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 / erythromycin base / cefepime attending: chief complaint: unresponsiveness major surgical or invasive procedure: tracheostomy picc line placement central line placement and removal history of present illness: this is a 82 year-old female with a history of cva and dementia (nonverbal at baseline with peg), chf, h/o c diff, afib, hypertension, hypothyroidism who presents from the ed after being found unresponsive at her nursing home. in late , pt was admitted to an osh for uti complicated by c diff colitis. per her daughter, pt has been more sleepy than usual for the past week with increasing o2 requirement. according to nh records, pt was diagnosed with lll pneumonia yesterday and started on levofloxacin. she developed worsening respiratory distress and was found unresponsive early this morning. had temp to 101 with sao2 96% on 4l. ems found her unresponsive and tachypneic. pt was intubated in the field by ems after receiving fentanyl and versed. her initial bp in the field was 200/100--> 140s systolic. she was brought to . vitals on arrival were notable for temp of 100.1 and bp 89/66. cxr showed rll infiltrate. wbc was 15.9 with left shift and 6 bands. received ns 2l, levo 500mg iv and vanco 1g iv. abg prior to transfer was 7.59/36/504/35. she was transferred to for further management. . in the ed, initial vitals were t 100.0, hr 67, bp 149/63, rr 14, sao2 100% intubated. she remained hemodynamically stable. head ct and ct c-spine with no acute process. cxr showed r-sided infiltrate. wbc was 21 with 88% neutrophils (no bands). trop was elevated to 0.18 with ck of 50 and ekg unremarkable. additional notable labs include lactate of 4.9, inr of 4.9, k of 2.7, and bun/cr 39/0.4. ua was negative. urine and blood cultures sent. she received 2l ns, 40 meq k, levo 250mg, and ceftriaxone 1g. pt was transferred to the for further management. . ros: unable to obtain as patient is intubated and sedated. past medical history: chf (ef unknown) h/o c diff in late a fib anemia h/o cva s/p peg-- was fully functional prior to cva, now nonverbal at baseline and dependent for all adls hypertension hypothyroidism social history: divorced. lives at house. otherwise unknown. family history: non-contributory physical exam: vitals: t: bp: 151/85 hr: 74 rr: 20 o2sat: 96% on ac 400/14 peep 5 fio2 50% gen: elderly female, intubated, no acute distress heent: perrl, sclera anicteric, no epistaxis or rhinorrhea, dry mucous membranes with poor dentition and oral hygiene, no oral lesions neck: no jvd, no bruits, no cervical lymphadenopathy, trachea midline cor: a fib, no m/g/r, normal s1 s2, radial and dp pulses +2 pulm: coarse upper airway breath sounds anteriorly, no wheeze or crackles abd: soft, nt, nd, +bs, no hsm, no masses; peg in place with no surrounding erythema or drainage ext: no c/c/e, no palpable cords neuro: opens eyes to voice and tracks. follows simple commands (open eyes, squeeze fingers). plantar reflex downgoing on l and upgoing on r. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 07:30am plt count-519* neuts-87.9* lymphs-7.7* monos-4.0 eos-0.1 basos-0.3 wbc-21.2* rbc-3.79* hgb-10.8* hct-33.0* mcv-87 mch-28.6 mchc-32.9 rdw-16.5* glucose-159* urea n-39* creat-0.4 sodium-144 potassium-2.8* chloride-99 co2-36* anion gap-12 pt-44.2* ptt-30.9 inr(pt)-4.9* ck-mb-notdone ctropnt-0.18* ck(cpk)-50 potassium-2.9* hgb-11.5* calchct-35 glucose-146* lactate-4.9* na+-144 k+-2.7* cl--92* tco2-37* 09:48am urine hyaline-0-2 rbc-* wbc- bacteria-none yeast-none epi-0-2 blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-tr color-yellow appear-clear sp -1.024 02:23pm pt-35.3* ptt-28.1 inr(pt)-3.7* plt count-558* wbc-27.4* rbc-4.13* hgb-11.7* hct-36.7 mcv-89 mch-28.4 mchc-31.9 rdw-16.1* digoxin-2.4* tsh-4.8* calcium-7.5* phosphate-2.6* magnesium-1.7 ck-mb-7 ctropnt-0.11* probnp-6848* ck(cpk)-75 02:23pm glucose-173* urea n-36* creat-0.4 sodium-145 potassium-3.6 chloride-104 total co2-29 anion gap-16 lactate-3.1* type-art o2-50 po2-157* pco2-37 ph-7.54* total co2-33* base xs-9 discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:04am 5.5 2.68* 7.9* 24.9* 93 29.3 31.5 17.8* 498* basic coagulation pt ptt inr(pt) 08:00am 15.7 25.2 1.4* chemistry renal & glucose glucose urean creat na k cl hco3 angap 04:04am 122* 7 0.2* 130* 3.6 98 26 10 chemistry totprot albumin globuln calcium phos mg uricacd iron 04:04am 7.6* 3.2 1.7 head ct impression: 1. no evidence of hemorrhage or recent infarction. 2. large area of encephalomalacia in the left mca distribution. c-spine ct impression: 1. no evidence of fracture in the cervical spine. 2. multilevel severe degenerative changes with bilateral multilevel neural foraminal narrowing. ct torso 1. diverticulitis with adjacent inflammatory change and phlegmon; no discrete abscess or drainable fluid collection. 