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: sulfa (sulfonamides) / avelox attending: chief complaint: hypotension to 70s major surgical or invasive procedure: -tunnel catheter for hd -blood and ffp transfusions -hemodialysis history of present illness: 68 yo f with tracheobronchomalacia, on heparin gtt for avr, who was transferred here from an osh for ip evaluation and possible y stent who is transferred to the micu for hypotension. she was initially admitted here on and had a ct of her airway done revealing tracheobronchomalacia. she was scheduled for the or on monday for rigid bronch. her bp remained stable on admission, and was in the 130s-140s/70s-80s throughout the day on and . on , her bp was 100/80 at 8 am (pulse 92 from 82), 92/43 at noon, and 87/54 at 4 pm (pulse 104). per thoracic surgery she was mentating throughout all of this. no uop recorded as she was incontinent, but at 8:45 pm a foley was placed and drained 250 cc urine. the micu team was called at 9 pm for hypotension. rn notes her bp was 62/palp (75/p w/doppler), pulse 120, respirations 32, and 98% on 3l. they attempted to give a 500 cc bolus but her last peripheral iv stopped working. she was transferred to the micu at this time for cvl placement and further monitoring. of note, her inr was subtherapeutic on admission at 1.4, and she was begun on a heparin drip (due to avr). her ptt was greater than 150 since 6 pm last night, and despite adjustments in the heparin gtt it was last measured at 147.5. her heparin gtt was shut off at the time of her micu transfer. . currently, she is awake but drowsy and is mentating appropriately. she is complaining of severe abdominal and back pain which she states has been going on since yesterday. she also feels very cold. . in terms of recent history, she was admitted to center on with sob and cough. initial cxr was clear. they felt she had a copd exacerbation and treated her with steroids, bronchodilators, and azithromycin. on , she became acutely sob and cxr showed lul infiltrate. she was begun on zosyn and cipro for possible pseudomonal pna (as had reportedly grown this in past). swallow study was negative for aspiration. on (day of transfer) she was on day 7 of cipro/zosyn. per their notes her sob and cough were much improved. her creatinine fluctuated between 1.8 and 2, and was 3 on discharge from the osh. her lasix and enalapril were discontinued there, and she was begun on ivf (total 500 cc). renal ultrasound showed r kidney 10.2 cm w/mult cysts, left normal, no hydro. she had a negative c diff there, blood cx negative x2, urine cx negative. abg 7.40/40/77 on . past medical history: pmh: 1. tracheobronchomalacia, s/p prolonged intubation/trach in s/p cabg 2. recurrent pneumonias, reported hx pseudomonas in sputum 3. bronchiectasis 4. cad s/p cabgx5 5. copd/restrictive lung disease fev1 680 ml (39% pred) in unchanged from , tlc 63% pred 6. pvd 7. chf (mild per notes) 8. bell's palsy 9. htn 10. hyperlipidemia 11. s/p avr 12. dm 13. ckd, felt diabetes, baseline cr 1.4 14. gerd w/hiatal hernia 15. esophageal stricture s/p dilatation x2 . s/p r cea social history: she lives alone in an facility. she is formerly a suitcase manufacturer. she denies any alcohol use or ever smoking cigarettes. she denies any asbestos exposure. family history: father died from mi at age 60, mother died from mi at age 70 physical exam: physical exam: vitals: 96.5f hr 99 bp 94/31 rr 40 100%/4ln.c. gen: conversant, alert and oriented female, apppears pale and uncomfortable heent: anicteric, mucus membranes very dry neck: supple cv: tachycardic, regular pulm: cta anteriorly abd: obese, ttp ruq/luq without rebound or guarding, +bs, guaiac negative ext: + pitting edema bilaterally, skin cold, pulses 1+ bilaterally pertinent results: 09:21pm glucose-125* urea n-70* creat-2.7* sodium-134 potassium-4.3 chloride-97 total co2-23 anion gap-18 09:21pm calcium-8.9 phosphate-5.3* magnesium-2.0 09:21pm wbc-13.1* rbc-3.70* hgb-11.0* hct-30.9* mcv-84 mch-29.7 mchc-35.5* rdw-13.6 09:21pm plt count-263 09:21pm pt-15.4* ptt-20.9* inr(pt)-1.4* . ct trachea impression: 1. severe diffuse tracheobronchomalacia. 2. cylindrical bronchiectasis, predominantly basal, and scattered nodular ground-glass opacities suggest chronic and ongoing aspiration. 3. small bilateral pleural effusion. 4. atherosclerosis, including coronaries. 5. moderate size hiatus hernia. . ct abd/pelvix impression: 1. large right pelvic side wall hematoma measuring 11.7 x 9.1 cm, with extension into the right rectus muscle. there is no evidence of intraperitoneal extension of hemorrhage. the possibility of active extravasation is not optimally assessed without intravenous contrast. 2. there are again seen scattered areas of ill-defined ground glass opacity and bronchiectatic changes within the lungs bilaterally, which are not significantly changed in comparison to most recent study from two days prior. . . echo : conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). a mid-cavitary gradient is identified, consistent with mild flow obstruction at rest. the patient was unable to cooperate with the valsalva maneuver. right ventricular chamber size and free wall motion are normal. a bileaflet aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. no aortic regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is an anterior space which most likely represents a fat pad, though a loculated anterior pericardial effusion cannot be excluded. impression: symmetric lvh with hyperdynamic systolic function, and no regional wall motion abnormalities. mild resting mid-cavitary flow obstruction. normally-functioning mechanical aortic valve prosthesis. . leni conclusion: no evidence of dvt. . cxr : impression: 1. newly inserted two right central lines with no evidence of complications. 