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: morphine / dilaudid (pf) attending: chief complaint: lethargy major surgical or invasive procedure: reason for micu transfer: hyponatremia, hypotension, respiratory distress history of present illness: . history of present illness: ms. is a 67 year old female with multiple medical problems, including diabetes mellitus, alcohol-related-cirrhosis, coronary artery disease with a bare metal stent, and chronic diastolic heart failure, who is admitted to the icu from the ed for management of hyponatremia, hypotension, and hypoxia. . she was diagnosed with a left lower lobe pneumonia on and was on day eight of ten of a levofloxacin course. she was referred to the ed by her pcp due to increasing fatigue and an inability to care for herself at home. . upon arrival to the ed, her vital signs were t 98.2, hr 84, bp 93/62, rr 20, saturating 90% ra. she complained of bilateral lower extremity pain that had been going on for weeks. her exam was notable for crackles in the left lower field and erythema in the right lower extremity. her labs were notable for a sodium of 121, chloride 86, cr 2.6, bun 37, probnp of 1329 (elevated from 687 in ), hematocrit of 31.5 (down from 34.3 in ), and white cells of 10.1k with 78% neutrophils. a ua showed few bacteria, positive leuks, 7 wbc, and negative nitrite. a repeat ua two hours later was completely neative. the urine sodium was less than 10. a chest x-ray showed a resolving left lower lobe opacity. lower extremity dopplers were negative for dvt in the right lower extremity. a cta was contraindicated in the setting of renal failure, and a v-q scan was ordered. suspicion was high for a pulmonary embolism given the patients prior history of pulmonary embolism; however, heparin was not initiated because she had guaiac positive stool. she was given one liter of normal saline, afterwhich her systolic blood pressure improved from the low 90s to the low 100s. . her vital signs upon transfer were bp 105/62, hr 62, sat 99 4l, rr unknown, and was reported to be afebrile. she had one 18 guage peripheral iv. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. coronary artery disease s/p rca w/bare metal stent on (single vessel disease) 2. diastolic chf (recent echo , ef~55%) 3. crohn's disease: h/o pancolitis w/o small bowel involvement; colonoscopy showed no active disease, was on 5- 4. chronic renal failure (cr~1.4 at baseline) 5. dm type ii on insulin 6. hypertension 7. h/o idiopathic dilated cmp, now resolved 8. peptic ulcer disease 9. alcoholic cirrhosis 10. gerd 11. rheumatoid arthritis 12. pulmonary embolus in 13. total right knee replacement with subsequent chronic pain 14. mal seizure in childhood 15. cervical disc disease 16. l5/s1 radiculopathy with anterolisthesis of l4 on l5 on x-ray with emg consistent with mild radiculopathy 17. history of gi bleed of unclear etiology (), questionable hemorrhoids 18. h/o mrsa right knee wound infection s/p knee replacement 19. anemia 20. h/o cdiff colitis () 21. osteopenia 22. chronic pancreatitis 23. cervical spndylysis 24. candidal esophagitis x3 social history: patient lives with a disabled son in . one other son currently incarcerated. last son recently back from rehab. she was married but divorced a long time ago. 4 pack year smoking history, quit 15 years ago. drank ~1 pint alcohol/day x 10 years, quit 15 years ago. denies illicit drug use. ambulates with a walker at baseline. family history: "mom died of cancer. father with dm requiring bilateral below the knee amputation. one sister has had cervical cancer(cured) and rheumatoid arthritis. son with stroke 2 years ago. extensive family history of hypertenison." physical exam: on admission: physical exam: vitals: t: 97.5 bp: 99/49 p: 81 r: 21 o2: 95% 2l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . on discharge: vs: 98.6 (98.8), 128/78 (120s-150s/70s-90s), 82 (70s-80s), 20, 95% ra gen: awake, alert, oriented x3, obese woman, nad, able to state days of week and months of year forwards but not backawards, able to give directions to her home (was not able to 2 days ago) heent: sclera anicteric, mmm neck: supple cv: rrr, no m/r/g lungs: ctab, no wheezes, crackles, or rhonchi, slightly diminished breath sounds at left base abd: soft, non-tender, non-distended ext: warm, no edema, dps palpable bilaterally pertinent results: admission labs: 11:52pm wbc-8.3 rbc-3.36* hgb-10.5* hct-30.9* mcv-92 mch-31.3 mchc-34.2 rdw-14.3 11:52pm glucose-114* urea n-36* creat-2.3* sodium-123* potassium-3.7 chloride-91* total co2-20* anion gap-16 11:52pm calcium-8.2* phosphate-3.9 magnesium-1.3* 11:52pm pt-14.1* ptt-29.5 inr(pt)-1.2* 11:52pm plt count-213 08:36pm urine color-straw appear-clear sp -1.006 08:36pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 06:30pm urine hours-random sodium-<10 potassium-22 chloride-<10 total co2-less than 06:30pm urine color-yellow appear-hazy sp -1.011 06:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 06:30pm urine rbc-<1 wbc-7* bacteria-few yeast-none epi-13 trans epi-2 06:30pm urine hyaline-9* 05:58pm lactate-0.8 04:50pm glucose-135* urea n-37* creat-2.6* sodium-121* potassium-4.0 chloride-86* total co2-22 anion gap-17 04:50pm estgfr-using this 04:50pm probnp-1329* 04:50pm wbc-10.1 rbc-3.46* hgb-10.8* hct-31.5* mcv-91 mch-31.3 mchc-34.3 rdw-14.4 04:50pm neuts-78.0* lymphs-14.5* monos-5.2 eos-2.0 basos-0.4 04:50pm plt count-245 04:50pm pt-14.3* ptt-29.8 inr(pt)-1.2* discharge labs: 05:17am blood wbc-8.8 rbc-3.63* hgb-11.1* hct-32.3* mcv-89 mch-30.5 mchc-34.3 rdw-14.6 plt ct-266 05:17am blood glucose-105* urean-13 creat-1.2* na-141 k-4.1 cl-106 hco3-23 angap-16 05:17am blood calcium-9.5 phos-3.4 mg-2.1 . imaging: cxr (): left lower lobe pneumonia. . cxr (): improved left lower lobe opacification, with interval development of bibasilar atelectasis in the setting of low lung volumes. . rle u/s (): no evidence of right lower extremity deep venous thrombus. . liver/gallbladder u/s (): 1. patent hepatic vasculature. 