2. right basilar airspace opacification likely due to pneumonic consolidation. 3. right upper lobe segmental atelectasis. chest (portable ap) study date of 6:40 am impression: 1. endotracheal tube in the appropriate position. 2. multiple rib fractures. 3. right hemidiaphragm elevation, probably due to atelectasis, recommend followup to document resolution. tte : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. the right ventricular cavity is dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. cxr : in comparison with study , there is now a tracheostomy tube in place with no evidence of pneumomediastinum or pneumothorax. little overall change in the cardiomegaly, pulmonary vascular congestion, basilar atelectasis, and bilateral pleural effusions. brief hospital course: # respiratory failure: likely secondary to aspiration given altered mental status and recent lethargy. she was able to wean to pressure support and fio2 of 40% upon arrival to icu. was initially broadly covered with vanco/cefepime in case of pnuemonia, but without any evidence of pneumonia on cxr or culture data, these antibx were stopped. urine legionella negative. on hd#3 patient developed htn and increased wob in the setting of flash pulmonary edema. improved with lasix and acute blood pressure treatment. developed right sided pleural effusion and was slowly diuresed in the icu. although patient carries a dx of chf, tte demonstrated intact ef of 55%. due to her prolonged intubation and failure to wean from the ventilator, a trach was placed on . # c diff colitis: hypotension resolved with iv fluid on admission. treated with vancomycin po and flagyl iv that was later transitioned to po. remaining culture data was negative. ct abdomen demonstrated colitis and diverticulitis. planned treatment course for 2 weeks starting with cessation of all other antibiotics on . last day of antibiotics should be . she was also given probiotics provided by her family by their request. # elevated troponin with lateral st depressions: enzymes peaked on admission and trended down over hospital course; ck was flat. lateral st depressions had been noted previously. cardiac changes felt to be due to myocardial strain. # afib: on coumadin, digoxin, and carvedilol as an outpatient. afib remained rate controlled. digoxin was supratherapeutic and held for the first 3 days and restarted at a lower dose. her last dig dose was at 0.4. coumadin was held because her inr was supratherapeutic. lfts were wnl. supratherapeutic inr was felt to be flagyl use. prior to trach placement she was systemically anticoagulated on a heparin gtt. after her trach placement she was restarted on coumadin at 5 mg daily. the day of discharge her inr was 1.4. given her low daily risk for stroke, no anticoagulation bridge was started with the coumadin. her goal inr is . # chf: tte demonsrated intact ef. initially restrated on digoxin, lisinopril and carvedilol in the icu, and lasix and spironolactone were held. she developed hypotension in the setting of c.diff diarrhea so her lisinopril and carvediolol were stopped. on discharge she is only on digoxin. she was being diuresed with iv lasix prn for a goal of 500 cc to 1 l negative daily. prior to discharge she was still positive 10.7 l from admission. # htn: the patient is on carvedilol 25mg , lasix 40mg po daily, lisinopril 40mg , and spironolactone 25mg daily as an outpatient. here these were all held given hypotension early on during her icu course which required levophed support. as her pressures stabilized she was diuresed with iv lasix as needed to maintain 0.5 to 1 l negative daily, but her other medications were not restarted given the diuresis. her bps remained well controlled. # elevated tsh: her tsh was mildly elevated at 4.8 on admission. unclear if she was supposed to be on levothyroxine as it was not on her outpatient medication list. as this likely represented sick euthyroid syndrome she was not started on levothyroxine. she will need her tsh rechecked in weeks after discharge. # hyponatremia: the patient??????s na has decreased to 130 today from 132 from 136. she is volume overloaded, but does not appear to have chf, cirrhosis, or nephrotic syndrome, so she most likely has siadh. also her k is low, making adrenal insufficiency unlikely. diuresis with lasix will likely help get rid of excess free water. she will need to be continue on diuresis as above. # rash: the patient developed a maculopapular rash over her torso and extremities which eventually faded and desquamated. it was thought to be secondary to a cefepime drug rash. cefepime was stopped on . it has greatly improved. she is now being given eucerin cream daily. # anemia: hct stable at 24.9 today (was 23.7 yesterday). her hct was in the low 30??????s on admission and has trended downward over her stay. no clinical evidence of bleeding. likely secondary to her acute illness. # fen: she was continue on tube feeds through her peg. # ppx: ppi, sqh until her inr is therapeutic, vat prophylaxis # code: full code (confirmed with daughter) medications on admission: coumadin 4mg daily levaquin 500mg (started ) regular insulin sliding scale acidophilus calcium carbonate 500mg po bid carvedilol 25mg digoxin 0.025 daily lasix 40mg po daily lisinopril 40mg prevacid 30mg po daily spironolacton 25mg daily fentanyl patch 25mcg q72 albuterol/atrovent inh prn discharge medications: 1. digoxin 125 mcg tablet : 0.5 tablet po daily (daily). 