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: quinolones / vancomycin analogues / levaquin attending: chief complaint: dyspnea major surgical or invasive procedure: picc placed by ir, replaced percutaneous cholecystostomy history of present illness: 80yo female with multiple medical problems including copd, cad s/p stent, stage 1 breast cancer s/p mastectomy, and colon cancer s/p colectomy was admitted with dyspnea. she is being followed in infectious disease clinic for pulmonary aspergillus infection and mycobacterium abscessus. upon presentation to clinic, she was noted to have persistent productive cough with sputum production and decreased energy. exam in clinic was notable for bp 80/45. she was then referred to the ed for further evaluation. upon arrival in the ed, temp 98.3, hr 82, bp 92/42, rr 19, and pulse ox 92%. labs revealed cr 2, alk phos 216, and hct 31.1. ruq us was notable for gallstone at the neck of the gallbladder and ct abd/pelvis revealed rll aspiration, distended gallbladder, ectactic infrarenal aorta, and diverticulosis. cxr revealed likely rll pneumonia. surgery was consulted for evaluation of the cholelithiasis and imaging findings. given that she is not having abdominal pain, they thought she did not have any clinical signs of cholecystitis. if she did develop clinical signs of cholecystitis, they recommended hida scan and consideration of percutaneous cholecystostomy tube. she was started on broad-spectrum coverage for hospital-acquired pneumonia with linezolid, zosyn, and clindamycin. review of systems: (+) per hpi. shortness of breath, productive cough, fatigue, decreased energy (-) denies pain, fever, chills, night sweats, weight loss, headache, sinus tenderness, rhinorrhea, chest pain or tightness, palpitations, nausea, vomiting, constipation, abdominal pain, change in bladder habits, dysuria, arthralgias, or myalgias. past medical history: 1. copd 2. gerd 3. coronary artery disease s/p stent placement 4. breast cancer s/p mastectomy 5. colon cancer s/p colectomy 6. h/o lle dvt 7. hypertension 8. hyperlipidemia 9. pulmonary aspergillosis 10. mycobacterial pulmonary abscessus - not currently undergoing therapy social history: home: lives in nursing home since occupation: retired, former hairdresser etoh: denies drugs: denies tobacco: 60 ppy smoking history, quit > 15 years ago family history: nc physical exam: exam on admission to micu : vs: 88 106/40 17 98% 2lnc gen: elderly lady, comfortable appearing. skin: no pressure ulcers heent: no jvd, neck supple, no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. chest: basilar crackles and diffuse scant rhonchi cardiac: s1&s2 regular without murmur abdomen: nontender, non distended, (-) sign extremities: peripheral edema to mid calf, warm without cyanosis neurologic: aaox3 but definite cognitive deficits. cn ii-xii grossly intact. exam on transfer to floor : vitals: t: 95.6 ax bp: 112/56 p: 78 r: 16 o2: 100% 2l nc general: oriented x3 (name, in hospital (), date), no acute distress, cooperative heent: sclera anicteric, dry mm neck: supple, jvp not elevated, no lad lungs: no supraclavicular or subcostal retractions, diffuse ronchi bilaterally, no wheezes or rales 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, negative sign gu: foley with clear yellow urine ext: extremities cool, 1+ pitting edema, pt dopplerable, unable to find dp by doppler, no evidence of infection neuro: cn ii-xii intact, 5/5 strength in ue and le bilaterally, sensation intact and symmetric bilaterally exam on discharge *** pertinent results: labs on admission : wbc-8.6 rbc-3.42* hgb-9.5* hct-31.1* mcv-91 mch-27.8 mchc-30.6* rdw-14.5 plt ct-172 neuts-79.1* lymphs-11.4* monos-5.9 eos-3.2 baso-0.4 pt-12.4 ptt-30.5 inr(pt)-1.0 glucose-80 urean-31* creat-2.0* na-140 k-3.6 cl-104 hco3-22 angap-18 alt-12 ast-25 ck(cpk)-29 alkphos-216* totbili-0.2 lipase-22 calcium-7.4* phos-3.3 mg-1.6 baseline cr 0.8-1.2 (most recently 1.2 on ) baseline hct ~30 other labs: iron studies caltibc-122* ferritn-127 trf-94* triglyc-166* cortsol-8.7 phenyto-12.0 levetiracetam (keppra)- pending **** voriconazole- pending - to be followed up in clinic labs on discharge *** micro: bcx no growth sputum contaminated bcx ngtd pleural fluid: gram stain negative; cultures ngtd bile culture: fluid culture: yeast, presumptively not c. albicans. sparse growth. anaerobic culture (preliminary): no anaerobes isolated. bronchial washings - aspergillus, mycobacterial abscess studies: ruq us - prelim report - markedly distended gallbladder, impacted gallstone in neck, no gallbladder wall thickening, no pericholecystic fluid, common duct is not dilated, pancreas not well-visualized, no son sign