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: zoloft attending: chief complaint: resp failure, altered mental status major surgical or invasive procedure: intubation/extubation central line placement and removal history of present illness: year old female with recent discharge after complicated hospitalization presenting with a one day history of acute mental status change, dypsnea and hypoxia. per the notes, she was initially noted to be confused on the shift on , specifically described as "restless, shouting," and was given 0.5 mg ativan and 975 mg acetaminophen and 25 mg of benadryl. she was up that shift, with visual hallucinations and crying. staff was unable to redirect or reorient her. she was sent to the ed for altered mental status evlaution. she was given an additional dose of 0.5 mg of ativan for anxiety without indicates she was complaining about pain in the left knee. . in the ed, vitals were 99.6 bp 120/64 hr 64 r 34, 95% nrb/91% ra. fsbg was 105. she was treated initially with 10 mg iv decadron and 2 g iv cefepime and 1 g vancomycin. she reported shortness of breath but denied chest pain. the ed team noted diffuse wheezing and a nonproductive cough. she was guaiac negative. she was started on iv fluid, then was treated with nebs, 2 g of magnesium. she was started on cpap and initially had improvement, but was unable to tolerate the mask after 45 minutes. due to increasing agitation the patient was intubated. ct head has a questionable lesion and neurology was consulted. mri was recommended. she is transferred to the for further management. . on arrival to the , the patient is having generalized clonus, which resolves with sedation. . the patient was hospitalized at from through for acute cholecystitis. she was medically managed with antibiotics. her course was complicated by sepsis from s. milleri bacteremia, nstemi in the setting of sepsis, respiratory failure requiring intubation, anuric renal failure and the development of back pain. given the bacteremia and nstemi, echo was performed which demonstrated a thickened mitral leaflet. it was determined that she could not tolerate a tee and the plan was for her to complete a 14 day course of zosyn followed by a 6 week course of pen g for presumed endocarditis. discitis/osteomyelitis was considered as the patient complained of back pain during the hospitalization during a period of bacteremia, but in the absence of neurologic findings, she was already planned to have a 6 week course of antibiotics, so no imaging was pursued. past medical history: - hypercholesterolemia - coronary artery disease - asthma - osteoarthritis - cbd stones s/p 2 ercp in with stent and stent removal - recent hospitalization with multiple insults, see above. social history: currently residing at . no tobacco, etoh. daughter is , has two other daughters. family history: non-contributory physical exam: vs: 97.6 100/37 69 16 100% on ac/450/16/8/100% gen: elderly, intubated, sedated, does not open eyes to name, does not withdraw heent: perrl and midline, intubated neck: car: regular resp: clear bilaterally, no wheeze, no ronchi abd: multiple hematomas, soft, positive bowel sounds ext: 2+ le edema, symmetric to mid-shin neuro: sedated, does not follow commands, brisk/symmetric reflexes in upper and lower extremities. sustained clonus in feet, no clonus in hands. toes mute. pertinent results: labs on admission: 03:06pm blood wbc-8.3 rbc-3.13* hgb-9.0* hct-27.8* mcv-89# mch-28.8 mchc-32.3 rdw-13.7 plt ct-360 03:06pm blood neuts-71.3* lymphs-22.7 monos-2.8 eos-2.8 baso-0.3 03:06pm blood pt-13.9* ptt-37.0* inr(pt)-1.2* 03:06pm blood glucose-107* urean-22* creat-1.2* na-142 k-4.7 cl-101 hco3-33* angap-13 03:06pm blood alt-37 ast-54* ck(cpk)-34 alkphos-100 totbili-0.5 03:06pm blood calcium-9.1 phos-3.7 mg-2.2 05:51am blood asa-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 08:01pm blood type-art temp-37.2 po2-121* pco2-57* ph-7.37 caltco2-34* base xs-6 intubat-not intuba 03:20pm blood lactate-1.1 . troponin trend: 03:06pm blood ctropnt-0.07* 04:09am blood ck-mb-11* mb indx-13.3* ctropnt-0.25* 10:00am blood ck-mb-16* mb indx-14.5* ctropnt-0.37* 03:16am blood ck-mb-12* mb indx-13.5* . last set of labs: 04:36am blood wbc-9.0 rbc-3.02* hgb-9.1* hct-27.4* mcv-91 mch-30.3 mchc-33.4 rdw-14.7 plt ct-309 04:36am blood pt-13.9* ptt-31.8 inr(pt)-1.2* 04:36am blood glucose-96 urean-22* creat-1.1 na-139 k-4.0 cl-107 hco3-27 angap-9 04:36am blood calcium-8.8 phos-2.6* mg-1.9 . imaging: ct torso: 1. diffuse ground-glass opacities predominantly within the upper lobes which may represent infection and or aspiration. small bilateral pleural effusions, slightly enlarged compared to the prior study. mild superimpsoed edema noted. 2. interval decompression of the gallbladder which currently appears contracted, with gallbladder wall thickening and a small amount of pericholecystic fluid and wall enhancement. these findings may be consistent with chronic cholecystitis. 3. stable aneurysm of the right superior pulmonary vein. . mri head: no acute abnormality is seen. there is no evidence for acute ischemia or abscess. . mri c-spine: multilevel cervical spondylosis. no definite evidence for infectious sequela in the cervical spine. . cxr : stable radiographic exam of the chest with unchanged position of lines and tubes, stable cardiomegaly and bibasilar opacification likely atelectasis. . echo: there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with infero-lateral hypokinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is minimal functional mitral stenosis due to mitral annular calcification. