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: codeine / iodine; iodine containing / soybean / lecithin attending: chief complaint: cc: major surgical or invasive procedure: radial artery cannulation intubation for respiratory failure picc line placement and removale chest tube placement and removal history of present illness: hpi: 50f w/ hiv (last cd4 408 ), hep c, copd, asthma, prior aspiration pna presents from rehab after recent icu admission to for copd flare. was being treated for copd flare c steroids, abx, nebs at rehab until yesterday when patient noted to have some dyspnea night prior to presentation; otherwise ros negative from rehab. evening of admission, pt. found unconscious in bathtub with o2 sat 55% ra. placed on o2 6l nc c o2 sat 88%. then started bipap 6l, c o2 sat 96%, bp 125/66, 115. abg done at rehab showing 7.30/85/71. . in ed, vitals: 75% nrb, 10, 98.0, 101/68, 96. intubated for gcs 5, hypoxic respiratory failure. head and c-spine ct done to look for fracture/bleed - negative. cxr done showing diffuse l lung opacity. given ceftriaxone / flagyl / vancomycin for aspiration pna and nosocomial pna. sputum sent, including samples for pcp. to . . in , pt. intubated, sedated and no history available. past medical history: pmh: 1. copd/asthma - recent admission for copd flare. was taking levofloxacin, nebs, theophylline, advair and solumedrol 80 q8 hrs. 2. aspiration pna - recurrent but unknown # hosp. 3. dmii - on nph 52 qam, 30 qpm + sliding scale 4. htn 5. r breast ca s/p lumpectomy/radiation therapy in . 6. hiv - cd4 408, 7. hep c 8. osa 9. diverticulitis 10. schizoaffective disorder 11. psoriasis social history: sh: lives in group home, continues to smoke ppd > 25 yrs, drinks socially. family history: fh: mother with emphysema. physical exam: vs - 97.3, 136/76, 87 - on vent a/c fio2 0.5, peep 5, vt 500, rr 20 heent - mmm, ett in place, eomi lungs - coarse rhonchi b/l at apices/axillae heart - rrr, s1, s2, no rmg abd - soft, nt, nd, bs+ ext - wwp, no peripheral edema, 2+ dp pulse, denuded, chronic venous stasis changes over legs b/l neuro - intubated, sedated. upgoing toe r, no response l babinski pertinent results: labs - see below; notable for ldh 480, wbc 18.7 imaging - cxr: diffuse, interstitial pattern over l lung field. diffuse pattern over r middle lobe ct head: there is no evidence of intracranial hemorrhage, shift of normally midline structures, hydrocephalus, major vascular territorial infarction, or fracture. the ventricles and sulci are symmetric. there is preservation of the normal /white matter differentiation. the paranasal sinuses are clear and the orbits are unremarkable. regional soft tissues demonstrate no significant abnormality. ct c-spine: no acute fracture. minimal grade 1 anterolisthesis of t1 over t2. large left upper lobe consolidation concerning for aspiration or pneumonia. . chest ct: 1. elevation of left hemidiaphragm. if there is clinical concern for diaphragmatic paralysis, fluoroscopic assessment may be helpful. no mass is identified in the expected course of the phrenic nerve. 2. centrilobular opacities in right lower lobe, which may be due to infectious small airways disease or aspiration. 3. trace left pleural effusion. no evidence of subpulmonic pleural effusion. 4. small low-attenuation lesion in upper pole portion of left kidney and low attenuation lesion in the thyroid gland left lobe, both incompletely evaluated on this study. if warranted clinically, dedicated ultrasound could be considered to evaluate these areas. . chest fluoroscopy: there is normal motion of the right hemidiaphragm. the motion of the left hemidiaphragm is sluggish. there is no evidence of paradoxical motion. impression: sluggish left hemidiaphragm but no evidence for diaphragmatic paralysis. . echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is moderately dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve appears structurally normal with trivial mitral regurgitation. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: dilated rv cavity with moderate pulmonary hypertension (? chronic). lvef appears preserved. . sputum gram stain (final ): pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. respiratory culture (final ): moderate growth oropharyngeal flora. acinetobacter baumannii. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ acinetobacter baumannii | cefepime-------------- 32 r ceftazidime----------- 16 i ciprofloxacin--------- =>4 r gentamicin------------ 4 s imipenem-------------- <=1 s levofloxacin---------- =>8 r tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s brief hospital course: 1. hypoxic resp. failure - differential included pna (cap vs. nosocomial vs. pcp . aspiration), likely concurrent with or exacerbating a copd flare. less likely possibilities included pe and chf. a cxr in the ed showed diffuse l lung opacity. patient was started on ceftriaxone, flagyl, vancomycin, bactrim, and prednisone. blood and sputum was sent for culture and patient was transferred to the for further management. in the , patient was underwent a bronchoscopy which showed: no inflammation, minimal secretions, and a partially obstructing lesion, likely a foreign body, which looked exactly like a piece of , report. of note, patient