2. small new right pleural effusion. brief hospital course: 68 yo woman with tracheobronchomalacia, on heparin gtt for transferred to from an osh for ip evaluation and possible y stent who was transferred to the micu for hypotension, decreased hct in the setting of retroperitoneal bleed. . 1. retroperitoneal bleed - pt had bleed and was hypovolemic in setting of blood loss while supratherpeutic on heparin. she received aggressive fluid resuscitation and prbc transfusions while in house as needed for bleeding. her anticoagulation was reversed with ffp. she did not require pressors. on ct scan, she was found to have a large right pelvic side wall hematoma with extension into the right rectus muscle. there was no evidence of intraperitoneal extension of hemorrhage. we monitored her hct closely during the acute episodes q4. although her hct stabilized, when we attempted to start anticoagulation with warfarin again at low doses, she subsequently developed a decreasing hematocrit which required further transfusions of ffp and hct. while attempting slow increase of coumadin to reach therapeutic inr for her avr, she began further dropping her hct with increase of her inr to 1.8. we reversed this inr with vit k. we decided that she was currently not a candidate for anticoagulation in the setting of her acute bleed and in the setting of increasing bleeds to even low levels of anticoagulation. . 2. arf on cri - after developing hypotension, she became anuric. the most likely explination is that she developed atn. she has required hemodialysis/ultrafiltration during her stay in the hospital, and she had a tunnel catheter placed to facilitate this in the future. she was initially on cvvh. she was converted to hemodialysis. she did experience two transient episodes of desaturiation of hemodialysis. the diasylate was changed to asili. she tolerated two additional dialysis sessions without incident. . 3. elevated wbc count - she was hypothermic and met criteria for sirs but this is all likely explained by hypovolemic shock. she ultimately had a gram stain positive for gram positive cocci in her sputum (culture negative to date ), from . we subsequently treated her with vancomycin. she began her course on and was dosed by level with a goal vancomycin trough >15. she will continue this course for 7 days total. she also had erythema on her right lower extremity. this was thought to be more consistent with venous stasis changes than cellulitis and did not change when vancomycin was started. . 4. tracheobronchomalacia - patient was originally transferred for stent placement for this problem. she and her family subsequently decided not to proceed with this procedure given the risk/benefit ratio and the complications she has had during her hospital stay. . 6. cv: pump - anti-hypertensives were held given hypotension. volume resuscitation as above. ischemia - no evidence of active ischemia. she had one episode of transient right-sided chest pain. her cardiac enzymes were negative. she was continued on statin for secondary prevention. aspirin was held given bleeding risk. antihypertensives also held. . 7. diabetes mellitus - she was treated with an insulin sliding scale while in the hospital to maintain glucoses <120. . 8. prophylaxis - she was maintained on ppi and pneumoboots while in the hospital. we attempted to anticoagulate her, but stopped as described above. . 9. access: she had a tunnel line and picc placed under ir while in the hospital. medications on admission: cipro 250 mg po q12h simvastatin 80 mg daily insulin sliding scale pantoprazole 40 mg daily olanzapine 2.5 mg po qhs prednisone 10 mg tid ferrous sulfate 325 mg daily buspirone 10 mg daily ezetimibe 10 mg daily amlodipine 5 mg daily ipratropium nebs q6h fluticasone-salmeterol 250/50 zosyn albuterol nebs tylenol discharge medications: 1. albuterol sulfate 0.083 % solution : one (1) inhalation q4h (every 4 hours) as needed. 2. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 3. buspirone 10 mg tablet : one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed. 5. ferrous sulfate 325 (65) mg tablet : one (1) tablet po daily (daily). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 7. amlodipine 5 mg tablet : one (1) tablet po daily (daily). 8. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). 11. olanzapine 5 mg tablet : one (1) tablet po hs (at bedtime) as needed for agitation/insomnia. 12. calcium acetate 667 mg capsule : two (2) capsule po tid w/meals (3 times a day with meals). 13. vancomycin 1,000 mg recon soln : one (1) intravenous dosing by level for 3 days. discharge disposition: extended care discharge diagnosis: retroperitoneal hematoma discharge condition: -good discharge instructions: please call if become dizzy, weak, temp >101, chills, abdominal pain or abnormal bruising. followup instructions: you should follow up with your pcp within one week of discharge md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis transfusion of packed cells diagnoses: pneumonia, organism unspecified abnormal coagulation profile acute and subacute necrosis of liver acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified iron deficiency anemia secondary to blood loss (chronic) candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease heart valve replaced by other means other shock without mention of trauma hyperosmolality and/or hypernatremia diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled hemorrhage, unspecified 

Answer: The patient is high likely exposed to