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: milk / dilantin attending: chief complaint: decreased urine output major surgical or invasive procedure: intubated on ventilator briefly history of present illness: 59 f with ceftriaxone-sensitive proteus mirabilis utis, l mca cva with residual r hemiplegia/aphasia at baseline, dm1, g tube, seizures, was sent from rehab with decreased uo x 12 hours and cr 4.1 from baseline 1.0. according to stonehedge papers, on , bun/cr 88/3.3, na 128, and urine grew out proteus mirabilis. she was given 4 l ivf and ceftriaxone 1 g daily from to 9/14m and her foley was changed. on , her na 123, k 5.7, cl 91, hco3 17, bun/cr 94/3.6. starting on , she had <200 ml uo in 8 hours, bg 53 increased to 76 after glucagon. her vitals were bp 112/75, hr 70, 98% ra. she was transferred to for further care. . in the ed, she was hypothermic to 32 c, hypotensive with sbp 80s, v paced at 60, 98% 2l nc, wbc 13, bands 5. rij was placed, pulled back per cxr. cxr negative for infiltrate. received levo/flagyl/vanco, bnp , lactate 1.4 to 1.9. could not send a ua in the ed since she was anuric at the time. ct abdomen without contrast was not read by the time the patient was transferred to the micu. . on micu , abg 7.19/36/99, and patient was intubated, became transiently hypotensive with sbp 70 in response to sedation meds, was given 500 ml ns bolus and started on levophed which was weaned 30 min later with normotension. urine output was several drops. ekg showed v pacing 60 resulting in rbbb with no signs of ischemia. . for her recent medical history, she was discharged from in , went to rehab, was transferred to stonehedge from in mid- for "increased medical needs" per patient's son. she was admitted at hospital /07 with arf and ceftriaxone-sensitive proteus uti. has mrsa, vre, cdiff history in . past medical history: --l sided mca stroke with aphasia/hemiplegia --type 1 diabetes mellitus w/ h/o dka and poor compliance --htn --asthma --dyslipidemia --fibroids --cataracts --adenomatous polyps --cri --skin excoriations from itching --vre, mrsa, cdiff in social history: used to live at rehab until mid , moved to rehab. legal guardian is son (only child), is unmarried. prior to cva, one 6 pk beer/wk, no smoking history, no illicit drug history. family history: aunt with type 2 diabetes. her mom had a fatal mi at the age of 54. her dad had ?copd. physical exam: t 95.6, 110/40, 119, 19, 98% ra general: use of accessory muscles to breathe, mildly labored, not speaking, not directing eyes appropriately to name, short height, shield like chest heent: anicteric sclerae, cannot assess jvd because of neck habitus, rij tpl lungs: secretions/rhonchi anteriorly heart: av paced, rrr, 2/6 sem, no rub, no g abdomen: firm, mildly distended, obese, normoactive bs, peg tube site clean with no erythema extr: no c/c/e, 2+dp pulses bilaterally neuro: does not follow commands, weak recoil to pain on left side skin: excoriations from scratching and desquamation throughout skin pertinent results: labs: 11:29pm type-art po2-187* pco2-36 ph-7.25* total co2-17* base xs--10 10:29pm glucose-89 urea n-95* creat-3.8* sodium-128* potassium-4.5 chloride-96 total co2-14* anion gap-23* 10:29pm calcium-7.7* phosphate-8.1* magnesium-3.1* 10:29pm osmolal-298 10:29pm cortisol-30.4* 09:55pm ck(cpk)-218* 09:55pm ck-mb-12* mb indx-5.5 ctropnt-0.04* 09:55pm cortisol-27.6* 07:14pm type-art po2-217* pco2-31* ph-7.23* total co2-14* base xs--13 06:52pm alt(sgpt)-18 ast(sgot)-21 ld(ldh)-167 alk phos-82 amylase-21 tot bili-0.1 06:52pm lipase-10 06:52pm albumin-2.8* 06:52pm cortisol-30.1* 06:52pm urine hours-random urea n-267 creat-103 sodium-21 potassium-35 tot prot-364 prot/crea-3.5* 06:52pm urine osmolal-312 06:52pm urine color-yellow appear-cloudy sp -1.021 06:52pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 06:52pm urine rbc-* wbc-21-50* bacteria-mod yeast-none epi-0-2 06:52pm urine eos-positive 05:37pm type-art temp-26.7 po2-518* pco2-32* ph-7.24* total co2-14* base xs--12 05:37pm lactate-1.1 05:37pm freeca-1.07* 05:22pm glucose-83 urea n-96* creat-3.8* sodium-126* potassium-4.6 chloride-96 total co2-12* anion gap-23* 05:22pm calcium-7.8* phosphate-8.1* magnesium-3.1* 05:22pm wbc-11.2* rbc-2.85* hgb-8.4* hct-25.5* mcv-89 mch-29.4 mchc-32.9 rdw-16.0* 05:22pm plt count-306 04:12pm type-art po2-99 pco2-36 ph-7.19* total co2-14* base xs--13 04:12pm glucose-115* lactate-1.9 na+-123* k+-4.9 cl--99* 04:12pm freeca-1.12 12:53pm lactate-1.5 12:40pm glucose-59* urea n-101* creat-4.1* sodium-125* potassium-5.1 chloride-93* total co2-15* anion gap-22* 12:40pm estgfr-using this 12:40pm ck-mb-10 mb indx-4.3 probnp-* 12:40pm ck(cpk)-230* 12:40pm ctropnt-0.04* 12:40pm