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: plavix / heparin agents attending: chief complaint: hemoptysis, fever, inability to ventilate major surgical or invasive procedure: tracheostomy revision arterial line central venous line peripherally inserted central catheter history of present illness: 73f h/o dm, multiple cvas, disseminated tuberculosis on tx since , trached for resp failure with prolonged intubation/failure to wean living at macu/ rehab, developed resp distress at 0530 on , rr-36-40; hr 136, t noted to be 99.8, bp noted to be 125/68. pt apparently was already on vanc and imipenem starting for presumed vap pna. mrsa apparently growing out of the sputum. per ems report 500ccs of blood suctioned this am from airway was noted to be difficult to ventillate. suctioned, with trach changes without succes, still difficulty with diminished r sided lung sounds. difficulty with bag valve mask as well. staff at hebreb denies trauma. . on arrival to the , pt's bp 88/38, rr 29, 96% satting. levophed started when spb transiently to the 50s. ivf given, bp with pressors rebounded to 110s-120s. in ed, hypotensive transiently, started on pressors. ip notified and tried to repositioned the trach. the patient was bronched and 80% occlusion of trach tube with granulation tissue was noted distal to the end of trach. ip unable to pass scope. pt was intubated from above. ett initally placed into the r mainstem bronchus with collapse of l lung noted. the tube was then pulled back with successful re-inflation of the l lung. pt given vanc, ceftax, flagl and was placed on levphed gtt to maps>60. fent and versed gtt were started as well. . pt previously admitted on for ataxia, was dx'd with acute stroke, disseminated tuberculosis, seizurers, was trached due to prolonged intubation/failure to wean, then xferred on to for further care. from there, the pat was reportedly xferred to macu at heb reb where she has been residing then (apparently off precautions). . id history: she was found to have pan-sensitive tuberculosis on 3 drug regimen (inh/eth/pza). her course has been complicated by worsening cvas (now bilateral), hypoxic respiratory failure, continued fevers. she has had an extensive id work-up and all studies negative to date except for tuberculosis. bone marrow (aspirate only) - with few blasts repeat bm - 10-20% blasts, core biopsy mds. liver biopsy - necrotic with few granulomas (no micro sent). all micro stains on pathology negative only positive tests: ace level and hit antibody b-glucan positive on , negative on repeat. had right vats, right supraclavic ln, and liver biopsy done biopsy shows granuloma suspicious for infectious process. tissue from lung growing afb. sputum cx also with afb when grew. tuberculosis is pan-sensitive. repeat ct chest/abd/pelvis did not show marked improvement but did not show worsening either. tuberculosis meds switched at beginning of - no response to holding rifampin. then tried changing to stm/levaquin to see if was one of the other drugs; no effect. trial of ambisome; no effect. has had loculated effusions but now no fluid; tapping them the first time showed no growth on cx; the second time there was no fluids. . she had bcx with coag neg staph seen on with no subsequent growth to date. rec'd empiric vanco tx with f/up tee (tte from was without vegetations) . ros was unobtainable due to mental status. past medical history: -pulm tuberculosis (pan sensitive) with liver/spleen granulomas s/p r sided vats, r supraclavic ln, liver bx + -h/o +ppd w/o tx -afb on bal -tx continious since 2/1 per prior dc summ -1)diabetes mellitus - diet controlled 2)osa - on bipap 12/8 3)cataract in the left eye 4)cva/tia (positive mri) - right frontal with l arm/hand hemiparesis; etiology likely moderate degree stenosis of the ica in the cavernous region, stable on recent cta 5)asthma 6)hypercholesterolemia 7)seizure- uncertain diagnosis - l arm involuntary movements 8)recent colonoscopy in with single sessile 4-5 mm non-bleeding polyp of benign appearance, s/p removal. mammography yearly unremarkable. 