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: respiratory failure, hypotension major surgical or invasive procedure: none history of present illness: the patient is a 74 yo female brought to ed from st. hospital for icu admission. the patient initially presented to from her nursing home in , ma with increasing lethargy and sob. history is extremely limited as the patient is not responsive, obtained entirely through documentation in chart. per notes from , the patient was in extremis upon arrival, unable to give history. the patient was quickly intubated for respiratory failure, lactate found to be 2.9. purulent urine was noted from foley. blood and urine cultures were sent, and the patient was given ampicillin and 4 liters ivf, with 1.4 liters of urine output documented at osh. a left femoral line was placed. the patient was started on levophed, up to 8mcg at one point, titrated down to 0.15 mcg on arrival to icu. . on arrival to ed, the patient was febrile to 103. blood and urine cultures were sent again, pt was given dose of vanc and zosyn, and 2 more liters of ivf. about 30 minutes after arrival, the patient was noted to have arm twitching and tonic/clonic seizure activity per nursing, resolved with 2 mg iv ativan. the patient was sent for a head ct and cxr. ua was repeated which again showed mod leuks, >50 wbcs, many bacteria, 0-2 epis. the patient was admitted to the icu for further management. past medical history: hypertension schizophrenia depression dementia diabetes- insulin dependent parkinsons social history: lives at , not able to obtain further info family history: not able to obtain physical exam: gen: intubated, not responsive to voice, responsive to painful stimuli heent: atraumatic, dry mucosa, ng tube in place with dark brown return neck: no lad, no jvd cv: rrr, no murmurs, no rubs lungs: decreased bs at left base, no crackles or wheeze abd: distended, soft, no focal tenderness elicited on exam, no rebound, g-tube in place, hypoactive bs ext: cool, dry. right le and ue contracted, + muscle rigidity skin: no rash neuro: non responsive to voice, pupils constricted and minimally reactive, withdraws to painful stimuli, no spontaneous movement of extremities at rest pertinent results: notable for hypernatremia, elevated lactate, elevated creatinine, leukocytosis, anemia 11:45pm glucose-170* urea n-71* creat-2.3* sodium-159* potassium-3.7 chloride-130* total co2-17* anion gap-16 11:45pm urine rbc-0 wbc->50 bacteria-many yeast-none epi-0-2 renal epi-0-2 11:45pm wbc-22.0* rbc-3.27* hgb-9.6* hct-29.4* mcv-90 mch-29.4 mchc-32.6 rdw-15.6* 11:45pm ck-mb-5 11:45pm ctropnt-0.05* 02:47am lactate-2.5* . cxr: no pneumonia or chf. . ct head: 1. no intracranial hemorrhage or mass effect. 2. marked cerebral atrophy. 3. mucosal thickening in the paranasal sinuses with aerosolized secretions in the nasopharynx. the patient may benefit from suctioning . ekg: sinus rhythm, normal rate, lad, normal intervals, low voltage, poor r wave progression, no acute st changes . eeg: impression: mild diffuse encephalopathy. no focal, lateralized, or epileptiform features although encephalopathies can, at times, obscure focal findings. of note, there was no clear electrographic correlate to observed episodes of leg shaking or body jerking on video and reported by the eeg technician. there were no electrographic seizures. . mri head w/o contrast: conclusion: no definite evidence for acute brain ischemia. brief hospital course: the patient is a 74 yo female brought to icu for respiratory failure and hypotension. # respiratory failure- unclear history of onset of sob and tachypnea. on presentation patient had a metabolic acidosis (ag and non-anion gap), with elevated lactate in the setting of hypotension and decreased perfusion. increased ventilation was likely partially compensatory respiratory alkalosis. also with likely underlying copd as pt on inhaler at nursing home. metabolic acidosis resolved with volume and free water repletion, however the patient continued to hyperventilate and became slightly alkalotic. cxr findings intially suggested rll pneumonia, likely aspiration, as well as possible lll pneumonia. also likely an element of fluid overload after aggressive volume resuscitation for sepsis. patient continued to show a pattern of hyperventilation followed by apnea while on mechanical ventilation, thought most likely ataxic breathing secondary to parkinson's disease. antibiotics were dc'd . extubated on , sat'ing high 90s-100% on 50% face mask and ultimatley oxygen was weaned to room air prior to transfer to the regular medical floor. # altered