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: history of present illness: 79-year-old white female with a history of chronic obstructive pulmonary disease, hypertension, paroxysmal atrial fibrillation, presents from rehabilitation facility following an episode of tachypnea, hypoxia and obtundation requiring endotracheal intubation. the patient is status post a recent prolonged hospitalization from to for gallstone pancreatitis requiring open cholecystectomy and choledochoduodenostomy on by dr. with a long hospitalization complicated by e. coli sepsis, a lower gastrointestinal bleed, with negative colonoscopy, volume overload, and a postoperative abdominal abscess, culture positive for vancomycin-resistant enterococcus requiring ct-guided drainage. the patient also suffered c. difficile colitis during this admission. toward the end of her hospitalization, the patient was noted to have acute tachypnea, ph 7.27, co2 70, which resolved with minimal intervention the following day. the patient was discharged to a skilled nursing facility on on a plan for linezolid for four weeks for her vre abscess, and flagyl for two weeks for her c. difficile colitis. at the skilled nursing facility, the patient has done poorly, with continued lethargy, anorexia and depression. she was noted to have decreased sodium to 119 on , which was question of serum-inappropriate antidiuretic hormone. the patient developed cough on , for which she was started on robitussin, and yesterday she was noted to have hypoxia with an oxygen saturation of 93% on 2 liters nasal cannula. this morning, shortly after breakfast, the patient was noted to become more tachypneic and somnolent, having an oxygen saturation in the 60s on 2 liters, improving to 97% on 100% non-rebreather. she became increasingly somnolent, and became completely unresponsive. the patient was bag mask ventilated and referred to for further evaluation. in the emergency department, she was afebrile, with heart rate in the 80s, blood pressure 140/80, oxygen saturation 90% on 100% non-rebreather. she was unresponsive to voice and pain. the patient was subsequently intubated, with improvement in her mental status following intubation. a cta of the chest was performed, without evidence of pulmonary embolism, with scattered ground-glass opacities, slightly increased right greater than left. electrocardiogram was without significant change. a head ct was negative for acute bleed or cerebrovascular accident. after receiving 4 liters of normal saline, ceftriaxone, flagyl and lasix, the patient was transferred to the intensive care unit. upon arrival to the intensive care unit, the patient spiked a temperature to 101, and dropped her systolic blood pressure from 130s to the 80s. the patient received a 1 liter fluid bolus without significant change. she was subsequently started on dopamine. past medical history: 1. hypertension 2. chronic obstructive pulmonary disease, fev-1 1.74 in 3. atrial fibrillation 4. congestive heart failure with an ejection fraction of 60%, basal septal hypertrophy, 1 to 2+ aortic regurgitation, and 1 to 2+ mitral regurgitation 5. history of gastrointestinal bleed on aspirin 6. degenerative joint disease 7. migraine headaches 8. cataracts 9. large substernal goiter and hypothyroidism allergies: aspirin medications on transfer: linezolid 200 mg twice a day, flagyl 500 mg by mouth three times a day, darvocet as needed, atenolol 100 mg by mouth once daily, ranitidine 150 mg by mouth once daily, levothyroxine 75 mcg by mouth once daily, lasix 40 mg by mouth once daily, amiodarone 200 mg by mouth once daily, zoloft, mycostatin, florinef, and prednisone social history: the patient is married and has her children very involved with her care. her son, , is a cardiologist in , . she has a 20 pack year smoking history. physical examination: temperature 101, heart rate 70s to 80s, blood pressure 170/48 on 16 mcg/kg/minute of dopamine. skin: dry, cool feet. head, eyes, ears, nose and throat: normocephalic, atraumatic, pupils equal, round and reactive to light and accommodation, extraocular movements intact, oropharynx dry. neck: prominent external jugular vein. lungs: bilateral inspiratory and expiratory rhonchi. cardiovascular: s1 and s2, no murmurs, gallops or rubs. abdomen: surgical scar healing well, hypoactive bowel sounds, soft, nontender, nondistended. extremities: no edema, peripheral pulses intact. neurological: moving upper extremities and lower extremities. laboratory data: white blood count 17.3, hematocrit 33.5, platelets 187. inr 1.4, ptt 30. sodium 130, potassium 3.7, chloride 94, bicarbonate 26, bun 13, creatinine 0.3. cpk 75, troponin-i 0.3. urinalysis was unremarkable. chest x-ray revealed increasing left-sided effusion, consolidation at the left base, a large mediastinal mass without tracheal deviation that was unchanged from that on . ct of the chest was negative for pulmonary embolism, moderate bilateral pleural effusion, slightly increased from . bilateral atelectasis, partial collapse adjacent to pleural effusions, large superior mediastinal mass with calcific density consistent with thyroid goiter. deviated trachea and esophagus, deviated anterior and to the right. calcification of the coronary arteries, ground-glass opacifications in both lungs, with central lobular emphysematous changes mostly at the bases. ct of the head: no acute bleed, chronic small vessel ischemic changes. hospital course: 1. pulmonary/thoracic: the patient was initially admitted with hypoxic and hypercarbic respiratory failure. as stated above, cta showed no evidence for pulmonary embolism. the patient was gradually weaned from the ventilator. the patient's left-sided pleural effusion was tapped on , which revealed a 700 cc pleural effusion which was transudative and sterile. the patient was extubated on . however, on , while receiving a bath, the patient again developed sudden acute hypoxia, respiratory acidosis, apnea, and generalized unresponsiveness, requiring emergent reintubation on . on , the patient underwent a percutaneous tracheostomy, complicated by a tear of the posterior trachea. the patient was taken emergently to the operating room, and required open sternotomy with surgical repair of her trachea, along with placement of bilateral chest tubes and mediastinal tubes. because of the tortuosity of her large substernal goiter, she had a partial thyroid resection. following this procedure, the patient was managed on ac ventilation, with eventual removal of her chest and mediastinal tubes. the patient continued to wean from the ventilator on ac and, at the time of this dictation, is tolerating pressure support for approximately 12 hours per day. the patient was bronchoscoped on an almost daily regimen by dr. of interventional pulmonology both for secretion clearing and checking placement of the endotracheal tube. the endotracheal tube position was changed multiple times. at the time of this dictation, the patient is scheduled to undergo placement of a customized tracheostomy tube obtained by dr. on . 2. cardiovascular/hemodynamics: the patient was weaned off pressors by . the patient's amiodarone was discontinued secondary to concerns for precipitating a myopathy. an echocardiogram in late revealed basal septal left ventricular hypertrophy with ejection fraction greater than 55%, 2+ mitral regurgitation, 2+ tricuspid regurgitation, and moderate pulmonary hypertension. the patient was restarted on her outpatient doses of captopril, on low doses of ace inhibitors and beta blockers. in the second week of , the patient's blood pressure began to trend to the 90s, with heart rate in the 110s, along with poor urine output. there were no electrocardiogram changes, and the patient did not complain of chest pain or shortness of breath. the patient's poor urine output is currently being managed with aggressive fluid boluses and resuscitation. she remains otherwise hemodynamically stable. 3. infectious disease: the patient was initially covered with broad spectrum antibiotics, including ceftazidime, flagyl, as well as linezolid. all blood cultures remained negative, though her sputum did grow klebsiella pneumoniae, with urine showing pseudomonas. her antibiotic therapy was tailored to zosyn, for which she received a seven day course. the patient did develop a rash on levaquin, which she was being treated for a urinary tract infection. following the tear of her trachea, the patient was begun on a 14 day course of empiric vancomycin for coverage of her history of methicillin resistant staphylococcus aureus, as per dr. , the thoracic surgery attending. 4. neurological: the etiology of the patient's recurrent respiratory decompensations was unclear. the fact that her chronic obstructive pulmonary disease was not felt to be very severe, a diagnosis of a potential respiratory muscle myopathy was entertained. while cks were negative, the patient was evaluated by neurology. the patient had a negative tensilon test. an electromyogram was also consistent with a myopathic process with a moderate to severe axonal polyneuropathy noted. at the time of this dictation, the differential diagnosis includes critical care myopathy vs. drug-induced myopathy. because of concern for drug-induced myopathy, linezolid and amiodarone were discontinued. all other medications were longstanding. the patient is currently scheduled to undergo a muscle biopsy by dr. in a combined operating room procedure on . 5. gastroenterology: the patient has a history of lower gastrointestinal bleed during her last hospitalization, with a negative colonoscopy. the patient has remained ob negative during this hospitalization. she had multiple c. difficile screens, which have been negative. an abdominal ct done on revealed no change in her abdominal fluid collection. 6. hematology: the patient developed thrombocytopenia to the 100s during the early part of her hospitalization. the etiology was unclear, but was felt to either be drug-related vs. thrombocytopenia sepsis. it has since resolved. the patient required intermittent transfusions of several units of packed red blood cells. 7. endocrine: the patient was continued on synthroid. given her periods of hypotension, an acth stimulation test was performed, which was negative. 8. renal: the patient's creatinine remained well within normal limits. however, as stated in the cardiovascular section, her urine output continued to be poor through the second week of . she was given aggressive fluid resuscitation with some improvement in her urine output but, at the time of this dictation, is currently receiving intravenous fluid boluses. a fractional excretion of sodium was calculated and was found to be 0.1 and negative of pre-renal insufficiency. 9. fluids, electrolytes and nutrition: the patient was briefly on total parenteral nutrition at the time of her tracheal seal, but is currently now tolerating tube feeds. she will need to undergo placement of a percutaneous endoscopic gastrostomy tube either by radiology or by dr. . an addendum will be completed for this hospitalization at the time of discharge. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours other esophagoscopy insertion of endotracheal tube insertion of endotracheal tube percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy other repair and plastic operations on trachea bronchoscopy through artificial stoma replacement of tracheostomy tube diagnoses: unspecified pleural effusion congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse acute respiratory failure iatrogenic pneumothorax pneumonia due to klebsiella pneumoniae 

Answer: The patient is high likely exposed to