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: no known allergies / adverse drug reactions attending: chief complaint: hypoxia major surgical or invasive procedure: none history of present illness: 54f mr, tracheomalacia s/p tracheostomy in , pvd, multiple aspiration pneumonias, dm2 among other conditions who had low oxygen saturations at her nursing facility patient is not able to provide further history, but denies pain. patient was succioneed by ems with improvement in saturation; however, she was found to have electrolyte abnormalities and a drop in her hct, and as such as admited. per report, she was guiaic negative in the ed. in the ed, initial vs were: 98 98 102/43 18 98% 10l on transfer, 96.1 ??????f (35.6 ??????c) (axillary), pulse: 72, rr: 17, bp: 121/48, o2sat: 100, o2flow: (room air). labs were notable for na 121, k 5.3, cl 81, bicarb 43, bun 21, cr 1, hct 25.4. ekg showed nsr at 75, with twi in v1. cxr showed on prelim atelectasis vs. pna. on arrival to the floor, she is in nad, but only verbalizes yes/no answers review of systems: (+) unable to obtain poor historian past medical history: past medical history: mental retardation tracheomalacia s/p tracheostomy h/o aspiration pneumonia e.coli bacteremia diabetes mellitus h/o c. difficile infection glaucoma hypertension hld osteoarthritis depression/anxiety, constipation psychosis past surgical history: tracheostomy and peg , r total knee replacement r hip replacement right common iliac artery stent placement and right external iliac recanalization with stent placement x2. social history: lives at nursing home father and brother are -guardians family history: unable to obtain physical exam: admission exam: =================================== vs - t 98 bp 150/1 hr 86 rr 22 96% on 60% trach mask general: would state shake head "yes or no" to questions, also says "yes" and "no" : sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad, poor dentition cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops although exam limited due to coarse breath sounds lungs: diffuse coarse breath sounds, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly. peg tube located in luq ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact although disconjugate gaze especially with right eye labs: please see attached discharge exam: ===================================== vs - t 97.4 bp 138/52 hr 102 rr 24 98% on 40% trach mask general: responds to name, no acute distress, baseline mr : sclera anicteric, mm dry, eomi neck: supple, jvp not elevated cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: bronchial breath sounds abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley ext: cool hands, but otherwise warm, well perfused, 2+ pulses, no clubbing. bilateral hands/feet with edema. neuro: answers yes/no questions. intermittently follows commands. pertinent results: admission labs: =============================== 01:00am blood wbc-9.4 rbc-2.72* hgb-8.8* hct-25.4* mcv-93 mch-32.5* mchc-34.8 rdw-17.3* plt ct-291# 01:00am blood neuts-49.7* lymphs-33.8 monos-13.3* eos-2.6 baso-0.6 07:20am blood ret aut-8.4* 01:00am blood glucose-164* urean-21* creat-1.0 na-121* k-5.3* cl-81* hco3-43* angap-2* 07:20am blood totprot-5.6* albumin-2.8* globuln-2.8 calcium-8.6 phos-3.5# mg-2.1 iron-44 07:20am blood caltibc-352 hapto-141 ferritn-304* trf-271 01:02am blood lactate-1.3 imaging: ========================= cxr findings: ap and lateral views of the chest. tracheostomy tube is seen in place. mild cardiomegaly is unchanged. there are bibasilar opacities that may represent atelectasis; however, aspiration or pneumonia cannot be ruled out. correlate clinically. no large pleural effusion or pneumothorax. impression: mild interstitial edema. bibasilar opacities are likely chronic. ct can be done to assess for subtle changes. chest (portable ap): tracheostomy tube remains in satisfactory position. overall, cardiac and mediastinal contours are difficult to assess given marked patient rotation, but are likely stable. lungs remain low lung volumes with overall improvement in aeration, suggesting that interstitial edema has resolved. basilar patchy opacities are unchanged and may reflect chronic changes. no large pneumothorax, although the sensitivity for detecting pneumothorax is somewhat diminished given supine technique. bilat lower ext veins: limited study due to the overlying edema. no dvt is seen in the common femoral veins or proximal superficial femoral veins bilaterally. flow was seen in the superficial femoral veins and popliteal veins bilaterally but technical limitations did not allow adequate assessment. other than the right posterior tibial veins which are patent, the calf veins are not well visualized. microbiology: ========================= gram stain (final ): pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. mrsa screen (final ): positive blood culture, routine (pending): blood culture, routine (pending): urine culture (final ): no growth. sputum site: endotracheal gram stain (final ): <10 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (preliminary): further incubation required to determine the presence or absence of commensal respiratory flora. pseudomonas aeruginosa. moderate growth. of two colonial morphologies. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 16 i ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem------------- =>16 r piperacillin/tazo----- r tobramycin------------ <=1 s discharge labs ============================ 03:00am blood wbc-6.7 rbc-2.59* hgb-8.2* hct-25.3* mcv-98 mch-31.8 mchc-32.4 rdw-17.0* plt ct-190 02:06am blood pt-9.4 ptt-26.1 inr(pt)-0.9 03:00am blood glucose-66* urean-23* creat-1.3* na-139 k-3.7 cl-103 hco3-30 angap-10 03:00am blood calcium-7.7* phos-3.9# mg-2.6 03:40am blood lactate-1.2 brief hospital course: 54f mr, tracheomalacia s/p tracheostomy in , pvd, multiple aspiration pneumonias, dm2 among other conditions who had low oxygen saturations at her nursing facility . # hypoxemia - pt initially was admitted due to low oxygen saturations at her nursing home. it was initially felt this could possibly due to infection and antibiotics were started. however, later in her hospital course, her presentation seemed more consistent with mucous plugging, and so antibiotics were stopped. she was started on guaifenesin and nac. she had a hypoxic event where she desatted to 50% which brought her to the micu and she was put on the ventilator. her improvement was rapid and she was satting 98% on 40% face mask upon discharge. pe was considered as a possible etiology of her hypoxia, and lenis were obtained which did not show evidence of clot, though this was a limited study. additionally, given her rapid improvement on the ventilator, this was not felt to be a likely etiology. sputum culture showed pseudomonas, but this was felt to be colonization rather than infection, and so antibiotics were discontinued (as stated above). she was seen by ip given her history of tracheobronchomalacia and it was decided that intervention was not necessary. overall, her etiology of hypoxia was felt to be secondary to mucous plugging. # hyponatremia: upon admission, patient has serum na of 120 which improved with fluid resuscitation. likely hypovolemic hyponatremia; this is supported by exam, bun/cr ratio elevated above 20, and metabolic alkalosis, which could very well be contraction. her na improved to 129 with fluids supporting the diagnosis of hypovolemic hypnatremia. as per nursing home, was same as reported from labs from facility. her sodium upon discharge was 139. # anemia: patient has normal hr and bp, and per report was guiaic negative. it was concerning for hemolysis versus anemia of chronic inflammation. her reticulocyte index indicates that her bone marrow is responding appropriately. her hemolysis labs did not suggest hemolysis as the cause of her anemia. fe studies were only notable for elevated ferritin, which makes most likely diagnosis of her anemia to be anemia of chronic inflammation. she did not require blood transfusions during this hospitalization. # hyperkalemia: upon presentation, patient had mild hyperkalemia (5.3) which is likely secondary to decreased intravascular volume, which caused a mild , possibly precipitating hyper k. no ekg changes to suggest cardiac effects. potassium improved to 4.7 from 5.3 with ivf. her potassium was 3.7 upon discharge. # metabolic alkalosis: likely contraction in the setting of volume depeltion. there is also a possibility that this is a compensatory metabolic alkalosis from a respiratory acidosis to mucus plugging of trach. her alkalosis improved with ivf, lending credence to the idea that it is secondary to volume depletion with contraction alkalosis. # dm: pt was initially continued on her home regimen of 56 units lantus qhs and insulin sliding scale. however, on the day of discharge, she became hypoglycemic to 32 that increased to 213 with 1.5 amps of d5. therefore, her home lantus was cut in half to 28 units to start tonight and depending on what her sliding scale requirements are, this should be titrated as necessary. chronic problems: ==================================== #hypothyroidism: she was continued