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 attending: chief complaint: fever, hypotension major surgical or invasive procedure: picc line placement intubation and extubation bronchoscopy history of present illness: this is a 30 year-old female with a history of spina bidifida, suprapubic catheter, recurrent utis who presents with fever, hypotension and mental status changes. per report, patient was found unconscious one day pta in on her wheelchair and was brought in by ambulance. patient reports that she had had 5 drinks prior to this episode. she denies any other substance use at the time. her main complaint is back pain that she says has never really gotten much better compared with her prior admission. she denied any symptoms that typically occur for her vp shunt if it has a problem, such as headache, nausea, or vomitting. . of note, patient was recently discharged after an admission for back pain and fevers. she was treated with a 5-day course of ceftriaxone for presumed complicated urinary tract infection. . in the ed, patient was febrile to 102, with a blood pressure of 96/50, and tachycardic to 129, o2sat:96% on ra. she received 4 litres normal saline iv fluids for tachycardia and borderline low-blood pressure, and was given 1 gram of ceftriaxone and 1 gram of vancomycin after blood and urine cultures were sent. she also received lorazepam and haloperidol for agitation on initial presentation. later in the ed course, patient was given total of 25mg diazepam iv for concern that tachycardia was related to etoh withdrawal. the tachycardia did not improve substantially. past medical history: pmh: 1. spinabifida with hydrocephalus, vp shunt, chiari malformation 2. seizures ? 3. utis/pyelonephritis with suprapubic cath 4. ovarian cysts 5. sacral decubitus ulcer 6. atypical chest pain 7. hx of pe with vena cava filter social history: the patient current lives with her mother and cousin in who help her with her activities of daily living. she reports she is predominantly wheel chair bound and cannot ambulate. tobacco: 1 ppd etoh: 5-6 beers at a time approximately once a week when "feeling depressed" illicits: reports no use current or ever family history: non-contributory physical exam: icu physical admission: . general appearance: well nourished, no acute distress eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic lymphatic: cervical wnl cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (percussion: resonant : ), (breath sounds: clear : ) abdominal: soft, non-tender, bowel sounds present, suprapubic catheter extremities: right: absent, left: absent skin: warm neurologic: attentive, follows simple commands, responds to: not assessed, oriented (to): person place and time, movement: not assessed, sedated, tone: not assessed pertinent results: labs on admission: 06:40am wbc-8.0 rbc-4.94 hgb-9.7* hct-35.2* mcv-71* mch-19.7* mchc-27.7* rdw-16.8* 06:40am neuts-39.0* bands-0 lymphs-49.3* monos-3.2 eos-7.4* basos-1.1 plt smr-very high plt count-690*# 06:40am glucose-139* urea n-7 creat-0.5 sodium-146* potassium-3.9 chloride-107 total co2-25 anion gap-18 06:40am urine blood-neg nitrite-pos protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.5 leuk-sm 06:40am urine rbc-18* wbc-7* bacteria-few yeast-mod epi-1 06:40am urine mucous-few . labs on discharge: 05:46am blood wbc-14.9* rbc-3.61* hgb-7.7* hct-26.7* mcv-74* mch-21.3* mchc-28.8* rdw-22.0* plt ct-539* 05:46am blood glucose-81 urean-5* creat-0.4 na-141 k-4.5 cl-102 hco3-32 angap-12 05:46am blood calcium-8.7 phos-3.6 mg-2.2 . ekg sinus tachycardia qrs changes v3/v4 - probably due to lvh but consider anterior infarct st-t wave abnormalities since previous tracing of , heart rate faster intervals axes rate pr qrs qt/qtc p qrs t 138 144 76 298/434 33 38 41 . microbiology: urine cx - mixed flora urine cx - enterococcus urine cx - yeast urine cx - yeast urine legionella ag - negative . , blood cx - negative . cryptococcal ag (blood) - negative . bal - gram stain 3+ pmns, cx negative, pcp negative, smear negative, acid fast culture pending, cytology negative for malignant cells . imaging: cxr impression: visualized portion of the ventriculoperitoneal shunt appears intact. . chest ct: impression: 1. interval worsening of bilateral ground-glass opacities predominantly in the upper and mid lung zones. multiple discrete nodules measuring up to 4 mm within both lungs are identified. these findings are concerning for an infectious process and possible ards. 2. multiple subcentimeter lymph nodes are identified within the bilateral axilla, left supraclavicular region, and pericardium as described above. 