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: patient recorded as having no known allergies to drugs attending: chief complaint: hyperglycemia major surgical or invasive procedure: fiberoptic intubation, ir-guided central line placement, ir-guided picc placement history of present illness: patient is a 25 yo m with pmhx sig. for microcephaly/cerebral palsy and is non-verbal and severely contracted at baseline who presents with lethargy and was found to be in dka at osh. per his mother, he developed a fever to yesterday. his grandmother, who also cares for him, recently had a cough treated with 5 day course of antibiotics. however, the patient never developed a cough; he may have looked a little more short of breath today. throughout the day today, he did became increasingly lethargic, though he completed eating his breakfast and lunch without problems. his mother felt that he was not responding as well to her voice, ie smiling or looking at her. his limbs were also more flaccid than at baseline. in addition, she noticed that his eyes were twitching, which has occurred in the past with fevers. they were also bloodshot. his mother noticed that he has been urinating more and drooling less. she denied any vomiting, diarrhea. he has had h1n1 already in . he also had a cough, treated with amoxicillin, in . he usually gets over these episodes rather quickly. . he was taken to , where vs were rectal temp of 100.5, sbp 95, hyperglycemia to 1392, na 162, and cr 2.2. he was given ctx there for uti despite a u/a with neg nitrite, leuk est. he was not given insulin. ct head at osh reports no acute pathology. . in the ed, vital signs were initially: 97.0, 98, 117/79, 18, 98%. exam was sig. for slight rhonchi on the right. labs were sig. for glucose of 1208, na 170, cl 128, creatinine 2.6, hct of 61, lactate 3.1. u/a showed ketones. cxr showed no infiltrate. bcxs, ucx were obtained. he is receiving ns 100 cc/hr. he was not started on insulin gtt. vs on transfer: 99, 117/87, 16, 100% on 2l. past medical history: microcephaly/cerebral palsy kyphosis s/ rod social history: pt lives with his parents. he goes to a day program from 9am -3pm. his grandmother also cares for him. he is wheelchair bound. he is fed pureed foods and ensure once a day. family history: both parents are healthy. no history of heart disease, dm. aunt with epilepsy physical exam: temp:97.0 hr:98 bp:117/79 resp:18 o(2)sat:98 gen: the patient is in no distress and appears comfortable. neck: supple. no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. heent: l pupil 2 mm larger than r, both reactive. erratic nystagmus. mm dry. chest: lungs are clear without wheeze, rales, or rhonchi. cardiac: regular rhythm; no murmurs, rubs, or gallops. abdomen: normoactive bs, soft, nt, nd. extremities: no peripheral edema, warm. neurologic: alert. wrists, elbows bilaterally flexed. increased tone in shoulder joint, less in elbow joint bilaterally. skin: there is a maculopapular rash on the back, which the mother states is his usual rash on dependent areas. erythematous rash on r groin. pertinent results: right upper quadrant ultrasound : there is limited assessment, particularly in the midline, due to overlying bowel gas. where visualized, the liver demonstrates no focal or echotexture architecture abnormality. main portal vein is patent with normal hepatopetal flow. no intra- or extra-hepatic biliary ductal dilatation is noted, with the common duct measuring 3 mm. the gallbladder is filled with echogenic shadowing stones. no evidence for gallbladder wall thickening or pericholecystic fluid is seen to suggest acute cholecystitis. the patient is nonresponsive, therefore sign cannot be assessed. no ascites is seen in the right upper quadrant. impression: cholelithiasis, without findings of acute cholecystitis. ct chest/abd/pelvis : 1. bibasilar areas of consolidation and peribronchovascular ground-glass opacities, probably representing combination of atelectasis with possible aspiration, inflammation, and/or infection. trace right pleural effusion. 2. patulous and edematous distal esophagus with circumferential wall thickening and intraluminal fluid, may represent esophagitis, clinical correlation recommended. 3. nearly diffuse small and large bowel wall thickening and hyperenhancement consistent with enteritis/colitis, such as infectious/inflammatory, less likely ischemic. appendix not visualized. no bowel obstruction seen. 4. area of hypoattenuation within the right hepatic lobe has somewhat rounded appearance but has vessels coursing through it, suggestive of perfusion heterogeneity or focal fatty infiltration. ct sinus : 1. diffuse mild mucosal thickening with layering high-density fluid seen throughout the paranasal sinuses. fungal colonization is not excluded, nor is infection. 2. area of demineralization along the superior aspect of the medial right maxillary sinus wall. 3. opacification of the - and oropharynx, with et tube and ng tube in place. 4. partial opacification of the visualized right mastoid air cells. 