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: no known allergies / adverse drug reactions attending: chief complaint: confusion, irritability major surgical or invasive procedure: none this hospitalization history of present illness: this is a 70 year-old female with a pmh significant for dementia, prior cva, history of deep venous thromboses, rheumatoid arthritis, hypertension and non-healing lower extremity wound brought in by her daughter for worsening confusion and increased irritability. . in the ed, her daughter noted that her mother appeared more irritable and confused over several days, and that she was 'making no sense'. she also noted right foot ulceration with possible purulent drainage for 1-week (which appeared 4-weeks prior). . of note, the patient was recently evaluated in clinic on . per her daughter's report, she had been doing well until when family members started noticing a significant decline in her memory, as well as irritation, agitation and paranoia. she was diagnosed with probable dementia and started on bnzs along with mirtazapine. she progressed to being unable to care for herself and her daughter brought her to live with her in in (she had been in prior to these). a work-up for reversible causes was reassuring, vitamin b-12, folate, tsh were normal. per the daughter, the daughter reports a leave of absence from work given her mother's full-time needs. she helps to care for her mother in terms of all of her activities of daily living as well as making sure she is safe at home, taking her medication, eating, not wandering outside, etc. she reports that her mother has periods of waxing and where her mental status will seem fairly good and then be quite poor to the point she does not even recognize her daughter. she also has periods of irritation as well as paranoia when she feels that people are stealing her belongings. this information was obtained from dr. clinic noted. . in the ed, initial vs 104.6 120 134/102 22 100% ra. laboratory studies revealed wbc 15.2, neutrophilia 89.9% without bandemia. creatinine 0.8. lactate 2.6. u/a moderately positive. a cxr showed no acute process or focal consolidation. she had evidence of right foot ulceration and drainage and radiographs showed no evidence of infection, just degnerative changes. she was given iv vancomycin 1 gram and ciprofloxacin 400 mg iv x 1 to empirically cover her infectious sources. she received acetaminophen 1000 mg po x 1. she was resuscitated with 1l ns x 2 for presumed sepsis and transferred to the medicine floor. vs prior to transfer 100.8 116/65 97 19 100% ra. . on arrival to the floor, history was difficult to obtain given her dementia. daughter not present. past medical history: past medical & surgical history: 1. rheumatoid arthritis 2. hypertension 3. history of cva 4. history of peptic ulcer disease () 5. history of thrombophlebitis 6. history of hepatitis b - per the patient's family, this was diagnosed in . history of hcv antibody positivity with negative hcv viral pcr. 7. anemia - appears to have both iron deficient and chronic disease 8. non-healing left lower extremity wound 9. cellulitis of the left lower extremity () social history: the patient is a retired pediatric psychiatrist. she is currently living with her son and daughter in . requires assistance with her adls. denies tobacco use or alcohol use; no recreational substance use. family history: her father died of an mi in his 70's. her mother died of ovarian ca. her siblings are healthy. physical exam: admission exam: . vitals: 102.2 151/85 135 32 100% ra general: appears in acute distress, russian-speaking only. alert and interactive, but grasping abdomen in pain with rigors on exam. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes dry. neck: supple without lymphadenopathy. jvd not elevated. cvs: sinus tachycardic with normal rhythm, without murmurs, rubs or gallops. s1 and s2 normal. resp: decreased breath sounds anteriorly bilaterally without adventitious sounds. no wheezing, rhonchi or crackles. stable inspiratory effort. abd: soft, tender diffusely in the epigastrum with voluntary guarding, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. inconclusive sign. extr: no cyanosis, clubbing; trace to 1+ peripheral edema to patellar region; bilateral lower extremity arthritis deformities in her feet; right malleolar ulcer with necrotic debris and granulation tissue; significant dry skin and callus noted; right lower extremity erythema to mid-shin, 2+ peripheral pulses neuro: cn ii-xii intact throughout. strength 5/5 bilaterally, sensation grossly intact. gait deferred. . discharge exam: . vitals: 99.2 97.4 130/60 65 20 98% 2l nc i/os: 560 / 940 | 700 + inc general: appears in no acute distress, russian-speaking only. alert and interactive and not agitated. