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: respiratory distress major surgical or invasive procedure: thoracentesis history of present illness: 82 year-old woman with hypothyroidism, obesity, recent admission last month for pneumonia (treated with vanco and zosyn), admitted with sob and hypoxia to 88%. she reports increased new lower extremity edema over the past few days. she denies cough, lightheadeness, nausea, vomiting, fevers, chills, or abdominal pain. of note, patient was discharged from the on for pneumonia. at this time, her bun was 11 and cr 1.1. she completed a course of vanco and zosyn on . while at rehab, she was continued on lasix 40 mg daily and her creatinine was noted to steadily rise. on , she was found to be coughing so was started on avelox (completed ) for empiric pna treatment. on , her bun was 34 and cr 2.5 and so her lasix was lowered to 20 mg daily. her lasix was ultimately stopped on when she was found to have a bun of 43 and cr of 3.2. her wbc was found to be rising on . at that time, she was noted to have a rash on her back and worsening le edema. upon arrival to the ed, her vitals were t 98.1, hr 97, rr 22, 98% on 3lnc (88% on ra), bp 111/79. in the ed, she was hypotensive to the 80s transiently, but responded to ivf boluses. her cxr was difficult to interpret but showed lll opacity with effusion and she was treated for pna with vanco and cefepime. given her elevated lfts, a ruq was performed which demonstrated gallstones but could not rule out cholectysitis. she was seen by surgery who felt her presentation was not consistent with cholectysitis (no abdominal pain, fevers) and therefor did not recommend surgical intervention. past medical history: - hypothyroidism - obesity - iron deficiency anemia - thoracic aorta aneurysms - h/o gallstones - h/o pancreatic pseudocysts and radiographic evidence of pancreatitis without clinical symptoms (noted ) - recent lll cap with planned vanco/zosyn course to end - h/o renal failure in due to "accidentally taking too much lasix" social history: patient currently residing at rehab facility after hospitalization for pna. she is married. she denies alcohol or tobacco use. family history: history of pancreatic cancer in family physical exam: vitals: bp: 135/52 p: 93 r: 20 o2: 98% on 2lnc general: alert, oriented x 2.5 (knows she is in a hospital, but not the name), not speaking in full sentences but not using accessory muscles heent: sclera anicteric, dry mucous membranes neck: supple, jvp not elevated, no lad lungs: diminished breath sounds at the left base, no crackles or wheezes cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, no guarding, bowel sounds present, no rebound tenderness, no organomegaly gu: no foley ext: warm, well perfused, 2+ pitting edema bilaterally with increased erythema of left lower leg skin: diffuse maculopapular (non-pruritic rash of the trunk and proximal extremities pertinent results: wbc-10.4 rbc-3.19* hgb-8.4* hct-26.9* mcv-84 plt ct-348 neuts-81.4* lymphs-11.4* monos-3.3 eos-3.5 baso-0.4 pt-14.7* ptt-30.8 inr(pt)-1.3* glucose-112* urean-52* creat-3.0* na-144 k-3.9 cl-110* hco3-21* angap-17 alt-81* ast-88* alkphos-139* totbili-0.4 lipase-571* probnp-1308* ctropnt-0.04* albumin-1.9* calcium-6.9* phos-4.7* mg-2.0 vanco-22.1* lactate-0.9 : upep abnormal : pleural fluid cytology: no malignant cells : bone marrow biopsy: pending imaging: cxr : 1. large left lung base opacification, combination of consolidation and large left effusion. 2. likely small right effusion. 3. central venous congestion. abdominal ultrasound : impression: the constellation of cholelithiasis, peri-pancreatic fluid, and lab evidence of pancreatitis is consistent with gallstone pancreatitis. ct abdomen and pelvis : 1. diffuse enlargement of the pancreas with areas of hypodensity that could represent pseudocysts, although these are not well delineated given lack of iv contrast. note that a pancreatic mass cannot be excluded. there are several focal fluid collections, likely representing pseudocysts, including within the gastrohepatic ligament, left upper quadrant, and likely splenic subcapsular. there is small abdominal and moderate pelvic ascites. there is apparent thickening of the distal stomach/proximal duodenum, with apparent mass effect from the pancreatic head enlargement. 2. cholelithiasis. 3. cecal and proximal ascending colonic thickening, which may be infectious or inflammatory, but ischemia cannot be excluded. 4. large left pleural effusion and left lower lobe collapse. small right pleural effusion and compressive atelectasis. echo : no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. bilateral lower extremity dopplers : 1. left distal popliteal vein dvt. left posterior tibial vein showed decreased flow consistent with thrombus. 