2. increased echogenicity and coarseness of the liver likely relates to underlying cirrhosis. 3. prominent but unchanged main pancreatic duct. 4. mild gallbladder wall thickening, likely related to the underlying liver disease. . ct head (): no evidence of an acute intracranial process. . tte (): mild focal lv systolic dysfunction. ef 45% (decreased from prior echo) . ecg (): normal axis and rate, q waves in iii and avf suggesting area of old ischemia, unchanged from prior ekgs . micro: urine legionella: negative urine cx (): klebsiella pneumoniae | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- =>512 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r sputum cx: moderate growth commensal respiratory flora. gram negative rod(s). rare growth. . dfa: negative . stool cx (): no salmonella or shigella found. no campylobacter found. no vibrio found. no yersinia found. no e.coli 0157:h7 found. . c diff: negative brief hospital course: ms. is a 67 year old female with multiple medical problems, including diabetes mellitus, alcohol-related-cirrhosis, coronary artery disease with a bare metal stent, and chronic diastolic heart failure, who was admitted to the icu from the ed for management of hyponatremia, hypotension, and hypoxia in the setting of uti. . # ams: pt was lethargic at presentation which was thought to be due to hyponatremia, hypoxia, or infection. pt became febrile to 100.6f. pt was given fluids and started on vancomycin and zosyn, then vanc and meropenem for treatment of presumed hap. her tox screen was negative expect for benzos which she was given in the ed. she also had a ct-scan of her head which did not show any acute process. urine cx was grossly positive for klebsiella, so infection was most likely important contributor to pt's ams. pt showed attention deficits on the floor, though remained largely oriented and alert, patient was discharged home with close follow-up. . #hypoxia: initial o2sat in the er was 90% on ra and she had an abg that showed po2 of 63 with a-a gradient. her cxr showed atelectasis, but no consolidation. pt was mildly febrile but without an elevated white count and only mild cough. based on a cxr from , pt had been treated for lll pna as an outpt with levoquin though her cough and malaise persisted. her oxygen saturation quickly improved to the mid 90s% on ra once in the icu. differential diagnosis of pt's hypoxia included atelectasis, infection, hypoventilation due to ams, acute exacerbation of pt's diastolic chf, or viral illness. pt was started on vanc and zosyn while sputum cxs were sent. viral dfa was negative. pt was switched to vanc and meropenem when her hx of esbl was noted. on transfer to the floor, suspicion for hap was low so vanc was d/c'ed. pt continued to sat well on the floor. . # uti: pt's urine cultures were positive for klebsiella sensitive to cephalosporins so patient was switched from meropenem to cefpodoxime for a 10 day course to be completed on . . #hyponatremia: likely to be hypovolemia hyponatremia due to decreased po intake as pt corrected appropriately with iv fluid. sodium remained within the normal range for the remainder of her hospitalization. . #hypotension: she initially had a systolic blood pressures in the low 100s, but she has been in this range before. she had poor po intake, and her hypotension may have reflected hypovolemia as it improved with fluid hydration. there was low concern for sepsis as she was only mildly febrile and she was not tachycardic. . #diarrhea: on day 2 of admission, pt had several loose bowel movements with no frank blood and guaiac negative. they were liquidy and orangey in appearance. pt states it did not feel like her crohn's, her last flare was three years ago. pt's h/h remained stable throughout her course. c.diff and stool cultures were negative. . #acute on chronic renal failure: likely pre-renal given pt's low fena and the quick improvement of her creatinine with fluids. . chronic issues #diasolic hf: stable. pt's torsemide was initially held in the setting of robust autodiuresis but then re-started prior to discharge. tte showed hypokinesis of the anterior wall and ef of 45%, slightly depressed from one year ago. ecg was normal. pt did not complain of any chest pain, worsening pnd, or exertional symptoms so concern for new or recent acs was low. pt was instructed to follow-up with her outpt cardiologist for further recommendations on optimizing her heart failure