ct abd/pelvis - prelim report - trace rll aspiration. distended gb- correlate clinically or with us. ectatic infrarenal ao- 2.4 cm. colonic tics, constipation. old l post rib fx, djd. cxr - prelim report - stable rul lobectomy, lungs are clear, trace right pleural effusion, left axillary clips hida: the findings are consistent with acute cholecystitis, however the accuracy of the test is diminished as the patient has been npo for several days. ct chest w/o contrast: 1. interval increase of bilateral pleural effusions, with an atelectatic right lung. multifocal consolidation opacities in the right lung, likely combination of bronchovascular crowding, atelectasis and/or multifocal pneumonia. mucous plugs in the right-sided bronchi, compatible and concerning for aspergillus pneumonia. 2. unchanged right bronchostenosis, incompletely assessed in the current study. cxr: as compared to the previous radiograph, there is a decrease in the volume of the post-surgical right lung. a small right pleural effusion has newly occurred. there is a small retrocardiac atelectasis. otherwise, the left lung is unremarkable. normal size of the cardiac silhouette. unchanged position of the left axillary and right paramediastinal clips. hida (repeat): non diagnostic (incomplete) gallbladder scan due to patient refusal to allow completion of exam. the gallbladder did not fill over 36 minutes, but the lack of full imaging does not allow confident diagnosis of acute cholecystitis. r leni: no dvt echo (tte): very suboptimal image quality.the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is moderate global left ventricular hypokinesis (lvef = 35-40 %) - apex appears to contract better than the base. the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mitral regurgitation is present but cannot be quantified. tricuspid regurgitation is present but cannot be quantified. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion brief hospital course: 80-year-old woman with pulmonary aspergillosis, pulmonary mycobacterium abscessus, admitted to the icu with borderline hypotension initially with concern for cholecystitis. . in the micu, hida scan demonstrated distended gallbladder without classic evidence of cholecystitis. the icu team her nausea may have been related to secretions. she had lots of secretions, cough and chest imaging studies revealed likely post-obstructive pneumonia and bilateral pleural effusions. patient was treated with linezolid (allergy to vancomycin), piperacillin-tazobactam, and was continued on the voriconazole that she had been taking at home. microbiologic data was unremarkable. she underwent a left-sided thoracentesis on with improvement of lung volume on the left and improvement of breathing. she also received frequent nebulizers and chest pt given secretions. there was no evidence of chf. her hypotension resolved with ivfs. the etiology was likely multifactorial: hypovolemia from poor po intake, pneumonia, cholecystitis. atenolol held in setting of hypotension and she was restarted on metoprolol in icu. her chronic pain meds were held due to hypotension and her pain was controlled on tylenol. she has a history of steroid use which was stopped in the icu because it is unclear why patient was on prednisone (per omr ip note, pt should've tapered off by this point); no evidence of adrenal insufficiency noted on random cortisol testing. she had on admission which also improved with ivf and lasix and lisionpril were held. on transfer to the floor, she was stable on o2 2l nc (home oxygen requirement 2l nc). . floor course: #. hypotension: on the floor, pt's bp remained stable 100-130s off anti-hypertensives. given poor po intake, she was continued on maintenance fluids. anti-hypertensives were held. she was converted back to po intake, but would repeatedly become hypotensive when diuresis was attempted with iv lasix. she did better with po lasix 20mg every day. she was discharged back on low doses of metoprolol succinate and lisinopril with stable systolic blood pressures around 100 to 110. . # delirium - after transfer from the icu, pt became progressively delirious despite being at baseline respiratory status. likely due to cholecystitis as her mental status improved s/p percutaneous cholecystostomy placement. all sedating meds stopped. pain controlled with lidoderm and tylenol. geriatrics was consulted to assist with medication regimen given that she was taking a number of sedating medications on admission and her keppra level was 58 two days prior to admission. they contact her outpatient neurologist who recommended having her on keppra monotherapy alone. her keppra levels should be checked regularly to