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 / fentanyl / oxycodone / meperidine attending: chief complaint: ards seconrday to septic shock major surgical or invasive procedure: tracheostomy and g-tube placement. history of present illness: ms. is a 64 year old woman with htn, ra, type 2 dm admitted to osh on with confusion, chills, fevers to 103 and a week of green sputum found to have pna on cxr, hypotension, and hypoxic respiratory failure. she was intubated in ed, started on dopamine, and transfered to the icu. she ruled in for nstemi. she was switched to norepinephrine (per cards) and hydrocort. she also received xigris. within 24 hours her hct dropped from 35% to 28% and xigris was stopped. pt was initially on ceftriaxone and azithro which was changed to levoquin vanco and clinda which was stopped on . due to possible exposure, doxycycline was also started. she went into a flutter with rvr and was cardioverted once unsuccessfully at the osh. she was started on diltiezem drip for rate control. for ? pcp pna, she was started on high dose bactrim as well. throughout her osh course she developed an increasing o2 requirment, and there was concern for ards with increasing difficulty in ventilation. her last abg on transfer was 7.30/45/51 sating 88% on 100%fio2; imvo 14; peep 8; tv 700. she was transfered here for further management. . pcp: . past medical history: ra- stopped methotrexate 5 months ago for a "reverse effect" according to notes. maintained on 20mg prednisone daily htn niddm gerd social history: lives with husband, quit smoking 23 years ago, occasional wine, no drug use. family history: non-contributory physical exam: pe: admitted intubated, on rotating bed t:36.9 hr:104 bp:133/51 (off pressors) rr:19 90% o2 sats wt:98.6kg ac tv:400 fio2:100% peep:15 pp:24 gen: intubated, sedated heent: et tube in place neck: unable to asses jvp 2/2 habitus cv: regular rate and rhythym, occasional pvcs. lungs: course bs anteriorly/laterally abd: soft, nt, nd. nl bs. ext: no edema. 2+ dp pulses bl skin: no lesions pertinent results: 11:03pm pt-12.9 ptt-27.2 inr(pt)-1.1 11:03pm plt count-268 11:03pm wbc-15.9* rbc-3.81* hgb-11.4* hct-31.7* mcv-83 mch-30.1 mchc-36.1* rdw-16.8* 11:03pm calcium-5.9* phosphate-1.9* magnesium-2.1 11:03pm estgfr-using this 11:03pm glucose-275* urea n-30* creat-0.9 sodium-138 potassium-3.8 chloride-108 total co2-22 anion gap-12 11:09pm freeca-0.72* 11:09pm lactate-2.3* 11:09pm type-art po2-69* pco2-45 ph-7.38 total co2-28 base xs-0 . osh micro data: mycoplasma igg - posative blood cx - gm posative cocci, speciation/sensis pending legionella - negative strep pneumo antigen - negative rsv - negative influenza a/b - negative . studies: cxr - has large left pulmonary infiltrate . ct abd/pelvis: 1. uncomplicated pancreatitis with no evidence of abscess or fluid collection. 2. pleural effusions, left greater than right, with consolidation in the right lower lobe consistent with pneumonia. 3. old fractures of the pelvis. brief hospital course: # hypoxic respiratory failure - secondary to mycoplasma pna for which she completed 14 day course of levofloxacin, evolved to ards from sepsis. subsequently complicated by likely ventilator associated pneumonia, culture and bronchial lavage negative, empirically treated with a course of vancomycin and cefepime. also, complicated by severe polyneuropathy from likely critical care neuropathy. nif was measured and was in the 30s range. pt was weaned to ps 5/0 on the 13th day of hospitalization and extubation was attempted. however the patient became increasingly tachypneic and agitated about 12 hours after extubation and was reintubated. failure was thought to be due to respiratory muscle fatigue, poor underlying lung function in the context of pneumonia, possible component of volume overload. a tracheostomy was placed the next day as well as a peg tube. she was successful with trach mask trials several days after trach placement on high flow o2. she was successful for > 12hours daily, but on several occasions became tachypneic in the evening, thought to be influenced largely by anxiety rather than fatigue, requiring placement back on ps overnight. she was, however, trialed for 24 hours on trach mask and was fatigued the following day requiring full 24 hours back on ps. this was likely to true respiratory muscle fatigue. . # pna: from mycoplasma, treated with 14 day course of