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: all drug allergies previously recorded have been deleted attending: chief complaint: altered mental status, septic shock major surgical or invasive procedure: intubation, central line placement, tunnelled line placement, deep tissue biopsy of thigh, cvvh, hemodialysis. tracheostomy history of present illness: 52 year old woman with hx of lupus nephritis, multiple sclerosis, hypertension who is presenting with altered mental status, fever, and shock. the patient was in her usual state of health until yesterday when she noticed a rash late in the evening which she mentioned to her family. per family, at that time she had no other symptom that she mentioned including headache or vomiting. early on the day of admission, the patient was found minimally responsive and moaning on her bed. ems was called. . of note she was recently seen in her nephrology clinic on at which time her blood pressure was 150/90 with hr 68. at the time she had 3+ bilateral lower extremity edema. her lisinopril was increased from 5mg to 10 mg daily and her lasix was increased from 20 mg to 40 mg daily. . in the ed, her initial vital signs were 104 140 60/palp 16 86% on 100%. she received 6l of ns. she was intubated for airway protection. a rij central line was placed after a failed attempt at the left ij. a cxr, ct head/torso were done. she received vancomycin and ceftriaxone at meningitic dosing. she received decadon 10mg x1. a fast u/s showed free fluid in the abdomen. past medical history: sle lupus nephritis (baseline cr 0.9->1.2 on ) multiple sclerosis depression panic disorder social history: stopped smoking . degree in computer programming. immigrated from at 10 years of age. lives with son. family history: unremarkable physical exam: t 99.9 hr 133 bp 74/37 rr 30 o2sat 100% vent: ac 450x20 peep 5 fio2 0.7 pip 16 gen: intubated heent: at, nc, perrla (4->2mm bilat), no conjuctival injection, anicteric, op clear, mmm, neck supple, no lad, no carotid bruits. trachea midline. rij in place. small evidence of lij attempt. no subcutaneous crepitus. mild neck stiffness cv: regular tachy, nl s1, s2, no m/r/g pulm: coarse crackles bilaterally abd: soft, nd, + bs, no hsm ext: cool, dry, +2 distal pulses bl, no femoral bruits. 3+ pedal edema neuro: intubated/sedated. opens eyes to command. pupils round and reactive. oculocephalics intact. withdrawals to noxious stimuli. unable to do strength or sensory testing. skin: multiple erythematous lesions on right thigh. petechial rash to lower back. psych: unable to assess pertinent results: cxr - 1. et tube approximately 1 cm above the carina. ng tube in appropriate position and ij catheter within the cavoatrial junction. 2. left suprahilar increased rounded density and left mid lung zone 1.7 cm nodule. dedicated lateral view may be of use in determining what these structures are. . ct torso - 1. moderate pleural effusions, pericardial effusion, ascites, subcutaneous edema, and mild interstitial pulmonary edema are all consistent with volume overload. 2. small anterior left pneumothorax. 3. consolidation in the lower lobes of the lungs bilaterally, most suggestive of aspiration, probably with a component of atelectasis as well. infection cannot be excluded. 4. fibroid uterus. . ct head - limited study without evidence of hemorrhage or mass effect. . ct abdomen/pelvis: 1. worsening of bibasilar effusions and associated airspace disease, most likely atelectasis, underlying infection cannot be excluded. slight decrease in pericardial effusion. 2. persistent, diffuse simple ascites, with new ascending/transverse colitis without dilatation or perforation. no definable abscess or focal collection, as clinically questioned. findings are suspicious for infectious colitis; however, this could also be seen with ischemic bowel as a result of prior hypoperfusion episode and/or ongoing vasculitis, given the history of sle. diffuse mild small bowel thickening is felt to be due to third spacing. 3. delayed enhancement and no evident excretion of contrast through the kidneys at this time, compatible with atn. 4. fibroid uterus. . ct right lower extremity: 1. surgical wound as described above in the mid thigh anteriorly with packing material. no soft tissue or muscle fluid collection or abscess. 2. diffuse low-attenuation throughout the muscles of the thigh, which may represent muscle edema. muscle infarct is not entirely excluded. 3. fluid tracking in both the deep and superficial fascial compartments of the anterior and posterior thigh. no soft tissue gas is present. 4. probable bone infarct of the proximal tibia. . echo: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is severely depressed (lvef= 20 %). right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe(3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a moderate sized pericardial effusion, mostly posterior (minimal anterior fluid seen). there are no echocardiographic signs of tamponade. impression: cardiomyopathy. moderate pericardial effusion without overt tamponade. . echo: the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 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. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is a small to moderate sized pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. brief hospital course: 52 year old woman with history of multiple sclerosis, sle c/b nephritis presenting with altered mental status found to be in shock complicated by multi-organ failure. . # septic shock: serratia bacteremia presumably from gi source given pancolitis on ct abdomen/pelvis. shock requiring max dose 4 pressors on presentation and she was initially started on broad spectrum antibiotics and stress dose steroids until blood cultures grew serratia bacteremia. also cardiogenic in setting of sepsis as ef was severely depressed on initial echo obtained upon presentation to the ed (since normalized s/p treatment of sepsis). serratia was initially covered with cefepime which was then changed to ciprofloxacin given sensitivities as per id recs. she completed a full 2 week course of the above antibiotics with resolution of her shock and discontinuation of pressor support. of note, she also grew serratia from right leg deep tissue biopsy (performed by surgery on presentation), but suspect leg was seeded from blood as opposed to leg as source of bacteremia. ct right le was negative for fluid collection/abscess/air. at the time of discharge, her bp was stable, she was afebrile, and there was no leukocytosis. . # livedo necrosis: right lower extremity biopsied on initial presentation out of concern for necrotizing fasciitis and source of sepsis. general surgery and dermatology were consulted and deep tissue biopsy did not show e/o nec fasciitis however did also grow serratia to lesser degree than in blood. ct right lower extremity was unrevealing for abscess and air was leg was presumably seeded from bacteremia as opposed to leg as source. aggressive wound care was performed daily. she will need follow up with dr. (surgery) as outpt. for wounds (ph# ). will need wound care per wound care recommendations. . # fungemia: albicans grew from blood cultures presumably from line source as initial cultures were drawn from tunnelled line. she was started on caspofungin pending sensitivities and tunnelled, picc and a-line were all discontinued. surveillance cultures were monitored without subsequent growth after initial positive. caspofungin was then changed to fluconazole as it was sensitive and she completed a 2 week course from date of first negative blood culture. . # rij/rt brachial dvt: developed in the setting of right sided tunnelled line. she was started on heparin gtt and tunnelled line was discontinued. she was started on coumadin, and the heparin gtt until inr . goal ptt should be between 50-70. . # anemia/hct drop: has baseline anemia from underlying renal dz and renal failure however now with acute drop while on heparin gtt. she did have bloody oral secretions but not enough to lose that amount of blood (23.5-->19). she has had no gross blood per gi tract however concerning is the increase in her bun. no other clear source of blood loss. prior to discharge, she had some frank blood from her tracheostomy, and heparin gtt was stopped. her hct remained stable. repeat bronchoscopy did not show any areas of frank bleeding, and it was thought to be secondary to trauma from the tube. heparin was stopped for 2 days, and then restarted without incident. her hct remained stable. . # respiratory failure: initially intubated on presentation in the setting of altered mental status. she was extubated, however failed x1 and was reintubated due to profound respiratory muscle weakness, copious oral secretions and inability to clear them. she was again extubated however had probable aspiration event with acute hypoxia and brdaycardia again requiring reintubation. given her prolonged intubation, she was trached and a peg was placed by interventional pulmonology. she tolerated this well, and at the time of discharge, she was on a tracheosty mask at 35% fio2. the tracheostomy tube was replaced with a shorter tube on the day of discharge. . # acute renal failure/lupus nephritis: patient had rising cr thought to be lupus nephritis prior to this admission. she became oliguric on admisison requiring initiation of cvvh which she tolerated well and was transitioned to hd. in the setting of fungemia, however, her tunnelled line was discontinued and her uop continued to improve. her cellcept was held on presentation and briefly restarted before again being held in the setting of fungemia. stress dose steroids were initiated on presentation and hydrocortisone was subsequently titrated down to prednisone 10mg daily and she was discharged on cellcept 500mg qid. she should also receive epogen per her regular schedule and follow up with her nephrologist. . # oral ulcers: during her course, she developed severe oral ulcers involving her lips and within the