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: severe pancreatitis major surgical or invasive procedure: placement of left ij cvl intubation mechanical ventilation history of present illness: this is a 38yo m with h/o paranoid schizophrenia who initially presented to in on with new dka and then developed severe pancreatitis/bandemia with possible hcap with bilat lower lobe infiltrates s/p intubation now transferred here for further management. pt was intially treated for dka however bc of persistent abdominal pain and fevers, a ct scan was obtained on which revealed finsing consitent with pancreatitis. on , pt was found to be obtunded and o2sats were in mid80s so pt was intubated for airway protection and presumed aspiration. pt has been hemodynamically stable, requiring no pressors. a central line has been placed in his right ij. pt was started on vanc/zosyn, which was then changed to vanc/doripenem. vanc was then dc'd however given increasing bandemia today, was added back on. pt had normal lactate. pt is on insulin gtt for hyperglycemia. repeat ct scan on showed no discrete abscess or pancreatic necrosis but there was worsening fluid surrounding the tail of pancreas. ct chest that today showed progressive lower lobe consolidation (atelectasis vs infiltrate) with small bilat pleural effusions. sputum cx at osh grew gpcs in chains/pairs and beta hemolytic strep not group a. . on arrival to the icu, pt was intubated and sedated. pt's ogt was pulled out during transport. o2 sats were 85% on arrival. rt performed recruitment maneuver and o2 sats improved to 98% on ac tv of 550cc, rr of 14, peep of 10, fio2 100%. tv was then decreased to 450cc bc peak pressures were getting high. pt is noted to be tachypnic, breathing up to 30. abg was ph 7.43 pco2 42 po2 101 and his vent settings were further adjusted to tv 450 rr 26 peep 15 fio2 80%. then, bc was still tachypnic and tv was ~500. . review of systems: unable to obtain past medical history: paranoid schizophrenia polysubstance abuse hypertension hypercholesterolemia social history: denies t/e at osh. has h/o ivdu family history: no family hx of pancreatitis physical exam: physical exam on admission to micu general: intubated, sedated, obese heent: ett in place, perrl neck: supple, unable to assess jvp due to body habitus lungs: diminished breath sounds bilaterally cv: rrr, no murmurs, rubs, gallops abdomen: soft, distended, non-tender, no rebound tenderness or guarding ext: warm, well perfused, trace bilat le edema pertinent results: labs on admission: 10:07pm glucose-207* urea n-21* creat-0.8 sodium-146* potassium-3.5 chloride-110* total co2-28 anion gap-12 10:07pm alt(sgpt)-33 ast(sgot)-62* ld(ldh)-329* ck(cpk)-1083* alk phos-71 tot bili-0.4 10:07pm lipase-142* 10:07pm albumin-2.5* calcium-8.1* phosphate-4.2 magnesium-1.9 10:07pm triglycer-343* 10:07pm wbc-11.6*# rbc-2.92*# hgb-9.3*# hct-26.7*# mcv-92 mch-31.9 mchc-34.8 rdw-14.3 10:07pm neuts-62 bands-13* lymphs-17* monos-3 eos-0 basos-0 atyps-0 metas-1* myelos-4* 10:07pm pt-15.6* ptt-26.3 inr(pt)-1.4* 10:23pm type-art temp-38.8 tidal vol-500 peep-10 o2-100 po2-101 pco2-42 ph-7.43 total co2-29 base xs-2 aado2-571 req o2-94 -assist/con intubated-intubated vent-controlled . micro blood cx 8/25,: pending urine cx : pending . imaging . tte : the left atrium is normal in size. no intracardiac shunt is suggested after intravenous saline injection at rest. mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function. (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are grossly normal. the ascending aorta is mildly dilated at the sinus level. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. symmetric left ventricular hypertrophy with gossly normal biventricular cavity sizes and global systolic function. no intracardiac shunt identified. . cxr : findings: in comparison with study of , the endotracheal tube lies approximately 5.4 cm above the carina. right ij catheter extends to the mid portion of the svc. continued low lung volumes may account for much of the prominence of the transverse diameter of the heart. atelectatic changes and effusion are seen at the left base. no definite vascular congestion. . ruq us : only portions of the pancreatic neck and head are visualized and demonstrate normal echotexture. the liver is also normal in echotexture without focal lesions. there is no intra- or extra-hepatic biliary dilatation. the portal vein is patent with appropriate hepatopetal flow. the gallbladder is unremarkable without stones or wall edema. the common bile duct is not dilated measuring 3 mm. the right kidney measures 12.7 cm. the left kidney measures 14.7 cm. there are no stones or hydronephrosis. the spleen is enlarged measuring 15.6 cm. there is a small amount of intra-abdominal ascites. in addition, there are three fluid collections anterior to the right kidney with one of the largest measuring 5.4 x 3.9 cm. these demonstrate no peristalsis and may represent non-peristalsing bowel or pseudocysts. impression: 1. ascites, consistent with known pancreatitis. 