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: penicillins / shellfish attending: chief complaint: sepsis major surgical or invasive procedure: : subtotal colectomy with end ileostomy and g-tube placement : tracheostomy history of present illness: mrs. is a 53 year old woman who was transferred from hospital after undergoing a right total knee replacement on , which was complicated by oversedation, when she was found to be in renal failure, febrile with leukocytosis. per records, she received a dose of vancomycin and cefazolin peri-operatively. she was admitted to icu. she subsequently developed ards, requiring steroid tx and pressors. she was started on imipenem and vancomycin empirically. cultures have remained negative. within a day or two, she was weaned off pressors and her white count had improved. she continued to have low grade fevers, until when her fever curve started to climb. her wbc rose to 32 on , 3-4 days prior to transfer she developed increased diarrhea, and stool came back positive for c diff toxin (). id was consulted. she was started on flagyl and vancomycin, but later became hypotensive, requiring levophed; steroids were restarted. ivig (one dose) was given per id recommendations. ct abdomen revealed some colonic thickening, but the study was limited due to lack of iv contrast. surgery evaluated the patient and recommended medical management. catheter tip on grew coagulase negative staphylococcus. due to concern for c diff toxic megacolon and sepsis, pt was transferred to micu for management. all blood cultures were negative at time of transfer. past medical history: dyslipidemia, hypothyroidism, depression, bladder repair social history: the patient lives with her husband and two daughters. smoked, no etoh, no drug use. traveled to and in when she developed vaginal yeast infection and uti. recently went camping in nh. family history: non-contributory physical exam: vs: t 98.9; bp 126/45; hr 93; rr 17; o2sat 100% on a vent vent: ac 400x15(1); fio2 0.6; peep 8; min vent 9.1 abg: ph 7.15; pco2 80; po2 119 general: intubated, sedated, does not open eyes to voice, does not follow up commands neck: jvp not elevated heent: nc, at, perrl, no scleral icterus cv: regular, hyperdynamic precordium, nl s1s2, no m/r/g pulm: cta abd:+ bs, soft, nt, nd extr: 2+ ankle edema; r knee slightly swollen, surgical incision c/d/i, toes dusky, dp and tp pulses are palpable bilaterally, neuro: intubated and sedated skin: macerated in groin/inner thighs right subclavian (placed @osh) site w/o signs of symptoms of infection pertinent results: radiology: ct chest/abdomen/pelvis 1. diffuse colonic wall thickening, consistent with history of c. difficile colitis. the maximal dimension of large bowel is approximately 6.4 cm in diameter, upper limits of normal. 2. no evidence of perforation. 3. multifocal pneumonia right knee x-ray: status post placement of a tricompartmental right total knee replacement without evidence of hardware-related complication. head ct: no hemorrhage, mass effect, hydrocephalus, or shift of normally midline structures is identified. the -white matter differentiation is preserved. the visualized paranasal sinuses and mastoid air cells remain normally aerated. old right basal ganglia is identified. atherosclerotic calcification is noted within the basilar artery. echo: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. no masses or vegetations are seen on the aortic valve. there is no valvular aortic stenosis. the increased transaortic gradient is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. ct abdomen/pelvis: 1. severe colitis of distal remnant colon. 2. no radiographic evidence for pancreatitis. 3. fluid along the subcutaneous fat at the incision site. cannot exclude early infection and clinical correlation is recommended. ct head: 1. no evidence of hemorrhage or mass effect. if high clinical suspicion for infarct, mri would be a more sensitive evaluation. 2. interval worsening of bilateral mastoid air cells opacification. please correlate clinically for signs of acute mastoiditis. : no dvt right leg. exam of left leg suspended due to cardiac arrest. cta chest/abdomen/pelvis: 1. diffuse wall thickening with surrounding fat-stranding and edema involving the hartmann's pouch with slight interval improvement. 2. no evidence of central or segmental pe. 3. multifocal air-space opacities as seen on the previous ct from likely representing active or resolving pneumonia. 4. focal small bowel intussception in the left upper quadrant without evidence of obstruction which may be transient - clinical correlation recommended. ct head: there is no intracranial hemorrhage, shift of normally midline structures, hydrocephalus, or evidence of acute major vascular territorial infarction. a mucus retention cyst is noted within the sphenoid sinus. the mastoid air cells appear well aerated. surrounding osseous structures are otherwise unremarkable. echo: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. ct head: there is no intracranial hemorrhage, shift of normally midline structures, hydrocephalus, or evidence of acute major vascular territorial infarct. -white matter differentiation appears preserved. an approximately 4-mm right sublenticular hypodensity may represent a sublenticular cyst or prominent virchow space. opacification of multiple ethmoid air cells is noted with a moderate-sized polyp within the sphenoid sinus. opacification of multiple bilateral mastoid air cells is observed. the sinus changes are likely inflammatory in origin. eeg: abnormal eeg due to diffusely low and slow rhythms overall. this suggests a moderate degree of diffuse encephalopathy mr : the evaluation of the lower brain is limited due to large amount of artifact caused by dental hardware. the artifact is specially limiting on the gre, dwi, and flair images. there are no definite areas of abnormal enhancement or masses. there are no intracranial hemorrhages. the /white matter is differentiation is maintained with no areas of slow diffusion given the limitations described above. there are scattered small subcortical, deep, and periventricular white matter t2 hyperintensities which likely represent small vessel ischemic changes. the ventricles and extraaxial csf spaces are within normal limits. there is asymmetry in the sizes of the temporal horns with the left greater