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 / sulfa (sulfonamide antibiotics) attending: chief complaint: abdominal pain major surgical or invasive procedure: ir guided doboff placement x 2 history of present illness: 70 yo female with a past history of dm, chf, pvd, cad s/p cabg who p/w abd pain on to . she presented to as a transfer for further management of acute pancreatitis. on presentation at the osh patient was found to have an elevated lipase 14,510 and amylase 4290 with a ct abdomen consistent with pancreatitis. she does not have a history of abominal pain on pancreatitis. ultrasound confirmed the presence of gallstones and there was some mild cbd dilitation. she was managed supportively with pain medication, ivfs and tpn. fluid resusication was complicated by thirdspacing and new pleural effusions on cxr. on , patient developed bradycardia, so she received epi/atropine/calcium with compressions, and was intubated and transferred to the icu. ekg showed transient lateral stds which improved without intervention, and enzymes remained flat. the following day she was started on vanco/clinda and later cipro for presumed aspiration pneumonia. cxr showed volume overloaded, so she was diuresed and extubated on . she was transitioned to bipap. amylase, lipase and lfts normalized on . a repeat ct scan was performed on to evaluate for pseudocyst given rising wbc and fevers to 102.2, but this was negative. patient had some anemia with a nadir hct of 24.9 and received 2 u prbc. patient also developed while in the hospital, but this improved to 1.2 prior to transfer, which was felt to be secondary to atn per renal consultation. in addition to renal, surgery, gi and critical care were involved with the patient's care. . on transfer, patient is sedated but responds to verbal stimuli. she is denying abdominal pain. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: -uncontrolled dm c/b retinopathy, nephropathy, neuropathy-refuses insulin -cad s/p mi and s/p cabg 2-3yrs ago; persantine stress showed no large wmas -chf (borderline lvef, mod diastolic dysfxn) with mult exacerbations -ckd dm (baseline cr=2.0) -legally blind -copd -gout -pvd -htn -hl -severe oa -hemorrhoids -h/o tubular villous adenoma on -s/p hip replacement social history: single, support from brother and his children, no tobacco or etoh family history: dm, htn physical exam: admission exam: vitals: t: 99.5 bp: 135/51 p: 74 r: 31 o2: 97% bipap 15/5 fio2 0.5 general: arouses to verbal stimuli and follows general commands heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: rhonchi bilaterally louder on expiration cv: regular rate and rhythm, 3/6 sem, normal s1 + s2, no rubs or gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: 2+ le edema, warm, well perfused, 2+ pulses, no clubbing, cyanosis discharge: vs: tm100.4 at 10pm, tc97.2 hr80s-90s, bp140s/60s, rr 32, o2sat 95% on 2l nc gen: elderly f tachypneic but denies pain or sob in nad, not diaphoretic heent: anicteric sclera, mmm, doboff in place lungs: crackles at bases worse on right, clear anteriorly heart: rrr 3/6 sem at rusb abd: obese, soft, non-tender, non-distended rectal: flexiseal in place gu: foley in place extrem: 2+ sacral edema neuro: alert, oriented x 3. legally blind and hoh but answers questions appropriately when prompted. pertinent results: admission labs: 12:16am blood wbc-30.4* rbc-3.24* hgb-9.2* hct-27.6* mcv-85 mch-28.6 mchc-33.5 rdw-15.5 plt ct-200 12:16am blood neuts-87* bands-7* lymphs-1* monos-3 eos-0 baso-0 atyps-0 metas-2* myelos-0 12:16am blood hypochr-normal anisocy-normal poiklo-occasional macrocy-normal microcy-normal polychr-normal ovalocy-occasional 12:16am blood pt-15.1* ptt-23.9 inr(pt)-1.3* 12:16am blood glucose-178* urean-81* creat-1.4* na-136 k-4.3 cl-103 hco3-25 angap-12 12:16am blood alt-84* ast-64* ld(ldh)-330* alkphos-272* amylase-24 totbili-1.6* 12:16am blood lipase-24 12:16am blood calcium-7.4* phos-4.1 mg-2.0 05:46am blood caltibc-155* ferritn-1033* trf-119* 02:07am blood type-art temp-37 po2-82* pco2-34* ph-7.46* caltco2-25 base xs-0 intubat-not intuba 02:07am blood lactate-1.5 03:53am urine color-straw appear-clear sp -1.006 03:53am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 12:48pm urine rbc-1 wbc-5 bacteri-few yeast-none epi-<1 transe-1 12:48pm urine casthy-1* 12:49pm urine hours-random urean-336 creat-23 na-68 k-37 cl-96 12:49pm urine osmolal-373 micro: 12:16 am blood culture