2. right and left calf veins not clearly evaluated. brief hospital course: 82 year-old woman presents with gallstone pancreatitis with peripancreatic fluid with concomitant pleural effusion which is likely an extension of abdominal cavity fluid. other active issues that the patient presented with are acute renal failure, lle dvt, and abnormal upep. hospital course: the patient arrived in respiratory distress and hypoxic chf and pleural effusion. a thoracentesis was performed on and one liter of transudative fluid was aspirated. she was placed on vanco, cefepime, and flagyl to cover both pneumonia and cholangitis. ercp consult was obtained and deferred eus or ercp until clinical status improved. pancreatitis was treated conservatively. ct scan performed and noted that her cbd was dilated, question if this is post-obstructive changes. patient also had truncal rash that was non pruritic, drug rash-like, but there is not a clear offending medication. this was followed conservatively. acute renal failure did not resolve after hydration, renal was consulted and followed noted that this is atn with uric acid crystals. spep noted to have possible polyclonal hypergammaglobulinemia. upep showed heavy chain bands, so heme-onc was consulted. lle dvt found and heparin gtt started. post-pyloric feeding tube was placed because of pancreatitis. the patient was stable for transfer to the floor. after being transferred to the floor, she became tachypneic, tachycardic with mild hypotension and thus was transferred to the trauma icu. this was thought to be due to pe for which she was treated with a heparin gtt. she was intubated on and cardioverted for rapid afib and started on pressors. she remained in the tsicu for the remainder of her stay. she was intubated and sedated. she required pressors for hypotension and amiodarone for paroxysmal afib. she continued to have a significant vent requirement with high peep due to pulmonary edema. she receieved a trach on . she had a dobhoff tube placed and was fed enterally. she had cvvh until due to continued renal failure. she was maintained on a heparin gtt for dvt. she got an ivc filter placed on . she was maintained on multiple abx: aztreonam for pna, flagyl for empiric cdiff, and fluconazole. the patient was relatively stable at the end of her hospitalization, but due to her significant illness and vent dependence and poor prognosis, she made the decision to come off of ventilator support on . she later died of respiratory arrest early on the morning of . problem list: #. gallstone pancreatitis without abdominal pain: post-pyloric feeding tube removed when patient demonstrated that she could eat orally without problem. ercp service considered eus to evaluate the pancreas parenchyma or ercp to evaluate for retained gallstones but the patient was not clinically stable enough to undergo these procedures. the patient underwent ir placement of pseudocyst drain on which returned approx 1800cc of fluid. this fluid was sent for culture though nothing grew. #. shortness of breath chf, pleural effusion, and possible pneumonia. on antibiotics for pneumonia. as needed lasix for chf. s/p 1 liter aspiration of pleural effusion on . pleural effusion likely to reaccumulate since thoracentesis. therapeutic thoracentesis as indicated. cytology on pleural fluid was negative for malignancy. patient reintubated on and ultimately underwent bedside tracheostomy. she was unable to be weaned from the vent. the patient persistently indicated and stated her desire to not be on the vent, even if it meant that she would die from respiratory failure. the patient was deamed competent to make that decision, and the vent was turned off on the night of . the patient passed away from respiratory failure at 1:40 am on . #. acute kidney injury non-oliguric atn, likely secondary to pancreatitis. renal service was consulted. she was started on cvvh in the tsicu due to uremia and acidosis. #. abnormal upep: heme-onc performed bone marrow biopsy on . #. lle dvt: heparin gtt #. hypothyroidism: levothyroxine #. dnr/dni: confirmed with the patient and healthcare proxy, (pt's daughter). after the patient underwent a tracheostomy and was able to communicate, it became apparent that the patient did not wish to continue her life on a ventilator in the icu. multiple family meetings were held during which it was decided that the patient was competent to make her own decisions regarding what interventions she wanted. the patient decided that she did not want to be on a ventilator, even if to be off the ventilator would lead to imminent respiratory arrest. on the patient was made cmo based on her own wishes, and the family was present and agreed. the ventilator was detached on the night of and the patient soon passed away due to respiratory failure on at 1:40am. #. communication: patient, hcp is (husband) daughter: (home) (work) . family declined autopsy. the surgical team took over patient's care for further managment of her gallstone pancreatitis. : she as started on flagyl and continued on vancomycin. due to a significant luekocytosis stool camples were sent for c difficile. hepain was continued with a goal of 60-80. patient's uop were poor, and she was admist