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: keflex / penicillins / erythromycin base / demerol / ceclor attending: chief complaint: sob major surgical or invasive procedure: none. history of present illness: 64 yo woman w/ h/o recurrent pes s/ filter, gib while anticoagulated, copd, who was discharged after being treated for new pe presented to the ed with sob and productive cough. she was readmitted after she was found to have a multifocal pneumonia and was treated with levo/flagyl and vanco. cultures were positive for mrsa. levo and flagyl were continued for suspected aspiration pna. the pt recovered quickly over since admission and she is now back on her home o2 requirement. she was getting bridged for her anticoagulation with lovenox starting in preparation for discharge. however, she developed severe abdominal pain and a palpable mass in her l abdomen. a ct was showed a new large hematoma in the muscles of the left anterior and lateral lower abdominal and pelvic wall, without any intraperitoneal or retroperitoneal extent, but with associated mass effect on the lower abdominal and pelvic bowel loops. surgery was and suggested no intervention, but monitoring for now. hct dropped 6 points in this setting, but she remained hemodynamically stable with tachycardia which has been present throughout her hospital stay (95-115). she required a total of 5 units prbc and 4 units ffp transfusions and was transferred to the micu for further monitoring. her hematocrit has since been stable with serial checks. . ros: she has baseline left to mid chest pain with exertion that is not currently bothering her. she denies current chest pain, sob, dysuria, increased urinary frequency. she has stable r knee pain. past medical history: 1. h/o rheumatic fever - age 8 -dx'ed last year with rheumatic heart disease per pt (states ed diagnosed this) and has had syndenham chorea 2. ?chf per pt. although echo revealed low normal lvef, mildly thickened aortic and mitral valves with mild mr . 3. orthostatic hypotension 4. chest pain - nearly monthly visits to ed with negative ischemic w/u in the past 5. duodenal/gastric ulcer 6. seven miscarriages 7. ulcerative colitis 8. diverticulosis-s/p colostomy and reversal colostomy-had colonoscopy showed only diverticuli without e/o active bleed 8. panic attacks x 15 yrs 9. depression - several sa in past 10. schizoaffective disorder 11. h/o polysubstance abuse 12. iron deficiency anemia (baseline unclear-high 20's to 30's) 13. copd 14. pe , c/b gib while on anticoagulation, s/ filter. new pe on , again on anticoagulation social history: lives in lodge house. she has a homemaker help with her cleaning. she gets meals on wheels. she has very limited funds. smoked 2 ppd x 40 yrs, quit smoking 4 months ago. former drinker, reports drinking two 6 packs per day for 2 yrs; quit 27 yrs ago. denies h/o illicits and ivda. h/o domestic violence. family history: daughter -40 - colitis. had 6 siblings. one sister died, 35, ovarian ca. brother, died at 48, stroke. sister, died at 64 from infection. father died at 65 of mi. mom was "psychotic", died of stroke at 93 physical exam: vs: 97.6 hr 114, bp 118/74 rr 20-30 sats 98% 2l. gen: nad, pleasant heent: peerla, mmm. neck: supple, no lad lungs: moderate air movement, decreased breath sounds at bases cv: rrr, s1s2 present, distant heart sounds, no murmurs abd: +bs, s/nd, + umbilical hernia, ulcer mid abdomen-reportedly chronic, unchanged, mildy errythematous base. no secretions. tenderness in l abdomen, palpable mass over unclear extension, no guarding, no rebound back: no cva tenderness. ext: 2+ on rle, 1+ edema lle/ no c/c/ 1+ dp neuro: a&ox3, cn ii-xii intact. moving all extremities. pertinent results: admission labs: 08:40pm pt-87.9* ptt-41.3* inr(pt)-11.8* 08:40pm wbc-16.2*# rbc-3.63* hgb-11.6* hct-33.5* mcv-93 mch-32.1* mchc-34.7 rdw-14.0 08:40pm neuts-90.5* bands-0 lymphs-4.7* monos-2.4 eos-2.0 basos-0.5 08:40pm glucose-127* urea n-16 creat-1.0 sodium-136 potassium-3.9 chloride-98 total co2-29 anion gap-13 11:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 12:47am lactate-1.3 03:07am blood wbc-7.5 rbc-2.85*# hgb-8.6*# hct-25.6* mcv-90 mch-30.3 mchc-33.6 rdw-14.4 plt ct-243 03:07am blood pt-22.4* ptt-31.1 inr(pt)-2.2* 03:07am blood glucose-105 urean-11 creat-0.6 na-141 k-4.0 cl-102 hco3-35* angap-8 03:07am blood calcium-9.0 phos-4.1 mg-2.1 04:34pm blood pep-hypogammag igg-535* iga-254 igm-109 . cta chest: 1. interval development of patchy areas of consolidation with mucous plugging, particularly in the right lower lobe, right upper and mid lobes suggest a new infectious process or aspiration. 