than right but the hippocampi appear to be within the normal limits. there is increased t2 signal within the mastoid air cells as well as fluid layering within the nasopharynx. some kind of tubing is seen within the mouth. there is mild mucosal thickening involving the left frontal, ethmoid, and sphenoid sinuses with mucous retention cyst within the sphenoid sinus. the visualized orbits are grossly normal. no suspicious bony abnormalities are seen. eeg: this telemetry captured no well-recorded or reliable pushbutton activations. the two recorded were probably artifactual. routine sampling and automated detection showed a very encephalopathic slow background. there was an occasional sharp wave discharge but no electrographic seizures, and most sharp features were artifactual. echo (tte): the left atrium is mildly dilated. the estimated right atrial pressure is 0-5mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%) tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. there is no ventricular septal defect. right ventricular chamber size and free wall motion 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 estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. echo tee: no mass/thrombus is seen in the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). right ventricular systolic function is normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. no mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. brief hospital course: neurological: the patient had a high fever spike and went into asystolic arrest while awaiting ultrasound. a neurology consult was obtained. she was started on the appropriate antibiotic and antiviral regimen. a cns infection was ruled out. head ct and mri revealed no anatomical or structural abnormality. eeg's obtained showed no seizure activity. her mental status has improved dramatically. she is now alert and oriented and able to converse freely. she understands her situation and wants to improve her health. cardiovascular: upon arrival, the patient was supported with pressors, which were weaned off. she required additional pressor support after her asystolic event of . she underwent multiple echocardiograms demonstrating no vegetations, and normal function. when her cardiovascuilar status had stabilized, and she was no longer requiring pressors, she was placed on metoprolol, which she has continued. pulmonary: she was transferred intubated, improving from her pneumonia, likely due to aspiration at hospital. she had continued to show marked improvement until the time of her asystolic event. she was then intubated, and after 7 days, she underwent a bedside tracheotomy for inability to wean from the ventilator. after the tracheostomy, she rapidloy progressed to tolerating trach mask for a substatial portion of the day. gi: after initial npo status, she was supported with tpn. she was then transitioned to tube feedings on pod 13, and these were advanced to goal. her feedings were held in the time around her asystolic event, and then advanced to goal. she remains on replete with fiber, full strength at her goal rate of 50 cc/hour. as she has a non-fenestrated tracheostomy in place at this time, and she has tolerated these tube feeds, a second swallowing evaluation has not been performed. this should be obtained prior to initiating oral feeding. gu: she had a candidal and lactobacillus uti, which have been adequately treated. she currently has an indwelling foley catheter with a daily urine output of approximately 2500cc. heme: she did require a blood transfusion on . her hematocrit at that time was 18.3. after transfusions her hematocrit rose to 25.7. her hematocrit is now stable and has steadily risen to 34.9 on the day of discharge. id: her c. diff has resolved and the last stool specimen sent on was negative. her urine cultures on revealed a candidal and lactobacillus uti. blood cultures obtained on the same day revealed candidemia and lactobacillus bacteremia. she was started on the appropriate antibiotics and surveillance blood cultures drawn on are negative. she has been instructed by id to stop the linezolid on , stop the caspofungin on , and stop the po vancomycin on . medications on admission: florinef discharge medications: 1. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: five (5) ml po q4h (every 4 hours) as needed: via g-tube. 2. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily): via g-tube. 3. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day): via g-tube. 4. ipratropium bromide 17 mcg/actuation aerosol sig: 6-8 puffs inhalation q4h (every 4 hours) as needed for when on vent: when on ventilator. 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day): via g-tube hold for sbp <100, hr <60. 6. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 7. albuterol 90 mcg/actuation aerosol sig: 6-8 puffs inhalation q4h (every 4 hours) as needed for when on vent: when on ventilator. discharge disposition: extended care facility: - discharge diagnosis: sepsis clostridium difficile colitis/toxic megacolon asystolic arrest respiratory failure discharge condition: stable discharge instructions: return to the emergency room or call the office if you experience: ** fever above 101.5 f ** inability to tolerate nutrition by mouth or g-tube ** chest pain ** shortness of breath ** difficulties with your tracheostomy ** any other concerns followup instructions: follow up with dr. in weeks. you may call his office at ( to make an appointment when you are stable enough to be seen in clinic. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances temporary tracheostomy other incision with drainage of skin and subcutaneous tissue transfusion of packed cells cardiopulmonary resuscitation, not otherwise specified other gastrostomy other permanent ileostomy other immobilization, pressure, and attention to wound injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent diagnoses: other postoperative infection urinary tract infection, site not specified unspecified essential hypertension severe sepsis unspecified acquired hypothyroidism acute respiratory failure pneumonitis due to inhalation of food or vomitus cardiac arrest intestinal infection due to clostridium difficile pressure ulcer, buttock disseminated candidiasis septicemia due to anaerobes knee joint replacement 

Answer: The patient is high likely exposed to