levofloxacin. subsequently complicated by likely ventilator associated pneumonia, culture and bronchial lavage negative, empirically treated with a course of vancomycin and cefepime. . # septic shock: lactate on admission 2.3, hypotension, elevated wbc with 2 bands, tachypnea and tachycardia. initially with pressor requirement. initial broad spectrum abx were discontinued once source of sepsis was found to be due to mycoplasma and a course of 14 days of levofloxacin was completed. the patient also was treated with stress dose steroids initially, which were subsequently weaned to baseline prednisone dose for chronic ra of 20mg. . # clostridium difficile infection: diagnosed on . pt. will complete a 7 day (post other antibiotics) course of flagyl (flagyl course to be completed on after receiving her tid dosing that day). diarrhea is much improved. . # pancreatitis: thought to propofol originally with elevated amylase and lipase. once her propofol was d/c'd, her amylase normalized. her lipase decreased, but remained elevated in the 150s. other lfts were normal. her tube feeds were held transiently when her lipase failed to completely resolve and she had mild epigastric discomfort. given that her epigastric discomfort was post g tube placement, it resolved and tube feeds were reinitiated. she did have high residuals so was not originally at goal. reglan was started and tube feeds were advanced. she is now tolerating tube feeds at goal without reglan. . # critical illness neuropathy: severe distal weakness, slight improvement towards the end of her hospital stay. emg and nerve conduction studies showed mild, proximal myopathy with a superimposed geneneralized polyneuropathy, predominantly axonal. the picture is consistent with critical illness polyneuropathy and myopathy. her strength has been consistently increasing, but deficit remains. she will need continued physical therapy for this. . # rash, eosinophilia: during her course of cefepime and vancomycin she developed a rash and eosinophilia. once her 7 day course of cefepime and vanco was complete, her rash resolved although she remained mildly subjectively itchy requiring fexofenadine. her eosinophils remained elevated, but this also started to resolve. there was no other clear drug source and suspiscion for infective cause was very low. . # low grade fever: intermittent low grade fever to tmax of 100.2. she has bal, urine and blood cultures pending from , but suspiscion for infection is low given normal wbc count and no left shift on diff. these cultures should be followed up. . # rheumatoid arthritis: patient was transiently on stress dose steroids in the setting of sepsis. steroids were reduced to her home dose of 20mg po prednisone with the resolution of sepsis. the need for pcp prophylaxis was discussed given chronically on 20mg prednisone daily. the need for this dose in the setting of her ra and pcp prophylaxis was discussed with her rheumatologist and her dose of prednisone was decreased to 15mg po prednisone as she is not currently complaining of joint symptoms. she was not started on bactrim while inpatient and if her chronic prednisone dose requirement increases, this should be readdressed. additionally, given her age, sex and chronic prednisone, she was started on vitamin d and calcium. . # anemia with hct drop: hct has been stable 24-26 from original drop from 29-31. anemia w/u included abd ct not revealing for bleed. ldh is elevated, haptoglobin elevated as well, but this is in the setting of inflammation and, thus may not reflect accurately hemolysis. stools were guaiac negative. iron revealed normal iron, elevated ferritin, and low tibc c/w acd. . # depression: patient has a history of depression and was on elavil previously. she is not sure why this was discontinued originally. while hospitalized, she was experiencing low mood and general anxiety. thus, celexa was started at 20mg daily on . this can be titrated as appropriate upon discharge. . # hypertension: after hypotension in the context of sepsis has resolved, the patient hypertension which was controlled with labetalol and captopril. she did require occasional fluid bolus in setting of negative fluid status and low uop and transient hypotension, to which her bp responded well. . # a-flutter: transient episodes in the context of high adrenergic state after acute sepsis resolved. hemodynamically stable and was in nsr