calcium-8.5 phosphate-9.0* magnesium-3.4* 12:40pm wbc-13.1* rbc-2.95* hgb-8.9* hct-27.0* mcv-91 mch-30.3 mchc-33.2 rdw-15.9* 12:40pm neuts-73* bands-5 lymphs-11* monos-8 eos-3 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-1* 12:40pm hypochrom-normal anisocyt-normal poikilocy-occasional macrocyt-normal microcyt-normal polychrom-normal burr-occasional 12:40pm plt count-352 . other labs: pth 376 iron 39 discharge hematocrit 28.1 discharge creatinine 2.4 discharge wbc 11.5 eosinophils upon discharge 15.8 discharge potassium 4.0 vit d 1,25 pending . other: 04:08am blood tsh-3.0 . studies: us abd limit, single organ port 6:38 pm impression: 1. small amount of pericholecystic fluid. no evidence of acute cholecystitis. 2. echogenic bilateral renal parenchyma, compatible with medical renal disease. . ct abdomen w/o contrast; ct pelvis w/o contrast impression: 1. gallbladder distension with pericholecystic fluid, sludge and equivocal stones and mural thickening. would recommend further evaluation for possible acute cholecystitis by ultrasound or hida scan. 2. generalized anasarca. 3. bilateral pleural effusions with associated atelectasis; with the air bronchograms that the patient has, cannot rule out basilar pneumonia. 4. pancreatic calcifications consistent with chronic pancreatitis. 5. no evidence of a large mass, colitis or free air. . echo study date of conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the aortic valve leaflets are mildly thickened with focal calcification of the non-coronary cusp. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. moderate (2+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. impression: no echocardiographic evidence of endocarditis. focal thickening of non-coronary cusp of aortic valve with trivial aortic regurgitation. moderate mitral regurgitation. moderate to severe tricuspid regurgitation. mild left ventricular hypertrophy with preserved regional and global left ventricular function but evidence of elevated left ventricular filling pressures.. mild right ventricular dilation with normal systolic function. moderate pulmonary hypertension. small pericardial effusion. compared with the prior study (images reviewed) of , the severity of mitral and tricuspid regurgitation have increased. the right ventricle now appears mildly dilated. the other findings are similar. . ecg study date of 8:30:50 am baseline artifact. probable atrial and ventricular sequential pacing. compared to the prior tracing sinus tachycardia is no longer present. read by: , h. intervals axes rate pr qrs qt/qtc p qrs t 65 0 156 472/480 0 -72 94 brief hospital course: 59 f rehab patient with ceftriaxone-sensitive proteus mirabilis utis, l mca cva with residual r hemiplegia/aphasia at baseline, dm1, g tube, with resolved pna, resolved urosepsis, ongoing arf from atn. in the micu, she was briefly on pressors and intubated intubated in the unit, now off pressers, extubated, and on 2l nc. her cr peaked at 4.1. renal was consulted and felt this was atn/hypoperfusion. cr has improved to 2.7 without further improvement. los +20 l, 2l positive yesterday. not diuresing well with lasix and metolazone. uo in teens/hr, no post-atn diuresis. renal reconsulted, recommending diuril, 160 mg iv lasix. also, she is s/p vanc/zosyn for urosepsis and subsequently developed peripheral eosinophilia, so she was switched to vanc/meropenem and completed a 10 day course of abx and 7 day course of fluconazole for yeast in her urine. she has had a hct in the low to mid 20's for most of her micu stay, but she was transfused 2 units upon transfer to the floor and her hct remained stable around 30 therafter. . # atn/acute renal failure: baseline cr 2.0 per pcp, cr was 4.1. likely atn but may have had a component of ain given eosinophilia. ulytes show prerenal etiology, renal consult detected many wbc and yeast, no white cell casts, no red cell casts in urine, diagnosed as atn. her acute on chronic renal insufficiency was attributed to hypotension associated with sepsis and decreased perfusion of kidneys. cr rapidly improved with aggressive fluid resuscitation but plateaud around 2.6-2.7. renal us showed no hydronephrosis. meds were renally dosed. renal was reconsulted and diuretics were held while she was on the floor. she likely has very large insensible losses and while she was 20l positive during her first 10 days, she was euvolemic at that point and she continued to be euvolemic for the rest of her stay. her free water was increased for hypernatremia which resulted in improvement in hypernatremia. her cr never improved better than 2.6 for the rest of her stay. . # urosepsis and pneumonia: she was intubated on for ph 7.19. patient was treated for