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . microbiology: bal: stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. yeast. ~/ml. legionella culture (preliminary): no legionella isolated. fungal culture (preliminary): no fungus isolated. . legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. . direct influenza a antigen test (final ): negative for influenza a viral antigen. refer to respiratory viral culture for further information. direct influenza b antigen test (final ): negative for influenza b viral antigen. refer to respiratory viral culture for further information. rapid respiratory viral antigen test (final ): respiratory viral antigens not detected. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. . clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. . urine culture (final ): no growth. . blood culture: no growth to date brief hospital course: year old female s/p recent complicated hospitalization presented with acute ams and required intubation in ed. . # atered mental status: her overall picture is most consistent with a global toxic-metabolic insult given the degree of impairment and the lack of focal findings on physical examination. on admission she had lower extremity clonus with increased tone/rigidity (predominantly in the legs) which resolved day 3 of hospital stay. patient was briefly treated with acyclovir which was discontinued upon normal mri (no temporal bleed). for concern of hap patient started on cefepime, levofloxacin and vancomycin which was discontinued upon negative bal and cxr more consistent with volume overload. no evidence of stroke on mri. due to concern of serotonin syndrome celexa and aricept were discontinued on admission. eeg demonstrated no seizure, but supported encephalopathy. most likely etiology is toxic encephalopathy secondary to medication use and multiple co-morbidities. patient improving at time of discharge, but remained intermittently confused to severely encephalopathic. ordered olanzapine standing , sublinguil olanzapine qhs. . # respiratory failure: patient intubated in ed prior to transfer, unclear case of respiratory distress. appeared to be for airway protection based on agitation. once weaned off sedation, patient extubated herself. at time of discharge stable on nc with 100% o2 sat. over course of stay patient was + 6 l, cxr demonstrated pulmonary edema and aggressive diuresis improved respiratory status. influenza and legionella antigen negative. continued outpatient copd inhalers and morphine for symptoms control of shortness of breath. oxygenation was stable on discharge, patient requiring 2 liters of oxygen. pt. experienced severe expiratory wheezed from the upper airway when agitated. this does not respond significantly to nebulizer treatments of to diuresis. this resolves when comfortably sedated. oxygen saturations are maintained throughout these events. . # decreased uop: decreased day 1 of hospital stay and improved throughout admission. failure most likely contrast-induced nephropathy vs prerenal (fena<1%). renal function normalized during hospital stay; was not monitored towards end of stay once pt.s family decided on comfort oriented care only. . # elevated troponins: no ekg changes. echo demonstrated improvement from prior echo on prior admission. most likely related to demand ischemia and trended downwards. patient started on high dose asa and statin - which were discontinued when goals of care were shifted to comfort/minimal invasiveness. . # hypotension: first day of admission patient's map 50 and was started on levophed. blood pressure improved once sedation was weaned and was stable off pressors. . # anemia: iron panel consistent with anemia of chronic disease. stable at baseline hct 28 (based on last admission). . # goals of care: following discussion with family and hcp decided on comfort focus due to poor extended prognosis with complicated medical issues as listed above. all non-essential medications were discontinued. she was discharged to a skilled nursing facility to optimize her symptoms and activity, with plans for transition to hospice and avoidance of hospitalization at time of her next event. . contact: hcp daughter home , cell medications on admission: zosyn 2.25 gm every 8 hours, last dose due celexa 20 mg daily nexium 20 mg daily lidoderm patch aspirin 325 mg daily lasix 20 mg daily mvi miralax daily colace lopressor 12.5 mg po bid aricept 5 mg daily simvastatin 10 mg daily trazodone 25 mg daily advair 250/50 mg combivent inhaler 2 puffs qid albuterol nebs prn, benadryl prn sarna--to back discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 2. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed for wheezing. 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 7. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for puritis on back. 8. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). 9. morphine 10 mg/5 ml solution sig: 2.5 mg po q4h (every 4 hours): hold for sedation. 10. acetaminophen 160 mg/5 ml solution sig: six y (650) mg po q6h (every 6 hours). 11. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 12. olanzapine 2.5 mg tablet sig: one (1) tablet po twice a day: hold for sedation. 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 14. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 16. morphine 10 mg/5 ml solution sig: 2.5 to 5 mg po q3h (every 3 hours) as needed for pain or sob. discharge disposition: extended care facility: house (hospice home) - discharge diagnosis: altered mental status/persistent encephalopathy respiratory failure discharge condition: stable, symptoms well controlled. discharge instructions: hospice care should be arranged concurrent with skilled nursing facility placement. followup instructions: with hospice care as above procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube closed [endoscopic] biopsy of bronchus diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia toxic encephalopathy acute kidney failure, unspecified asthma, unspecified type, unspecified acute respiratory failure pressure ulcer, lower back pressure ulcer, stage ii other drugs and medicinal substances causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to