2. resolution of the previously identified pulmonary embolism. 3. extensive centrilobular and paraseptal emphysematous change. 4. fluid-attenuating structure adjacent to the right t11-12 neural foramen is also unchanged and could be a perineural cyst. . ct abdomen/pelvis: 1. new large hematoma in the muscles of the left anterior and lateral lower abdominal and pelvic wall, without any intraperitoneal or retroperitoneal extent, but with associated mass effect on the lower abdominal and pelvic bowel loops. 2. unchanged infectious or inflammatory opacities in the right middle and lower lobes. . ir embolization: 1. right inferior epigastric arteriogram demonstrates no extravasation of contrast and successful embolization with gelfoam until stagnation of flow. 2. the right internal mammary artery demonstrated no areas of active extravasation of contrast. . cxr: there is an irregular opacity in the right lower lobe concerning for pneumonia. there are no pleural effusions. there is no pneumothorax. the left subclavian catheter tip overlies the mid svc. heart size normal. mediastinal and hilar contours are normal. impression: opacity in the right lower lobe concerning for pneumonia. . lenis: extensive occlusive thrombus is demonstrated from the common femoral vein at the takeoff of the greater saphenous vein extending distally to the popliteal veins bilaterally. no color flow, compressibility, or waveforms are demonstrated within these areas of thrombus. impression: extensive, completely occlusive, bilateral deep venous thrombi extending from the common femoral veins to the popliteal veins. . ecg: sinus tachycardia, normal ecg except for rate brief hospital course: 64f w/ h/o recurrent pe s/ filter, gib on anticoagulation, copd, recently admitted for new pe, readmitted for multifocal pna, who developed a large abdominal wall hematoma in the context of enoxaparin injections. # multifocal pneumonia: she was admitted with multifocal pneumonia. she was started on levofloxacin and vancomycin. she completed a 7 day course of levofloxacin. mrsa was found to grow in her sputum so she was continued on a 14 day course of vancomycin. she originally presented with elevated wbc count and left shift which quickly resolved with the initiation of antibiotics. her productive cough improved as well and she remained on her baseline home o2 of 2l. approximately 4 days after completion of her 14 day course of vancomycin, the patient developed worsening cough, sob, and upper respiratory symptoms. a repeat cxr showed evidence of a new consolidation in the rll. the patient was started back on levofloxacin/flagyl. vancomycin was added to her regimen when blood cultures showed 2/4 bottles with gpc in clusters and chains. additionally, her sputum culture grew out gnrs. levofloxacin was discontinued and meropenem was started for concern for pseudomonas given the patient's long hospital course. her o2 sat remained stable 93-100% on 2l nasal cannula (which is her baseline). she was given mucomyst inhaled nebulizers to assist in breaking up thick sputum. her gnrs in the sputum grew out e. coli. because of the sensitivity profile of the e. coli and the patient's allergy to penicillin and cephalosporins, the patient was continued on meropenem. her gpcs were found to grow out coag negative staph. surveillance cultures had no further growth and the coag negative staph was thought to likely be a contaminant. her vancomycin was discontinued. she will continue a 14 day course of meropenem and she was discharged with a picc to complete this course. . # pulmonary embolism/dvts: she has had multiple pes and has had one even since the placement of a trapease ivc filter. ct during recent previous hospitalization revealed appropriate location of filter and cta on this admission showed improvement of clot. admission labwork revealed an inr of 7.9. coumadin was thus held and reversed with ffp and vitamin k given her history of gib on anticoagulation. in the interim, therapeutic lovenox injections were initiated, but within days of starting, she developed a large abdominal wall hematoma near to lovenox injection site. once her hematocrit stabilized, she was started on a heparin gtt with coumadin overlap. while her coumadin with an inr 1.2, she was found to have a large hct drop and a ct scan of the abdomen showed a new rectus hematoma. she was subsequently transferred to the micu for closer monitoring. it was decided after her second hematoma while on anticoagulation, the risks of anticoagulation outweigh the benefits at this time and she was not anticoagulated. in terms of her hypercoagulable workup, it has been negative thus far