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 (bulk) / compazine / bactrim ds / sulfa (sulfonamide antibiotics) / dapsone / levaquin / lisinopril attending: chief complaint: left ear pain and hearing loss major surgical or invasive procedure: none history of present illness: ms. is a 55 year old woman with h/o restrictive lung disease (bleomycin toxicity), sarcoidosis, systolic chf (ef 10%, adriamycin toxicity), factor v leiden, s/p trach and peg placement, here with recurrent fevers. she was admitted to last year for respiratory distress was intubated and unable to wean off the . she then got a trach and peg tube. her hospitalization was complicated by pna, recurrent fevers, and c.diff. she was then discharge to rehab. in she was transferred to for continued weaning. she has had a complicated course since then w/ pneumomediastinum, r pneumothorax with ct placement in , worsening chf with ef decreased from 30% to 10%, requiring temporary hd, anemia of chronic disease requiring blood transfusions (last on for hct of 25). recurrent c-diff with extended course of flagyl and vanco and resistant pseudomonas pna most recently + sputum cult on for which pt was being treated with colistimethate and aztreonam. . pt was being weaned off the with 20hours off the on trach mask and only requiring 4 hours of support. however, in the last 2 days, she was only able to tolerate respiratory trial off the for most of 1.5 hours. she had increased sputum and became febrile to 102. she also c/o increase l ear pain and decrease hearing. she had a ct scan of maxillofacial sinuses from that showed mastoiditis and otitis media. as per note, there was concern for cholesteatoma and she was transfer here for ent eval. . on arrival to the ed, her initial vitals were temp of 97.6, 115, 99/75, 30, 100% on trach on . patient was given vanc and cefepime and receiced 2l of ns. her bp responded by increasing to 110s/60s. she has reamined sinus tachy in 110s. she had a femoral line placed which the patient was pulled as per nursing report. she had some of of the fluid and vanco infiltrated into her tight. her ct of her maxillofacial sinuses in ohs was evaluated by our radiologist and the prelim reports that there is no new findings when compared to prior ct done in . . on arrival to the micu, pt is on via trach with pressure control fio2 35%, peep 5, pip 35, rate of 14 sating 100%. pt is overall comfortable. she is sleepy, but responsive. answering appropriately to questions. she had just received some ativan prior to my evaluation. . review of systems: unable to fully assess rom given that she is non-verbal due to trach and sleepy on arrival. (+) per hpi. she c/o increase l side ear pain and decrease hearing on l side, mild l facial edema as per ohs note. occ diarrhea past medical history: - s/p trach/peg -sarcoidosis: treatment history: methotrexate , stopped due to reaction, prednisone 10-20-10-7.5mg stopped due to cushingoid side effects in . - non-hodgkin's lymphoma (27 years ago) s/p chemotherapy c/b bleo lung tox, autologous bmt, and high-dose myeloablative total body irradiation. - pulmonary embolism with factor-5 leiden- long term coumadin goal inr therapy - status post cva with memory deficit. - stage iii-iv chronic kidney disease. - systolic chf- adriamycin from large cell lymphoma several years ago. recent echo 30%. - hypertension. - hyperlipidemia - mild sleep apnea. - anxiety - gout. - anemia - on aranesp - iron overload. - multiple environmental allergies social history: currently living at rehab x2 weeks. she has been on disability for the past 15 years, but used to work in a hotel as a reservations consultant. - tobacco: none - alcohol: none - illicits: none family history: - maternal: clots, pe, tia, factor v leiden, dementia at 92 - paternal: cad, pancreatic ca - siblings: sister died from complications of dm, another sister with thyroid problems and high cholesterol - children: one healthy daughter without v leiden - uncle: colon cancer physical exam: vitals: 115, 129/77, rr 26, 100% on general: sleepy but responsive to verbal stimuli. non-verbal due to trach, but answering appropriately to questions. no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, mild left facial edema and non tender l ear or mastoid process. l tympanic membrane with yellowish opacity, bulging. r with pearl white membrane. lungs: rhochorus through out, no increase in wob cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, mildly distended, bowel sounds present (hyperactive), no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses on bil le, no clubbing, cyanosis