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: aspirin / percocet / codeine / nutren pulmonary / zosyn attending: chief complaint: hypoglycemia major surgical or invasive procedure: none history of present illness: 85yow with h/o asthma, htn, pvd, copd, and mat, recently admitted to /06 for sepsis in the setting of pneumonia and uti, and was also treated for decompensated diastolic chf, referred from rehab for concern of acute renal failure. she had been discharged on vancomycin and meropenem, with course due to complete on . today at rehab her labs returned with a creatinine of 6.7 and 6.6. on arrival to the ed vs t 99.9 hr 107 bp 130/92 rr 16 97%on 2lnc. in the ed patient's creatinine was at baseline 1.5, however, she became acutely hypotensive with sbp in the 90s, going as low as 80/37. she was also noted to have a t of 100.8r and fs of 23 with lethargy. she was treated with 2 amps d50, 1l ns iv fluids, and admitted. lactate was not elevated. she was also given levofloxacin 500mg iv x1. on presentation now she denies having headache, chest pain, sob, abdominal pain, nausea, diarrhea, or dysuria. she continues to have a non-productive cough, which she has had since her illness developed. she does not take anything by mouth and has had a peg for 3-4months for feeding and medication administration. past medical history: 1)asthma > 5 hospitalization with no history of intubations. she has been on steroids since the beginning of . prior to this, she had been steroid free for the past 2 years. recent hospitalization with intubation complicated by mrsa pneumonia, d/c on to rehab, rehospitalized in early )hypertension. 3)steroid induced hyperglycemia. discharged on insulin following her admission. 4)peripheral vascular disease, status post left fem-peroneal bypass in 5)multi-focal bacterial pneumonia. 6)chronic obstructive pulmonary disease- pft - fvc 61% pred, fev1 56% pred, fev1/fvc 92%, reduced fvc related to gas trapping, ~400 cc worse than pft from one year ago. 7)multi-focal atrial tachycardia. 8)oral thrush. 9)question left hilar mass. 10)mult aspirations in past requiring now being on feeding tube 11)hx. mrsa pna 12) bell's palsy 13) uti 14) gib social history: denies history of smoking. only social alcohol, ~3 drinks /week. no other drug use. widowed, with 3 children and 8 grandchildren. family history: asthma in her father physical exam: pe: t 97.1 hr 88 bp 144/82 rr 28 100%nrb; 97%2lnc gen: lying at 30degrees, speaking full sentences, alert and oriented, nad heent: right facial droop, perrl, surgical pupils bilaterally, op clear with dry mm neck: supple, no lad, jvp 9cm, soft tissue swelling bilaterally supraclavicular cv: pmi nondisplaced, rrr, no mrg resp: coarse bilaterally with coarse crackles throughout and occasional bilateral wheeze, decreased at bases bilaterally abd: +bs, soft, nt, nd, peg in place c/d/i ext: no edema, echymoses, anterior skin tears, 1+ dps bilaterally symmetric neuro: a&ox3, cn ii-xii intact with exception of right facial droop, strength 5/5 bue, lle, r hip flexor, 3+/5 r foot dorsi/plantar flexion. coordination intact ftn bilaterally with slow deliberate movement. sensation intact to fine touch in the bue/ble skin: pressure sores on sacrum. skin tears on anterior ble pertinent results: admission labs : blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg . glucose-30* urea n-97* creat-1.5* sodium-136 potassium-5.4* chloride-100 total co2-26 anion gap-15 . wbc-10.1# rbc-3.33* hgb-10.9* hct-33.0* mcv-99* mch-32.7* mchc-32.9 rdw-18.3* plt count-323 neuts-74* bands-0 lymphs-11* monos-13* eos-2 basos-0 atyps-0 metas-0 myelos-0 . cxr pa and lat admission: impression: partial interval clearing of known left lower lung lobe consolidation. . lenis : no evidence of dvt. . cxr : impression: ap chest compared to : mild pulmonary edema which is new. there is also recurrence of consolidation at both lung bases which could be atelectasis or increasing moderate bilateral pleural effusion, but raises concern for pneumonia. heart is partially obscured by elevated left hemidiaphragm but does not appear grossly enlarged. tip of left pic catheter projects over the junction of the brachiocephalic veins. rightward displacement of the trachea at the level of the aortic arch is due to tortuous head and neck vessels as demonstrated by the ct of the chest on . . chest ct : 1. as previously mentioned there is limited assessment for hilar mass due to absence of intravenous contrast. if there is a contraindication to iodinated contrast, the mri of the chest should be considered or a gadolinium injection in conjunction with chest ct. 2. worsening of left lower lobe atelectasis and development of new scattered nodules and small areas of consolidation is highly suspicious for recurrent aspirations. infectious etiology is superimposed on the recurrent aspirations cannot be excluded. 