urosepsis and pneumonia with meropenem and vancomycin. positive urine culture for proteus mirabilis on at rehab, but urine cultures were negative at . patient has a history of vre and mrsa, and since she has dm, broad coverage antibiotics were used. cxr was negative on and thereafter showed small effusions after fluid resuscitation of > 20l, with only very mild fluid overload overall. she was extubated on without complication. for alternative infection sources, ct abd without contrast showed cholelithiasis/sludge with 3 mm gallbladder thickening but no cholecystitis, mild ascites. abd us showed too little ascites to for paracentesis, no hydronephrosis, and again cholelithiasis with no cholecystitis. for her complete antibiotic course, she was given ceftriaxone from , levo/flagyl/vanc x1 in ed, zosyn/vanc day 1 . due to peripheral hypereosinophilia to maximum 22, zosyn was stopped and changed to meropenem/vanc day 1 . blood cultures, urine cultures were negative, likely since the patient had been treated with ceftriaxone before . . for her pneumonia, sputum culture showed esbl klebsiella and pan-resistant pseudomonas (except to zosyn). it was undetermined whether this was due to colonization or a true infectious etiology, but the patient continued to clinically improve on antibiotics. she was continued on a total of a 10 day course of antibiotics, which were stopped on . she remained afebrile for the rest of her stay . #skin excoriation: ms. was scratching her skin excessively, causing significant excoriation and bleeding. she was given a mitt and restraints. dermatology was consulted and diagnosed xerosis cutis. she was given a 1:1 mixture of eucerin cream and 2.5% hydrocortisone. in addition, she was kept mildly sedated with morphine and benadryl. when restraints were released, her mitt was enough to keep her from doing any more physical damage to her skin. . # hypertension: on the floor she was moderately well controlled on labetalol 400mg po bid. her sbp was noted to be in the 170s, so her labetalol was titrated to 300mg po tid. this resulted in brief sbp in the 90's, so her labetalol was titrated back to 400mg po bid and she was discharged on that dose. . # gap metabolic acidosis: patient had a gap metabolic acidosis on that resolved by discharge, likely due to uremia and lactic acidosis. urine was negative for glucose and ketones. . # dm1: patient has a history of dka episodes, is insulin-dependent. it was unknown at what age dm started. she was maintained on insulin sliding scale with good control of bg. . # anemia: baseline hct 25, attributed to anemia of chronic disease. patient received several rbc transfusions to maintain hct in setting of fluid resuscitation. she has a history of guaiac positive stools, but her stools were guaiac negative during . her hct stabilized at 29-30 for the last 5 days of her stay. . # left mca cva with residual r hemiparesis/aphasia at baseline: her home regimen includes asa, statin, and oxcarbazepine for seizure prophylaxis. she was maintained on half dose oxcarbazepine per neuro recommendations since this medication is partly metabolized renally. . # asthma: she is not on a steroid inhaler at baseline. albuterol and atrovent inhalers were administered during pneumonia, but were not needed after pneumonia resolved. . # nutrition: she was on tf glucerna 60 ml/hr at rehab, was assessed by nutrition as being mildly overfed, and was maintained on tf glucerna 25 ml/hr during . . # prophylaxis: she was maintained on ppi, heparin sc tid, and a bowel regimen. . # code status: full, discussed multiple times with son , who states that he had multiple extensive conversations with his mother regarding code status. according to , she stated her wish before her cva in that if she was not able to speak for herself, that she wished to be kept full code even if she is to be chronically vented or in a chronically debilitated or vegetative state. medications on : lantus 14 units daily glucerna 65 ml/hr continuous norvasc 10 mg daily clonidine 0.1 mg avapro 75 mg daily labetalol 400 mg isosorbide dn 90 tid loratadine 10 daily ranitidine 75 simvastatin 40 daily asa 81 daily oxcarbazepine 900 qam, 600 iron 220 mg daily senna colace lactulose discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 4. docusate sodium 50 mg/5 ml liquid : two (2) po bid (2 times a day). 5. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 6. ranitidine hcl 150 mg tablet : 0.5 tablet po bid (2 times a day). 7. white petrolatum-mineral oil cream : one (1) appl topical (2 times a day). 8. hydrocortisone 2.5 % cream : one (1) appl rectal (2 times a day). 9. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day): continue until . 