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: patient recorded as having no known allergies to drugs attending: chief complaint: transferred from for hyptension. major surgical or invasive procedure: none history of present illness: 73 year old woman with mmp s/p recent hospitalization for persistent fevers who is transferred from rehab for sbp into 60s . she has been there since after admit for and line infection and pseudomonas in sputum s/p 14 day course caspo/linezolid/ (to finish but reportedly only got /linezolid through ). she was noted to have a hct drop 6/18 to 23 (may have been transfussed 2uprbc's-not clear from d/c summary) but hct 29.3 . additionally was hypothermic with elevated wbc, hypernatremia to 157, melanotic stools. she became hypotensive to sbp 80 so reportedly received 2 uprbc's (though no change in hct) and unknown quantity of ivf. uop noted to be only 25cc/hour. c. diff reportedly negative. : bp 64/40 with improvement to 97/70 with 25 gm albumin. was started on aztreonam 1gm q12 (given h/o esbl resistent organisms/pseudomonas in the past), vanco 1 gm q24 . lab data from shows hct 30.0->23.5->29.3(? s/p 2 uprbc's though not clear from d/c summary)->29.6(s/p 2uprbc's). sodium 154, creatinine 0.6, wbc 17.7 (69% pmn, 0 bands, 20% lymph). blood cultures 6/18 grew 1 bottle coag neg staph, 1 bottle gpc's in clusters. she was transferred here for further management. cxr reportedly concerning for lll process. she was given d5w @ 100cc/hr and started free water boluses via peg 300cc q6. past medical history: past medical history: -recent hospitalization for line infection: and grown at rehab. treated with caspofungin, linezolid, and meropenem for 14 day course (through ), picc placed , tee negative. cad: stent to lad 97, s/p cabg for 2vd with prosthetic mvr, and closure of foramen ovale on , complicated by mediastinal hemorrhage, prolonged shock, renal failure, neurologic impairment -cardiomyopathy, ef 40% on echo -anoxic encephalopathy: trach/peg on : consult report from dr. () from states prognosis for a meaningful full recovery at this point is likely zero. -respiratory failure: attempted to wean from vent on last admit but unable: vent at current settings ac 500 x 12/peep 5/ fio2 40%; grew pseudomonas in sputum s/p 14 day course of meropenum -renal failure atn, noted on last admit to make 1l urine/day but again required hd after discharge at rehab (tues/thurs/sat) -a-fib -hypertension -hypercholesterolemia -insulin dependent diabetes -spinal stenosis -copd social history: no etoh, previous 20 pack year smoking history, quit 20 years ago, previously lived w/ daughter, who is hcp, since either at or family history: unknown. physical exam: vs: t 94.8 ax hr 82 bp 102/77 rr 13 sat 100% ac: 550/12/40/5 gen: nad heent: op clear, mm slightly dry, mouth open, eyes open, sclera injected neck: trach tube in place, no significant surrounding discharge, jvp to jaw at 15 degrees, no lad respiratory: decreased breath sounds at bases with transmitted upper airway sounds but no distinct wheezes/rales/rhonchi cv: rrr no murmurs, rubs, gallops; s1 s2 present, radial pulses 1+ bilaterally, dp/pt non-palpable bilaterally (though dopplerable) abdomen: midline, left lower quadrant well-healed scars, peg tube in place, bs present, nt, nd extremities: 4+ pe all 4 extremties, multiple decubitus ulcers on left arm, left leg, right leg (with ? pustular discharge and necrotic toes r) back: sacral decubitus ulcers neuro: eyes open with disconjugate gaze, no corneal blink reflex though occaisional fasiculations, no oculocephalic reflex, pupils 3mm bilaerally, unresponsive, no gag, no response to painful stimuli x4 extremities and sternal rub, spontaneous left arm movement noted, + spontaneous respirations. pertinent results: admission labs: abg: ph 7.43 pco2 38 po2 121 hco3 26 tsh:12 creat:40 na:41 ua: color yellow appear clear specgr 1.020 ph 5.0 urobil neg bili neg leuk sm bld lg nitr pos prot 30 glu neg ket neg rbc 17 wbc 49 bact mod yeast many epi 0 156 127 41 ------------<99 4.4 24 0.5 estgfr: >75 ca: 7.8 mg: 2.3 p: 3.2 alt: 29 ap: 131 tbili: 0.1 alb: 2.0 ast: 26 : 83 lip: 34 triglyc: 172 cortsol: 10.6 9.7 16.2>---<201 30.5 n:89 band:4 l:1 m:5 e:1 bas:0 hypochr: 2+ anisocy: 1+ poiklo: 1+ macrocy: 2+ polychr: 1+ target: occasional tear-dr: occasional how-jol: 1+ plt-est: normal pt: 12.7 ptt: 33.2 inr: 1.1 cxr: bilateral efffusions/pulmonary edema/atelectasis, midline present on r, ? ett high at 7.8cm. ecg: nsr (82), axis, intervals nl, low voltage, qw iii (old), twi iii, avf; v5 uninterpretable. no st changes. tee : normal functioning mitral annuloplasty ring with very mild mitral regurgitation. no vegetations identified. complex (non-mobile) aortic atherosclerosis. small secundum type atrial septal defect. regional left ventricular systolic dysfunction c/w cad. eeg : this is an abnormal portable routine eeg due to the very low voltage, slow and unvarying background, suggestive of severe encephalopathy, possibly due to diffuse cortical damamge. occasionally focal slowing was seen in the right temporal region suggestive of subcortical dysfunction. cultures: urine yeast. >100,000 organisms/ml.. urine: negative for legionella serogroup 1 antigen. stool cdiff negative blood cultures pending sputum: serratia and pseudomonas brief hospital course: a/p: 73 yo woman with cad s/p cabg/mvr complicated by mediastinal hemorrhage, and anoxic brain injury in persistent vegetative