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: shellfish / flexeril / tricyclic compounds attending: chief complaint: hypotension major surgical or invasive procedure: picc line placement history of present illness: 51 yo f w esld hcv and septic hip who presented to an outpatient appt for reclast at which time she was noted to have a bp in the 70s. the patient was feeling well until the night prior to presentation when she had several loose bowel movements without blood. she slept last night and awoke this am feeling nauseous. she ate 1 bite of breakfast and vomited nonbloody gastric contents. she denied any fever, chills, or shortness of breath. she was scheduled for an outpatient reclast infusion so was picked up by an ambulance for transport at which time emts noted her sbp to be in the 70s. the patient insisted on going to her appt rather than the ed. at her appt she was again noted to have sbps in the 70s so was transported to the ed. . in the ed, patient was triggered for an initial bp of 73/43. she was given 2l ns without effect. a femoral cvl was placed and she was given vanc, zosyn, hydrocort, and norepi with improvement in her sbps to the 100s-120s. her labs returned notable for wbcs 7.8 with 23% bands, creat 1.5, k 6.6 and lactate 3.7. u/a was negative for evidence of uti. blood and urine cultures were drawn. ekg revealed peaked t waves so she was given insulin, dextrose, bicarb, and ca gluconate. k went from 6.6 to 5.5. she is was noted to be very sleepy but arousable and able to protect her airway. cxr was c/w a retrocardiac opacity. vs prior to transfer were: 101/65 85-90 16 93% ra. . on the floor, the patient reports feeling better. she does complain of bilateral lower abdominal pain. her mother says she is still not at her baseline but is much improved since arriving at the ed; most specifically, she is much less lethargic. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, constipation. no dysuria. denied arthralgias or myalgias. past medical history: 1. hcv cirrhosis, diagnosed , nonresponder to interferon / ribavirin, s/p tips for ascites. course has been complicated by encephalopathy, thrombocytopenia, ascites, and hydrothorax. was on list but inactivated due to recurrent infections. 2. hyponatremia baseline 128-133 3. secondary adrenal insufficiency 4. asthma 5. diabetes mellitus 6. gerd 7. anxiety 8. history of urinary tract infections 9. s/p hip fracture and orif in , which was complicated by polymicrobial septic hip (e. coli, enterococcus, coag neg staph, klebisiella) s/p washout , hardware removal , with wound vac in place at home. 10. history of le cellulitis 11. possible prolactinoma suggestion of microadenoma 12. hypercalcemia thought due to aggressive vitamin d repletion social history: lives with her mother. 1 daughter and a granddaughter. stopped smoking in , previously smoked ppd for several years, unclear how long. sober since , drank an unclear amount of drinks per day before that. h/o iv heroin, stopped in . no other drugs used. no sick contacts or recent travel. family history: father - copd, alcohol cirrhosis mother - diabetes, htn, hl daughter - congenital heart dz physical exam: on admission: vitals: 85, 101/65, 16, 93% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: on admission (): wbc-7.8 rbc-3.15* hgb-9.9* hct-30.3* mcv-96 mch-31.4 mchc-32.6 rdw-18.2* plt ct-61* neuts-66 bands-23* lymphs-7* monos-1* eos-1 baso-0 atyps-0 metas-2* myelos-0 hypochr-2+ anisocy-2+ poiklo-1+ macrocy-normal microcy-normal polychr-1+ ovalocy-1+ schisto-1+ pt-17.8* ptt-36.2* inr(pt)-1.6* glucose-93 urean-48* creat-1.5* na-121* k-6.6* cl-91* hco3-22 angap-15 alt-22 ast-50* alkphos-273* ctropnt-0.06* calcium-8.2* phos-5.1*# mg-2.0 lactate-3.7* . upon discharge (): wbc-8.8 rbc-2.45* hgb-7.5* hct-23.1* mcv-94 mch-30.4 mchc-32.2 rdw-20.1* plt ct-62* pt-21.8* ptt-38.3* inr(pt)-2.0* glucose-166* urean-35* creat-0.6 na-137 k-4.1 cl-107 hco3-23 angap-11 alt-27 ast-37 alkphos-204* totbili-2.4* albumin-2.8* calcium-8.4 phos-2.4* mg-1.7 . micro: blood cx (): pseudomonas aeurginosa urine cx (): no growth stool cx (): no c. diff, salmonella, shigella, or campylobacter blood cx (, , , ): no growth stool cx (): no c. diff cmv viral load (): not detected stool cx (): no c. diff, cryptosporidium, or giardia . imaging: portable cxr (): 1. lll consolidation, worrisome for pna with possible superimposed atelectasis. 