source: line- right picc line. **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. isolated from only one set in the previous five days. sensitivities performed on request.. anaerobic bottle gram stain (final ): gram positive cocci in clusters. reported to and read back by amber # 0800. . imaging: ruq us: tiny -like stones seen within the gallbladder and there also is a layer of sludge. there are no signs of cholecystitis. no biliary dilatation. small right pleural effusion. . ct torso: 1. acute pancreatitis, with extensive inflammation and free fluid tracking through mesentery and into thorax. findings concerning for necrosis of the pancreatic neck and proximal body. 2. cholelithiasis. 3. pulmonary hypertension. 4. age-indeterminate l3 compression deformity. . nchct: 1. diffuse cerebral atrophy, without acute intracranial process. 2. under-pneumatized mastoids, with fluid opacification. please correlate clinically for evidence of mastoiditis. . video swallow: findings: barium passes freely through the oropharynx and esophagus without evidence of obstruction. there was no gross aspiration. multiple episodes of penetration were noted with thin and thick consistency barium. for details, please refer to speech and swallow division note in omr. impression: no evidence of aspiration. multiple episodes of penetration with thin and thick consistency barium. . mrcp: findings: extensive high signal intensity is present within the pancreas consistent with acute inflammation. the pancreas also has reduced signal intensity on t1-weighted imaging. there is a focal area of non-enhancement within the neck of the pancreas with an adjacent intrapancreatic fluid collection. these findings are suggestive of necrosis. the remainder of the pancreas enhances normally post-contrast. the pancreatic duct is nondilated. a number of fluid collections are noted in the lesser sac, the largest measuring 5.4 x 3.6 cm. a further 4.5 x 3.5 cm collection is present adjacent to the head of the pancreas, this collection extends cranially to the level of the caudate lobe of the liver. a fluid collection is also noted tracking over the right lobe of liver. there is layering of fluid in the neck of the gallbladder likely a composite of small stones and sludge. no common bile duct dilatation is present and no filling defects are identified. no focal liver lesions. the kidneys, adrenal glands are normal. the spleen is normal measuring 12 cm. the portal vein, splenic vein and smv are patent. the celiac and sma are also patent. there are bilateral pleural effusions with associated atelectasis. impression: 1. there is evidence of acute pancreatitis with multiple peripancreatic fluid collections. 2. a focal area of non-enhancement is present in the neck of the pancreas suggestive of necrosis. 3. no common bile duct stone / dilatation. cholelithiasis. 4. pleural effusions, atelectasis. brief hospital course: 70 yo female with a past history of dm, chf, pvd, cad s/p cabg who presents with abdominal pain to an osh and found to have gallstone pancreatitis, with a course complicated by bradycardic arrest, pulmonary edema, fevers and leukocytosis, required 11 day micu stay. # pancreatitis: presumed secondary to gallstones. ruq u/s showed gallstones but no cholecystitis. ct abdomen shows possible pancreatic necrosis but no fluid collection. she was continued on vanco, cefepime, flagyl until and had no fevers after abx were stopped. surgery was consulted and recommended ercp and post-pyloric feeds, plan for cholecystectomy once stabilized, inpt vs outpt. ercp said no indication given no cholestatic picture. she will follow up with dr. of general surgery in weeks to plan her cholecystectomy. she was continued on bowel rest and dobhoff was placed for post-pyloric feeds, eventually transitioned to ng tube with feeds tolerated without abdominal pain. leukocytosis trended down. swallow evaluated and diet advanced to clears prior to transfer out of micu. on floor she continued on nectar thick liquids and ground solids. a doboff tube was placed on for continued tube feeds as she had poor po intake for many days. this can be weaned as she starts to eat more by mouth and she may no longer need the tfs after some weeks. she should be evaluated by nutrition to measure her changing caloric needs to adjust her tfs accordingly. speech and swallow was reconsulted and felt she could tolerate a nectar-thick liquid and pureed solid diet. she had a video swallow that did not reveal any silent aspiration. she should be re-evaluated by speech and swallow at the ltac to ascertain whether her swallowing function has improved and she can advance her diet. their recommendations were the following: 1. puree solids and nectar thick liquids 2. medications crushed in applesauce or via ng tube for a more reliable means 3. tid oral care 4. 