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: tetracyclines / zinc / optiray 350 attending: chief complaint: respiratory distress major surgical or invasive procedure: none history of present illness: 69yo woman with h/o aspiration and copd presenting with an episode of respiratory distress at home. she had j tube removed on and has deteriorated since this time. she had the j tube for 4 years and was taking tube feeds and supplementing with oral intake. she wanted the j tube removed for quality of life and this was done on . since this time, anything she would eat or drink would come out the j-tube hole onto the skin. she has had constant leakage of green fluid onto the abdomen, leading to erythema and pain. she complained of generalized abdominal pain. on she was seen in the clinic for a complaint of pain and the notes indicate the site was healing, though slightly erythematous. her caretaker notes the onset of significant weakness over the last few weeks since the j tube was removed and her oral intake became unreliable and the leakage continued. she usually is able to cough if she aspirates and does the incentive spirometer reliably. over the last 2 weeks, she has not been able to do this. . this morning, she was given an enema because she had not had a bowel movement in the last week. she did not eat breakfast, but was noted to have ronchorous upper airway sounds consistent with her prior history of aspiration. . in the ed, initial vs were: 97.3 138/62 100 30 84-95% on 4l nc. she had a wbc of 20 with 20% bands and new arf. she had a high oxygen requirement in the ed, satting mid-80s on 100% nrb. respiratory deep suctioned her and produced a significant amount of grey/green foul sputum. this was sent for culture. her oxygen saturation stabilized and mental status improved once this was done. she had a rectal temperature done, which was 99 degrees. she was given 1600 cc iv fluids. cxr demonstrated an infiltrate and she was treated for aspiration pneumonia with levofloxacin 750 mg x 1, ceftriaxone 1 g iv x 1 and clindamycin 600 mg iv x 1. ct torso revealed acute on chronic aspiration and possible pancreatitis. her lipase returned elevated. given her variable oxygen requirement, she was admitted to the for further monitoring. upon arrival to the floor, she complains of being thirsty and of abdominal pain. she is awake and answers questions, but sometimes makes nonsensical comments. her caretaker arrived and reported that her the current state is her most recent baseline. prior to the j tube removal, she was mobile with a rolling walker, conversant and not confused. the patient headache, blurred vision, mouth sores, chest pain or leg pain. she has some shortness of breath. past medical history: 1. castleman's disease: unicentric. found incidentally on splenectomy done for "splenic pain" around . has had lymph nodes sampled in past to r/o lymphoma but all have shown reactive lymph tissue only. followed here in heme/onc by dr. . 2. hx anaplastic thyroid cancer s/p radical neck dissection, at age 15 3. esophageal webs and esophageal dysmotility. has had numerous esophageal dilatations. 4. recurrent aspiration pneumonias sputum cx growing pseudomonas, mrsa 5. chronic pulmonary disease 6. mrsa osteomyelitis of olecranan s/p multiple debridements 7. hx bipolar d/o 8. gerd 9. osteoporosis: has broken both hips, left in , right with failed orif and redo at 10. hx zoster 11. hx depression, chronic pain 12. htn 13. parkinson's disease social history: retired social worker. with walker and assistance at baseline. no etoh, , drugs. lives at home w/ 24 hour health aid. poa = (a lawyer). family history: 1. father: htn, dm, depression, died mi, age 59. 2. mother: htn, hypercholesterolemia, died mi, age 82. 3. sister: htn physical exam: vs: t 100.1 bp 176/57 hr 95 spo2 94% 5l gen: elderly, awake, asking for water, uncomfortable heent: perrl, op clear, mm dry neck: supple, nontender car: regular, no murmur resp: ronchi r>>l, no crackles or wheezes abd: open wound in mid-epigastrium with green discharge soaking through thick dressings and a towel. some bleeding on wound edge. erythema surrounding wound, particularly on lower portion. abdomen soft but with diffuse mild tenderness. + bs ext: scds in place, no edema, 2+ dp pertinent results: admission labs: 02:05pm wbc-20.8*# rbc-4.41 hgb-14.0 hct-42.0 mcv-95 mch-31.7 mchc-33.3 rdw-15.2 02:05pm plt smr-normal plt count-409 02:05pm pt-14.1* ptt-30.9 inr(pt)-1.2* cxr : new infiltrate in the left perihilar and left lower lobe in the presence of a chronic elevated left hemidiaphragm. the findings are most compatible with pneumonia. repeat radiography to document resolution after appropriate therapy recommended. . ct abd/pelvis : 1. acute on chronic aspiration in both lung bases, right greater than left, which is worse compared to ct from 12/. small left pleural effusion. 2. faint fat stranding around the pancreas. please correlate clinically for possible pancreatitis. . ruq ultrasound : limited evaluation of the liver demonstrates mild intrahepatic biliary ductal dilatation and dilatation of the common bile duct up to 1 cm. the gallbladder is distended with a large shadowing stone measuring 1.7 cm in the dependent portion. however, there is no gallbladder wall thickening or pericholecystic fluid. the main portal vein is patent with hepatopetal flow. evaluation of the pancreas was not possible due to overlying bowel gas and ostomy bag. impression: 1. cholelithiasis without evidence of acute cholecystitis. 