active work up by the nephrology team. tpn was started, pt was consulted. patient was noted to be in atn with nephrology activley following along. diet was advance to low fat regular diet. in the pm of patient had preogresive work of breathing. ecg was performed, abg, and she was ruled out for mi, cxr. due to increasing respiratory distress she was transferred to the icu. a family discussion was had with the decision to possibly recinf patient's dnr order. foley to gravity, contineud on heparin. she as made npo. patient was intermittantly bolused overnight. : patient continued to have worsening acidosis.hypotension responding to volume. new onset rapid afib - became more hypotensive with lopressor. loaded with amio x 2 to no effect. worsening hypercarbia (39-55). family discussion and agreed to allow intubation. hypotensive post intubation, requiring dual pressors. post film showing white out of the l lung. bronchoscopy performed and mucus plugs suctioned. l svc cvl placed. with worsening acidosis and elevated cr, temp hd line placed in case dialysis. l central aline placed and put on monitor. as per renal team held off on on cvvh. shocked for unstable afib - improved rate control. patient transiently required dual pressors but levophed was weaned off and she remained on neosynephrine. improved acidosis while intubated and on bicarb gtt. resumed hep gtt. : 600cc fluid from thoracentesis, ct with large pseudocyst surrounding liver, ir placed perc drain, returned 1800 cc fluid. family informed about the progress. remains on pressors : maintained cvvh and kept i/o even during am. transient hypotension sbp 80's, map < 60, responding to ivf and albumin. transfused 1u prbc for hct 22. lactate clearing to 2.2 from 2.6. able to remove 1l o/n from cvvh and decrease neo requirement overnight. : transient hypotension on cvvh, minimal improvement after albumin. given 1 uprbc for hc of 23.3. tf held for high residuals despite reglan. kub obtained with dilated loops-continues to stool, primary team aware. pt with small amount tf suctioned from mouth, but no further episodes after manual drainage. picc discontinued and cultured : stopped cvvh. repeat ct scan showing loculated pseudocyst collection to liver and increased in size. plan for drain in am. post-pyloric dobhoff placed. continued tube feeds and resumed coumadin. : perihepatic perc drain placed by ir-1400 drained, cultures sent. ivc filter placed by ir. family meeting held-agree to trach : percutaenous trachesotomy placed. right hd catheter removed secondary to contamination, tip sent and blood sent from site, left subclavian discontinued secondary to erthyema. tip sent and blood culture. right tlc subclavian resited. cultures form peritoneal fluid negative, as well as thoracentesis. luekocystosis presumed to be secondary to h/o pna during hospitalization, persistent leukocytosis likely from pancreatic and splenic artery compression, also positive for mm in upep/spep with s/p bone marrow biopsy indicative of reactive (not malignant) bone marrow : petechial rash on forearms-heparin stopped in am. started topical hydrocortisone and benadryl. anticoagulation stopped. : derm to eval for skin lesions - biopsied. no recs. refusing care and frustrated. ethics cs obtained - family meeting in am. pressor dependent, when off, map's to 60's. improving cr and still making urine. - alb + lasix. - rash back from path = leukocytophilic vasculitis, sending vasculitis labs, family mtg held with ethics, no conclusion reached. back on ac overnight for tachypnea significant family discussions re withdrawal of care. on patient was made cmo and expired shortly thereafter. medications on admission: levothyroxine 175 mg daily albuterol/atrovent prn lactobacillus 1 tab lovenox 30 mg daily tylenol prn milk of magnesia 30 mg po prn anatic gel prn gi upset bisacodyl 10 mg prn lasix 40 mg daily (stopped ) discharge medications: none discharge disposition: expired discharge diagnosis: pancreatitis with multiorgan failure respiratory arrest discharge condition: na discharge instructions: na followup instructions: na procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis thoracentesis thoracentesis percutaneous abdominal drainage percutaneous abdominal drainage biopsy of bone marrow drainage of pancreatic cyst by catheter temporary tracheostomy closed [endoscopic] biopsy of bronchus closed biopsy of skin and subcutaneous tissue diagnoses: pneumonia, organism unspecified acidosis acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism atrial fibrillation acute respiratory failure iron deficiency anemia, unspecified other ascites acute venous embolism and thrombosis of deep vessels of proximal lower extremity cholangitis other pulmonary embolism and infarction acute pancreatitis other paraproteinemias cyst and pseudocyst of pancreas calculus of bile duct without mention of cholecystitis, without mention of obstruction dependence on respirator, status kwashiorkor 

Answer: The patient is high likely exposed to