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: captopril / neurontin / shellfish / nsaids / promethazine / valproate sodium attending: chief complaint: sob, cough, fevers major surgical or invasive procedure: intubation mechanical ventilation cvl placement picc placement history of present illness: 69 y.o. female with copd, chf, dm2, gerd/esophagitis, who was admitted initially on for cough, sob, and fever. she was diagnosed with flu/mrsa pneumonia and underlying copd flare and treated appropriately with tamiflu, antibiotics, and steroids. however, on she was transferred to the micu for increasing respiratory distress. her symptoms gradually improved with supportive care and was transferred back to the medical floor on . however, the patient next had persistent hypoglemia to the 70s with associated mental status changes requiring d50 and d5ns. because of difficult to control blood sugars, he was transferred back to the micu. . then, on , she was noted to have lower quadrant pain. she underwent ct scan demonstrating a significant abdominal wall rectus sheath hematoma on the left side, 12x5cm. her hct dropped from 35.1 to 19.1, requiring 14 units prbcs, 12 units plasma, and 1 cryo, possibly due to punctured epigastric vein. ir/vasc surgery was consulted and she underwent angio embolization of the l inferior epigastric vein with insicion and hematoma evacuation x2 followed by vac. she was taken by the sicu service and was intubated. during her course on the surgical services she had received 24u prbc, 13ffp, 5 plts, 1 cryo. she then had low grade fevers with spikes to 101, growing pseudomonas from her sputum and urine. her cvl was changed on and she underwent trach placement for persistent need for ventilator support. she was started on meropenem on for the pseudomonal infection. lastly, she developed acute renal failure with baseline cr 1.5-1.7 increasing to 2.3->2.7 with fena of 1.3%. patient has since been monitored for the aforementioned medical problems during her course in the icu until discharge. past medical history: dm2 gerd h/o esophagitis (ischemic vs fungal) in post op setting copd (on home 02 at night, fev1 in of 32% predicted) osa, cannot tolerate cpap. depression htn s/p tah s/p pe in , with ivc filter, not anticoagulated after developed abdominal wall hematoma focal seizures diastolic chf, echo ef >55%, mild pulm artery hypertension oa s/p cva x 2 with right facial droop ckd s/p right tibial stress fracture social history: retired seamstress, waitress. living in house facility. daughter is hcp, incidentally pt's other daughter is also hospitalized on for complications of her recently diagnosed apml. pt was a former smoker, 3ppd x 30 years, quit in , per the records pt has a distant history of etoh abuse (), denies current drinking, denies illicit drug use. many sick contacts at house family history: malignancy (pancreas, larynx), cad, htn, dm, asthma; daughter recently diagnosed with leukemia physical exam: vitals: t:99.1 bp:160/80 p:120 r:24 sao2:99%2l general: awake, alert, nad, pleasant, appropriate, cooperative. heent: ncat, perrl, eomi, no scleral icterus, mmm, no lesions noted in op neck: supple, no significant jvd or carotid bruits appreciated. ? lipodystrophy. + right shoulder lipoma. pulmonary: significant wheezing in all lung fields, prolongation of respiratory phase. cardiac: tachycardic, regular, nl s1 s2, no murmurs, rubs or gallops appreciated abdomen: soft, nt, nd, normoactive bowel sounds, no masses or organomegaly noted. large midline scar, well healed. extremities: no edema, 2+ radial, dp pulses b/l. tender to palpation on right. lymphatics: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted skin: no rashes or lesions noted. neurologic: alert, oriented x 3. able to relate history without difficulty. pertinent results: admission labs: =============== 06:40am plt smr-normal plt count-274# 06:40am hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-1+ 06:40am neuts-83.4* bands-0 lymphs-12.4* monos-3.1 eos-0.7 basos-0.4 06:40am wbc-8.4 rbc-4.04* hgb-11.0* hct-35.1* mcv-87 mch-27.4 mchc-31.4 rdw-16.7* 06:40am ctropnt-0.07* 06:49am lactate-1.8 06:49am comments-green top 08:00am ck-mb-7 probnp-202 08:00am ctropnt-0.08* 08:00am ck(cpk)-231* 08:00am estgfr-using this 08:00am glucose-118* urea n-30* creat-1.6* sodium-146* potassium-3.5 chloride-101 total co2-32 anion gap-17 08:30am urine rbc-0-2 wbc-0-2 bacteria-rare yeast-none epi-0-2 08:30am urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:30am urine color-yellow appear-clear sp -1.018 08:30am urine uhold-hold 08:30am urine hours-random 10:55pm ck-mb-6 ctropnt-0.04* 10:55pm ck(cpk)-159* studies: ========= ct abdomen (): impression: large hemorrhage into the subcutaneous fat of the left lower abdomen/back. the largest collection in the left lower abdominal wall measures 12.5 x 5.3 cm and is virtually unchanged in dimensions when compared to the ultrasound examination performed eight hours earlier at the same day. of note, there is an extension of the hematoma around the left flank into the left lower back. the superior margin of this posterior collection is not completely included in the study. the hemorrhage may have been caused by puncture of a superficial vessel, such as the superficial epigastric vein, during s.q. heparin injection. . microbiology: ============= 2:15 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (preliminary): oropharyngeal flora absent. pseudomonas aeruginosa. sparse growth. non-fermenter, not pseudomonas aeruginosa. sparse growth. sensitivity testing performed by microscan. gram negative rod #3. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | non-fermenter, not pseudomonas aerugin | | amikacin-------------- 8 s =>64 r cefepime-------------- 8 s ceftazidime----------- 4 s =>16 r ceftriaxone----------- =>32 r ciprofloxacin--------- =>4 r =>2 r gentamicin------------ =>16 r =>8 r imipenem-------------- =>8 r levofloxacin---------- =>8 r meropenem------------- 4 s 8 i piperacillin---------- r =>64 r piperacillin/tazo----- <=4 s =>64 r tobramycin------------ =>16 r =>8 r trimethoprim/sulfa---- =>2 r . 3:21 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): oropharyngeal flora absent. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. pseudomonas aeruginosa. moderate growth. non-fermenter, not pseudomonas aeruginosa. moderate growth. sensitivity testing performed by microscan. pseudomonas aeruginosa. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | non-fermenter, not pseudomonas aerugin | | pseudomonas aeruginosa | | | amikacin-------------- 8 s 4 s cefepime-------------- 8 s 16 i =>64 r ceftazidime----------- 4 s 16 i =>64 r ceftriaxone----------- =>32 r ciprofloxacin--------- =>4 r =>2 r =>4 r gentamicin------------ =>16 r =>8 r =>16 r imipenem-------------- =>8 r levofloxacin---------- r meropenem------------- 4 s 8 i 4 s piperacillin---------- <=4 s 64 i =>128 r piperacillin/tazo----- <=4 s 64 i =>128 r tobramycin------------ =>16 r =>8 r 8 i trimethoprim/sulfa---- r fungal culture (preliminary): aspergillus fumigatus. . 2:45 pm urine source: catheter. **final report ** urine culture (final ): pseudomonas aeruginosa. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | amikacin-------------- 16 s cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ =>16 r . 7:53 pm catheter tip-iv source: r rad art line. **final report ** wound culture (final ): staphylococcus, coagulase negative. >15 colonies. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ 8 i levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ 2 s . 4:30 pm tissue left flank skin. **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs. reported by phone to lima cc5b 19:35 . tissue (final ): enterococcus sp.. sparse growth. staphylococcus, coagulase negative. isolated from broth media only, indicating very low numbers of organisms. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r linezolid------------- 2 s penicillin g---------- =>64 r vancomycin------------ =>32 r anaerobic culture (final ): no anaerobes isolated. . 4:59 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): sparse growth oropharyngeal flora. staph aureus coag +. heavy growth. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. gram negative rod(s). sparse growth. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s . blood cultures are all negative or show no growth to date. . stool cultures have all been negative. brief hospital course: 69 f with copd/chf, dm2, admitted with copd/flu/pna, s/p rectus sheath hematoma and bleed s/p epigastric vein embolization, intubation and trach, with psuedomonal uti/pna also with worsening transferred to the micu for further care. the following issues were investigated during this hospitalization: . #respiratory failure: multifactorial in etiology including flu/pna, chronic copd, potential component of edema. s/p trach on . patient was started on a trial off the vent on which she has continued to tolerate well. she has completed treatment for pnas. of note, she was found to have aspergillus in her sputum, but ct chest was unremarkable and clinical exam was improving. thus, treatment was deferred. she may need continued lasix prn for diuresis. . #acute renal failure: likely atn from hypotension. patient received two sessions of hd and has since been voiding to lasix with improvement of bun/creatinine. . #uti: positive for pseudomonas. fully-treated with meropenem. . #hematoma: s/p embolization. hct has remained stable in mid 20s. hd stable. patient is also s/p debridement of wound given poor healing. vac dressing in place with dressing changes every 3 days. . #eye twitiching: patient has a history of seizure disorder and given eye twitching without other explanation, eeg was obtained which showed no epiliteform changes, but did show toxic metabolic encephalopathy, which has been attributed to the patient's multiple co-morbidities. no further work-up was pursued. . #thrombocytopenia: brief period of thrombocytopenia thought to be due to medications. hit antibody was negative and platelet count has since rebounded. no further issues. . #copd: patient was continued on nebulizers as well as prednisone, which was gradually tapered down with goal of reaching a lower, maintenance dose (previously on 20 mg). . #htn: patient was maintained on diltiazem, but given increasing blood pressure, hydralazine and metoprolol were added with better control. ace-inhibitor was held given renal failure. . #dm2: monitored with figersticks and humalog insulin sliding scale and standing nph. . # kidney lesions: new lesion found on r kidney appears enlarged and worrisome for rcc. will need further imaging for reevaluation once stable vs. outpatient . #fen: continue tube feeds medications on admission: albuterol amlodipine 10 daily atorvastatin 20 diltiazem xr 180 fluticasone 1-2puffs 50mcg daily home 02, 2l nc at night atrovent mvi reglan with meals nortriptyline 50 qhs oseltamavir (started ) 75mg nystatin oral suspension trileptal 300 percocet qid protonix 40 daily kcl 20mg daily sucralfate 1g qid asa 81 daily colace predinsone 20 70/30 nph/humolog (35 qam, 5qpm) senna discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 3. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 5. bisacodyl 10 mg suppository sig: one (1) suppository rectal (2 times a day) as needed. 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 7. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation q4h (every 4 hours). 8. albuterol 90 mcg/actuation aerosol sig: 4-6 puffs inhalation q4h (every 4 hours). 9. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 10. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 11. metoclopramide 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 12. ranitidine hcl 15 mg/ml syrup sig: one (1) po daily (daily). 13. oxcarbazepine 600 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 15. diltiazem hcl 90 mg tablet sig: one (1) tablet po qid (4 times a day). 16. prednisone 5 mg tablet sig: 3.5 tablets po daily (daily): continue very slow steroid taper, decreasing by 2.5 mg every week. start 15 mg on and continue decreasing by 2.5 mg every friday, to off, as tolerated. . 17. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 18. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily) for 10 days. 19. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 20. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 21. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 22. fentanyl 75 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 23. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 24. fentanyl citrate (pf) 50 mcg/ml solution sig: one (1) injection q4h (every 4 hours) as needed for breakthrough pain. 25. insulin sliding scale continue your insulin regimen, per the sliding scale included. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary flu mrsa pna rectus sheath hematoma pseudomonas pna pseudomonas uti renal failure . secondary dm2 gerd esophagitis copd osa depression htn s/p tah history of pe w/ ivc filter focal seizures diastolic chf oa s/p cva x 2 with right facial droop ckd discharge condition: stable. discharge instructions: you were seen and evaluated for the flu and a pneumonia, both of which were appropriately treated. your hospital course was then complicated by a large hematoma (blood collection) in your leg, which was repaired surgically. during the course of surgical repair and recuperation, you had breathing difficulty, which was felt to be due to a new pneumonia. ultimately, you had to receive a tracheostomy to assist with your breathing and you have continued to be monitored for your breathing status, kidney function and hematoma. you have improved a great deal, though you need continued therapy and rehabilitation. you are now being discharged to , where you can continue to be cared for. take all of your medications as directed. keep all of your follow-up appointments. call your doctor or go to the er for any of the following: chest pain, shortness of breath, fevers/chills, nausea/vomiting, worsening pain or swelling in your leg, decreased urinary output or any other concerning symptoms. followup instructions: provider: , phone: date/time: 10:30 md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis injection of steroid temporary tracheostomy arteriography of other intra-abdominal arteries injection of antibiotic injection of antibiotic other endovascular procedures on other vessels transfusion of packed cells transfusion of packed cells other laparotomy other laparotomy closed biopsy of skin and subcutaneous tissue transfusion of other serum transfusion of platelets excision or destruction of lesion or tissue of abdominal wall or umbilicus other immobilization, pressure, and attention to wound other immobilization, pressure, and attention to wound diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified toxic encephalopathy acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified infection with microorganisms resistant to penicillins obstructive chronic bronchitis with (acute) exacerbation hematoma complicating a procedure other convulsions personal history of tobacco use depressive disorder, not elsewhere classified sepsis accidental puncture or laceration during a procedure, not elsewhere classified chronic kidney disease, stage iii (moderate) acute respiratory failure defibrination syndrome pneumonia due to pseudomonas alkalosis long-term (current) use of insulin paralytic ileus methicillin susceptible pneumonia due to staphylococcus aureus personal history of venous thrombosis and embolism other ascites tachycardia, unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure pseudomonas infection in conditions classified elsewhere and of unspecified site influenza with pneumonia other specified disorders of skin other late effects of cerebrovascular disease, facial weakness other injury of abdomen accidental cut, puncture, perforation or hemorrhage during injection or vaccination allergy to seafood 

Answer: The patient is high likely exposed to