or edema. pertinent results: head ct : findings: there is complete opacification of the left mastoid air cells and the left middle ear. this is similar in appearance to the study. there is no underlying bony destruction. opacification of the left mastoid air cells are seen as far back as . remaining visualized paranasal sinuses and right mastoid air cells are clear. . impression: chronic opacification of the left mastoid air cells and left middle ear with no evidence of underlying bony destruction. . chest x-ray : impression: overall, there is slight increased opacity of the interstitial markings and ultimately it is difficult to determine whether there is a superimposed process on the extensive background of abnormal lungs. consider, if clinically feasible, a trial of diuresis with repeat radiography to discern whether there is an element of superimposed pulmonary edema. . 10:20pm blood wbc-16.5*# rbc-3.31* hgb-10.6* hct-32.2*# mcv-97 mch-32.1* mchc-33.0 rdw-19.8* plt ct-209# 03:51am blood wbc-12.1* rbc-2.91* hgb-9.6* hct-29.3* mcv-101* mch-32.9* mchc-32.8 rdw-18.9* plt ct-266 06:05am blood neuts-54 bands-4 lymphs-12* monos-15* eos-0 baso-0 atyps-0 metas-2* myelos-13* 10:20pm blood glucose-66* urean-29* creat-1.3* na-135 k-5.2* cl-98 hco3-29 angap-13 03:51am blood glucose-117* urean-61* creat-1.4* na-141 k-4.0 cl-108 hco3-25 angap-12 03:57am blood cortsol-7.9 06:30am blood vanco-18.3 10:30pm blood lactate-1.1 brief hospital course: ms. is a 55 year old woman with h/o restrictive lung disease (bleomycin toxicity), sarcoidosis, systolic chf (ef 10%, adriamycin toxicity), factor v leiden, s/p trach and peg placement who was sent from due to concern for mastoiditis. also noted to have fevers and being treated for pseudomonal pneumonia. . # ? mastoiditis: the osh was concerned for possible infection and sent her to for ent evaluation. after review by our radiologist, there was no significant change in the ct scan when compared to in . seen by ent- felt no clinical or radiological evidence of acute mastoiditis, and fluid likely chronic. no clear evidence of cholesteotoma on ct scans. they recommend outpatient follow up with dr. . she was briefly started on iv vancomycin which was discontinued prior to discharge. . #. fevers: on her last in she presented with fevers which were not thought to be due to infection. she was started on vanc and meropenam however they were discontinued prior to discharge. she presents now with a leukocytosis and increased difficulty weaning off concerning for a pulmonary process. she was recently found to have pseudomonas growing in her sputum on (2 strains that were multi-drug resistant that was sensitive to amikacin. however there has been state shortage of amikacin and he was started on colistimethate and had aztreonam added on ). she was on aztreonam and colistin upon . she has also been receiving flagyl and vancomycin for c.diff and had multiple + c-diffs and has on and off diarrhea. she was afebrible and was tolerating being capped. viral panel, legionella negative as were blood cultures. her aztrenoam was stopped and started on meropenam and continued on colistin for pseudomonas, plan for 2 week course per id with an end date of . she will need her creatnine checked at least every other day while she is on colisitin. . #. respiratory failure: secondary to bleomycin toxicity and reccurent pna. she failed to be extubated and has trach. currently has increase amounts of sputum and has hx of pseudomonas pna. she arrived trached and on . she has a history of becoming anxious when on the trach mask in which ativan was effective for relief. chest x-ray showed some bilaterally intertitial opacities which may be due to some pulmonary edema. she also has a history of sarcoidosis and is on chronic steroids for this. she is on hd for fluid removal given hx of chf and poor renal tolerance of diuresing. currently doing well on and tolerated trach collar. she was capped during the day and was ventilated overnight. . # chronic systolic congetive heart failure: hx of cardiomyopathy due to adriamycin. pt had prior ef of 30% during prior hospitalizations. as per ohs notes, her ef was decreased to 10% on with severe l ventricular systolic dysfx, dilated hypokinetic r ventricle. repeat echo in and in her ef remained at 10%. her lisinopril 20mg and carvedilol 25mg. . # cki: pt had creatine peaked at 3.2 in with aggressive diuresing to help with weaning off . she also developed hyperk and as per note was started on hd to help with fluid removal, she is currently receiving hd for volume status management (last on and . current creatine at 1.8. she may require dialysis when returns to ltac as is starting to show signs of volume overload, but respiratory status doing well. . # chronic anemia: pt with hx of anemia of chronic disease that was fully worked up. last iron 92, tibc of 126. her hct decreased from 33.8 in to 25.1 on and she received 2 units of prbcs. current hct now stable at low 30s. . # upper ext dvt: pt was on lovenox which appear to have stop. uncertain the dates on the lovenox. no ue edema noted. she was restarted lovenox- will continue for long term course given history of dvt and factor v leiden. her creatinine has been stable around 1.5 however if her creatinine worsens she should be switched to lovenox one a day. . # code: full (discussed with patient). daughter, hcp, medical facility: floor- pa page- medications on : 1. acetaminophen 650 mg po/ng q6h:prn fever 2. albuterol 0.083% neb soln 1 neb ih q4h:prn sob/wheezing 3. ascorbic acid (liquid) 500 mg po/ng daily 4. aztreonam mg iv q6h 5. nph 5 units daily 6. bisacodyl 10 mg po/pr daily:prn constipation 7. lisinopril 20 mg po/ng daily 8. calcium acetate 667 mg po/ng tid w/meals 9. lorazepam 1 mg po/ng q6h:prn anxiety 10. carbamide peroxide 6.5% 5-10 drop ad duration: 11. metoclopramide 5 mg po/ng qidachs 12. carvedilol 25 mg po/ng 13. metronidazole (flagyl) 500 mg po/ng q6h 14. chlorhexidine gluconate 0.12% oral rinse 15 ml oral 15. prednisone 5 mg po/ng daily 16. cholestyramine 4 gm po bid 17. simethicone 40-80 mg po/ng qid:prn abdominal discomfort 18. colistin 75 mg ih 19. vancomycin oral liquid 250 mg po/ng q6h 20. estrogens conjugated 1 gm vg daily 21. venlafaxine 37.5 mg po tid discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob/wheezing. 3. ascorbic acid 500 mg/5 ml syrup sig: one (1) po daily (daily). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 6. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 7. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 8. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous q 12h (every 12 hours). 9. cholestyramine-sucrose 4 gram packet sig: one (1) packet po bid (2 times a day). 10. nph insulin human recomb 100 unit/ml suspension sig: five (5) units subcutaneous once a day. 11. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous three times a day. 12. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 13. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 14. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 15. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for abdominal discomfort. 16. venlafaxine 37.5 mg tablet sig: one (1) tablet po tid (3 times a day). 17. colistimethate sodium 150 mg recon soln sig: one (1) recon soln injection (2 times a day). 18. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours). 19. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 20. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 21. meropenem 1 gram recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 22. ondansetron 4 mg iv q8h:prn nausea discharge disposition: extended care facility: northeast - discharge diagnosis: primary diagnosis serous otitis pneumonia (pseudomonas) c. diff secondary diagnosis chronic systolic congestive heart failure chronic renal failure anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the icu because there was concern that you had an infection deep in your left ear. you had the ears, nose and throat specialist evaluate you and they did not think that you had a significant infection. you were also evaluated by the infectious disease doctors during your . there were a few changes to your antibiotics. the iv vancomycin, aztreonam and fagyl were discontinued however your meropenam and colisitin were continued. they recommended a 2 week course with an end date of . medications changed during your stop aztreonam stop flagyl start meropenam end change colisitin 150mg subcutaneous end start ranitidine 150mg daily followup instructions: please follow up with ent as an outpatient with dr. as an outpatient . md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnoses: anemia of other chronic disease congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified sarcoidosis other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) pneumonia due to pseudomonas intestinal infection due to clostridium difficile chronic systolic heart failure long-term (current) use of anticoagulants primary hypercoagulable state gastrostomy status tracheostomy status unspecified mastoiditis nonsuppurative otitis media, not specified as acute or chronic 

Answer: The patient is high likely exposed to