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 / metoprolol attending: chief complaint: pt found down after 10 hours; transfer from osh for abnormal lfts, unable to wean from ventilator. major surgical or invasive procedure: left ij central line placed on right chest tube pulled out on lumbar puncture left ij central line retreived on left picc line palced on tracheostomy placed on left picc line retreived on after positive blood cultures thoracosentesis draining 500 cc history of present illness: 60 y/o f with pmhx of borderline dm and crohns disease who was admitted to osh on after being found non-responsive at home for 8-10 hours. she was hypothermic, bradycardic and hypotensive. bs was 1467 on admission with elevated anion gap consistent with dka. she was also noted to have elevated serum ck, increased amylase and lipase and wbc of 30k. ct head was negative. in the ed she was intubated for airway protection and given vanc/levo. she was given one dose of hydrocortisone and started on a levophed gtt. her presumptive diagnosis was dka acute pancreatitis. she was transferred to the icu where she was warmed, her bradycardia resolved and she was weaned from levophed. brief course: 60 yo wf w pmhx of t2dm, crohn's disease, initially presented on at osh after being found down at home w bs of 1400. pt was intubated in er for airway protection, and req'd pressors for hypotension. etiology of ms was thought to be dka acute pancreatitis. started empirically on vanco/levoflox. osh course complicated by iatrogenic ptx s/p chest tube, arf likely rhabdo (ck peak 11,000) requring hd, and failed extubation req re-intubation. pt also noted to have incr alkphos & ggt, nl tbili, u/s unrevealing. was briefly on tpn. bronch performed on 8/30transferred to icu on for further management. was on vanco& fluco on transfer. for workup of her altered mental status, she has had normal mri, lp, and unrevaling eeg. pt continued to spike fevers despite normalization of her pancreatic enzymes. she underwent trachestomy on . central line removed , replaced by picc. cefepime & cipro added empirically for persistent fevers.line cx +coag neg staph, lines removed on . thoracentesis performed on was unrevealing. started on meropenem on for esbl enterobacter from sputum cx. pt was started on vanc and meropenem for hospital acquired pneumonia. based on sputum cx, vanc was discontinued after an 8 day course and meropenem was continued. hospital course continued to be signif for persistent fevers (o/n 102f) and episodes of tachycardia and hypertension thought anxiety. pt was seen by id on and underwent c/a/p ct to look of source of infection and it showed increasing/stable upper lobe opacities and decreasing pleural effusions as well as diffuse lad. surgery was consulted to biopsy one of the lymph nodes and they did not feel as though it was worth the risk and thought that lad was likely infection. on , pt noted to have increasing wbc again and id recommended starting pt on po vanc on to cover for cdiff. no diarrhea noted, cdiff stool pending. pt also followed by psych due to agitation/delirium. they noted increased cogwheel rigidity, which they thought haldol and dose. cpk was not elevated. pt is very interactive and less frustrated after having a passy muir valve placed. past medical history: borderline dm (presented with dka) crohns disease social history: pt takes care of mentally challenged family and has not been taking care of herself. family history: non-contributory physical exam: vitals: t 96.7 bp 110/58 hr 66 sats 94% on vent ac/40%/12/500/peep 5 gen: comfortable, intubated, sedated, does not respond to commands heent: pinpoint pupils bilaterally, minimal response to light, sclera anicteric, no epistaxis or rhinorrhea, neck: rij with erythema around base, right subclavian temp dialysis line with mild erythema at site, no purulent drainage cor: rrr, no m/g/r pulm: coarse bs bilaterally, bs at bases abd: soft, nt, nd, active bs, no tenderness ext: no c/c/e +dp/pt neuro: minimal response to sternal rub skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 05:17pm lactate-0.7 05:17pm type-art po2-66* pco2-48* ph-7.40 total co2-31* base xs-3 intubated-intubated 05:30pm pt-14.9* ptt-27.9 inr(pt)-1.3* 05:30pm plt count-125* 05:30pm neuts-88.0* lymphs-8.3* monos-2.4 eos-0.8 basos-0.5 05:30pm wbc-17.2* rbc-3.12* hgb-9.7* hct-28.4* mcv-91 mch-31.2 mchc-34.3 rdw-15.5 05:30pm triglycer-148 05:30pm albumin-3.0* calcium-8.6 phosphate-4.4 magnesium-2.3 05:30pm probnp-4265* 05:30pm lipase-57 05:30pm alt(sgpt)-23 ast(sgot)-12 ld(ldh)-188 alk phos-752* amylase-44 tot bili-0.5 05:30pm estgfr-using this 05:30pm glucose-204* urea n-44* creat-2.9* sodium-145 potassium-3.6 chloride-108 total co2-29 anion gap-12 08:46pm urine mucous-rare 08:46pm urine rbc-8* wbc-24* bacteria-few yeast-occ epi-0 trans epi-<1 renal epi-<1 08:46pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 08:46pm urine color-yellow appear-clear sp -1.008 brief hospital course: ap: 60 yo wf w t2dm, crohn's disease, presents w/ altered mental status likely to dka from acute pancreatitis, w/ complicated hospital course including line assoc pneumothorax s/p ct placement/removal, ventilator associate pneumonia, funguria, arf rhabdo requiring intermittent hd, w persistent delirium, fevers and leukocytosis, all of which are resolved. 1. fevers/leukocytosis - over the weekend of , pt noted to have rise in wbc and low grade temp. all cx neg at that point. repeat chest ct stable. per id,even though no diarrhea, pt started on po vanc empirically for possible cdiff and wbc improved. c diff x2 neg. per id, po vanc discontinued after a 7 day course. the patient did not have any further leukocytosis for 4 days prior to discharge and was without low grade fevers for over 5 days prior to discharge. 