2. right pleural effusion and increased interstitial markings reflecting mild pulmonary edema. . abdominal u/s (): minimal amount of intra-abdominal ascites. the amount of fluid within the abdominal quadrants would be a high-risk procedure even for a diagnostic aspiration and we would recommend deferral of attempting sampling at this time. . pa&lat cxr (): chronic bilateral pleural effusions and bibasilar opacities/atelectasis, possibly due to chronic aspiration. increased left retrocardiac consolidation is again worrisome for pneumonia. . ruq u/s (): 1. unchanged cirrhotic-appearing liver, without suspicious hepatic lesion or intrahepatic fluid collection to suggest abscess. 2. contracted gallbladder related to recent meal. biliary sludge and stable cholelithiasis but no findings of acute cholecystitis. . ct abdomen/pelvis w/ contrast (): 1. patchy opacity in the right lung base may represent aspiration or infection. 2. small bilateral pleural effusions with associated compressive atelectasis, underlying infection not excluded. 3. findings compatible with cirrhosis and portal htn. 4. wall edema in the distal rectum suggestive of proctitis. . mandible xr (): patchy osteopenia of the mandible. multiple erosions. brief hospital course: 51 year old woman with hcv cirrhosis s/p tips in , which has been c/b encephalopathy, thrombocytopenia, ascites, hydrothorax, and multiple infections, and septic right hip who presented to an outpatient appointment for reclast at which time she was was noted to be hypotensive and confused, and was sent to the ed. please see admission note for further details. brief hospital course by problem: . # sepsis: the pt presented with vomiting, hypotension, and altered mental status and was found to have 7.8 wbcs with 23% bands. u/a was negative and urine culutures showed no growth. a cxr revealed a lll consolidation suspicious for pna, however the pt denied respiratory symptoms and was not hypoxic. an abdominal u/s revealed an unchanged cirrhotic-appearing liver, w/o evidence of abscess or ascites. an abdominal ct revealed wall edema in the distal rectum suggestive of proctitis. she was empirically treated for sbp with vanco, zosyn, and ciprofloxacin and received albumin. blood cultures came back positive for pseudomonas aeruginosa, however no source was identified. antibiotics were narrowed to cefepime to cover pseudomonas and flagyl for potential gi source considering proctitis seen on ct. a picc line was placed. the patient's mental status improved with lactulose, rifaximin, and antibiotics and her vitals remained stable. several repeat blood cultures were all negative. the pt was discharged home with vna to help with antibiotic administration and picc care. cefepime was continued for a 14-day course. . # arf: on admission the pt was noted to have a cr of 1.5 which was felt to be prerenal secondary to hypotension. she was treated with fluids and her creatinine normalized. cr was 0.6 upon discharge. . # : on admission the pt was noted to have a k of 6.6. an ekg revealed peaked t waves so she was given insulin, dextrose, bicarb, and calcium gluconate and her potassium normalized. . # diarrhea: pt reported several loose bms prior to admission and experienced several days of watery diarrhea during this admission. a flexiseal was placed. stool cultures were negative for c. diff, salmonella, shigella, campylobacter, cryptosporidium, or giardia, and cmv viral load was undetectable. an abdominal ct revealed wall edema in the distal rectum suggestive of proctitis, however this was felt to be unlikely to explain her watery diarrhea. unclear etiology. flagyl 500 mg q8 was continued for a 14-day course. . # poor dentition: there was concern that her dentition may be a source of infection so dental x-rays were done and dentistry was consulted. there are two teeth that will need to be extracted so an op appt was made with oral surgery on . . # hcv cirrhosis: s/p tips in , has been c/b encephalopathy, thrombocytopenia, ascites, hydrothorax, and multiple infections. lfts were stable during this admission. continued home meds plus increased lasix to 120mg qd and increased spironolactone to 150mg qd. . # s/p hip fracture and orif in , c/b polymicrobial septic hip s/p washout , hardware removal , with wound vac in place at home. a wound care consult was placed and . # secondary adrenal insufficiency: stable. continued prednisone 5mg daily. . # diabetes: stable. continued home meds. . # asthma: stable. continued home meds. . # gerd: stable. medications on admission: albuterol sulfate 90 mcg 2 puffs amoxicillin 2g prn dental work calcitriol 0.25 mcg capsule qod clotrimazole 10 mg troche qid doxycycline hyclate 100mg po bid effexor 75mg po bid ergocalciferol (vitamin d2) 50,000 units qmwf fluticasone-salmeterol 250 mcg-50 mcg/dose inh folic acid 1 mg po daily furosemide 80mg po bid gabapentin 100mg po bid insulin glargine 22 units qpm insulin lispro sliding scale ipratropium bromide 1-2puff prn ketoconazole 2% cream lactulose 45ml tid ( bm/day) montelukast 10mg po daily oxycodone 5mg po daily oxycodone 10mg po bid prednisone 5mg po daily rifaximin 500mg po bid spironolactone 100mg po daily calcium carbonate 1g po tid magnesium oxide 400mg po bid/tid multivitamin 1 tab daily sodium chloride 0.65 % nasal prn discharge medications: 1. cefepime 2 gram recon soln sig: two (2) gram injection q12h (every 12 hours) for 8 days. disp:*32 gram* refills:*0* 2. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 3. normal saline flush 0.9 % syringe sig: ten (10) cc injection every eight (8) hours: for duration of picc line. disp:*30 * refills:*0* 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation (2 times a day). 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po every other day (every other day). 6. venlafaxine 75 mg tablet sig: one (1) tablet po bid (2 times a day). 7. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po every mon/wed/fri. 8. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. furosemide 40 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*0* 11. spironolactone 100 mg tablet sig: 1.5 tablets po daily (daily). disp:*45 tablet(s)* refills:*0* 12. gabapentin 100 mg capsule sig: one (1) capsule po q12h (every 12 hours). 13. lantus 100 unit/ml solution sig: twenty two (22) units subcutaneous every evening. 14. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous four times a day. 15. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation (2 times a day) as needed for wheezing. 16. ketoconazole 2 % cream sig: one (1) topical twice a day. 17. lactulose 10 gram/15 ml syrup sig: forty five (45) ml po three times a day: titrate to bowel movements daily. 18. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 19. oxycodone 5 mg tablet sig: 1-2 tablets po once a day as needed for pain. 20. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 21. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 22. rifaximin 550 mg tablet sig: one (1) tablet po twice a day. 23. calcium carbonate 1,000 mg tablet, chewable sig: one (1) tablet, chewable po three times a day. 24. magnesium oxide 400 mg tablet sig: one (1) tablet po twice a day. 25. multivitamin tablet sig: one (1) tablet po daily (daily). 26. sodium chloride 0.65 % aerosol, spray sig: nasal as needed. 27. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours). 28. clotrimazole 10 mg troche sig: one (1) mucous membrane four times a day. 29. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 8 days. disp:*24 tablet(s)* refills:*0* 30. outpatient lab work on monday and weekly thereafter: cbc, chem7, lfts, with results to be faxed to ( coordinator), liver center at discharge disposition: home with service facility: home care services discharge diagnosis: primary: - sepsis secondary to pseudomonas infection . secondary: - hcv cirrhosis - adrenal insufficiency - diabetes - acute renal failure - right hip wound discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , you were admitted to the hospital because you had vomiting with low blood pressure. you were found to have an infection in your blood which we are treating with antibiotics. your kidneys were sick, but have gotten better. you were seen by a dentist, who recommended to see an oral surgeon to discuss teeth extraction. . please continue to take your home medications. we have made the following changes: - started cefepime 2g iv twice daily, last doses on - started metronidazole 500 mg orally every eight hours, last doses on - increased lasix to 120mg by mouth daily - increased spironolactone to 150mg by mouth daily - holding amoxicillin while you are taking cefepime. please talk to the oral surgeons about this when you see them next week. . please keep your appointments and take your medications as directed below. followup instructions: oral surgery clinic at . , yawkey ambulatory center. date/time: 2:00 pm. phone: . your oral surgeon will be requesting further information about how long you have been taking reclast. . , md phone: date/time: 10:50 . , md phone: date/time: 1:30 . clinic phone: date/time: 9:00 . xray (scc 2) phone: date/time: 9:20 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: hyperpotassemia thrombocytopenia, unspecified esophageal reflux cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic hepatitis c with hepatic coma acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis asthma, unspecified type, unspecified anxiety state, unspecified septic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other ascites diarrhea glucocorticoid deficiency other and unspecified coagulation defects other specified disorders of rectum and anus septicemia due to pseudomonas non-healing surgical wound 

Answer: The patient is high likely exposed to