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 6-10 puffs inhalation q4h (every 4 hours) as needed. 3. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation qid (4 times a day). 4. fentanyl 25 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. morphine sulfate 2 mg iv q4h:prn pain with turning please give when repositioning if needed for pain 7. lactobacillus acidophilus oral 8. white petrolatum-mineral oil cream : one (1) appl topical daily (daily). 9. insulin regular human 100 unit/ml solution : one (1) injection asdir (as directed): insulin sliding scale. 10. heparin (porcine) 5,000 unit/ml solution : one (1) inj injection tid (3 times a day). 11. vancomycin 250 mg capsule : one (1) capsule po q6h (every 6 hours) for 6 days: last day . 12. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 6 days: last day . 13. warfarin 5 mg tablet : one (1) tablet po once daily at 4 pm: titrate to a goal inr of . 14. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 15. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: - discharge diagnosis: primary - respiratory failure inability to wean from the ventilator requiring trach placement clostridium difficile colitis secondary - drug-induced rash atrial fibrillation history of cva with a peg in place discharge condition: stable, afebrile, continuing to require a ventilator. discharge instructions: you were transferred to this hospital with unresponsiveness and respiratory failure which was thought to be due to infection with pneumonia. you were already intubated (tube to help you breathe) before being transferred. you were treated with antibiotics and several attempts at weaning you off the ventilator were made, however you could not be weaned. a tracheostomy was placed for chronic ventilatory support. you also had an infection with clostridium difficile which caused you to have diarrhea. you were treated with oral vancomycin and flagyl and will need to finish the 2 week course. medication changes: 1. you will need to take 6 more days of po vancomyin and po flagyl (last day of antibiotics is ). 2. you will need to continue on coumadin 5 mg daily and have your inr check daily until you are therapeutic (inr ) on a stable dose. the dose may need to be adjusted. 3. your bp medications (lisinopril, spironolactone, lasix, and carvediolol) were stopped and you were given iv lasix for diuresis. you should continued to be diuresed for a goal of 500 cc to 1 l negative daily and eventually restarted on a regimen similar to you previous one. you will need to have your tsh checked in weeks to determine if you require thyroid hormone replacement. followup instructions: you should follow up with you primary doctor within 1-2 weeks, dr. (). you should also follow up with an interventional pulmonologist (the doctor who placed your tracheostomy) in weeks. you should schedule the appointment with dr. , (. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube other bronchoscopy other bronchoscopy non-invasive mechanical ventilation other intubation of respiratory tract other intubation of respiratory tract temporary tracheostomy diagnoses: abnormal coagulation profile anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases other persistent mental disorders due to conditions classified elsewhere hypopotassemia pulmonary collapse acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus alkalosis intestinal infection due to clostridium difficile long-term (current) use of anticoagulants late effects of cerebrovascular disease, hemiplegia affecting unspecified side dermatitis due to drugs and medicines taken internally hypovolemia hyperosmolality and/or hypernatremia other disorders of neurohypophysis late effects of cerebrovascular disease, aphasia gastrostomy status foreign body accidentally entering other orifice other nonspecific abnormal serum enzyme levels diverticulitis of colon (without mention of hemorrhage) cephalosporin group causing adverse effects in therapeutic use foreign body in larynx other late effects of cerebrovascular disease, dysphagia other antiprotozoal drugs causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to