10. lactulose 10 g/15 ml syrup : thirty (30) ml po tid (3 times a day) as needed. 11. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed. 12. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q6h (every 6 hours) as needed. 13. diphenhydramine hcl 25 mg capsule : one (1) capsule po q6h (every 6 hours) as needed. 14. morphine 10 mg/5 ml solution : one (1) po q6hr:prn as needed. 15. oxcarbazepine 300 mg tablet : one (1) tablet po bid (2 times a day). 16. insulin please see attached sheet for directions on fixed dose and sliding scale coverage. 17. oxcarbazepine 300 mg tablet : 1.5 tablets po qam (once a day (in the morning)). 18. quetiapine 25 mg tablet : 0.5 tablet po bid (2 times a day) as needed. 19. labetalol 200 mg tablet : two (2) tablet po bid (2 times a day). 20. outpatient lab work please check chem10 and cbc with differential 2 times per week. discharge disposition: extended care facility: - discharge diagnosis: primary: --l sided mca stroke with aphasia/hemiplegia --arf - atn +/- ain --xerosis cutis . secondary: --type 1 diabetes mellitus w/ h/o dka and poor compliance --htn --asthma --dyslipidemia --fibroids --cataracts --adenomatous polyps --cri --skin excoriations from itching --vre, mrsa, cdiff in discharge condition: hemodynamically and medically stable discharge instructions: 59 f with ceftriaxone-sensitive proteus mirabilis utis, l mca cva with residual r hemiplegia/aphasia at baseline, dm1, g tube, seizures, was sent from rehab with decreased uo x 12 hours and cr 4.1 from baseline 1.0. according to stonehedge papers, on , bun/cr 88/3.3, na 128, and urine grew out proteus mirabilis. she was given 4 l ivf and ceftriaxone 1 g daily from to 9/14m and her foley was changed. on , her na 123, k 5.7, cl 91, hco3 17, bun/cr 94/3.6. starting on , she had <200 ml uo in 8 hours, bg 53 increased to 76 after glucagon. her vitals were bp 112/75, hr 70, 98% ra. she was transferred to for further care. . in the ed, she was hypothermic to 32 c, hypotensive with sbp 80s, v paced at 60, 98% 2l nc, wbc 13, bands 5. rij was placed, pulled back per cxr. cxr negative for infiltrate. received levo/flagyl/vanco, bnp , lactate 1.4 to 1.9. could not send a ua in the ed since she was anuric at the time. ct abdomen without contrast was not read by the time the patient was transferred to the micu. . on micu , abg 7.19/36/99, and patient was intubated, became transiently hypotensive with sbp 70 in response to sedation meds, was given 500 ml ns bolus and started on levophed which was weaned 30 min later with normotension. urine output was several drops. ekg showed v pacing 60 resulting in rbbb with no signs of ischemia. . she finished her course of antibiotics. she was found to have c-diff and started on flagyl. her renal failure remained stable and she was given free water and d5w for her hypernatremia, which resolved by the day of discharge. . she should have labwork twice weekly to assess her creatinine, sodium, hematocrit, and eosinophilia, and electrolytes (chem10 and cbc with differential). . she will be continued on flagyl until . she will need subq heparin. . she scratches if she the mitt is taken off. she seems to have improved with 1:1 mixture of eucerin cream and 2.5% hydrocortisone. morphine and diphenhydramine helped with this too. followup instructions: please follow up with her primary care provider. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization injection of antibiotic transfusion of packed cells other oxygen enrichment diagnoses: pneumonia, organism unspecified acidosis anemia of other chronic disease mitral valve disorders acute kidney failure with lesion of tubular necrosis unspecified septicemia severe sepsis candidiasis of other urogenital sites hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified chronic kidney disease, unspecified acute respiratory failure hypotension, unspecified long-term (current) use of insulin right bundle branch block late effects of cerebrovascular disease, hemiplegia affecting unspecified side calculus of gallbladder without mention of cholecystitis, without mention of obstruction personal history of noncompliance with medical treatment, presenting hazards to health diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled chronic pancreatitis diseases of tricuspid valve late effects of cerebrovascular disease, aphasia attention to gastrostomy family history of diabetes mellitus septicemia due to pseudomonas eosinophilia other specified erythematous conditions pressure ulcer, hip other and unspecified superficial injury of other, multiple, and unspecified sites, without mention of infection other specified diseases of sebaceous glands 

Answer: The patient is high likely exposed to