1:1 supervision with meals a. self-feeding and meal set-up b. swallow 2-3 times per bites/sip c. alternate consistences d. only feed when awake/alert/attentive 5. recommend using ng for supplemental nutrition, hydration, and medication until pt able to meet these needs on a full po diet. 6. follow up fri as overall status improves # cholelithiasis: thought to be the cause of her pancreatitis. surgery was consulted in the micu and recommended open ccy and an ercp-guided sphincterotomy. ercp was consulted and recommended mrcp prior to sphincterotomy. mrcp showed peripancreatic collections and necrotizing pancreatitis. surgery and ercp felt the best option was to have her follow up with dr. in weeks to discuss her ccy and that because she did not have cholangitis she would not need a sphincterotomy. # fevers/leukocytosis: multiple possible etilogies including recovering pancreatitis and suspected pneumonia in the setting of recent code. c. diff was negative x2 although the patient does have diarrhea it is thought pancreatic insufficiency. she has a flexiseal for this that can be discontinued when able. shee was continued on broad spectrum abx as above and completed >8 days for hcap. after this treatment she continued to have low grade fevers (around 100.4) on most nights accompanied sometimes by tachypnea. this was felt initially to be aspiration but as above she was evaluated by s+s and had a video swallow that did not reveal aspiration. therefore, the fevers have been attributed to her resolving pancreatitis and fluid collections. there is no surgical intervention for these and most likely she will continue to have low grade fevers until this completely resolves. the fevers and her tachypnea have resolved with tylenol. cultures are pending at time of discharge and we will call if they return positive. # respiratory failure: presumed secondary to pulmonary edema in a patient with underlying chf who received aggressive volume at osh for pancreatitis. abg at admission and subsequently with relative hypoxia without hypercarbia and respiratory alkalosis consistent with tachypnea. continued abx as above with little improvement in o2 requirement, but responded well to 100mg iv lasix boluses with rapid decline in o2 requirement to 2.5l at time of micu transfer. on the floor she continued to remain at about 94-96% on 2.5l nc with tachypnea to the mid-30s. she had a repeat cxr the day after transfer to the floor that showed persistent fluid overload and more aggressive diuresis with 100mg lasix iv 100mg tid and metolazone was started. it was felt the tachypnea was likely multifactorial and not only related to volume overload but also deconditioning. on discharge she was on lasix 100mg iv tid with 5mg metolazone prior to the lasix dose and was satting 95% on 2l nc. she will need further diuresis at ltac with goal to have her off o2 and her peripheral edema improved. her lytes should be checked and repleted daily while she is on iv diuretics. foley is in place to help with uop monitoring but should be discontinued when able. # altered mental status: patient altered at admission, quiet at baseline per family. oriented to person, time at time of micu transfer. remained alternately confused at times and at other times a+ox 3 throughout stay on floor. of note patient is legally blind and speaks italian as her first language (although understands and speaks english as well) and per family is not altered. she is a+ox3 at discharge. # cad/chf: ekg without ischemic changes. continued betablocker but held ace-i, statin, nitrate. lasix as above. # dm: insulin drip early in admission but transitioned to iss with glargine, dose was 15 units qpm at time of micu transfer. she continued to have high iss requirements and lantus was uptitrated to 35units qhs. # hypernatremia: na elevated, likely dehydration from diuresis and no po intake. free water flushes via dobhoff adjusted prn and na still elevated at time of micu transfer. on floor the na started to trend down with free water flushes. on