state with h/o gib, hypotension, gpc's in blood, decreased urine output, hypernatremia, hypothyroidism. # hypotension: the patient was hypotensive upon admission. given a blood culture positive for gpc in clusters she was started on vancomycin. in addition she had grown pseudomonas and serratia per osh culture data and was started on zosyn. we treated the underlying infections and aggressively hydrated the patient with iv fluids. in addition we identified a candidal uti and treated empirically for sepsis with iv fluconazole. the patient required vasopressin temporarily but was successfully weaned and was able to maintain a blood pressure with systolics in the 90-100's. . # anoxic brain injury/plan of care: per neurologists, the patient has no meaningful hope of significant neurologic recovery from her anoxic brain injury. we consulted social work and our ethics servie and discussed the objectives of care with the patient's family and health care proxy. the family's decision was made to make the patient dnr, to not escalate care, and to avoid procedures that would cause pain. . # respiratory failure: thought to be secondary anoxic brain injury exacerbated by new-onset pna. the patient was kept on mechanical ventilatory support throughout her stay and was not successful in attempts to wean. # h/o gib: the patient had guiac positive stool but given her degree of morbidity it was deemed that an appropriate gi bleed workup would not be appropriate at that time. she was maintained on a ppi and transfused as necessary. . # hypothyroidism: the patient was found to have elevated tsh to 12 with low ft4 and t3 which was thought to be contributing to hypotension, hypothermia. we started her on levothyroxine. . # hypernatremia: likely to dehydration. the patient had a free water deficit of 3.2l and was given multiple free water and d5w boluses which successfully normalized her sodium. labs ruled out central di as a possiblity. . # diabetes melitus: the patient was given insulin throughout her stay to maintain a glucose below 150. . # h/o renal failure requiring hd: the patient was started on epogen and her urine output was monitored closely. she responded well to fluid boluses and did not require hemodialysis during this stay. . # cad: we held her asa as she had gi bleeding. . # sacral decubitis ulcers: the patient was placed on a kinair bed and received a wound care consult. she had wound care by protocol throughout her stay for several decubitus ulcers, including on to the coccyx and others on her buttocks. the family declined any possibility of surgery for a diverting colostomy to improve her wound care. medications on admission: alteplase 2 mg to picc albumin 25gm vancomycin 1gm q24 aztreonam 1gm iv q12 ipratropium/albuterol inhaler 4 puffs qid artificial tears ou q2 lispro insulin qid per sliding scale vitamin c 500mg qd docusate 100mg pantoprazole 40mg via peg qd zinc 220mg po qd epo 3,000 u mwf polyvinyl alcohol opthalmic 2 gtt ou q2 prn fluticasone 220mcg q12 perative 60ml/hr tube feeds via peg with 300cc free water q6 hours discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. tablet, delayed release (e.c.)(s) 2. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day) as needed. 3. docusate sodium 50 mg/5 ml liquid : po bid (2 times a day). 4. artificial tear with lanolin 0.1-0.1 % ointment : one (1) appl ophthalmic prn (as needed). 5. zinc sulfate 220 (50) mg capsule : one (1) capsule po daily (daily). 6. ascorbic acid 90 mg/ml drops : five (5) po daily (daily). 7. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q6h (every 6 hours). 8. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation qid (4 times a day). 9. beclomethasone dipropionate 80 mcg/actuation aerosol : two (2) inhalation inhalation (). 10. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q2h (every 2 hours) as needed for secretions. 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 12. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 13. levothyroxine 50 mcg tablet : one (1) tablet po daily (daily). 14. heparin lock flush (porcine) 100 unit/ml syringe : one (1) flush intravenous daily (daily) as needed. 15. piperacillin-tazobactam na 4.5 gm iv q8h day 1: 16. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 17. fluconazole 200 mg iv q24h day 1 discharge disposition: extended care facility: - discharge diagnosis: sepsis anoxic brain injury pseudomonas and serratia pneumonia hypernatremia discharge condition: stable discharge instructions: please administer the medications as prescribed. of note, the patient's family has made her dnr and asks for no escalation of care and no procedures that would cause discomfort. followup instructions: provider: , md phone: date/time: 1:20 md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances diagnoses: other primary cardiomyopathies pure hypercholesterolemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis unspecified acquired hypothyroidism candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status chronic kidney disease, unspecified heart valve replaced by other means pneumonia due to pseudomonas persistent vegetative state long-term (current) use of insulin septic shock pressure ulcer, buttock pressure ulcer, lower back disseminated candidiasis pressure ulcer, heel dehydration hyperosmolality and/or hypernatremia gastrostomy status chronic respiratory failure tracheostomy status 

Answer: The patient is high likely exposed to