for > 1week prior to discharge, continued on bb. . # steroid induced hypergylcemia: transiently on glargine, then changed to regular ss only as steroids were weaned. her blood sugars have been well controlled. she has not been requiring ss coverage, but this should be initiated if glucose control worsens. # fen: peg tube in place. tube feeds restarted after peg tube placement on . . # ppx: heparin sq, ppi . # code: full code medications on admission: meds on transfer: doxycycline 100mg lopressor 2.5mg iv q4' and 5mg iv q6' asa 81mg daily zithromax 500mg iv daily (started - one dose given) bactrim 400mg iv q8' (started - one dose given) solumedrol 60mg iv q6' (was 125mg iv q6hour until ) fludrocortisone 0.1mg ngt daily reglan 5mg iv q8' vancomycin 1gm iv q12' (started - got one dose) digoxin 0.125mg daily ng since lovenox 40mg sc daily nexium 40mg daily lantus 20u sc daily lopid 300mg via ng riss ativan prn tylenol orn morphine prn levaquin 500mg iv daily (started ) discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 3. albuterol-ipratropium 103-18 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours) as needed for when on vent. 4. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours) as needed for when on vent. 5. insulin regular human 100 unit/ml solution : see sliding scale for appropriate dosing injection asdir (as directed). 6. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 7. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed. 8. captopril 12.5 mg tablet : one (1) tablet po tid (3 times a day). 9. labetalol 200 mg tablet : two (2) tablet po tid (3 times a day). 10. acetaminophen 325 mg tablet : 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 11. acyclovir 5 % ointment : one (1) appl topical 6x/d (6 times a day). 12. citalopram 20 mg tablet : one (1) tablet po daily (daily). 13. albuterol sulfate 0.083 % solution : inhalation q4h (every 4 hours) as needed for shortness of breath, wheeze. 14. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 15. calcium carbonate 1,250 mg/5 ml(500 mg) suspension : ten (10) ml po tid (3 times a day). 16. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 2 doses: to complete 3 doses on and then to be discontinued. 17. prednisone 5 mg tablet : three (3) tablet po daily (daily). 18. heparin lock flush (porcine) 100 unit/ml syringe : mls intravenous daily (daily) as needed. 19. ativan 1 mg tablet : 0.5-1 tablet po every 4-6 hours as needed for anxiety. discharge disposition: extended care facility: medical center - discharge diagnosis: primary: 1. hypoxic respiratory failure requiring intubation now s/p tracheostomy and peg 2. community acquired pneumonia 3. ventilator associated pneumonia 4. ards 5. pancreatitis 6. depression 7. rheumatoid arthritis 8. polyneuropathy and myopathy of critical illness 9. anemia 10. clostridium difficile colitis discharge condition: stable, had been tolerating trach mask, currently on pressure support and tolerating well. discharge instructions: return to the emergency room if you develop fever, chills, if diarrhea persists or worsens post antibiotic course, worsening abdominal pain, nausea, inability to advance tube feeds. . please take your medications as prescribed. please note we have started you on the antidepressant celexa. additionally, we have decreased your prednisone for rheumatoid arthritis to 15mg daily. if your dose increases chronically from this, you should discuss with your doctor the need for pcp . followup instructions: please follow up with your primary care doctor t when appropriate from rehab. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: pneumonia, organism unspecified anemia of other chronic disease subendocardial infarction, initial episode of care esophageal reflux unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified severe sepsis depressive disorder, not elsewhere classified atrial flutter acute respiratory failure other specified septicemias septic shock intestinal infection due to clostridium difficile dermatitis due to drugs and medicines taken internally rheumatoid arthritis other specified antibiotics causing adverse effects in therapeutic use acute pancreatitis disorders of diaphragm critical illness myopathy critical illness polyneuropathy cephalosporin group causing adverse effects in therapeutic use pneumonia due to mycoplasma pneumoniae 

Answer: The patient is high likely exposed to