3. small hiatal hernia. 4. 4-mm hypodense lesion in the right lobe of the liver which is too small to characterize. 5. left breast soft tissue density (2,67) measuring 9x13 mm of unclear significance. . echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). diastolic function could not be assessed. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: sub-optimal technical quality due to poor echo windows. left ventricular function is hyperdynamic, a focal wall motion abnormality cannot be fully excluded. no pathologic valvular abnormality seen. pulmonary artery systolic pressure could not be determined. . bilateral le u/s: impression: no evidence of dvt bilaterally. . cxr: impression: improved aeration of lungs with persistent multifocal patchy opacities and interval decrease in bilateral pleural effusions. brief hospital course: patient is a 30 year old female with history of spina bifida, suprapubic catheter, recurrent utis who initially presented with mental status changes, with a subsequent prolonged hospital course including sepsis, respiratory failure. 1. sepsis: on presentation, the patient was noted to have fever, hypotension, and altered mental status. she was initially given broad spectrum antibiotics for presumed sepsis from a urinary tract infection. she also had a cortisol stimulation test to rule out adrenal insufficiency which was negative. urine cultures grew vancomycin resistent enterococcus, and she was eventually placed on linezolid and completed a course of antibiotics. her hypotension resolved with iv fluids and antibiotics. the patient had continued fevers with treatment, so blood, urine and sputum cultures were sent. she was noted to have a new oxygen requirement as well, and was started on broad spectrum antibiotics with vancomycin, ceftriaxone and aztreonam for presumed infectious, ?aspiration pneumonia. see below under respiratory failure for remainder of events 2. respiratory failure: as above, the patient developed increased oxygen requirement, along with fevers, so suspected pulmonary infection was entertained, and she was started on broad spectrum antibiotics. she developed hypercarbic respiratory failure requiring transfer to the intensive care unit and intubation. she had a bal performed which was unrevealing with negative cultures. her respiratory status slowly improved and her antibiotics were tapered down to azithromycin alone to complete a 7 day course. infectious disease service was involved in her care. she was successfully extubated and weaned to room air by time of discharge. she had completed her course of azithromycin and was discharged on ipratropium nebulizers. 3. mental status changes: the patient was initially admitted to the intensive care unit with mental status changes, and sepsis as above. her mental status changes were also attributed to alcohol intoxication as her etoh level was elevated on admission. her mental status quickly resolved to baseline during hospital course. 4. supraventricular tachycardia: throughout her stay in the icu she had sinus tachycardia with heart rate 110-120s. this did not respond to fluid bolus or pain control. her lower extemity dopplers were negative for dvt and she has ivc filters due to previous pe, so we decided pe was an unlikely cause. she remained stable during remainder of her hospital course. 5. fen: due to concern for aspiration causing her lung pathology, she received a swallow study which showed silent aspiration. she had difficulty clearing her own secretions after intubation. she was re-evaluated once stabilization on floor and was noted to have continued aspiration with thin liquids. she was given instructions on how to pre-thicken her liquids at home, and how to obtain liquid thickener from the pharmacy. 6. ?obstructive sleep apnea: the patient was also noted to have episodes of apnea on her first visit to the the icu, so she was maintained on cpap at night during her hospital course. she should have a formal sleep study performed as an outpatient, arranged by her primary care physician. 7. chronic pain: the patient was maintained on her outpatient neurontin, lidocaine patch, fentanyl patch, and morphine (extended and immediate release) with good pain control. 