discharge it was 147. her sodium should be checked daily and her free water flushes should continue to be titrated to keep her sodium level wnl. # family communication: hcp = h:, c:. she has a large family that visits daily and would like updates. # diarrhea: patient developed diarrhea in the micu. cdiff was negative. initially thought antibiotic adverse effect but continued after antibiotics discontinued. possibly pancreatic insufficiency. flexiseal is in place to prevent skin breakdown and should be discontinued when able. # compression fractures: the patient was noted to have compression fractures on ct imaging and was started on calcium and vitamin d. she should follow up with her pcp : bisphosphonate therapy when she is less ill. # anemia: this is likely anemia of chronic disease. guaiac negative so gib less likely. will need to f/u with pcp for further workup. # transitions of care: - blood cultures are pending and we will call ltac with results - sodium checks daily with titration of free water flushes as appropriate - lytes check daily and replete prn - flexiseal and foley in place and when can tolerate can remove medications on admission: 1. januvia 100mg daily 2. amlodipine 5mg daily 3. isosorbide mononitrate er 60mg daily 4. furosemide 80mg daily alt with 60mg daily 5. carvedlil 25mg 6. captopril 25mg tid 7. glizide 10mg 8. simvastatin 80mg qhs 9. citalopram 20mg daily 10. allopurinol 100mg daily 11. colchicine 0.6mg prn gout 12. tramadol prn gout pain 13. omeprazole 20mg daily 14. miralax prn discharge medications: 1. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 2. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 3. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 4. carvedilol 12.5 mg tablet : two (2) tablet po bid (2 times a day): hold for sbp<100 hr<60. 5. allopurinol 100 mg tablet : one (1) tablet po daily (daily). 6. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day): hold for loose stool. 7. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation: hold for loose stool. 8. acetaminophen 650 mg/20.3 ml solution : six y (650) mg po q6h (every 6 hours) as needed for pain, fever. 9. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed for anxiety.insomnia. 10. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation: hold for loose stool. 11. calcium carbonate 200 mg (500 mg) tablet, chewable : one (1) tablet, chewable po q 12h (every 12 hours). 12. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 13. insulin lispro 100 unit/ml solution : as dir subcutaneous four times a day: per sliding scale. 14. insulin glargine 100 unit/ml solution : thirty five (35) units subcutaneous at bedtime. 15. metolazone 2.5 mg tablet : two (2) tablet po every eight (8) hours: 30mins prior to lasix dose. 16. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 17. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 18. furosemide 100 mg iv q 8h hold for sbp<100 19. outpatient lab work patient requires daily sodium, potassium, and magnesium checks while on lasix and tube feeds so that free water flushes and lasix can be dosed appropriately and lytes can be repleted. 20. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: - discharge diagnosis: pancreatitis acute systolic heart failure deconditioning from prolonged hospitalization dysphagia diabetes discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital with pancreatitis. you had a lot of fluids to treat this which caused you to have trouble breathing. we have been helping with this with medications. you also did not eat for a long time so you are very weak. we have placed a feeding tube so you can have tube feedings while you gain your strength back. procedure: parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere anemia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation polyneuropathy in diabetes acute respiratory failure other specified cardiac dysrhythmias calculus of gallbladder without mention of cholecystitis, without mention of obstruction acute systolic heart failure hyperosmolality and/or hypernatremia acute pancreatitis legal blindness, as defined in u.s.a. background diabetic retinopathy hip joint replacement diabetes with neurological manifestations, type ii or unspecified type, uncontrolled diabetes with renal manifestations, type ii or unspecified type, uncontrolled malnutrition of moderate degree diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to