was admitted to hospital ~ 3 months prior to this admission after aspirating . urine was sent to check for legionella antigen and was negative. sputum was sent to assess for pcp and was negative. patient was ruled out for acs with negative cardiac enzymes x 3. an arterial line was placed. a bal was performed and the initial read showed gram-positive cocci and gram-negative rods. patient was maintained on theophylline, albuterol/atrovent inh, fluticasone, montelukast, and prednisone. sputum culture returned positive for acinitobacter baumanni which was sensitive to bactrim and imipenum. a repeat bronchoscopy was performed on which showed continuing obstruction. a central line was attempted, with resulting r pneumothorax. ct surgery was consulted and a chest tube was placed with good resolution of pneumothorax. a femoral line was placed, then removed once patient had a l picc line placed. the bronchopscopy was repeated on with removed. a repeat bronchoscopy performed on - no findings were documented. patient was extubated on without difficulty. the chest tube was also removed on . shortly after extubation, the patient became somewhat agitated, crying out and moving around restlessly in bed. she was treated with haldol and zyprexa with good effect and her agitation had entirely resolved by the next day. speech and swallow evaluation was ordered and is discussed below in fen in more detail. imipenum was discontinued on and the a-line was discontinued secondary to concerns of infection. patient appeared somewhat tremulous on and although she says that she is normally shaky at baseline, albuterol was changed to prn and patient was started on serovent. seroquel was restarted with aplan to uptitrate to home dose as tolerated, which was done. imipenim was restarted and bactrim and imipenem were continued for a 14 day course and prednisone was started for possible copd exacerbation and tapered. . #altered ms - differential diagnosis included hypoxia insetting fo respiratory distress, infection (given hiv status, unknown cd4 count, not on haart or prophylaxis), seizure (possibly secondary to infection), toxic/metabolic, and less likely, cva. a ct scan was obtained in the ed which was negative for masses or bleeding with preserved grey-white matter differentiation. toxicology screen was negative. seroquel was discontinued for it's sedating effects and possible contribution to her mental status. there was some concern that depakote may also be contributing so that was discontinued on . mental status improved as patient stabilized and she is now back to her baseline. . #neck pain: patient had plain films of the cervical spine to rule-out possible fracture, but while in the complained of diffuse posterior cervical neck pain on palpation. patient was placed back into a rigid neck collar, which she tolerated very poorly. the neck collar was removed and patient denied any further neck pain. given her somewhat questionable mental status, repeat flexion and extension films were obtained and showed some minimal instability at at c2/3 and c3/4, of indeterminate acuity. a formal spine/ortho consult was obtained and patient was cleared of possible cervical spinal trauma. . #cardiac - patient had some chest pain on . ecg was negative. pain was not relieved with nitroglycerin sl, but did entirely resolve with 2 mg iv morphine. patient had been ruled out for acs with three sets of negative cardiac enzymes on admission. another set was set and again was negative. her chest pain was attributed to anxiety. patient also became somewhat intermittently tachycardiac during her stay in the icu. there was no obvious etiology and patient was comfortable, making good urine so not further action was taken. . #dm ii - patient was initially maintained on an insulin gtt per protocol. currently she is being covered with an insulin sliding scale and glargine. she was started on nph in the a.m. and dose increased to help with high afternoon sugars, and we continue to adjust this regimen. . #htn - nifedipine was held in the acute setting of infection. once patient was more stable, it was restarted at her usual outpatient dose. patient remained hypertensive with sbp in the 160-170's. nifedipine was changed to diltiazem, which was uptitrated, and captopril was added with good control. . #hiv - patient is not on haart or any prophylaxis. her most recent cd4 count on was 296. . #hyperlipidemia - atorvastatin was continued at outpatient dose. . #schizoaffective d/o - depakote sprinkles and seroquel were both discontinued secondary to concerns they may be contributing to patient altered mental status. citalopram was continued. after patient's mental status improved, her seroquel was restarted and is being tapered up to her previous dose. . fen - maintained on tube feeds without problem while intubated, then transitioned over to a diabetic diet. a speech and swallow evaluation was ordered and after bedside eval, a videoswallow study was ordered. patient was cleared for a ground solid diet with nectar-thick liquids. meds should be crushed and given with purees. lytes were repleted as necessary. on the day of discharge she was tolerating a regular diabetic diet without any signs or symptoms of aspiration. . ppx - ppi, sc