5. marked ventriculomegaly with very thin cerebral cortex, incompletely visualized on the current study. echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. ct chest/abdomen/pelvis : 1. extensive right lung and left lower lobe consolidations with air bronchograms are new compared to two days prior, with increased left greater than right small pleural effusions. 2. foley balloon catheter located within the urinary bladder. there is new diffuse anasarca with slight increase in small ascites. no definite findings to account for increased abdominal pressure otherwise. 3. while small bowel loops which are better distended today show no wall thickening, there is apparent persistent wall thickening along the ascending and descending colon, representing non-specific colitis. 4. patulous esophagus with circumferential wall thickening, again possibly representing esophagitis. intraluminal fluid extends to the thoracic inlet, increasing risk for aspiration. 5. rounded peripheral hypodense region in the right hepatic lobe re-demonstrated on non-contrast study, probably representing focal fatty infiltration. cxr : one supine view. comparison with the previous study done . bilateral interstitial infiltrates consistent with edema persist. mediastinal structures are unchanged. these are partially obscured by bilateral rods. an endotracheal tube, nasogastric tube and picc line remain in place. all of these are somewhat obscured by orthopedic hardware but appear unchanged. impression: limited study demonstrating persistent bilateral interstitial infiltrates consistent with edema. micro: all cultures from admission through negative, including flu, rsv, urine, stool and sputum. sputum did grow yeast. 8:18 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin--------- 0.5 s gentamicin------------ <=1 s meropenem------------- 2 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s 2:35 pm sputum source: endotracheal. gram stain (final ): pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. stenotrophomonas (xanthomonas) maltophilia. moderate growth. pseudomonas aeruginosa. sparse growth. identification and sensitivities performed on culture # (). sensitivities: mic expressed in mcg/ml _________________________________________________________ stenotrophomonas (xanthomonas) maltophilia | trimethoprim/sulfa---- <=1 s fungal culture (preliminary): yeast. test result reference range/units aspergillus antigen 0.2 <0.5 test ---- fungitell (tm) assay for (1,3)-b-d-glucans results reference ranges ------- ---------------- >500 pg/ml * negative less than 60 pg/ml indeterminate 60 - 79 pg/ml positive greater than or equal to 80 pg/ml admission labs: 170 / 128 / 57 --------------< 1208 3.9 / 22 / 2.6 ck: 530 mb: 3 trop-t: 0.04 ca: 8.9 mg: 3.1 p: 3.6 alt: 86 ap: 321 tbili: 1.0 alb: 4.4 ast: 49 ldh: dbili: tprot: : lip: 474 osms:434 freeca:1.26 lactate:3.1 ph:7.10 (venous) cbc: 5.7 > 17.4 / 61 < 122 n:80.7 l:15.6 m:2.8 e:0.1 bas:0.7 urine prot 25 glu 1000 ket 15 other labs hgb a1c: 9.7 enzymes & bilirubin ck(cpk) 03:39am 291 06:17am 297 05:30am 790* 02:19am 2699* 03:59am 5212* 01:59pm 8391* 05:02am * 08:59pm * 01:04pm * 06:57am * 03:31am * 08:11pm * 12:08pm 9652* 04:17am 6016* 06:00am 1322* 09:59pm 1169* 06:30pm 1185* 02:20pm 1233* 06:01am 748* 09:25pm 530* renal & glucose creat 05:02pm 1.0 05:23am 1.2 03:48am 1.3* 04:20pm 1.5* 04:00pm 1.7* 05:57pm 1.8* 03:39am 2.1* 02:09pm 2.4* 05:30am 2.5* 01:59pm 2.4* 01:04pm 2.7* 03:31am 2.6* 08:11pm 2.4* 08:44pm 2.0* 03:58am 1.6* 02:20pm 1.2 09:25pm 2.6* blood gases (all venous) po2 / pco2 / ph 01:32pm 52* / 45 / 7.37 12:40pm 43* / 50* / 7.42 03:47pm 60* / 45 / 7.48* 01:22am 42* / 40 / 7.34* 05:21am 40* / 28* / 7.33* 04:09pm 46* / 42 / 7.14* 11:05pm 39* / 47* / 7.13* 02:22pm 52* / 53* / 7.11* discharge labs: 145 / 112 / 19 ---------------< 124 3.7 / 21 / 0.8 ca: 8.0 mg: 2.0 p: 3.0 6.3 > 9.0 /27.3 < 523 brief hospital course: is a 25 year-old with cerebral palsy who is non-verbal at baseline. he was brought to the hospital by his family for fever, lethargy and concern for dehydration. he was noted to be in diabetic ketoacidosis/hyperosmolar hyperglycemic nonketotic syndrome with profound hyperglycemia. his hopsital course was complicated by aspiration pneumonia and respiratory failure/ards requiring mechanical ventilation, septic shock requiring pressor support and renal failure. he also developed a ventilatory associated pneumonia with sputum growing pseudomonas and stenoptrophomonas. he currently has improved significantly in terms of hemodynamics and renal fuction which are both at baseline and his persistant issue has been difficulty assessing readiness for extubation. active problems: 1. respiratory failure as above, initially in setting of aspiration with development of ards. improved over time and then subsequently developed ventilator associated pneumonia as above. now being treated with antibiotics. intubation was difficult even with use of fiber optics. extubation has been complicated by difficulty predicting readiness. this is due to a combination of the following: a) 6mm ett which has non-trivial resistance. he actually appeared to fatigue when kept on pressure support ventilation for more than a couple hours. b) abnormal baseline respiratory mechanics secondary to his body habitus and underdeveloped lungs and also with chronic respiratory acidosis c) difficulty assessing mental status d) concern about need for reintubation. 