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: compazine / pepcid / nitroglycerin / dicloxacillin / neurontin / tape / detrol / ambien / methadone attending: chief complaint: altered mental status major surgical or invasive procedure: tee picc placement removal of central catheter history of present illness: 62 y/o female brought in from with altered mental status for one week and six blood cultures growing . at , initially received ertapenum for presumptive uti. urine cultures came back as yeast. blood cultures positive for staph epi and yeast, and so started on fluconazole and vancomycin. later placed on caspofungin for multiple blood cultures with yeast. per patient's husband, for the last week she was hallucinating with visual and tactile hallucinations. pain meds and psychotrophic meds were stopped, without resolution of mental status changes. . in ed, febrile to 101.4, given vanco, levo, flagyl, and ceftriaxone. lp was unsuccessful. . past medical history: 1. mrsa 2. metastatic thyroid ca s/p iodine and xrt and now on synthroid 3. right lower extremity cellulitis 4. nuerogenic bladder: pt self catheterizes 5. chronic low back pain: pt is on continuous morphine pca. 6. depression 7. type 2 dm 8. chronic arachnoiditis 9. esophageal dysmotility 10. dvt and pe s/p placement of ivc filter. felt to be hypercoagulable 11. chronic utis with pseudomonas/klebsiella 12. obstructive sleep apnea 13. osteoarthritis 14. chf now recovered. lvef of 60%. 15. htn 16. anemia of chronic disease 17. right ankle graft 18. seizure 19. s/p klebsiella line infection 20. s/p ercp for retained stone 21. hospitalized at with r thumb/forearm cellulitis s/p several courses of vancomycin 22. splenic cyst 23. osteomyelitis of the right second toe with chronic ulceration s/p distal phalangectomy of the right second toe with ulcer excision 24. peripheral vascular disease 25. squamous cell carcinoma 26. s/p cholecystectomy social history: married. currently residing at after recent hospitalization. cared for by husband at home. pt has one son. worked as a research chemist. no etoh or tobacco use. family history: father has cad, mother with cva physical exam: well appearing white female t 96.4, 156/64, 74, 18, 100 pain: skin: no rashes. heent: perrl. eomi. sclera anicteric. mucous membranes dry. neck: no lad chest: no axillary lad, non erythematous, no rashes. lungs clear. heart: regular rhythm. soft 2/6 systolic murmur at lusb. back: no cva tenderness. abd: scars from prior g tube and ccy. + bs. soft, nt, nd, no suprapubic tenderness. ext: - cce. abscent pulses. neuro: alert. caox3. cn 2-12 intact. motor strength equal and in both upper extremities. pertinent results: 05:39am blood wbc-5.8 rbc-3.53* hgb-10.4* hct-29.6* mcv-84 mch-29.5 mchc-35.2* rdw-17.1* plt ct-371 05:39am blood plt ct-371 05:39am blood urean-14 creat-0.6 na-140 k-4.1 hco3-34* 05:01am blood glucose-204* urean-15 creat-0.7 na-139 k-3.8 cl-100 hco3-33* angap-10 05:39am blood phos-3.5 mg-1.4* 05:39am blood tsh-1.1 05:39am blood t4-pnd free t4-2.2* . us guid for vas. access: 1. successful placement of double-lumen picc line, via a left brachial vein, terminating in the superior vena cava. ready for use. 2. limited venography by hand ejection showing significant narrowing of the left axillary and distal veins, with evidence of collateral circulation. . tte echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr: tip of left-sided picc catheter within distal svc or upper cavoatrial junction. . tee echo: no atrial septal defect is seen by 2d or color doppler. there is symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. no vegetation seen. catheter seen entering right atrium via the svc. the catheter tip visibile in the right atrium near the tricuspid valve (contact with valve notclearly documented). would consider pullback of catheter to ra/svc junction if clinically indicated. brief hospital course: a/p: 62 y/o female with h/o chronic pain with long-term hickman now p/w uti, fungemia, and altered mental status. patient intitially presented to the micu on the , and was transferred to the hospitalist service for further management. . #) septicemia due to infection: improved significantly. likely due to underlying infection ( albicans fungemia) as she has had mental status changes in the past with infections that have resolved once her infection is treated with concern for brain lesions. most metabolic derangements, including uremia and arf, have resolved. tox screen negative. no evidence of seizure. lft's normal. head ct negative x2 for acute processes or masses. lp was unsuccessful and unlikely to be successful given her significant scarring. transiently on precedex with improvement. - caspofungin x14 days, to end on - she currently has a left arm picc. when iv medications are complete, this should be removed. it is strongly recommended by our id consultants that she not have a new central line placed in the near future. in speaking with her pcp (dr. there is no likely immediate need for one. - surgery d/c'd line , tip culture ngtd - ophtho exam showed no eye involvement - chest ct showed multiple nodular paranchymal lesions with tiny cavitations concerning for fungal infection, inflammatory process, or metastatic thyroid ca - pt will require repeat chest ct in 2 months time - tte/tee to eval for vegetation were negative . #) uti - bacterial: neurogenic bladder with intermittent catheterizations. had foley from . u/a on admission was notable for many bacteria, elevated wbcs and small esterase positivity. - changed foley on admission to icu - received cefepime x 3 d given her history of utis with e coli and pseudomonas that have been resistant to bactrim and fluoroquinolones. - urine culture here is negative, but grew yeast at osh. - cefepime d/c'd - patient initially also given vancomycin, which was discontinued due to no bacterial infection found . #) skin lesion: papular nodule on right shin. ddx folliculitis v. metastatic nodule v. skin seeding of fungemia. - derm performed punch biopsy - pathology: -epidermal acanthosis with spongiosis and dyskeratosis (see comment). -no evidence of fungal organisms on pas-d stain. -no evidence of metastatic carcinoma. -multiple tissue levels examined. - will need suture removal . #) thyroid carcinoma: metastatic papillary thyroid ca s/p thyroidectomy + xrt. found to have elevated thyrotropin stimulated thyroglobulin and treated with radioactive iodine in . new lung lesions and rising tsh (was on suppression therapy). endocrine consult believes lung nodules unlikely to be thyroid ca. history of poor absorption. - followed by dr. - endocrine consulted - changed from levothyroxine to levoxyl 150mcg (goal is suppression therapy) - tsh and free t4 were rechecked to assess trend (will require 6-8 weeks on this new regimen to reach steady state) - outpatient endocrine follow up with dr. . #) acute renal failure: -resolved after iv hydration. cr returned to baseline of 0.8-0.9. was likely due to infection, ams and decreased po intake. . #) hypertension - benign: - bps labile, likely due to pain, and narcotics - metoprolol, and clonidine. - the patient is normally on hydralazine, however she has gotten in trouble in the past with concurrent titration of her pain regimen and antihypertensives at the same time. in discussions with her pcp, concurs, and she should have a completely stable pain regimen prior to adding any hypertensives. she has been running in the 150 range when in mild pain - no other change in anti-hypertensives at this time new pain med regimen . #) diabetes, type 2 uncontrolled: - insulin sliding scale - metformin 850 . #) anemia of chronic disease: - known h/o guaiac positive stools that have been evaluated by endoscopy without bleeding source identified (non-bleeding grade ii internal hemorrhoids seen). also with component of anemia of chronic disease. - hct baseline of 30 - follow hct, transfuse 1 unit for syptomatic improvement; otherwise transfuse for hct < 21 . #) h/o dvt/pe: - on warfarin at home for h/o hypercoaguability and h/o dvt and pe. also has ivc filter in place. - warfarin at home dose, follow inr #) back pain - chronic - we started fentanyl patch for our basal rate at 50mcg, then using morphine pca have determined: 1. currently she requires the patch alone while sleeping (reports no pain, and used no pca doses overnight). do not increase the patch if at all possible, as in the past she has gotten in trouble with these increases 2. given her all her breakthrough doses have been during the day, we are adding a low dose sustained-release morphine at 15mg 3. i would strongly recommend that you continue the pca currently to capture further timing data, and that would make a very small increment in her daytime morphine-sr doses (such as to 30 only). i would not add any nighttime meds 4. as she becomes more active she will likely require more daytime coverage, but the nighttime will remain at 50mcg of fentanyl. - i have discussed this regimen with the pcp (dr. who concurrs this is a good plan #) access: left arm picc line #) code: full code. #) contact: (. note: patient requested to be on dr. service at , as he was the original attending on the case medications on admission: caspofungin 50 mg iv qd vanco 1 g (last - trough >20 on ) asa 324 mg daily levothyroxine 200 mcg daily ferrous sulfate 325 mg daily senna 8.6 mg docusate sodium 100 mg dulcolax 10 mg daily lactulose 30 gm daily metformin 850 mg (being held) quinine sulfate 324 mg qhs baclofen 20 mg tid lisinopril 20 mg daily hctz 12.5 mg daily pantoprazole 40 mg daily tizanidine 2 mg daily citalopram 40 mg daily (recently decreased to 20 mg daily) seroquel 75 mg qhs folic acid 1 mg daily amitriptyline 50 mg daily trazodone 100 mg daily morphine 15 mg q6h metoprolol tartrate 50 mg tid hydralazine 50 mg q6h clonidine 0.2 mg patch qweekly(every friday) warfarin 7.5 mg qhs discharge medications: 1. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 3. senna 8.6 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 6. olanzapine 10 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 7. clonidine 0.2 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qthur (every thursday). 8. levothyroxine 100 mcg tablet sig: 1.5 tablets po bid (2 times a day). 9. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). 10. riss riss as per protocol qac/hs 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 12. caspofungin 70 mg recon soln sig: fifty (50) mg intravenous q24h (every 24 hours) for 9 days. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 14. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day). 15. fentanyl 50 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 16. morphine 1 mg/ml syringe sig: 0.5 mg injection every 10 : pca, no basal rate. 17. amitriptyline 50 mg tablet sig: one (1) tablet po hs (at bedtime). 18. metformin 850 mg tablet sig: one (1) tablet po bid (2 times a day). 19. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). 20. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed. discharge disposition: extended care facility: & rehab center - discharge diagnosis: candidemia line infection thyroid ca chronic back pain type ii dm, uncontrolled hx dvt/pe htn discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: - will need suture removal from bx of shin lesion - provider: , md phone: date/time: 1:00 - pt given information from sw on the mind/body institute in , ma re: outpatient emotional support. pt may benefit from sw support at ecf. - provider: , m.d. phone: date/time: 11:00, endocrinology dept, . - provider: , md phone: date/time: 3:15 **pt requesting to be on dr. service at ecf. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart incision with removal of foreign body or device from skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue diagnoses: obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants disseminated candidiasis infection and inflammatory reaction due to other vascular device, implant, and graft lumbago delirium due to conditions classified elsewhere postsurgical hypothyroidism neurogenic bladder nos acquired acanthosis nigricans 

Answer: The patient is high likely exposed to