2. intra- and extra-hepatic biliary ductal dilatation, not significantly changed compared to the recent ct.if there is concern for choledocholithiasis, ercp may be performed for further evaluation. brief hospital course: 69 year old female with multiple medical problems presented with respiratory distress from aspiration event in setting of persistent j tube leakage and abdominal pain. imaging studies supported clinical exam of acute on chronic aspiration. her respiratory status improved post deep suction by respiratory therapy. she was treated for aspiration pneumonia with iv levofloxacin and flagyl starting and throughout her hospitalization completing a 7 day course of antibiotic therapy. goals of care were discussed at length with the patient and her health care proxy. the decision was made to allow the patient to eat and drink as she wished with the knowledge that she will continue to aspirate and ultimately experience infection, respiratory distress and death. patient showed clear understanding and accepted these risks. patient requested that she not be hospitalized if she were to develop symptoms of respiratory distress or pneumonia after her discharge. she was offered hospice services to help with symptom management should she not wish to return to the hospital. patient will be evaluated by home health services bridged to hospice. her respiratory symptoms remained stable after intitial presentation to the floor. she continued to experience regular asymptomatic oxygen desaturations with eating. patient will be discharged home on continuous supplemental oxygen. . surgery was consulted regarding her gastrocutaneous fistula. they presented the options of sclerotherapy, laproscopic surgery, or replacing the g-tube. patient chose to replace the g-tube to stop the leaking. she does not want to rely on the g-tube for feedings. however, she is concerned that eating has become "too much work". she would like to have the option of using the tube for medications and nutrition if needed for comfort. g-tube was placed (reinserted) at bedside by dr. on . the g-tube is a foley catheter that can be used to deliver feeds and medications is needed. she will receive vna services to manage her g-tube after discharge. home health aid, , was instructed to use her g-tube only at the patient's request or for comfort measures. . gi team was consulted on admission as patient presented with significant abdominal pain that did not correspond to her fistula. ct scan showed fat stranding around the pancreas and gall stones. hida scan was not consistent with acute cholecystitis and gi recommended no interventions. patient's symptoms of abdominal pain and nausea improved. . code: dnr/dni/dnhospitalize confirmed with patient in the presence of her health care proxy . emergency contact/health care proxy: . home health aide: medications on admission: sinemet 25/100 every 4 hours while awake-8/12/4/8--not filled since lexapro 20 mg daily neurontin 300 mg qhs lamictal 200 mg daily levothyroxine 100 mcg daily ativan 1 mg qam, 2 mg qpm oxycodone sr 20 mg oxycodone 5 mg tab 4 times per day primidone 25 mg daily seroquel 300 mg at bedtime vitamin d 400 iu twice daily iron sulfate 325 mg daily refresh eye drops, neo-poly-dex eye, 1 gtt both eyes each night zofran 4 mg every 8 hours prn discharge medications: 1. acetaminophen 500 mg/5 ml liquid : five (5) ml po every six (6) hours as needed for fever or pain. disp:*500 ml* refills:*2* 2. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed for rash. disp:*1 bottle* refills:*2* 3. lexapro 20 mg tablet : one (1) tablet po once a day. 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. disp:*1 bottle* refills:*2* 5. carbidopa-levodopa 25-100 mg tablet : one (1) tablet po qid (4 times a day): to be given 8am, noon, 4pm, 8pm. 6. seroquel 300 mg tablet : one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 7. gabapentin 300 mg capsule : one (1) capsule po at bedtime. 8. zofran odt 4 mg tablet, rapid dissolve : tablet, rapid dissolves po every eight (8) hours as needed for nausea. disp:*20 tablet, rapid dissolve(s)* refills:*3* 9. primidone 50 mg tablet : 0.5 tablet po daily (daily). 10. levothyroxine 100 mcg tablet : one (1) tablet po daily (daily). 11. oxycodone 5 mg/5 ml solution : ten (10) ml po every six (6) hours as needed for pain. disp:*600 ml* refills:*2* 12. ativan 0.5 mg tablet : 1-2 tablets po every 6-8 hours as needed for anxiety. disp:*30 tablet(s)* refills:*2* 13. lamictal oral discharge disposition: home with service facility: hospice discharge diagnosis: aspiration pneumonia gastrocutaneous fistula chronic cholecystitis malnutrition discharge condition: patient is afebrile and hemodynamically stable. she requires supplemental oxygen to maintain oxygen saturations greater than 93%. she requires assistance for ambulation. discharge instructions: you presented to the hospital in respiratory distress. you were found to have an aspiration pneumonia and you were started on iv antibiotics. you completed a 7 day course of antibiotics and your symptoms improved. . you were also found to have tract (fistula) between your stomache and your abdominal skin at the site of your prior g-tube that was leaking fluid. you were evaluated by the surgery team who offered multiple interventions to resolve the leaking. you decided to have the g-tube replaced to stop the leaking of the fluid. . your chronic abdominal pain was evaluated extensively and the gi team was consulted. they determined that there was no need for intervention at this time. . followup instructions: home health and hospice services will follow up with you to manage your symptoms. procedure: replacement of tube or enterostomy device of small intestine diagnoses: unspecified essential hypertension acute kidney failure, unspecified unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified paralysis agitans anxiety state, unspecified pneumonitis due to inhalation of food or vomitus enlargement of lymph nodes acute pancreatitis fistula of intestine, excluding rectum and anus chronic cholecystitis postsurgical hypothyroidism personal history of malignant neoplasm of thyroid other colostomy and enterostomy complication dyskinesia of esophagus tracheoesophageal fistula, esophageal atresia and stenosis 

Answer: The patient is high likely exposed to