ensure that she does not have a return to possibly toxic levels. . # right leg pain - pt complained right thigh pain which was likely msk as it improved with palpation. leni negative for dvt. also possibly peripheral vascular disease as pt has cool extremities from calf to feet and pain slightly decreased when pt dropped leg over side of bed. pain controlled with tylenol. . # cholecystitis- surgery saw pt and due to concern for cholecystitis, hida done, which was indeterminant. pt underwent repeat hida but refused to continue after partically completed. per surgery, second hida and intermittent ruq pain was still concerning for cholecystitis even though pt has no fever or leukocytosis. perc cholecystostomy tube placed by us on . bile cultures were negative but pt had been on antibiotics. she was continued on zosyn for a total of 2 weeks, ending . her tube should stay in place for a total of 4 to 6 weeks or until it stops draining, whichever comes first. it can then be removed by any physician. . #. multiple pulmonary infections: the patient has been getting ongoing treatment though id for pulmonary aspergillosis & m. abscessus and was found to have post-obstructive pneumonia on chest imaging. on the floor, her respiratory status remained at baseline and she was comfortable on 2l nc (home o2 2l nc). pleural effusions were transudative, possibly due to fluid resuscitation in micu. she was treated with linezolid for 10 days for pneumonia, zosyn for 14 days for pneumonia and cholecystitis, voriconazole on an ongoing basis for aspergillosis. she was given frequent nebulizers (albuterol, ipratropium and acetylcysteine) and chest pt. . #. congestive heart failure: the patient had large pleural effusions after fluid resuscitation in the icu. an echocardiogram showed an ef of 35-40% with focal hypokinesis. it was initially very difficult to diuresis her as she became repeatedly hypotensive. interventional pulmonary did not want to drain her effusion a second time because they felt it would likely recur, and she should be diuresed instead. after she stabilized, she was started on low-dose ace-i and beta blocker, and was able to tolerated 20mg of po lasix daily. she should have a repeat cxr and ett once she is stabilized to reassess her contractile function and the extent of her pleural effusions, as her decreased ef may have been due to hypotension or acute illness. . # nutrition - pt with poor po intake which may have contributed to her hypotension. nutrition was consulted. given her need to be npo due to cholecystitis and concern for aspiration, she received intermittent tpn. she had a video swallow study which did not show signs of aspiration. however, she requires 1:1 assist with eating as she does not eat on her own. she was discharged with diet of mechanical soft solids and thin liquids. . # anemia - hct remained stable at approximately 25-28 but was slightly lower than baseline (~30). stools were guaiac negative. iron studies suggested anemia of chronic disease, which is conisistent with pt's chronic infections. . #. chronic pain: per report, pt's back pain was increasing during week prior to admission. on her admission medication list were a number of narcotics. per her son, she was less lucid/more confused on phone when talking to him prior to admission. in the hospital, her pain was well controlled on standing tylenol and lidocaine patch. it is highly recommended that pt not receive narcotics as outpatient as they make her very confused. . #. hypothyroidism: continued on levothyroxine . #. hyperlipidemia: continued on statin . code: she is full code, as confirmed with her and her son. she would like all treatments in the acute setting, but would not like prolonged life-support if she were to become critically ill. . communication: patient, son medications on admission: (confirmed on day after arrival to floor () with rehab records in chart) nitro patch (0.1mg/hr) q24h kcl 10meq daily spiriva 1 cap daily semprex-d (pseudoephedrine/antihistamine) motrin 400mg tid with meals vitamin d3 50k iu qmonth multivitamin daily calcium carbonate 500mg tid mintox (gi cocktail) prn comapzine prn baclofen 5mg tid prn back spasm oxycodone 5mg q6h prn protein powder with each meal cefpodoxime 14 day course finished nitro tab prn milk of magnesia prn natural tears prn vitamin b12 1ml qmonth sc fentanyl patch 25mcg q72h atenolol 12.5mg daily lasix 20mg daily aspirin 81 mg po/ng daily @ 2238 view omeprazole 40 mg po daily lidocaine 5% patch 1 ptch td daily to back 12 hours on, 12 hours off acetylcysteine 20% 0.5 ml neb q8h 0.5 ml via nebulizer three times a day at 06am, 12 pm and 6 pm polyethylene glycol 17 g po/ng daily:prn constipation senna 1 tab po/ng :prn constipation guaifenesin ml po/ng q6h:prn cough bisacodyl 10 mg po/pr daily:prn constipation docusate sodium 100 mg po bid phenytoin infatab 75 mg po/ng levothyroxine sodium 50 mcg po/ng daily folic acid 1 mg po/ng daily atorvastatin 20 mg po/ng hs benzonatate 100mg po tid duoneb0.5-3.0mg solution per nebulizer qid beer 12oz qpm as needed (has not received) discharge medications: 1. oxygen oxygen 2l/min at all times. 