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes moist. neck: supple without lymphadenopathy. jvd not elevated. cvs: regular rate and rhythm, without murmurs, rubs or gallops. s1 and s2 normal. resp: decreased breath sounds anteriorly bilaterally with only faint inspiratory crackles throughout the lung bases. no wheezing, rhonchi. stable inspiratory effort. abd: soft, non-tender, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. extr: no cyanosis, clubbing; trace to 1+ peripheral edema to patellar region; bilateral lower extremity arthritis deformities in her feet; right malleolar ulcer with necrotic debris and granulation tissue consistent with venous stasis ulcer; right lower extremity erythema to mid-shin, 2+ peripheral pulses, ace wrap in place neuro: cn ii-xii intact throughout. strength 5/5 bilaterally, sensation grossly intact. gait deferred. pertinent results: admission labs: . 02:37pm blood wbc-15.2*# rbc-5.24 hgb-11.9* hct-39.5 mcv-76* mch-22.8* mchc-30.2* rdw-17.2* plt ct-171 02:37pm blood neuts-89.8* lymphs-6.9* monos-3.0 eos-0 baso-0.3 04:26am blood pt-13.8* ptt-31.0 inr(pt)-1.3* 02:37pm blood glucose-138* urean-14 creat-0.8 na-138 k-4.0 cl-101 hco3-22 angap-19 02:37pm blood alt-16 ast-35 ld(ldh)-480* alkphos-119* amylase-66 totbili-0.5 05:24am blood ck-mb-2 ctropnt-<0.01 02:37pm blood lipase-26 02:37pm blood albumin-4.4 calcium-9.4 phos-1.4*# mg-1.9 08:54am blood caltibc-373 ferritn-118 trf-287 05:24am blood vanco-12.7 02:38pm blood lactate-2.6* k-3.7 06:00pm blood type- po2-23* pco2-40 ph-7.36 caltco2-24 base xs--3 . discharge labs: . 06:50am blood wbc-10.1 rbc-4.05* hgb-9.6* hct-29.7* mcv-73* mch-23.6* mchc-32.2 rdw-17.9* plt ct-294 04:26am blood neuts-90.3* lymphs-6.4* monos-2.4 eos-0.6 baso-0.3 06:50am blood glucose-97 urean-13 creat-0.5 na-140 k-4.0 cl-106 hco3-28 angap-10 06:50am blood calcium-8.5 phos-2.3* mg-2.2 . urinalysis: hazy, pos for le, negative for nitr, trace protein, wbc 14 . microbiology data: urine culture - mixed bacterial flora blood culture (x 2) - no growth blood culture (x 2) - no growth mrsa screen - negative legionella antigen - negative c.diff toxin - negative . imaging: ct head w/o contrast - no acute intracranial process. mild age-related atrophy and mild chronic small vessel ischemic disease. . chest (pa & lat) - the heart is mild to moderately enlarged. the mediastinal and hilar contours are unremarkable aside from mild unfolding of the descending thoracic aorta. there is no pleural effusion or pneumothorax. the lungs appear clear. . ankle (ap, mortise & la) - no definite evidence for osteomyelitis, but pes planus with destruction of the subtalar joint effusion, degenerative change, and demineralization, all likely chronic findings. . ct abd & pelvis with co - no intra-abdominal abscess or collection. multiple enlarged right inguinal lymph nodes are likely reactive given patient's history of right foot cellulitis. metallic material noted in the uterus likely representative of an old iud without evidence of fluid collection. tiny bilateral pleural effusions. . cta chest w&w/o c&recon - no definite main, lobar, or proximal segmental pulmonary embolus. multifocal patchy bilateral airspace opacities, right asymmetrically greater than left lung. this may represent multifocal pneumonia or potentially aspiration pneumonia given air space opacity and air bronchograms seen in the superior segments of the lower lobes and also in the posterior right upper lobe. alternatively, though less likely, this could represent a pulmonary edema type pattern. moderate bilateral pleural effusions with adjacent compressive atelectasis. . unilat lower ext veins - no dvt of the visualized veins in the right lower extremity. the right calf veins were not visualized and thus not interrogated. . ct low ext w/o c right - soft tissue thickening and stranding in the right lower extremity, predominantly distally and anterolaterally. this could represent cellulitis in the appropriate clinical setting. no soft tissue foci of gas to suggest fasciitis or abscess formation. no drainable fluid collections. no acute fracture or dislocation. moderate degenerative changes at the medial compartment of the knee and proximal tibiofibular joint. pes planus deformity of the foot with stable marked narrowing and destructive changes at the tibiotalar joint and incompletely seen ankylosis at the subtalar joint. this may represent changes secondary to long-standing rheumatoid arthritis. achilles tendinosis. . 