2. pseudocysts versus non-peristalsing bowel anterior to the right kidney. 3. splenomegaly. portable abdomen x-ray : findings: one abdominal radiograph in supine position was obtained. quality of the film is compromised due to exclusion of pelvic area and right peridiaphragmatic region. normal bowel gas pattern, without evidence of free air. no abnormal calcifications. impression: unremarkable abdominal radiograph. ct chest w/contrast study date of 2:31 pm impression: 1. similar appearance to acute pancreatitis with fluid surrounding the tail of the pancreas and extending inferiorly along anterior perirenal fascia. this is slightly more better contained when compared with , but no significant change from . 2. unchanged bilateral pleural effusions with bilateral lower lobe dependent consolidation which most likely represents atelectasis though infection is not excluded. 3. endotracheal tube 6.7 cm from the carina. this should be advanced. ct abd & pelvis w/o contrast study date of 5:33 pm impression: 1. no evidence of retroperitoneal or other hematoma. 2. intra-abdominal free fluid and peripancreatic stranding consistent with the provided history of pancreatitis. 3. increase in small pleural effusions bilaterally. 4. splenomegaly. brief hospital course: 38m with h/o schizophrenia p/w severe pancreatitis c/b acute respiratory failure requiring intubation, increased abdominal pressures, and acute kidney injury. # acute pancreatitis: etiology unclear, but may be related to hypertriglyceridemia which, in turn, may have been caused by zyprexa or clozapine. osh ct scans showed no evidence of gallstones, and lft's were not suggestive of obstruction, making gallstone pancreatitis unlikely. patient denies history of recent etoh abuse, and lack of elevated transaminases upon osh admission argued against recent etoh abuse. pancreatitis was severe given complications mentioned above but reimaging did not show any abscess formation, pseudocysts, necrosis. patient eventually started tolerating enteral feeds and is now eating a normal diabetic diet without abdominal pain. # acute respiratory failure: -likely secondary to healthcare acquired pneumonia (as seen on ct), pulmonary edema (patient +28l fluid balance at one point), atelectasis, and possibly ards as well from pancreatitis. patient was treated for a hospital acquired pna, persistently diuresed, with improvement in lung function. patient did well with gradual weaning of sedatives and was started on psv several times prior to becoming fully extubated. -he received a 8 day course of vanc/zosyn which was completed on . #acute kidney injury due to acute interstitial nephritis (ain) -creatinine had normalized as of (to 1.0); rose to 1.5 to 1.6 on -did not improve with iv fluids. patient actually takes good po. -nephrology felt patient developed acute interstitial nephritis, possibly due to zosyn used for the pna. he has elevated urine and serum eosinophils -per our nephrologists, if no significant change in his creatinine (i.e. stays below 2.0), no intervention is necessary. if creatinine rises above 2.0 nephrology should be consulted and it is possible at that point that he may need a renal biopsy and/or steroids. -he has an appointment with our nephrologist dr. on which we would like for him to keep # paranoid schizophrenia: -followed by psych here, with med adjustments -has auditory hallucinations, but not visual -clozapine 200 qhs; also given haldol for agitation in the icu. -haldol dose was decreased as tolerated and weaned off methadone 10 q8h -qt interval was within range but should continue to follow while on haldol -will need to continue monitoring cbc while on clozapine due to possibility of developing agranulocytosis -should be followed by psychiatry while at the ltac and after discharge -has persistent mouth/jaw movements which may represent tardive dyskinesia . #anemia -received 3 prbc transfusions in micu -hct stable -no evidence of bleeding or hemolysis . # diarrhea - now resolved - c. diff negative x 2.