3. small amount of ascites, unchanged. . brief hospital course: a/p: 85yow with h/o copd/asthma, recurrent aspiration pnas (s/p g-tube placement), mat, htn, pvd, with recent admit for sepsis in the setting of lll pneumonia (mrsa by bal) and uti (resistant pseudomonas), returned to hospital with hypoglycemia, transferred to the icu for recurrent episodes of hypoxemia, likely secondary to mucous plugging/aspiration. . # hypoxia: on the floor prior to micu transfer, patient had 4 episodes over 72 hours of acute desaturation to 70-80's. during these episodes she has become tachycardic to 120's and sbp has dropped to 90's (diastolic chf). she generally improves fairly quickly to mid to upper 90's with supplemental oxygen (nc, face mask, nrb). triggers have included ?blood transfusion (determined not to have been transfusion reaction) and pulmonary toilet. these have occurred in the setting of intermittent low grade fevers (99-101). ekgs are unchanged and lenis negative making ischemic or pulmonary embolis less likely. acute event precipitating transfer likely mucus plugging and/or aspiration, on top of poor lung function at baseline from aspiration pna and lll collapse. sputum from grew pseudomonas sensitive to zosyn and mrsa and vanco, cipro, flagyl changed to zosyn, vanco. likely contribution of underlying pneumonia. she was stable on 40% high flow o2 for most of her micu stay with persistent intermittent desaturations to high 80s with subjective sob. o2 sats improve with suctioning, aggressive chest pt, nebulizers, and increase in fio2. following improvement, she was quickly able to return to 40% o2. she was quite deconditioned and was unable to clear her secretions which was believed to have a significant contribution to desaturations. also possible contribution of volume overload and was treated with diuresis. she was otherwise managed with advair, tiotropium, around the clock albuterol/atrovent nebs, as well as prn albuterol nebs. she completed a 14 day course of vancomycin on . repeat sputum cultures showed rare gnrs. she was continued on zosyn to complete a 14 day course. she was evaluated by interventional pulmonology for possible mini-trach to aid in suctioning which the patient declined. however, her oxygen requirement and secretions improved substantially. at the time of discharge she had been stable on nasal cannula, had not required deep suctioning in 3 days, and had no increased work of breathing. . # fever: patient had low grade fevers since admission, without leukocytosis or left shift. ddx was infection, atelectasis, and much less likely malignancy. possible sources of infection included ?pna, candidal infection (oral thrush, groin candidiasis and urinary yeast infection), picc line infection, g-tube infection, skin wounds. pseudomonas uti was panresistant including resistance to meropenem. however, patient was treated with meropenem with hope that high concentration in urine would be adequate to eradicate infection and when admitted with low grade fevers, no leukocytosis, and no left shift, she had a clean ua and improved cxr. she finished her 14 day course of vancomycin (for mrsa pna) and meropenem (for pseudomonas uti) on and they were discontinued on in the am. on evening of she had temp to 100.3 during transfusion and cxr had ?rll consolidation. she was restarted on tx for mrsa/asp pna. sputum culture grew mrsa and pseudomonas and was treated with zosyn and vanco as above. urine, stool, and blood cultures were all negative throughout admission. she was afebrile at the time of discharge off of all antibiotics. . # asthma/copd: she has distant smoking history with severe reactive disease. had persistent diffuse wheezing throughout admission. likely exacerbated by pneumonia. she was managed with advair, tiotropium, albuterol, and atrovent as above as well as a steroid taper. she had received a 10 day taper of steroids with her last dose of prednisone on , but steroids were again restarted as she was more bronchspastic. she was initially restarted on methylprednisolone 20 mg iv q8h which was then changed to 40 mg po prednisone. she completed 1 week of 40 mg prednisone which was then decreased to 30 mg daily. she was discharged to complete a slow steroid taper. . # mat: patient with history of mat, who came in not on a rate controlling but has been controlled on diltiazem in the past. during recent admissions she has been on 30mg qid but in notes was on as high a dose as 90 qid. patient has had several episodes of tachycardia during hospitalization, especially during hypoxemia. ekgs have all shown mat with ivcd but no st-changes. she received diltiazem with minimal response and was changed to verapamil. verapamil was slowly uptitrated with improvement in her tachycardia. beta blockers were avoided in setting of severe lung disease. . # renal failure: creatinine has been consistently elevated on her multiple recent admissions and may reflect a new baseline for her; appears to be 1.3-1.4. her creatinine was slightly elevated throughout admission but was otherwise stable. she did have one jump in her creatinine thought to be secondary to overdiuresis and then came back down with stoppage of her lasix. however, she did havea significant increase in her bun of unknown etiology. her standing lasix dose was stopped with