazinamide 1250 mg po daily pyridoxine 50 mg po daily senna 8.6 mg po bid as needed. simvastatin 40 mgpo daily sucralfate 1 g po qid tobramycin sulfate 180 mg iv q36h x 5 days: doses due 7/24pm, 7/26am, 7/27pm; course will then be complete vancomycin 1000 mg iv q 24h x 10 days: discontinue if blood cultures from remain negative. discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. albuterol 90 mcg/actuation aerosol : 1-2 puffs inhalation q6h (every 6 hours) as needed. 3. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 4. insulin regular human 100 unit/ml solution : one (1) injection injection qid per sliding scale: 2 units for bg 150-200, 4 units for bg 201-250, 6 units for bg 251-300, 8 units for bg 301-350, 10 units for bg 351-400. 12 units for bg>400. 5. insulin glargine 100 unit/ml solution : seven (7) units subcutaneous at bedtime. 6. isoniazid 300 mg tablet : one (1) tablet po daily (daily). 7. pyrazinamide 500 mg tablet : 2.5 tablets po daily (daily). 8. pyridoxine 50 mg tablet : one (1) tablet po daily (daily). 9. sucralfate 1 g tablet : one (1) tablet po qid (4 times a day). 10. ethambutol 400 mg tablet : three (3) tablet po q36h (every 36 hours). 11. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 12. acetaminophen 160 mg/5 ml solution : six y (650) mg po q6h (every 6 hours) as needed. 13. lactulose 10 g/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 14. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 15. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 16. sodium bicarbonate 650 mg tablet : one (1) tablet po q6h (every 6 hours). 17. cipro 10 mg/ml solution : four hundred (400) mg intravenous once a day for 4 days. 18. meropenem 500 mg recon soln : five hundred (500) mg intravenous q12h (every 12 hours) for 4 days. 19. fentanyl citrate 25-100 mcg iv q6h:prn 20. midazolam 2-4 mg iv q4h:prn 21. tobramycin sulfate 40 mg/ml solution : one hundred (100) mg injection q48h (every 48 hours) for 4 days. discharge disposition: extended care facility: - discharge diagnosis: 1. pneumonia 2. renal failure 3. tuberculosis discharge condition: stable vitals. responds to noxious stimuli. cannot follow commands. persistently tachypneic. discharge instructions: you were evaluated and treated in the hospital for complicated bacterial pneumonia, renal failure, and your long-standing disseminated tuberculosis. you will need to continue taking antibiotics for 4 days as prescribed to complete a 14 day course. please call your doctor or return immediately to the emergency department for any difficulty breathing, fevers greater than 102, or any other concern. followup instructions: please call your primary care doctor to arrange follow-up in the next week. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis asthma, unspecified type, unspecified myelodysplastic syndrome, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonia due to pseudomonas septic shock hyperosmolality and/or hypernatremia other complications due to other internal prosthetic device, implant, and graft late effects of cerebrovascular disease, aphasia tracheostomy status dependence on respirator, status late effects of cerebrovascular disease, hemiplegia affecting nondominant side sickle-cell trait other primary progressive tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically 

Answer: The patient is high likely exposed to