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: neck pain with bilateral arm numbness major surgical or invasive procedure: anterior/posterior cervical fusion with instrumentation c4-7 history of present illness: ms. has a long history of neck and arm pain. she has attempted conservative therapy including injections and has failed. she now presents for surgical intervention. past medical history: obesity htn hypothyroidism cervical spondylosis and spinal stenosis h/o tuberculosis at age 12 anxiety w/ panic attacks and clostrophobia h/o tonsillectomy h/o total abdominal hysterectomy social history: denies family history: n/c physical exam: on admission: a&o x 3; nad rrr cta b abd soft nt/nd bue- good strength at deltoid, biceps, triceps, wrist flexion/extension, finger flexion/extension and intrinics; sensation diminished c6/c7 dermatomes; + , hyper reflexic at biceps, triceps and brachioradialis ble- good strength at hip flexion/extension, knee flexion/extension, ankle dorsiflexion and plantar flexion, /fhl; sensation intact l1-s1 dermatomes; + clonus, reflexes symmetric at quads and achilles . on discharge: a&o x 3; nad neck: posterior site with steri-strips in place; no drainage, no erythema, from rrr cta b abd soft nt/nd bue- good strength at deltoid, biceps, triceps, wrist flexion/extension, finger flexion/extension and intrinics; ble- good strength at hip flexion/extension, knee flexion/extension, ankle dorsiflexion and plantar flexion pertinent results: 06:30am blood wbc-15.8* rbc-4.04* hgb-11.1* hct-33.2* mcv-82 mch-27.5 mchc-33.5 rdw-15.0 plt ct-470* 03:40am blood wbc-14.3* rbc-3.26* hgb-9.0* hct-26.2* mcv-80* mch-27.6 mchc-34.4 rdw-13.9 plt ct-311 04:50am blood wbc-16.4* rbc-3.59* hgb-9.9* hct-28.4* mcv-79* mch-27.6 mchc-34.9 rdw-14.1 plt ct-308 02:43am blood wbc-19.9* rbc-3.62* hgb-9.9* hct-29.4* mcv-81* mch-27.4 mchc-33.8 rdw-13.9 plt ct-247 06:30am blood glucose-121* urean-16 creat-0.8 na-139 k-3.5 cl-102 hco3-27 angap-14 11:51am blood glucose-141* urean-11 creat-0.5 na-138 k-3.6 cl-108 hco3-23 angap-11 01:57am blood glucose-122* urean-13 creat-0.5 na-138 k-3.0* cl-102 hco3-26 angap-13 02:43am blood glucose-170* urean-12 creat-0.5 na-136 k-3.5 cl-103 hco3-26 angap-11 06:30am blood calcium-8.9 phos-3.2 mg-2.0 06:30am blood calcium-8.8 phos-3.6 mg-2.0 06:54pm blood calcium-8.3* phos-4.3 mg-2.0 02:43am blood calcium-8.4 phos-2.3* mg-1.7 . on discharge: wbc rbc hgb hct mcv mch mchc rdw plt ct 10.3 3.98* 10.9* 32.2* 81* 27.3 33.8 15.3 553 . glucose urean creat na k cl hco3 angap 122 15 0.7 141 4.2 108 24 13 . calcium phos mg uricacd iron 9.0 3.7 2.0 . hba1c: 6.9 . micro: 10:30 am bronchoalveolar lavage right bronchial lavage. **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): commensal respiratory flora absent. yeast. ~1000/ml. . 11:31 am bronchoalveolar lavage left bronchial lavage. **final report ** gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): commensal respiratory flora absent. enterobacter cloacae. ~5000/ml. piperacillin/tazobactam sensitivity testing available on request. yeast. ~4000/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . mrsa screen (final ): no mrsa isolated. . blood cx: ngtd . urine cx: ngtd brief hospital course: ms. was admitted to the spine surgery service on and taken to the operating room for c4-7 fusion through an anterior approach. please refer to the dictated operative note for further details. the surgery was without complication and the patient was transferred to the pacu in stable condition. teds/pnemoboots were used for postoperative dvt prophylaxis. intravenous antibiotics were given per standard protocol. initial postop pain was controlled with a pca. on hd#2 she returned to the operating room for a scheduled c4-7 decompression and fusion as part of a staged 2-part procedure. please refer to the dictated operative note for further details. the second surgery was also without complication and the patient was transferred to the pacu in a stable condition. postoperative hct was stable. while in the pacu ms. became hypoxic and striderous and was emergently re-intubated. she remained that way over night and extubated in the morning. after extubation she was delerious and required oxygen therapy. she was transfered to the sicu for further evaluation where she was subsequently reintubated for a similar clinical picture. she developed low grade fevers and she was started on zosyn and vancomycin. follow up chest x-ray showed improvement and she was extubated with success. she was transfered out of the sicu and to the medical service for further evaluation. . while on the medical service, she was treated for pulmonary edema, hypertension, pneumonia, and delerium. please see below for these issues. . delerium: likely multifactorial; secondary to surgery/intubations, poor sleep, pain. she was treated for pneumonia (bal grew enterobacter) with 7 days of antibiotics (initially started on vancomycin/zosyn, then narrowed to ciprofloxacin once sensitivies returned for total 10 days). geriatrics was consulted to help with evaluation and management of delerium. all narcotics, benzodiazepines, and gabapentin were discontinued. she was placed on standing tylenol with a lidocaine patch. she was started on zyprexa 5mg qhs to help normalize sleep/wake cycles. per review of records and discussion with pcp office, it was determined that she likely has a slowly progressive underlying dementia that is probably contributing to her altered mental status as well. . urinary retention: unclear etiology, suspect hypotonic bladder. she likely has chronic spinal stenosis, but unclear why