2d-echo - the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 65%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. the left ventricular inflow pattern suggests impaired relaxation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: impression: 70f with a pmh significant for dementia, prior cva, history of deep venous thromboses, rheumatoid arthritis, hypertension and non-healing lower extremity wound brought in by her daughter for worsening confusion and increased irritability found to have multiple sources of infection and presentation concerning for severe sepsis. . # severe sepsis - the patient presented with a few weeks of delirium vs. dementia concerns per her daughter with a progressive decline over several months; this admission with acute irritability and confusion for several days - presenting with fevers, sustained blood pressure, but tachycardia and worsening confusion. she had two apparent infectious sources on admission: right medial malleolar wound with necrotic debris and erythema up to the right patella, and positive ua. cxr negative on admission, and ucx ultimately showed mixed flora. she was initially covered with iv vancomycin and zosyn given her high fevers, tachycardia and confusion, concerning for sepsis. she initially responded to 4l of normal saline for iv fluid resuscitation with adequate uop. podiatry was consulted regarding her foot wound and discussed debridement, but this was ultimately deferred given that acs and vascular surgery felt this was likely venous stasis dermatitis. her wbc on admission was 15 and peaked at 22 with improvement following antibiosis. on , the patient developed refractory svt to the 160s (see below) and hypotension requiring transfer to the micu for neosynephrine and esmolol drips. she also had a new oxygen requirement. svt spontaneously terminated, and the patient was rescuscitated with 2 liters iv normal saline with restoration of normal blood pressure. pressors were successfully weaned within 1 hour of arrival to the micu. given her history of clot burden, a cta chest was performed showing no pulmonary embolus, but evidence of multifocal pneumonia with concern for aspiration was noted. given her clinical worsening, she was empirically covered with linezolid and meropenem for broader empiric coverage of her right lower extremity wound and for multifical pneumonia issues. she transferred back to the medicine floor following hemodynamic stability. her leukocytosis steadily improved and she remained afebrile. she will complete 14-days of linezolid and meropenem (ending ) while at rehab. her luekocytosis normalized on discharge. . # supraventricular tachycardia - the patient developed a slightly irregular svt to the 180-190s associated with hypotension on the am of , concerning for atrial tachycardia with aberrency, refractory to both beta-blockers and adenosine. the most likely etiology was severe sepsis causing metabolic derrangements, given her lack of coronary or structural heart disease and her recent sepsis physiology. pulmonary embolus was considered, but cta chest was reassuring. a low-dose beta-blocker was continued following stability of her tachycardia issues. . # dementia vs. delirium - recently seen by dr. in gerontology clinic given moderately-progressive decline in mental status with concern for dementia. a reversible work-up with tsh, b12 and folate levels were reassuring. ct head imaging was without acute intracranial process from and showed mild age-related atrophy and mild chronic small vessel ischemic disease. she had no notable neurologic deficits on exams, nor did she in clinic. delirium was considered more likely given her waxing and status. a u/a obtained in clinic did show some evidence of early urinary tract infection. lorazepam was recently discontinued in clinic, although resperidone was continued as it was thought to control her symptoms well. a component of pseudo-dementia or depression was also considered. vascular dementia is possible given her prior cva history, although no new neurologic deficits have been noted. alzheimer's dementia or body dementia have also been considered. her acute decompensation has almost certainly been attributed to her sepsis on admission and concern for multiple sources of infection. she was switched to seroquel, in lieu of risperidone, this admission. her qtc was monitored given her