on home levothyroxine #h/o psychosis: cont on how valproate/seroquel. #htn: she was initially continued on home amlodipine/metoprolol, but these were held upon transfer to the icu. however, it is felt safe to re-start these medications, as her bp was 130/67 upon discharge. transitional issues ================================= # pt has two blood cultures 10/20 and that are pending upon discharge that need to be followed-up on # pt's home lantus was decreased to 28 units qhs (down from 56 units qhs) due to hypoglycemia. her insulin sliding scale requirements should be monitored given this decreased dose of lantus and be used to increase her lantus as necessary. # code status: full code medications on admission: the preadmission medication list is accurate and complete. 1. valproic acid (as sodium salt) *nf* 500 mg/10 ml (10 ml) oral daily 2. vitamin d 400 unit po daily 3. amlodipine 10 mg po daily hold for sbp <100, hr <60 4. levothyroxine sodium 25 mcg po daily 5. metoprolol tartrate 150 mg po bid hold for sbp <100, hr <55 6. glargine 56 units bedtime insulin sc sliding scale using reg insulin 7. aspirin 325 mg po daily 8. fenofibrate *nf* 54 mg oral daily 9. lactobacillus acidophilus *nf* 1 tablet oral daily 10. multivitamin with minerals *nf* 9 mg/15 ml iron oral daily 11. polyethylene glycol 17 g po daily 12. quetiapine fumarate 200 mg po tid 13. quetiapine fumarate 50 mg po tid 14. valproic acid (as sodium salt) *nf* 750 mg oral qhs 15. albuterol 0.083% neb soln 1 neb ih 16. latanoprost *nf* 0.005 % ou daily discharge medications: 1. aspirin 325 mg po daily 2. glargine 28 units bedtime insulin sc sliding scale using reg insulin 3. levothyroxine sodium 25 mcg po daily 4. acetylcysteine 20% 1-10 ml neb q2h:prn mucus 5. glucagon 1 mg im q15min:prn hypoglycemia protocol 6. guaifenesin ml po q6h 7. heparin 5000 unit sc tid 8. valproic acid (as sodium salt) *nf* 500 mg/10 ml (10 ml) oral daily 9. valproic acid (as sodium salt) *nf* 750 mg oral qhs 10. vitamin d 400 unit po daily 11. polyethylene glycol 17 g po daily 12. multivitamin with minerals *nf* 9 mg/15 ml iron oral daily 13. metoprolol tartrate 150 mg po bid hold for sbp <100, hr <55 14. latanoprost *nf* 0.005 % ou daily 15. lactobacillus acidophilus *nf* 1 tablet oral daily 16. fenofibrate *nf* 54 mg oral daily 17. albuterol 0.083% neb soln 1 neb ih 18. amlodipine 10 mg po daily hold for sbp <100, hr <60 19. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 20. quetiapine fumarate 200 mg po tid 21. quetiapine fumarate 50 mg po tid discharge disposition: extended care facility: - discharge diagnosis: - mucous plug - hypovolemic hyponatremia - anemia of inflammation discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: dear ms. , it was a pleasure taking care of your here at . you came into the hospital because you were having a hard time breathing. we believe this was from mucus that was stuck in your trach. you have been started on guaifenesin and acetylcysteine to help prevent mucous plugging. it is important to make sure you are breathing through humdified air to help prevent the mucous clot from clogging your airways. you were also found to have some electrolytes to be abnormal. these were most likely from being dehydrated. they were normal after you received some intravenous fluids. you were also found to be slightly anemic. you have a history of anemia and this is thought to be due to inflammation. the following changes were made to your medications *decreased your lantus to 28 units qhs (down from 56 units qhs) *added guaifenesin to help decrease mucous plugging *added acetylcysteine to help decrease mucous plugging *added heparin subq to help prevent clots while you are bedbound. *added glucagon and dextrose to be administered per the insulin sliding scale depending on your glucose levels followup instructions: please have your extended care facility arrange follow up with a md. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: hyperpotassemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism peripheral vascular disease, unspecified unspecified glaucoma constipation, unspecified dysthymic disorder other and unspecified hyperlipidemia alkalosis long-term (current) use of insulin osteoarthrosis, unspecified whether generalized or localized, site unspecified accidents occurring in residential institution other specified anemias tracheostomy status other diseases of trachea and bronchus mild intellectual disabilities foreign body in larynx inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation 

Answer: The patient is high likely exposed to