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: transfer summary/history of present illness: the patient is a 53-year-old female, with a history of advanced multiple sclerosis complicated by quadriplegia, prior history of tracheostomy, now dnr/ transferred from outside hospital on with evaluation for recurrent cholangitis in the setting of hepaticojejunostomy and cholecystectomy. the patient is now postoperative day #2, status post percutaneous transhepatic cholangiography and biliary drain placement. on the evening of , the patient had acute shortness of breath and hypoxia with desaturations to 80% on 4 liters, improving to 97% on nonrebreather, despite atrovent nebulizations x 1, lasix 80 mg iv x 1, and morphine 2 mg iv x 2, and deep suction with minimal secretions. she had a chest x-ray which was suggestive of a left lower lobe collapse. the patient declined intubation and bronchoscopy, and was transferred to the icu for mask ventilation and aggressive chest physical therapy with intent to re-expand left lung. at the time of initial icu eval, the patient is in mild distress on mask ventilation. she symptomatically feels less dyspnea. denies chest pain, fevers, and chills. past medical history: as above. 1. longstanding advanced multiple sclerosis complicated by quadriplegia. 2. history of tracheostomy. 3. status post hepaticojejunostomy . 4. status post cholecystectomy. 5. history of liver biopsy in with a history of biliary cirrhosis, status post ercp with common bile duct stent removal. 6. history of recurrent utis, recent pseudomonas uti. 7. status post ileal conduit. 8. status post peg placement. 9. low back pain. 10.myodystrophy. 11.history of c. diff in the past. medications on transfer: 1. vancomycin 1 gm. 2. flagyl 500 mg , day #5. 3. zosyn 4.5 gm, day #8. 4. colace. 5. senokot. 6. fentanyl patch 50 mcg q 72 h. 7. baclofen 20 mg po tid. 8. l-hyoscyamine 0.125 mg tid. 9. reglan 10 mg 5 x per day. 10.lansoprazole 30 mg qd. 11.prozac 20 mg qd. 12.heparin subcutaneous. 13.milk of magnesia prn. 14.dulcolax prn. 15.benadryl prn. 16.compazine prn. 17.ambien. social history: she lives in a chronic care facility in . a brother, , is involved in her care. that number is (. allergies: no known drug allergies. initial evaluation: the patient is afebrile at 97, blood pressure 100/67, pulse 107, respiratory rate 22, 97% on room air. her i's and o's are 900/800 for 24 hours. her drain had drained 200 cc over the last 24 hours. general: she was responding appropriately to questions. heent exam: shows mild icteric sclerae. cardiovascular: significant for tachycardia, regular. lungs: show scattered rhonchi and expiratory wheezing. decreased breath sounds on the left side. abdominal exam: biliary drain present. her peg shows mild erythema at site but no active exudate. otherwise, she had some mild right upper quadrant tenderness. no rebounding. extremities: warm, well-perfused. labs from am: white cell count 34.2 up from 14.3, hematocrit 33.9, platelets 435. chemistries unremarkable. her abg shows a gas of 7.41, 43, 62. her lfts show an alt of 124, ast 107, alk phos 788 up from 496, total bili 2.8, lactase 1.3. she has blood cultures from and which are pending at time of transfer. urine culture from the 29 is also negative. of note, at the outside hospital from , the patient had a urine culture with providencia stuartii, enterococcus, and in had a history of pseudomonas uti with c. difficile infection. she had an mr of the abdomen on showing status post cholecystectomy and choledochojejunostomy, with moderate intrahepatic biliary dilation, with question of a common bile duct stricture, and multiple cystic lesions of the pancreatic body and tail consistent with a chronic pancreatis, versus intraductal papillary mucinous tumor. her chest x-ray from time of transfer shows questionable consolidation in left lower lobe, but no tracheal deviation, and right side without focal consolidation. hospital course by review of systems - 1) pulmonary: the patient was transferred initially to icu for acute hypoxia and respiratory distress. initial chest x-ray suggestive of lobar collapse presumed secondary to mucous plugging. she has a history of tracheostomy, but at current point her code status is dnr/dni. she, therefore, was not a candidate for intubation. one of the goals of transfer to icu was for more aggressive physical chest pt. over the course of her icu stay, the patient's respiratory status improved markedly. zosyn and flagyl she had been on empirically for a history of utis. the patient had vancomycin added for ?mrsa. her sputum cultures were obtained, but never did grow out positive organisms. however, clinically she did improve over her icu course, and vancomycin was continued for a 14-day course which will be completed on the . there was also concern, given patient's history, that part of the respiratory demise may have been secondary to aspiration. as such, she underwent further adjustment of her peg tube to a j-tube in an effort to minimize the risk of aspiration. at the time of this dictation, the patient is beginning to tolerate her tube feeds without difficulty. in summary, the patient will complete her vancomycin course for 14 days. she will still require aggressive chest physical therapy and mobilization. she has been given inexsufflator to help mobilize secretions. her o2 requirements have decreased dramatically. at time of dictation, she is satting into the mid-90s an fio2 of 0.4. her chest x-rays have shown remarkable improvement from her initial lobar collapse. 