she is acutely hypotonic. her foley was discontinued for several days, but she required consistent straight catheterizations to void. foley replaced until mental status improves. she may need urology consult as an outpatient if urinary retention does not resolve. no contributing medications. outpatient issues: -- reattempt voiding trial at rehab; may need urology follow-up as outpatient if retention remains problem . cervical spondylosis/stenosis: s/p laminectomy, fusion, instrumentation on : recovering well, occasional paresthesias to be expected. she is oob to chair with mj collar when out of bed. per spine surgery she is recovering well and will plan on following up with surgery as an outpatient. outpatient issues: -- continue daily wound care -- follow-up with surgery for suture removal. . . hypoxia: secondary to flash pulmonary edema in the setting of severe hypertension and pneumonia (bal showed enterobacter). pulmonary edema improved with diuresis. pneumonia was treated for total 10 days. . hypertension: stopped home verapamil and metoprolol, achieved excellent control with labetolol 200mg and lisinopril 10mg daily. outpatient issue: -- continue to monitor bp in new regimen of labetolol and lisinopril. . anemia: secondary to blood loss. improved without need for transfusion. hematocrit stable at time of discharge . dm2: hb 6.9%. discussed with patient and family. treated with riss. outpatient issues: -- needs outpatient diet/exercise counseling and likely initiation of oral . -- will need outpt cholesterol panel and management as well. . the patient was full code for this admission. medications on admission: klonipin 0.5mg prn anxiety hctz 25mg qday verapamil 240mg qday gabapentin 300 q 12hrs levothyroxine 125 mcg daily paxil 40mg daily discharge medications: 1. paroxetine hcl 10 mg/5 ml suspension sig: one (1) po daily (daily). 2. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day). 7. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100, hr<50. 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily): hold for sbp<100. 9. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qpm (once a day (in the evening)). discharge disposition: extended care facility: nursing & therapy center - ( center for rehabilitation and sub-acute care) discharge diagnosis: cervical stenosis and spondylosis flash pulmonary edema hypertension delerium pneumonia anemia hypothyroidism diabetes mellitus type 2 gerd chronic low back pain urinary retention discharge condition: good discharge instructions: you came to the hospital and had the following operation: anterior/posterior cerivical decompression with fusion. your post-operative course was complicated by fluid in your lungs requiring additional intubation, high blood pressure, pneumonia and delerium. you were treated with antibiotics. your confusion will likely improve as you recover from your surgery and hospitalization. we made the following changes to your medications: to control your blood pressure: start taking labetalol 200mg. take one 200mg tablet twice daily. start taking lisinopril 10mg. take one 10mg tablet daily. stop taking hydrochlorothiazide stop taking verapamil . during your hospitalization you were found to be intermittently confused and sedation medications were discontinued: stop taking gabapentin stop taking klonipin . to control anxiety/insomnia: start taking olazapine 5mg. take one 5mg tablet at night. . further instructions include: activity: you should not lift anything greater than 10 lbs for 2 weeks. you will be more comfortable if you do not sit or stand more than ~45 minutes without getting up and walking around. -rehabilitation/ physical therapy: 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. you can walk as much as you can tolerate. limit any kind of lifting. -collar: you have been given a collar. this brace is to be worn when you are walking. you may take it off when sitting in a chair or while lying in bed. -wound care: once the incision is completely dry you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. cover it with a sterile dressing. call the dr. office if the incision is draining. . please call the office if you have a fever>101.5 degrees fahrenheit and/or drainage from your wound. . again it was a pleasure taking care of you. please feel free to contact with any questions or concerns. followup instructions: name: , a. location: primary physicians at address: , , phone: when: tuesday, , 2:30 name: , location: address: , bldg. rm 239, , phone: when: , :30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus other cervical fusion of the anterior column, anterior technique excision of intervertebral disc excision of bone for graft, other bones other cervical fusion of the posterior column, posterior technique insertion of interbody spinal fusion device insertion of interbody spinal fusion device fusion or refusion of 4-8 vertebrae fusion or refusion of 4-8 vertebrae diagnoses: esophageal reflux pneumonia due to other gram-negative bacteria congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism abnormality of gait pulmonary collapse acute respiratory failure osteoporosis, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other isolated or specific phobias retention of urine, unspecified hypoxemia obesity, unspecified acute diastolic heart failure accidents occurring in residential institution delirium due to conditions classified elsewhere stridor cervical spondylosis with myelopathy panic disorder without agoraphobia hypertonicity of bladder body mass index 45.0-49.9, adult 

Answer: The patient is high likely exposed to