9)sickle trait social history: has been living in rehab macu since getting tx for disseminated tuberculosis. previosly lived alone in . supportive family nearby. remote history of tobacco use. one-two glasses of alcohol per week. retired, used to work in a post office. family history: diabetes in son, sister, and brother. with epilepsy. brother with possible lung cancer. uncle with tuberculosis. physical exam: vitals: tm 102.0; tc 102.0; bp 95-102/49-60; hr 120 (100-135), o2 sat 100% on ac 300x20, peep 5, fio2 0.6. rr 31-48. in: ivf 3l. uop: 1l general: intubated, sedated, responsive to painful stimuli. heent: ncat, perrl, eomi, no scleral icterus, mmm, stoma closed with vaseline gauze, but persistent air leak. pulmonary: musical wheezes bilaterally. rhonchorous upper airway sounds, trach leak. cardiac: tachy, no murmurs, rubs, gallops. abdomen: soft, nt, nd, normoactive bowel sounds, no masses or organomegaly noted extremities: 1+ edema bilat. cannot follow commands today. dopp pulses bilat. skin: no rashes or lesions noted. neurologic: intubated from above and sedated. does not follow commands. stool: guaiac negative pertinent results: admission labs: 06:55am blood wbc-5.7# rbc-3.54*# hgb-10.8*# hct-31.4*# mcv-89 mch-30.4 mchc-34.4 rdw-16.0* plt ct-172 06:55am blood neuts-52 bands-1 lymphs-24 monos-18* eos-0 baso-0 atyps-4* metas-0 myelos-0 plasma-1* 06:55am blood pt-12.8 ptt-24.7 inr(pt)-1.1 06:55am blood glucose-253* urean-27* creat-1.0 na-139 k-5.0 cl-109* hco3-23 angap-12 06:55am blood alt-52* ast-70* ld(ldh)-484* alkphos-103 amylase-90 totbili-0.3 02:30am blood calcium-8.3* phos-3.1 mg-2.0 03:54pm blood type-art temp-38.2 rates-20/13 tidal v-300 peep-5 fio2-60 po2-119* pco2-39 ph-7.33* caltco2-21 base xs--4 intubat-intubated . discharge labs: 03:29am blood wbc-2.9* rbc-2.84* hgb-8.7* hct-25.3* mcv-89 mch-30.7 mchc-34.6 rdw-15.3 plt ct-132* 04:10am blood neuts-60 bands-0 lymphs-29 monos-8 eos-0 baso-0 atyps-1* metas-2* myelos-0 03:29am blood pt-13.1 ptt-28.4 inr(pt)-1.1 03:29am blood glucose-74 urean-18 creat-0.8 na-138 k-3.6 cl-109* hco3-22 angap-11 03:40am blood alt-14 ast-42* ld(ldh)-489* ck(cpk)-21* alkphos-118* amylase-57 totbili-0.4 03:40am blood lipase-21 03:40am blood albumin-1.9* calcium-8.4 phos-2.3* mg-1.8 02:54am blood hapto-<20* 02:54am blood igg-2855* iga-1037* igm-42 06:50pm blood tobra-12.0* 05:30pm blood tobra-1.5* 01:46am blood type-art temp-38.8 fio2-40 po2-161* pco2-34* ph-7.45 caltco2-24 base xs-0 intubat-intubated 01:46am blood lactate-1.0 . micro: blood cx () neg; (7/15,7/19,) pending sputum afb smear negative x3 sputum (): pseudomonas aeruginosa | cefepime-------------- 32 r ceftazidime----------- =>64 r ciprofloxacin---------<=0.25 s gentamicin------------ 4 s imipenem-------------- =>16 r meropenem------------- 8 i piperacillin---------- =>128 r piperacillin/tazo----- =>128 r tobramycin------------ <=1 s . heb reb micro data: sputum - pseudomonas sensitive to cefepime, resistant to carbapenems . imaging: . cxr - improved pulmonary aeration, with persistent right basilar opacity, likely residual consolidation. minimal blunting left cp angle. . ct chest/abd/pel - 1. interval worsening of bilateral airspace opacities, predominantly within the right lower lobe which would be consistent with worsened pneumonia. 2. stable mediastinal and supraclavicular lymphadenopathy consistent with history of tuberculosis. 3. 10 mm hyperdense cyst in the midpole of the right kidney, likely hemorrhage into a cyst. attention can be focused on this lesion on subsequent imaging. . cxr - tracheostomy tube tip is 2 cm from the carina. right picc line tip projects over the mid svc. the mild pulmonary edema persists, right more than left. no appreciable change demonstrated in the parenchymal opacities. small pleural effusion is unchanged. there is no pneumothorax. brief hospital course: 72f h/o cva, disseminated tuberculosis presents with hemoptysis and failure to ventillate, vap, septic shock. . #septic shock: hypotension, tachycardia, fever likely due to ventilatory associated pneumonia (see below). the patient was resuscitated with intravenous fluids and required levophed for blood pressure support that was slowly weaned off during her stay. she was treated with cefepime and tobramycin per id team. blood cultures were consistently negative. a cns source was considered but in the setting of lung source (increased sputum production with mdr pseudomonas) and improvement of mental status to near baseline per her family after treatment, this was considered less likely. . #pulmonary: respiratory failure - due to mechanical failure, tracheomalacia resulting in tracheostomy tube obstruction. at presentation, unable to ventilate with bloody secretions out ot the et tube due to trach osbruction with granulation tissue. ip was consulted and revised her trach with placement of device and excision of granulation tissue. the was replaced by ip on with