2. atorvastatin 20 mg tablet : one (1) tablet po hs (at bedtime). 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 4. lisinopril 5 mg tablet : one (1) tablet po daily (daily). 5. levetiracetam 500 mg tablet : one (1) tablet po bid (2 times a day). 6. levothyroxine 50 mcg tablet : one (1) tablet po daily (daily). 7. voriconazole 200 mg tablet : 1.5 tablets po q12h (every 12 hours). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily). 10. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 11. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 12. ipratropium bromide 0.02 % solution : one (1) treatment inhalation q6h (every 6 hours). 13. levalbuterol hcl 0.63 mg/3 ml solution for nebulization : one (1) treatment inhalation q6h (every 6 hours) as needed for shortness of breath/weezing. 14. acetylcysteine 20 % (200 mg/ml) solution : 0.5 ml miscellaneous three times a day: give at 6am, 12pm and 6pm. 15. furosemide 20 mg tablet : one (1) tablet po daily (daily). 16. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 17. metoprolol succinate 25 mg tablet sustained release 24 hr : one (1) tablet sustained release 24 hr po once a day. discharge disposition: extended care facility: nursing home - discharge diagnosis: primary diagnoses: acute cholecystitis acute on chronic systolic heart failure bronchial stenosis post-obstructive pneumonia hypotension delirium poor nutrition anemia secondary diagnoses: h/o cva chronic pain pulmonary aspergillosis mycoplasma abscessus discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: out of bed with assistance to chair or wheelchair discharge instructions: ms. , you were admitted to because your blood pressure was low during your visit to your infectious disease doctor. your blood pressure improved with fluids. you were treated for a pneumonia and a gallbladder infection with antibiotics. a tube was placed in your gallbladder to help drain the infection. you were confused, likely due to your infection and medications you were receiving. geriatrics at made changes to your medication regimen. many changes were made to your medications. only take the medications that are on your discharge papers from this hospitalization. stop all medications that are not listed on your discharge medication list as many of them make you confused. the drain in place to drain your gall bladder infection should stay in place for a total of 4 to 6 weeks or until it stops draining, whichever comes first. it can then be removed by any one of your doctors. followup instructions: you will be seen by your primary care doctor at your rehab facility. please follow-up with your infectious disease doctor, dr. , , :30am. provider: scan phone: date/time: 8:30 cc clinical center, provider: clinic interventional pulmonary (sb) phone: date/time: 11:00 de building ( complex), procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances thoracentesis percutaneous aspiration of gallbladder injection or infusion of oxazolidinone class of antibiotics diagnoses: acidosis anemia of other chronic disease other chronic pain coronary atherosclerosis of native coronary artery esophageal reflux unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of bronchus and lung personal history of malignant neoplasm of breast peripheral vascular disease, unspecified personal history of tobacco use percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia acute respiratory failure personal history of malignant neoplasm of large intestine personal history of venous thrombosis and embolism personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hyperosmolality and/or hypernatremia delirium due to conditions classified elsewhere calculus of gallbladder with acute cholecystitis, without mention of obstruction aspergillosis pneumonia in aspergillosis other diseases of trachea and bronchus acute on chronic combined systolic and diastolic heart failure acquired absence of breast and nipple dysphagia, oropharyngeal phase personal history of methicillin resistant staphylococcus aureus malnutrition of moderate degree acquired absence of intestine (large) (small) acquired absence of organ, lung pulmonary diseases due to other mycobacteria 

Answer: The patient is high likely exposed to