oropharynx. hsv1 was cultured from lip ulcers and she was started on valtrex for a 14-21 day course. topical viscous lidocaine was used for pain control. she is currently on a prophylactic dose of valtrex. . # pancytopenia: leukopenia on presentation secondary to sepsis/dic vs. due to lupus vs. in setting of cellcept. her cellcept was held and her sepsis was treated and her wbc count and hct improved. platelet recovery lagged however improved to the 100k range where they remained stable. . # sle: with lupus nephritis as above. off cellcept temporarily given fungemia and on hydrocortisone. she was discharged on prednisone 10mg qdaily and cellcept qid. . # ms: stable without active issues. . # nutrition: a peg tube was placed and she tolerated tube feeds. she was started on an oral diet after a speech and swallow evaluation. when she has adequate nutritional intake by mouth her tubefeeds can be weaned. she had some discomfort surrounding her peg tube and was evaluated several times by interventional pulmonology and no problems were found. this is likely due to pain at the surgical site. . # hypertension: maintained with good blood pressure control on his current medications. medications on admission: celexa 10 mg daily lasix 40 mg daily prednisone 20 mg tid cellcept mg omeprazole 20 mg daily aspirin 81 mg daily multivitamin daily lisinopril 10 mg daily (increased from 5 daily on ) discharge medications: 1. mupirocin calcium 2 % cream : one (1) appl topical (2 times a day). 2. artificial tear with lanolin 0.1-0.1 % ointment : one (1) appl ophthalmic prn (as needed). 3. docusate sodium 50 mg/5 ml liquid : po bid (2 times a day). 4. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 6. lidocaine hcl 2 % solution : one (1) ml mucous membrane tid (3 times a day) as needed. 7. atovaquone 750 mg/5 ml suspension : ten (10) ml po daily (daily). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 9. valacyclovir 500 mg tablet : one (1) tablet po daily (). 10. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). 11. furosemide 40 mg tablet : one (1) tablet po daily (daily). 12. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 13. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 14. prochlorperazine 10 mg iv q6h:prn 15. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 16. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution : five hundred (500) units/hour intravenous continuous infusion. 17. morphine sulfate 1 mg iv q4h:prn 18. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 19. warfarin 2.5 mg tablet : one (1) tablet po once daily at 4 pm. 20. prednisone 10 mg tablet : one (1) tablet po daily (daily). 21. mycophenolate mofetil 200 mg/ml suspension for reconstitution : one (1) po qid (4 times a day). 22. sucralfate 1 gram tablet : one (1) tablet po qid (4 times a day). 23. papain-urea 830,000-10 unit/g-% ointment : one (1) appl topical daily (daily). discharge disposition: extended care facility: , discharge diagnosis: primary deep venous thrombosis acute renal failure respiratory failure oral ulcers septic shock secondary discharge condition: stable discharge instructions: you were admitted with altered mental status and low blood pressures. you were treated with medications to bring up your blood pressure. you were treated for a severe cellulitis of your leg and a fungal infection of your blood. additionally, your respiratory status required that you receive ventilatory support. a tracheostomy and percutaneous endoscopic gastrostomy tube were placed during your stay to support your respiration and nutrition. plastic surgery and wound care were consulted to help take care of your wounds. there wound care recommendation will be followed at the rehabilitation facility. followup instructions: provider: , phone: date/time: 12:00 provider: , md phone: date/time: 2:30 provider: , m.d. phone: date/time: 11:30 please follow up with , in the next 2-4 weeks. his office can be reached at (. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis other bronchoscopy other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy incision with removal of foreign body or device from skin and subcutaneous tissue bronchoscopy through artificial stoma closed biopsy of skin and subcutaneous tissue replacement of tracheostomy tube diagnoses: systemic lupus erythematosus nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere acute kidney failure with lesion of tubular necrosis severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure unspecified disease of pericardium acute respiratory failure iatrogenic pneumothorax cellulitis and abscess of leg, except foot cardiogenic shock disseminated candidiasis acute systolic heart failure multiple sclerosis other and unspecified infection due to central venous catheter herpes simplex without mention of complication other and unspecified mycoses critical illness myopathy ulcer of thigh septicemia due to serratia universal ulcerative (chronic) colitis 

Answer: The patient is high likely exposed to