mental status- patient showed improvement () and has been stable since then. pt is opening eyes spontaneously, tracking with her eyes, lip smacking c/w parkinson's dementia. had previously been unresponsive, off sedation, in the abscence of receiving narcotics. eeg showed no epileptiform activity, consistent with encephalopathy, thus her change in mental status is likely not explained by subclinical seizures as previously hypothesized. head ct ruled out cerebral edema rapid correction of hypernatremia. neurology was consulted, and felt taht toxic/metabolic etiology was most likely. lfts were normal. tsh elevated with normal t3 and free t4, possibly related to illness. mri brain without evidence for anoxic brain injury. there was also likely an element of polypharmacy as patient has improved s/p d/c'ing sedating meds-- ativan and keppra. per the patient's guardian, in the past when she has been very sick she has had similar change in mental status with prolonged period of recovery back to baseline. # uti/urosepsis/hypotension- thought secondary to sepsis given ua suggestive of infection, purulent urine, fever, and leukocytosis. all cx data negative so far. echo was negative for effusion or systolic dysfunction. adrenal insufficiency was ruled out. blood culture have remained negative to date. patient was weaned off levophed on day 1 of admission, cvp was responsive to 500cc lr boluses, and she completed a course of vanc/zosyn. # erythema at r sc insertion site- first noticed with significant erythema at the insertion site. likely chloraprep reaction, significantly improved after d/c'ing use of chlorhexadine. there is an area of skin breakdown next to the tape but it does not look infected. she has been afebrile without a leucocytosis or any other evidence to suggest a line-related infection. # hypernatremia- likely hypovolemic hypernatremia, sodium 151 at osh, up to 159 in ed. na normalized quickly with free water repletion. . # arf- baseline creatinine unknown, creatinine at osh 3.3, improved here with volume repletion, suggesting prerenal etiology. cr stable now at 1.2, . # anemia- baseline hct unknown, hct at osh 43, likely reflecting hemoconcentration. however residual in ng tube was also concerning for ugib. labs ruled out hemolysis. iron studies suggest iron deficiency anemia and aocd. no clear etiology for acute hct drop. there was no evidence of bleed on head ct, no other obvious source of bleed other than gi. guiac negative. received transfusion 2 u rbc for hct 20.8 had appropriate bump to 29.9 and hct has been stable since then. # diabetes- insulin dependent, last hgb a1c not known, fs 95-161 over past 24 hours. she should continue her insulin sliding scale as prior to admission. # pt with tonic-clonic activity in the ed, which resolved with ativan. on depakote at nh, but seizure history unclear. be secondary to fever/ infection/ hypernatremia. ct head negative for acute bleed. pt had seizure-like activity again twice on (rhythmic ue shaking) that resolved with 2mg and 2.5mg iv ativan respectively. eeg c/w encephalopathy, no epileptiform activity. per neuro recomendations, keppra was d/c'd. the patient was continued on depakote and aspiration precautions # access- r sc central line placed (). removed prior to transfer back to her long term care facility # communication- guardian (cell). . # code status - was full code during this hospitalization per discussion with legal guardian. medications on admission: buproprion 50 mg depakote 250 mg famotidine 20 mg metoprolol 12.5 mg mirtazapine 7.5mg qhs calcium carbonate w/ vitamin d combivent tylenol novolog sliding scale discharge disposition: extended care facility: odd fellows home discharge diagnosis: urosepsis respiratory failure diabetes type ii with complications dementia parkinson disease schizophrenia discharge condition: improved discharge instructions: no new specific discharge instructions. no new discharge medications. resume previous medications. other care plans per extended care facility. followup instructions: per long term care facility md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube transfusion of packed cells diagnoses: acidosis urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia other convulsions depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere unspecified schizophrenia, unspecified paralysis agitans acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin encephalopathy, unspecified hyperosmolality and/or hypernatremia leukocytosis, unspecified contracture of joint, ankle and foot 

Answer: The patient is high likely exposed to