a permanent customined shiley trach. also became significantly volume overloaded after fluid resuscitation due to hypotension and was diuresed successfully but continued to require mechanical ventilation due to occasional apnea and serially poor rsbis. . apnea: periodic during her stay. review of rehab records indicate she was requiring ventilatory support throughout. respiratory muscle weakness vs. central cause due to prior cva and brain injury. continued ventilatory support with ac or mmv as tolerated. attempt to wean with further treatment of vap. . vap (resistant pseudomonas) - colonized chronically with multiple resistent pseudomonas bacteria. increased sputum at presentation with septic physiology requiring pressors. id was consulted. she was treated initially with vancomycin and imipenem. based on sputum culture data from rehab she was changed from imipenem to cefepime and vancomycin was discontinued. repeat sputum cultures at again grew pseudomonas that was now resistant to cefepime, therefore tobramycin was added. per the id team, the patient should be treated for a 14 day course of cefepiem/tobramyin which will complete on . daily tobramycin peaks and troughs should be measured and the dosing adjusted to prevent toxicity (the patient was therapeutic at discharge). she continued to spike low-grade fevers most likely to be medication-related rather than infectious origin (see below). disseminated tuberculosis - pulmonary tuberculosis with liver/spleen granulomas s/p r vats; diagnosed and has been on a regimen of ethambutol, isoniazid, pyrizinamide as she could not tolerate a 4-drug regimen. given her new pulmonary symptoms, she was r/o for active pulmonary tuberculosis with three negative sputum afb smears. plan to complete 9 month course of the 3-drug regimen, ie, through . id: h/o multiple vaps with esbl ecoli and mdr pseudomonas. also with h/o vre from urine and dissemintated tuberculosis. pseudomonas again cultured from sputum supporting new vap. plan to complete 14 day course tobramycin and cefepime, ie through . however, tobramycin was stopped 2 days early for concern of worsening renal function. also on 9 month regimen of ethambutol, isoniazid, pyrizinamide for disseminated tuberculosis. fevers: continued to spike low-grade temperatures daily. differential included infection (although being treated with pathogen-directed antibiotic), medications, transfusion reaction, mds/aml, or central cause. no evidence of vegetation on tee during last admission and given that blood cultures remained negative an endovascular source seemed less likely. heme-onc was consulted as patient has underlying mds with borderline aml transformation, but they did not believe that her fevers were due to her underlying hematologic disorder. per rehab records, in the absence of infection, the patient had been febrile daily for weeks which most likely supports a drug fever (inh, ethambutol most likely) and may not improve until she completes her course for tuberculosis. she was started on standing dosed tylenol and lfts should be followed every week. renal: acute prerenal failure which resovled rapidly with intravenous fluids. no further renal failure and creatinine was at baseline 0.8-1.0 until just prior to discharge. renal function should be followed daily while continue treatment with tobramycin for vap. on discharge, cr up to 1.4, presumed secondary to tobramycin, which has now been discontinued. urine lytes not pre-renal. please check cr in days to ensure it is downtrending. hypernatermia: patient with slightly elevated sodium secondary to free water deficit. free water increased to 100cc q4h, please follow sodium on chemistries until stabilizes and adjust free water boluses as needed. neuro: h/o r ica watershed infarct with residual l hemiparesis and aphasia. mental status became depressed in the setting of infection, but improved on to near baseline with antibiotics. heme-onc: -pancytopenia - h/o mds with bone marrow bx revealing borderline transformation to aml. heme-onc was consulted, but based on stable pancytopenia and no peripheral blasts, there was no evidence progression of disease. a repeat bone marrow bx can be considered in the future. weekly differential should be followed to evaluate for evidence of blasts. -anemia - combination of mds and chronic hemolysis due to multiple blood transfusions. no evidence dic. dat weakly positive initially due to elevated igg, but a repeat test was negative. hematocrit was followed and remained