2. ventilator associated pneumonia he developed new fevers on . sputum grew pseudomonas and then stenotrophomonas. day of transfer, is day of meropenem for pseudomonas and day of bactrim for stenotrophomonas. 3. elevated b-glucan isolated elevation in beta glucan x 3 with unclear significance. have been treating with micafungin as has been persistantly febrile. this was changed to voriconazole on . he should have a repeat beta glucan. 4. diabetes mellitus now on lantus 15 units and regular insulin sliding scale. when taking meals, should have sliding scale changed to shorter acting. 5. fevers likely secondary to vap but persisted intermittently even with treatment. concern also for fungal infection given elevated beta glucan. central line removed and pan cultured as well. other possible source is sinus as has evidence of disease on ct. 6. cerebral palsy continued baclofen and valium for contractures. 7. anemia this has been stable. unclear baseline. initially with gastrocult positive emesis. fob negative. no evidence of hemolysis. resolved problems: 1. septic shock: required phenylephrine from - with one day also requiring vasopressin. covered very broadly with antibiotics including antifungals. no culture growth. likely ards/distributive physiology. 2. ards as above, no inciting organism identified. likely large aspiration in setting of vomiting. 3. diabetic ketoacidosis/hyperosmolar hyperglycemic nonketotic syndrome very hyperglycemic and with hgb a1c 9.7 so more consistent with dmii. improved on insulin gtt and then transistioned to sq. trigger may have been viral uri. 4. hypernatremia initially profound dehydration. resolution hindered by ivf resusitation. has improved with enteral free water. 5. acute renal failure became anuric in setting of sepsis. also with elevated intra-abdominal and bladder pressures which increased the maps necessary for renal perfusion. improved without need for dialysis. 6. elevated ck this elevated after agressive fluid resusitation leading to significant edema including scleral edema and likely resulted from the anatomical limitations on fluid distribution exacerbated by oligura. this improved with improving urine output and resolution of edema. 7. access significant diffculty with iv access requiring io access intilliary and ir guided ij line and then picc. unable to get arterial blood gases. 8. elevated lipase and transaminases: ruq us with cholelithiasis but not evidence of cholecystitis. 9. thrombocytopenia initially low platelets which improved with resolution of sepsis. 10. lle edema asymmetric but multiple ultrasounds negative for dvt medications on admission: fexofenadine 30 mg daily ranitidine 75 mg diazepam 6 mg/4 mg/6 mg baclofen 5 mg tid discharge medications: 1. baclofen 10 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic q2h (every 2 hours) as needed for eye lubrication. 5. metoclopramide 10 mg tablet sig: one (1) tablet po qid (4 times a day). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 7. diazepam 2 mg tablet sig: three (3) tablet po bid (2 times a day). 8. diazepam 2 mg tablet sig: two (2) tablet po daily (daily). 9. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 11. insulin glargine 100 unit/ml solution sig: fifteen (15) units subcutaneous once a day. 12. insulin regular human 100 unit/ml solution sig: sliding scale injection four times a day. 13. meropenem 500 mg iv q8h 14. pantoprazole 40 mg iv q24h 15. fentanyl citrate (pf) 100 mcg/2 ml (50 mcg/ml) syringe sig: 25-50 mcg intravenous every four (4) hours as needed for agitation. 16. voriconazole 200 mg iv q12h 17. sulfameth/trimethoprim 185 mg iv q8h day 1 = 18. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 19. midazolam 0.5-1 mg iv q4h:prn discomfort discharge disposition: extended care facility: discharge diagnosis: primary: septic shock, respiratory failure, diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, diabetes mellitus, ventilator associated pneumonia, acute renal failure secondary: cerebral palsy discharge condition: mental status: non-verbal, baseline level of consciousness: alert activity status:bedbound discharge instructions: dear , you were admitted with high sugar and dehydration. you got very sick and needed medicine to support your blood pressure and a tube to help you breath. you are doing much better. you are going to to have the tube removed in a setting where they are more prepared to manage the potential complications in people your size. we will miss you. followup instructions: per has been followed by here pcp procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: thrombocytopenia, unspecified anemia, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin septic shock rash and other nonspecific skin eruption hematemesis hypovolemia hyperosmolality and/or hypernatremia ventilator associated pneumonia kyphosis (acquired) (postural) rhabdomyolysis other and unspecified mycoses infantile cerebral palsy, unspecified microcephalus edema diabetes with other coma, type ii or unspecified type, uncontrolled pneumococcus infection in conditions classified elsewhere and of unspecified site 

Answer: The patient is high likely exposed to