regimen. . #cad: pt's carvedilol was initially held in the setting of her initial hypotension but as her blood pressures improved this was re-started. pt was continued on her aspirin and simvastatin. ecg on showed no changes from previous. . #diabetes mellitus type ii: stable. pt was maintained on a regular insulin sliding scale while in the hospital. . transitional issues . - follow-up newly depressed ef with outpt cardiology. determine whether her outpatient cad/chf regimen should be altered. medications on admission: -carvedilol 25mg po bid -ciprofloxacin 250mg -codeine/guaifenesin 100/10mg q6hrs prn -cyclobenzaprine 5mg prn pain/spasms -diazepam 10mg qhs prn pain -fluticasone/salmeterol 250/50mcg 1 puff, -gabapentin 600mg -hydrocortisone cream -lantus 40 units sq qhs -ipratropium/albuterol 18/103mcg 1-2 puffs q6 hrs prn -levofloxacin 250mg po daily, day was on -lidocaine patch 5% q12hrs to affected area -zenpep(lipase-protease-amylase) 20k/68k/109k units, 4 capsules po tid with meals -mesalamine (asacol) 400mg e.c. 4 tabs, tid -nitroglycerine .4mg sl prn -omeprazole 20mg -oxycodone er 20mg tid -oxycodone/acetaminophen 5/325mg 1 tab tid prn -simvastatin 20mg daily -torsemide 80mg daily -aspirin 325mg daily -docusate -ergocalciferol 800 units daily -ferrous sulfate 325mg daily -glucosamine/chondroitin 250/200mg cap tid -lac-hydrin cream -omega three fatty acids 1000mg discharge medications: 1. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 2. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for wheezing. 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 4. lipase-protease-amylase 5,000-17,000 -27,000 unit capsule, delayed release(e.c.) sig: four (4) cap po tid w/meals (3 times a day with meals). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 6. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 7. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 8. mesalamine 400 mg tablet, delayed release (e.c.) sig: four (4) tablet, delayed release (e.c.) po tid (3 times a day). 9. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 10. gabapentin 300 mg capsule sig: two (2) capsule po bid (2 times a day). 11. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for pain. 12. torsemide 20 mg tablet sig: four (4) tablet po daily (daily). 13. ciprofloxacin 250 mg tablet sig: one (1) tablet po twice a day: please start taking this medicine on . 14. cyclobenzaprine 5 mg tablet sig: one (1) tablet po bid prn as needed for pain. 15. diazepam 10 mg tablet sig: one (1) tablet po qhs prn as needed for pain. 16. lantus 100 unit/ml solution sig: forty (40) units subcutaneous at bedtime. 17. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn as needed for chest pain. 18. oxycontin 20 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po three times a day. 19. aspirin 325 mg tablet sig: one (1) tablet po once a day. 20. ergocalciferol (vitamin d2) 400 unit tablet sig: two (2) tablet po once a day. 21. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 22. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 5 days: please stop taking this medicine on . disp:*20 tablet(s)* refills:*0* 23. hydrocortisone topical 24. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 25. omega-3 fatty acids 1,000 mg capsule sig: one (1) capsule po twice a day. 26. glucosamine-chondroitin 250-200 mg capsule sig: one (1) capsule po three times a day. 27. lac-hydrin topical discharge disposition: home with service facility: vna discharge diagnosis: (primary) urinary tract infection (secondary) diabetes diastolic congestive heart failure hypertension coronary artery disease cirrhosis crohn's disease rheumatoid arthritis discharge condition: mental status: alert and oriented but intermittently confused/inattentive level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted to because you were feeling poorly, were sleepy and confused, and because you were not breathing as well as you normally do. we found a bacteria in your urine that might have been explaining your symptoms and so we treated you with an antibiotic. . also, please weigh yourself every morning, md if weight goes up more than 3 lbs. . the following medications were changed during this admission: 1. please start taking cefpodoxime. you will stop taking this medicine on . this is an antibiotic for your urinary tract infection. 2. please stop taking advair until you talk to your pcp about whether this is needed. . please take all your other medications as prescribed. followup instructions: department: rheumatology when: monday at 1 pm with: , md building: lm bldg () campus: west best parking: garage department: health center when: thursday at 12:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: div. of gastroenterology when: monday at 11:00 am with: , md building: ra (/ complex) campus: east best parking: main garage procedure: central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified regional enteritis of unspecified site long-term (current) use of insulin other emphysema rheumatoid arthritis personal history of venous thrombosis and embolism hypoxemia metabolic encephalopathy other and unspecified alcohol dependence, unspecified chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to