stable prior to discharge. # gi: patient continue on tube feeds and tolerated them well, however with free water bolus patient had vomiting with this. had no change in her exam and did not have distress. hit+ - during prior admission. no heparin products were given. dm2: continued on glargine 15 units qhs and iss. #fen: tube feeds. #ppx: lansoprazole, venodynes, no heparin given hit+ #access: picc was removed prior to discharge #code: full confirmed with hcp #dispo: acute rehab #contact: (son,hcp) , medications on admission: ethambutol 800mg po qd ( x 1yr) inh 300mg po qd () pyrazinamide 1250 mg qd ( recorded start) pyridoxine 50 mg po qd imipenem 500 iv q 8h vanc 1 g iv q 8h flagyl 500mg po q8h -mucomyst inh q 4-6 hrs -albuterol/atrovent inh -asa 81 -darbo 100 mg sc q 12h -gabapentin liq 100 tid -glargine 15sc q 12h + hiss -metop 12.5 po bid -oxycodone prn -asa 81 -sertraline 100 qd -simvastatin 40 qd -artificial tears discharge medications: 1. acetaminophen 325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 2. albuterol 90 mcg/actuation aerosol : 6-8 puffs inhalation q4h (every 4 hours) as needed for wheezing/sob. 3. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 4. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 5. ethambutol 400 mg tablet : three (3) tablet po daily (daily). 6. insulin glargine 100 unit/ml solution : fifteen (15) units subcutaneous at bedtime. 7. insulin regular human 300 unit/3 ml insulin pen : asdir units subcutaneous four times a day: 4 units for fsbs 150-200, and 2 units for every additional 50 fsbs points over 200. 8. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 9. isoniazid 300 mg tablet : one (1) tablet po daily (daily). 10. lactulose 10 g/15 ml syrup : thirty (30) ml po q6h (every 6 hours). 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 12. pyrazinamide 500 mg tablet : 2.5 tablets po daily (daily). 13. pyridoxine 50 mg tablet : one (1) tablet po daily (daily). 14. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 15. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 16. sucralfate 1 g tablet : one (1) tablet po qid (4 times a day). 17. tobramycin sulfate 40 mg/ml solution : one y (180) mg injection q36h (every 36 hours) for 5 days: doses due 7/24pm, 7/26am, 7/27pm; course will then be complete. 18. vancomycin in dextrose 1 g/200 ml piggyback : one (1) gram intravenous q 24h (every 24 hours) for 10 days: discontinue if blood cultures from remain negative. discharge disposition: extended care facility: hospital discharge diagnosis: 1. disseminated tuberculosis 2. former right ica stroke with residual left hemiparesis 3. pseudomonas pneumonia, ventilator associated 4. respiratory failure, ventilator-dependent 5. tracheal obstruction with granulation tissue, debrided 6. focal tracheobronchomalacia discharge condition: fair discharge instructions: your tracheostomy was revised to improve your breathing and you were treated for ventilator associated pneumonia. you received an appropriate course of antibiotics. your creatinine increased slightly which we presume is secondary to one of the antibiotics you were receiving. please re-check creatinine in days. your sodium was also rising, and we increased the amount of free water boluses through your feeding tube. please have your electrolytes checked until stable. followup instructions: as needed with dr procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances arterial catheterization bronchoscopy through artificial stoma bronchoscopy through artificial stoma bronchoscopy through artificial stoma bronchoscopy through artificial stoma transfusion of packed cells replacement of tracheostomy tube replacement of tracheostomy tube local excision or destruction of lesion or tissue of trachea tracheoscopy through artificial stoma diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis asthma, unspecified type, unspecified myelodysplastic syndrome, unspecified acute respiratory failure pneumonia due to pseudomonas iatrogenic pneumothorax septic shock late effects of cerebrovascular disease, hemiplegia affecting unspecified side anticoagulants causing adverse effects in therapeutic use hypovolemia hyperosmolality and/or hypernatremia other and unspecified complications of medical care, not elsewhere classified gastrostomy status mechanical complication of tracheostomy sickle-cell trait miliary tuberculosis, unspecified, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically 

Answer: The patient is high likely exposed to