antipsychotic needs, and was reassuring. she tolerating evening seroquel without issue. . # rheumatoid arthritis - known diagnosis of rheumatoid arthritis (diagnosed 20 years prior in ). patient received methrotrexate for 20-years and was treated with remicade from -. she has some swelling of her bilateral mcp joints at baseline. had been on sulfasalazine as well. now managed on ibuprofen only for pain control, no immune modulator therapy. we discontinued nsaids for her arthritic pain and utilized standing tylenol. . # hypertension - history of hypertension, recent omr notes reveal a blood pressure in the 136/70 range. not currently on anti-hypertensives. no evidence of chronic renal failure. . transition of care issues: 1. will complete treatment with broad-spectrum empiric antibiotic coverage given aspiration vs. community acquired icu pneumonia and right lower extremity infection. linezolid and meropenem for 14-days (ending ). 2. we discontinued mirtazapine and risperidone and she will be maintained on an evening dose of seroquel. we avoided deliriogenic medications, especially benzodiazepines. 3. continue low-dose beta-blocker given recent atrial tachycardia issues in the setting of infection. taper dose as needed once infection resolves. 4. needs follow-up with rehab infectious disease specialist, , md and infectious sources. medications on admission: home medications (confirmed with daughter, records) 1. ibuprofen 400 mg po bid 2. mirtazapine 7.5 mg po qhs 3. risperidone 0.25 mg po bid (liquid formulation) discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 2. quetiapine 25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)): at 1800 . 3. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for fever or pain. 4. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 5. linezolid 600 mg/300 ml parenteral solution sig: six hundred (600) mg intravenous q12h (every 12 hours) for 14 days: started , ending . 6. meropenem 1 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 14 days: started , ending . discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: 1. severe sepsis (presumed sources: right lower extremity wound, multifocal pneumonia) 2. supraventricular tachyarrhythmia 3. acute delirium . secondary diagnoses: 1. dementia 2. hypertension 3. rheumatoid arthritis discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: patient discharge instructions: . you were admitted to the internal medicine service at on cc7 regarding management of your multiple sources of infection and worsening confusion and delirium. you were treated with broad-spectrum and volume resuscitation, which resulted in improvement in your clinical status. you required a brief medical icu stay for tachycardia which improved with treatment of your underlying infection. your right foot wound and pneumonia were the presumed sources of infection. you will continue with 14-days total of iv . you were improved following discharge and stable for discharge to a rehabilitation facility. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * you have pain that is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: . * upon admission, we added: start: seroquel 12.5 mg by mouth in the evening (at 18:00) start: linezolid 600 mg iv every 12-hours for 14-days total (started , ending ) start: meropenem 1 gram iv every 8-hours for 14-days (started , ending ) start: metoprolol 25 mg by mouth three times daily start: acetaminophen 325-650 mg by mouth every 4-6 hours as needed for pain . * the following medications were discontinued on admission and you should not resume: discontinue: mirtazapine discontinue: ibuprofen discontinue: risperidone . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: department: gerontology when: monday at 10:30 am with: , md building: lm campus: west best parking: garage . department: senior health when: thursday at 2:00 pm with: maibor building: lm campus: west best parking: garage procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified hypocalcemia urinary tract infection, site not specified unspecified essential hypertension unspecified septicemia severe sepsis hypopotassemia other specified cardiac dysrhythmias cellulitis and abscess of leg, except foot septic shock iron deficiency anemia, unspecified rheumatoid arthritis personal history of venous thrombosis and embolism personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta other alteration of consciousness venous (peripheral) insufficiency, unspecified ulcer of ankle dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to