hep, pneumoboots . access - piv and picc . code - full; confirmed verbally with patient on . . communication: problem. report patient has hcp: aunt who has not been able to be contact for the duration of this admission. patient verbalized that she would like to speak for her if she is unable to speak for herself. she works at house, phone number , a group housing facility which the patient has lived at for more than 5 years. need to clarify if or another ruah house employee (nurit adem) will be the new hcp or if this is a temporary arrangement until the aunt can be contact; pcp is at clinic at hospital, phone # i, , attending of record, assumed care on the day of discharge. i spoke directly with patient's nurse practioner about the kidney lesion and thyroid lesion and recommended follow up with urology and endocrine for further evaluation. she understood and will discuss follow up with patient's pcp this d/c summary was faxed to the np. medications on admission: meds: nph 52 am, 30 pm protonix 40 theophylline 200 qd albuterol nebs solumedrol 80 iv q8 diamox 250 po bid moxifloxacin 400 iv qd singulair 10 qd advair 500/50 1 puff spiriva 1 puff qd nifedipine xl 60 po qd ecasa 81 qd atorvastatin 40 qd quetiapine 75 tid depakote 750 celexa 20 qd nicotine patch tylenol 650 q8 arimidex 1 mg daily potassium chlride 40 meq po daily prn k<4.0 discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. quetiapine 25 mg tablet sig: three (3) tablet po tid (3 times a day). 4. divalproex 250 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po bid (2 times a day). 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. nicotine 21 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). disp:*30 patch 24hr(s)* refills:*2* 7. acetaminophen 650 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain. 8. anastrozole 1 mg tablet sig: one (1) tablet po daily (). 9. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*2* 10. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*qs qs* refills:*2* 11. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*qs qs* refills:*2* 12. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 13. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for sob/wheezing. disp:*qs qs* refills:*0* 14. albuterol sulfate 0.083 % solution sig: one (1) inhalation q2h (every 2 hours) as needed. disp:*qs qs* refills:*0* 15. multivitamin capsule sig: one (1) cap po daily (daily). 16. docusate sodium 100 mg tablet sig: one (1) tablet po bid (2 times a day). 17. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 18. prednisone 10 mg tablet sig: one (1) tablet po once a day for 1 days. disp:*1 tablet(s)* refills:*0* 19. insulin nph human recomb 100 unit/ml cartridge sig: thirty five (35) units subcutaneous qam. 20. insulin nph human recomb 100 unit/ml cartridge sig: twenty (20) units sc subcutaneous at bedtime. 21. regular insulin sliding scale please use a regular insulin sliding scale four times a day - before meals and qhs. 22. home oxygen home oxygen at 3l/min via nasal cannula to keep oxygen sats >92%. discharge disposition: home with service facility: homecare discharge diagnosis: aspiration pneumonia chronic obstructive pulmonary disease asthma h/o breast cancer type ii diabetes mellitus hypertension hepatitis c obstructive sleep apnea schizoaffective disorder psoriasis hiv discharge condition: stable. patient oxygenating at 97% on 3l, which is her baseline. discharge instructions: # please take all of your medications as prescribed # please call your pcp or return to the ed if you have difficutly breathing, chest pain, worsening cough, fevers, chills, nausea, vomiting, or any other symptom that is of concern to you. # do not smoke. # please follow-up with your primary care doctor a thyroid ultrasound to evaluate a thyroid lesion that was seen on ct scan. this may need to be biopsied. # please follow-up with a urologist regarding a small kidney cyst on your ct scan. followup instructions: # please follow up with your np, (attending physician is . , at , on friday at 9:30 a.m. her pager is pager , fax . please follow-up with your primary care doctor a thyroid ultrasound to evaluate a thyroid lesion that was seen on ct scan. this may need to be biopsied. # please follow up with dr. on at 3:00 to have your stitches removed. provider: , md phone: date/time: 3:00 # please follow-up with a urologist (kidney doctor) regarding a small kidney cyst on your ct scan. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus removal of intraluminal foreign body from trachea and bronchus without incision diagnoses: pneumonia due to other gram-negative bacteria tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified viral hepatitis c without hepatic coma acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax long-term (current) use of insulin chronic obstructive asthma with (acute) exacerbation other psoriasis asymptomatic human immunodeficiency virus [hiv] infection status disorders of diaphragm cervical spondylosis without myelopathy schizoaffective disorder, unspecified inhalation and ingestion of food causing obstruction of respiratory tract or suffocation foreign body in main bronchus malignant neoplasm of breast (female), unspecified 

Answer: The patient is high likely exposed to