concern for overdiuresis. . # anemia: anemic at baseline, most recently hct running 29-32 and was stable at her baseline throughout admission. . # chf: diastolic dysfunction on recent echo. possibly contributing to sob. her hr was managed with diltiazem and then verapamil as above. . # eosinophilia: possible drug reaction. began trending downward (11->9->8.2->7.1) on . did improve off zosyn, but no other signs of reaction to zosyn and seemed to start prior to zosyn being started. she tolerated reinitiation of zosyn without trouble. eosinophils normalized without issue and remained normal for the remainder of her admission. . # steroid-induced diabetes: patient's blood sugars are very sensitive to steroids. she was discharged on a steroid taper and standing long acting insulin. patient developed hypoglycemia as reason for admission in setting of not being on steroids, standing insulin and having delays in her tube feeds. on admission we discontinued her admission glargine 22u. however, bgs increased with restart of steroids and lantus was restarted and slowly uptitrated to obtain optimal bg control with levels<150. . # hilar mass: seen on numerous non-contrast chest ct, not yet characterized with contrast ct given poor renal function. will need biopsy once more stable and possible pet. . # decubitus and stasis ulcer: managed per wound care recs. . # fen: strict npo given history of aspiration. probalance full strength; goal rate: 50 ml/hr . # code status: full code . # contacts: daughter medications on admission: mvi liquid colace syrup 60mg daily advair 250/50 inh tiotropuim 1cap inh daily prevacid 30mg daily singulair 10mg daily lasix 60mg daily meropenem 500mg iv bid vancomycin 1g iv qod neurontin 300mg daily lidoderm tp to right inner thigh, 12hr on/off lantus 22units qhs atrovent nebs tid tylenol prn milk of mag prn dulcolax prn mylanta prn trazodone 50mg qhs prn sleeplessness ambien 10mg prn sleeplessness fibersource hn 50ml/hr continuous; flush with 100ml q8hr discharge medications: 1. gabapentin 300 mg capsule : one (1) capsule po hs (at bedtime). 2. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 3. docusate sodium 150 mg/15 ml liquid : fifteen (15) po bid (2 times a day). 4. fexofenadine 60 mg tablet : one (1) tablet po once a day. 5. montelukast 10 mg tablet : one (1) tablet po daily (daily). 6. prevacid 30 mg susp,delayed release for recon : one (1) po once a day. 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily): 12 hours on/off. 8. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed for sob, wheezing. 9. albuterol sulfate 0.083 % solution : one (1) inhalation every 4-6 hours as needed for sob, wheezing. 10. fluticasone-salmeterol 500-50 mcg/dose disk with device : one (1) puff inhalation twice a day. 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 12. verapamil 40 mg tablet : one y (140) mg po q8h (every 8 hours). 13. nitroglycerin 0.3 mg tablet, sublingual : one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 14. zolpidem 5 mg tablet : one (1) tablet po hs (at bedtime) as needed. 15. insulin glargine 100 unit/ml solution : fourteen (14) units subcutaneous at bedtime. 16. prednisone 10 mg tablet : three (3) tablet po daily (daily): take 3 tablets once daily for one week, followed by 2 tablets daily for one week, followed by one tablet daily continuously until you see your pulmonologist. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: hyperkalemia hypovolemia secondary: resolving pseudomonal uti (from last admission) resolving mrsa pneumonia (from last admission) discharge condition: stable. satting fine on nasal canula discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500ml per day. . you came back into the hospital with dehydration, low blood sugars and an elevated potasium. we rehydrated you and adjusted your insulin and tube feeds. . we changed your furosemide back to 40mg every day. please weigh yourself daily. if you gain 2 or more pounds, please take an extra 40mg dose of furosemide and check your weight again in the morning. repeat this for one day, then call a physician. followup instructions: please follow up with the physicians at the rehab. . please follow up with your pcp in the next 1-2 weeks. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: hyperpotassemia anemia, unspecified long-term (current) use of steroids other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified infection with microorganisms resistant to penicillins candidiasis of mouth chronic kidney disease, unspecified pulmonary collapse acute and chronic respiratory failure other specified cardiac dysrhythmias pneumonia due to pseudomonas long-term (current) use of insulin methicillin susceptible pneumonia due to staphylococcus aureus chronic obstructive asthma with (acute) exacerbation acute diastolic heart failure hypovolemia candidiasis of skin and nails foreign body in larynx swelling, mass, or lump in chest inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation ulcer of calf herpes zoster without mention of complication 

Answer: The patient is high likely exposed to