for hyperhomocysteinemia, factor v leiden and antiphospholipid antibody. malignancy workup included a colonoscopy and egd as well as cea, all of which were within normal limits. spep revealed hypogammaglobulinemia, but was otherwise unremarkable. during her hospital course, she also began to complain of worsening lower extremity pain. lenis were obtained which showed evidence of extensive, completely occlusive, bilateral deep venous thrombi extending from the common femoral veins to the popliteal veins. radiology felt that these clots were most likely acute to subacute in nature. in this setting, hematology/oncology saw the patient again to consider the risks vs benefits of anticoagulation. antithrombin iii, prothrombin mutation, lupus anticoagulation and venom viper were sent to reevaluate the reason for her hypercoagulability. the hematology/oncology team still felt that the risks of coagulation outweigh the potential benefits given that the patient has had multiple bleeding episodes in the setting of anticoagulation. # abdominal wall hematoma: as mentioned above, she developed a large left-sided abdominal wall hematoma from a lovenox injection site that caused a significant hct drop (originally 28.1-->19.4). despite the drop, she remained hemodynamically stable (has sinus tachycardia at baseline prior to bleed). she received 3 units prbcs, 4 units ffp. her hematocrit then stabilized and once stable, she was restarted on heparin gtt. coumadin was re-initiated and heparin gtt was continued while awaiting her inr to become therapeutic. while her coumadin with an inr 1.2, she was found to have another hct drop (25.9-> 22.2) and a ct scan of the abdomen showed a new right-sided rectus hematoma. she was subsequently transferred to the micu for closer monitoring. she was given 1 unit ffp and 9 units prbcs between until her hematocrit became stable and she bumped appropriately to transfusion. it was decided after her second hematoma while on anticoagulation, the risks of anticoagulation outweigh the benefits at this time and she was not anticoagulated. she has complained of abdominal pain with movement and has maintained stable hematocrits. her pain is most likely to the large rectus hematoma that will resolve over time. her hct remained stable after her anticoagulation was discontinued. # thoracic mass: ct chest and abdomen revealed a stable thoracic mass (stable x 3years) and thought potentially consistent with neural cyst. it was not further evaluated by mri given its long term stability and also she has metal hardware in place s/p elbow surgery and facial plates. it should be followed up with imaging to ensure it remains unchanged in the future. # ? zoster: patient reports having a history of "herpes" on her right buttock. during her stay, she developed a tingling, itchiness and multiple small erythematous skin lesions on her right buttock over the s2, s3 dermatomal distribution. there were no vesicles appreciated. she was treated with acyclovir. # candidal vaginitis: treated with fluconazole x 2 with resolution of symptoms. # h/o gi bleeding during recent admission: recent colonoscopy showed diverticulosis with no active signs of bleeding. she had no blood in her stools during this admission even while anticoagulated. her stools were guiac-ed multiple times and were found to be guiac negative. # constipation: she is constipated at baseline and requires daily scheduled bowel regimen to maintian regularity. # hyperlipidemia: continued on lipitor. # depression/sad: continued on prozac, risperdone, wellbutrin, and klonopin. # ulcerative colitis: remains in remission. she was continued on mesalamine. # orthostatic hypotension: she remained asymptomatic even while ambulating with physical therapy. she was continued on midodrine. medications on admission: 1. fluoxetine 30 mg daily 2. risperidone 3 mg po hs 3. bupropion sr 150 mg 5. nicotine 7 mg/24 hr patch 6. hexavitamin daily 7. ascorbic acid 500 tab 1 8. calcium carbonate 500 tab 9. ferrous gluconate 325 po daily 10. atorvastatin 20 mg daily 11. fluticasone salmeterol 250/50 12. midodrine 5 mg tab 1 tid 13. tiotropium bromide capsule one cap /day 14. mesalamine 1200 tid 15. pantoprazole 40/ day 16. albuterol nebs prn (tid generally) 17. docusate sodium 18. warfarin 5 mg/day 19. ipratropium nebs prn (tid generally) 20. clonazepam 1mg po tid discharge medications: 1. fluoxetine 10 mg capsule sig: three (3) capsule po daily (daily). 2. risperidone 1 mg tablet sig: three (3) tablet po hs (at bedtime). 3. bupropion 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 4. hexavitamin tablet sig: one (1) cap po daily (daily). 5. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. midodrine 5 mg tablet sig: one (1) tablet po tid (3 times a day). 8. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po tid (3 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. nicotine 7 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 12. ferrous gluconate 300 mg tablet sig: one (1) tablet po daily (daily): please do not take this with levofloxacin. 13. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane q4h (every 4 hours) as needed. disp:*100 lozenge(s)* refills:*0* 14. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day). disp:*qs bottle* refills:*2* 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 17. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety. disp:*20 tablet(s)* refills:*0* 18. saline flush 0.9 % syringe sig: three (3) ml injection twice a day for 20 doses: prior to each vanco dose. disp:*20 syringe* refills:*0* 19. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 20. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 21. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 22. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 23. oxycodone 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 24. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qd (). 25. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 26. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day). 27. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 28. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 29. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 30. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed: for picc line. 31. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 7 days. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: 1) pulmonary embolism with history of dvt and ivc filter placement in 2) community acquired pneumonia 3) history of gi bleed (extensive) in when anticoagulated 4) abdominal wall hematoma, with acute blood loss anemia requiring 10 units prbcs when anticoagulated for current pulmonary embolism 5) noscomial pneumonia with gnr in sputum, 6) coagulopathy 7) noscomial uti with e. coli - quinolone resistant 8) vagnitis, attributed to broad spectrum antibiotic usage 9) otitis externa 10) tachycardia 11) diarrhea 12) incidentally noted left renal cyst/mass nos 13) coagulase negative staphylococcal bacteremia 14) rectus sheath hematoma in setting of anticoagulation . secondary: 1) chronic orthostatic hypotension 2) recurrent otitis externa 3) ulcerative colitis in remission 4) chronic obstructive pulmonary disease 5) depression 6) h/o schizoaffective disorder discharge condition: stable. discharge instructions: please take all medications as prescribed, please keep all follow-up appointments. please call your primary care doctor, dr. , or return to the emergency department if you experience fevers, chills, worsening shortness of breath, dizziness, lightheadedness, worsened chest pain, nausea, vomiting, diarrhea, blood in your stools or any symptoms that concern you. . please take all of your medications as prescribed and follow up with your primary care doctor below. followup instructions: you need to set up a followup appointment to see dr. in weeks. please call ( to set up this appointment. . you had the following appointment scheduled prior to your hospitalization: provider: surgery clinic phone: date/time: 1:00 ***follow up ct scan or ultrasound of left kidney is recommended as well as urologic follow up due to incidentally noted left renal cyst/mass that may be malignant.******* md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified arteriography of other intra-abdominal arteries other endovascular procedures on other vessels transfusion of packed cells transfusion of other serum diagnoses: acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified constipation, unspecified other and unspecified hyperlipidemia long-term (current) use of anticoagulants methicillin susceptible pneumonia due to staphylococcus aureus pneumonia due to escherichia coli [e. coli] personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use acute venous embolism and thrombosis of deep vessels of proximal lower extremity ulcerative colitis, unspecified other and unspecified coagulation defects other pulmonary embolism and infarction candidiasis of vulva and vagina other disorders of muscle, ligament, and fascia orthostatic hypotension schizoaffective disorder, unspecified herpes zoster without mention of complication nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs infective otitis externa, unspecified 

Answer: The patient is high likely exposed to