2. altered ms - per notes, pt improved significantly from admission when she was essentially unresponsive. head ct, mri, lp, eeg all unrevealing. ms change likely multi-factorial including delirium recent dka, infection, icu course and also ? anoxic event. pt then had issues w delirium and was followed by psych. pt was initially on haldol but she developed cogwheel rigidity, so was switched to zyprexa. zyprexa was weaned to off on . overall, the patient has had dramatic improvement in her mental status, although she has some residual deficits. she underwent some cognitive testing by ot that revealed some deficits. she currently needs some help with daily activities. pt will need outpt neuropscyh eval to further evaluate. 3. hypoxia - resolved. pt had both effusions and vent assoc pna. pt is sp treatment with both vanc and meropenem. passy muir valve was decannulated on . the patient has done well since removal of her trach. she also has some left lower lobe collapse which was evaluated by pulmonary and they recommended conservative management. over time, this should reexpand. the patient is breathing in the mid 90s on ra with ambulation. 4. hx of arf - resolved and likely rhabdo as cpk 11k on admission. 5. hx of fungal uti - s/p tx w fluconazole, last ucx ngtd 6. acute pancreatitis - per records from here, on admission at osh, pt's lipase was in range. etiology of this attack remains unclear, pt has had us at osh per records which was neg and ct a/p here which also did not show any abn. pt was initially seen by gi here for eval and they recommended mrcp for further eval once arf resolved. anti-mitochondrial ab negative. mrcp ordered and revealed evidence of pancreas divisum or a dominant dorsal duct an nondistended pancreatic duct. pt will need to fu w dr. as outpt. dr. did mention that there is an association between new onset diabetes and pancreatic adeno within 2 year frame. mrcp does not show any mass, which is re-assuring but if repeat ct shows persistent lad (see below), concern will be higher. 7. hx of crohn's - no reports of abd pain or diarrhea here. cont to monitor. gi consult appreciated, since asymptomatic and was not on anything as outpt for this, no meds right now, dr. will follow as outpt. 8. hx of atrial fibrillation - in setting of acute illness. pt had tte and cta of chest which were neg for structural hrt dz and neg for pe respectively. tsh wnl. cont to monitor. was on tele but has been in nsr but with frequent ectopy. cont tele for now 9. dm - per sister she was told she had diet controlled about 5 years ago. had bs in 1400 on admission likely stress response from acute pancreatitis. patient now on metformin 850 mg po bid with lispro sliding scale. 10. diffuse lymphadenopathy - pt's recent ct c/a/p on and have shown diffuse lad. on , gen was consulted for biopsy but they declined stating that she is high risk for or as she was recovering from vap and that lad was likely infection. dr. will determine whether he wants to perform repeat ct scan in f/u appointment. radiologists here thought that the lad was not concrening for malignancy and did not recommend reimaging. . fen -patient repeatedly evaluated by nutrition, currently tolerating po comfortably but not achieving large caloric intake. would continue calorie counts and if patient does not improve her intake, consider supplemental tube feeds. . code status - full . comm: with sister, / lives in ct. she only has one sister. medications on admission: medications on transfer: chlorhexidine mouthwash senna prn pantoprazole 40mg daily fluconazole 200mg iv daily heparin 5000u sc tid fentanyl gtt propofol gtt multivitamin iv levofloxacin 250mg iv q48hrs regular insulin ss nystatin powder duoneb q4hrs epoeitin 40000units bisacodyl magnesium tylenol ativan prn vancomycin discharge medications: 1. insulin regular human 100 unit/ml solution sig: see sliding scale attached units injection asdir (as directed): see attached lispro sliding scale. 2. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 4. metformin 850 mg tablet sig: one (1) tablet po twice a day. 5. diltiazem hcl 180 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: hold for sbp<100, hr<55. discharge disposition: extended care facility: eagle rehab discharge diagnosis: altered mental status diabetic ketoacidosis acute pancreatitis vent associated pneumonia rhabdomyolysis acute renal failure cognitive deficits s/p acute illness abdominal lymphadenopathy discharge condition: vital signs stable discharge instructions: return to emergency room if having severe abdominal pain, confusion, high fevers, high blood sugars that do not improve at with aggressive insulin treatment. followup instructions: 1. dr. , gi, . patient to call and arrange appointment. 2. pcp, . , , ph: . patient to arrange f/u 3. outpatient neuropsych testing at . patient to call and schedule appointment at . 4. patient to arrange f/u with physician located near her that casemanagment is helping locate for her. patient should arrange close f/u. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy removal of tracheostomy tube diagnoses: acute kidney failure with lesion of tubular necrosis unspecified pleural effusion acute and subacute necrosis of liver candidiasis of other urogenital sites atrial fibrillation atrial flutter regional enteritis of unspecified site acute respiratory failure iatrogenic pneumothorax pressure ulcer, lower back other and unspecified infection due to central venous catheter staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus ventilator associated pneumonia rhabdomyolysis acute pancreatitis diabetes with ketoacidosis, type i [juvenile type], uncontrolled pressure ulcer, stage ii other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms 

Answer: The patient is high likely exposed to