2) cardiovascular: despite the patient's acute hypoxia, the patient has remained hemodynamically stable during the entire icu course. she was, however, found to be persistently tachycardic into the 120s and 130s. ekgs and telemetry showed sinus rhythm. the exact etiology of the sinus tachycardia is unclear. she had several sets of negative cardiac enzymes. a tsh was checked and was normal. it was presumed that her volume status was optimized. she also had an echocardiogram which essentially was unremarkable, showing an ejection fraction of near-60% without any structural abnormalities, or definite pericardial effusions. it is thought that some of the tachycardia may be secondary to autonomic dysfunction with her multiple sclerosis. given the fact that she was also slightly hypertensive at times into the systolic 140s and 150s, she was empirically treated with a beta blocker. her heart rates have shown marked improvement. she has come down into the 60s and 70s. her pressures have shown improvement. she will be discharged on atenolol. 3) gi: the patient has a complicated biliary history, having been status post hepaticojejunostomy and status post cholecystectomy with a history of recurrent cholangitis. there was initially thoughts about biliary strictures. she came to the icu postoperative day #2, status post ptc. she will be completing antibiotics, ciprofloxacin and flagyl, initially for urinary tract infections, that also will cover any biliary source of infection. during her icu course, her lfts did show marked improvement. her alk phos has been slightly elevated; the patient is currently asymptomatic without any signs of fevers or white count, and this will be followed quite closely. also from a gi standpoint, it was thought that aspiration may be a contributing factor to her respiratory demise. she currently had a peg tube in place. it was then decided that the patient may benefit from a j-tube to prevent further risk of aspiration. she underwent successful j-tube placement on without complications. at the time of discharge, the patient is tolerating her tube feeds well. she will likely need aggressive promotility agents, including reglan and a possible return of her l-hyoscyamine 0.125 mg tid. she also now has a double-lumen picc in place also placed on , in case she may require chronic tpn. 4) infectious disease: the patient was initially transferred to the icu on both metronidazole and zosyn initially for treatment of urinary tract infections, and also as coverage for biliary manipulation. she will complete her course of flagyl on . her zosyn was initially continued. however, she later developed a macular slightly raised rash on the lower extremities. it was thought that this may have been secondary to a possible drug rash related to zosyn. as such, the patient was switched to ciprofloxacin on . she will complete her course of cipro on . meanwhile, the patient was started on vancomycin on , and was then transferred to the icu, for thought of a possible infectious etiology of her respiratory compromise. sputum cultures, blood cultures, and urine cultures from her icu stay have all been negative. she has remained afebrile during her icu course, and her white count has come down considerably although still mildly elevated. 5) hematology: the patient's hematocrit and platelets have remained during the hospital course. she, as always, will require constant, continuous dvt prophylaxis. also of note, she had a double-lumen picc placed in her left upper extremity on . 6) renal/fen: the patient's electrolytes remained stable during her hospital course. she had good urine output. she was felt to be relatively euvolemic at time of discharge. she had her peg tube readjusted to a j-tube, and was restarted on tube feeding on the with promod with full fiber strength with goal tube feeding rate to be 70 cc/h. it is important that she also receive promotility agents to prevent the risk of aspiration. as mentioned above also, she has a double-lumen picc in the case that her new j-tube does not reduce the risk of aspiration, and the patient possibly may require tpn. disposition: the patient, at this time, is dnr/dni. she will be returning back to nursing home. discharge diagnoses: 1. acute respiratory distress thought secondary to left lower lobe collapse secondary to mucous plugging, questionable aspiration pneumonia now resolving. 2. history of recurrent cholangitis, status post percutaneous transhepatic , stable. 3. status post percutaneous endoscopic gastrostomy tube revision to jejunostomy tube. 4. mild hypertension and sinus tachycardia. discharge condition: fair. discharge medications: 1. fentanyl patch 50 mcg q 72 h. 2. prozac 20 mg qd. 3. reglan 10 mg qid and at bedtime. 4. heparin 5,000 u q 8. 5. dulcolax prn. 6. magnesium hydroxide prn. 7. senokot 2 tabs . 8. colace . 9. compazine prn. 10.miconazole powder prn. 11.ambien prn. 12.baclofen 20 mg tid. 13.protonix 40 mg qd. 14.flagyl 500 mg q 12 until . 15.vancomycin 1 gm q 24 h until . 16.ciprofloxacin 400 mg q 12 until . 17.morphine iv prn. please see addendum to discharge summary for further adjustments to medications prior to her discharge. dr., 12-697 dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances arterial catheterization percutaneous [endoscopic] gastrojejunostomy other percutaneous procedures on biliary tract percutaneous hepatic cholangiogram endoscopic retrograde cholangiopancreatography [ercp] diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified other pulmonary insufficiency, not elsewhere classified pulmonary collapse multiple sclerosis cholangitis obstruction of bile duct quadriplegia, unspecified biliary cirrhosis 

Answer: The patient is high likely exposed to