8. vp shunt: the patient has a known vp shunt which was noted on ct scan during admission and felt to be functional. she should follow up with her neurosurgeon at , dr. , on discharge. this was communicated with the patient. 9. gerd: the patient was maintained on a ppi. 10. tobacco: the patient was maintained on nicotine patch. 11. mixed iron-deficiency anemia and anemia of chronic disease: continued ferrous sulfate. 12. left breast tissue mass: this was noted on ct chest, of unclear significance. this should be followed up with further outpatient testing per her pcp. 13. social issues: the patient was noted to have some home stressors and social work was involved during her hospital course. she also became quite focused on certain things during her hospital stay, for example, she was adamant that she wanted a cpap machine at home. i explained to her that she needed to have formal testing for obstructive sleep apnea, which could be set up, and if positive, then she could have that arranged. it appears as though she may have stolen the cpap machine from her room on discharge. medications on admission: #. gabapentin 600mg tid #. docusate sodium 100mg #. senna 8.6mg #. omeprazole 20mg #. heparin 5,000 unit tid #. nicotine 21 mg/24hr q24h #. acetaminophen 500mg tid prn #. lactulose 10gram/15ml q8h prn #. miconazole nitrate 2% powder topical #. ferrous sulfate 325mg daily #. morphine 15mg tablet q3h prn #. ibuprofen 600mg tid #. lidocaine 5% daily #. ceftriaxone-dextrose x 2 days discharge medications: 1. wheelchair motorized wheelchair. please dispense one. no refills. 2. gabapentin 300 mg capsule : two (2) capsule po q8h (every 8 hours). disp:*120 capsule(s)* refills:*2* 3. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed. 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical qdaily (). disp:*30 adhesive patch, medicated(s)* refills:*0* 5. bisacodyl 10 mg suppository : one (1) suppository rectal hs (at bedtime) as needed. disp:*30 suppository(s)* refills:*0* 6. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical tid (3 times a day) as needed for to back and legs. 7. morphine 15 mg tablet sustained release : one (1) tablet sustained release po q12h (every 12 hours) as needed for pain. disp:*60 tablet sustained release(s)* refills:*0* 8. fentanyl 25 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours) as needed for back pain. disp:*15 patch 72 hr(s)* refills:*0* 9. morphine 15 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for severe breakthrough pain. disp:*40 tablet(s)* refills:*0* 10. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 12. ipratropium bromide 0.02 % solution : one (1) nebulizer inhalation three times a day. disp:*90 nebulizer treatments* refills:*2* 13. fexofenadine 60 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. nebulizer 1 nebulizer machine. please include nebulizer mask. discharge disposition: home with service facility: vna discharge diagnosis: 1. urinary tract infection 2. sepsis 3. aspiration pneumonia 4. chronic low back pain secondary: spina bifida recurrent utis history of pe sacral decubitus ulcer discharge condition: stable. oxygenating well, mentating well. discharge instructions: if you develop increased shortness of breath, fevers, chills, or pain in your back, you will need to call your primary care doctor or go to the emergency room. please take medications as directed. please follow up with appointments as directed. followup instructions: please follow up with your primary care doctor, dr. ( on thursday at 10am (will be seeing his nurse practitioner). he will need to schedule you for a sleep study to see if you have obstructive sleep apnea and would benefit from a cpap machine at home. please follow up with neurosurgery doctor, dr. . please call to make an appointment with this physician in the next weeks. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified fiber-optic bronchoscopy diagnoses: anemia of other chronic disease esophageal reflux tobacco use disorder urinary tract infection, site not specified unspecified septicemia sepsis acute respiratory failure pneumonitis due to inhalation of food or vomitus pressure ulcer, lower back iron deficiency anemia, unspecified personal history of venous thrombosis and embolism lumbago alcohol abuse, continuous presence of cerebrospinal fluid drainage device paroxysmal supraventricular tachycardia spina bifida with hydrocephalus, unspecified region 

Answer: The patient is high likely exposed to