- as c.diff negative i see no contraindication to anti-motility agents (imodium) . # htn and sinus tachycardia: - sinus tach chronic, asymptomatic, thought initially to be vbolume related - in the setting of hypertension (on ) will add atenolol, which will also help with the tachycardia . ## diabetes mellitus, uncontrolled, no complications - new diagnosis for this patient - dka on admission, resolved - hba1c 8.6 - started on glargine plus humalog iss qid - good control currently on this regimen . # mother has guardianship in - not fully consistent with ma laws - ma guardianship application initiated by our attorneys - mother willing to remain his guardian (due to antipsychotics will need ) . #following critical care illness and prolonged hospitalization patient is very weak and will need inpatient rehab stay in an ltac or a rehab hospital. there, his active medical issues of acute renal failure, uncontrolled hypertension, diabetes, and psychosis can be managed and he can receive the physical and occupational therapy he needs which cannot be provided at an acute hospital . full code medications on admission: home medications: depakote zyprexa atenolol gemfibrozil . meds on transfer: lansoprazole 30mg ng daily captopril 25mg doripenem 500mg iv q8h valproic acid 1250mg q12h tylenol 650mg q6h prn versed drip 6mg/hr combivent q6h 8puffs lacri-lube every 2 hours chlorhexidine 15ml q12h fentanyl drip 12.5mcg/hr lovenox 40mg q24h clozapine 200mg daily insulin regular drip insulin glargine d5w at 100ml/hr discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, fever. 2. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 4. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 5. haloperidol 5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for agitation. 6. clozapine 50 mg tablet sig: five (5) tablet po daily (daily). 7. ipratropium bromide 0.02 % solution sig: one (1) unit dose inhalation q6h (every 6 hours). 8. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 9. insulin glargine 100 unit/ml solution sig: eight (8) units subcutaneous qam. 10. insulin glargine 100 unit/ml solution sig: twelve (12) units subcutaneous at bedtime. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: - acute pancreatitis - resolved - healthcare acquired pna - resolved - encephelopathy (toxic-metablic)- resolving - paranoid schizophrenia - chronic - diabetes mellitus with dka - acute interstitial nephritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital in the setting of an acute pancreatitis flare. subsequently you were diagnosed with a pneumonia. in the setting of infection you were confused. . check your blood glucose level four times a day (before each meal and at bedtime) and call your physician if the result is less than 70 or greater than 200. you were admitted to the hospital in the setting of an acute pancreatitis flare. subsequently you were diagnosed with a pneumonia. in the setting of infection you were confused. . check your blood glucose level four times a day (before each meal and at bedtime) and call your physician if the result is less than 70 or greater than 200. followup instructions: department: west clinic when: monday at 2:00 pm with: , md specialty: nephrology building: de building ( complex) campus: west best parking: garage **please have a semi-full bladder upon arrival to this appointment** procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus central venous catheter placement with guidance diagnoses: anemia, unspecified toxic encephalopathy unspecified essential hypertension other, mixed, or unspecified drug abuse, unspecified pulmonary collapse pure hyperglyceridemia other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified pneumonitis due to inhalation of food or vomitus acute glomerulonephritis with other specified pathological lesion in kidney diarrhea diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled other disorders of plasma protein metabolism pulmonary congestion and hypostasis hyperosmolality and/or hypernatremia ventilator associated pneumonia rhabdomyolysis acute pancreatitis paranoid type schizophrenia, chronic physical restraints status penicillins causing adverse effects in therapeutic use other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to