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 / sulfa (sulfonamides) / erythromycin ethylsuccinate / zithromax / zofran attending: chief complaint: fever, dyspnea, sepsis major surgical or invasive procedure: rij placement picc line placement history of present illness: ms. is a 78 y.o. f with hypertension, atrial fibrillation on coumadin, recurrent utis on suppressive therapy, s/p cva with residual l sided weakness, who presents with fever and shortness of breath. the patient's symptoms started 5 days ago with shortness of breath and fever 101-103. she also complained about cough productive of white sputum. she tried treating with honey for the cough. also complained of nasal congestion but no rhinorrhea. denies myalgias. denies sick contacts. recent hospitalizations in the last 6 months. per her husband, the patient was more confused than her baseline dementia. from omr notes, on , husband called pcp and said patient was coughing up "fluids" and requested evaluation. pcp for evaluation on that day. husband called again later that day to say the patient's cough had improved with only edema over the shins. at that time, no shortness of breath. pcp called spironolactone 25 mg daily in that day. on , visited patient who stated fever 101 and sounded very congested. at that point, pcp referred to and she was brought in by ems. in the ed, initial vs: t 99.1 hr 122 (120-140s) bp 128/80 rr 28 98% nrb. labs drawn and significant for leukocytosis 25.8 and inr 4.4. ua contaminated with epi. blood cultures and urine cultures pending. ekg with ? new rbbb. portable cxr and cta completed. she was given aspirin 325 mg po x 1, levofloxacin 750 mg iv x 1, and vancomycin 1 gm iv x 1 (ordered, but not given). 2 l ns given. foley catheter placed. review of systems: (+) per hpi, nausea (-) denies chest pain, abdominal pain, vomiting, constipation, diarrhea. past medical history: - s/p right mca cva - with left-sided hemiplegia - atrial fibrillation, on anticoagulation. target inr 2.0-3.0 - hypertension - hypercholesterolemia - glaucoma - seizure disorder - followed by dr. - recurrent urinary tract infections on macrodantin - depression - anemia - seborrheic dermatitis . past surgical history: none social history: lives at home with husband. wheelchair bound. quit smoking 15 years ago, ~50 pack year history family history: brother with mi at 58. physical exam: vital signs: t 100.2 hr 130 bp 132/48 rr 24 o2 89% 4 l nc gen: elderly obese female with facemask on, talking in full sentences heent: anicteric, eomi, op - no exudate, no erythema, no cervical lad, unable to assess jvp due to habitus chest: scattered wheezes, decreased bs bilaterally at bases cv: irreg irreg, no m/r/g abd: ndnt, soft, obese ext: + pitting edema to shins neuro: a&o x name, hospital, dob derm: no rashes noted pertinent results: admission labs: wbc 25.8 hgb 10.2 hct 34.2 plt 308 mcv 74 n 91.7 l 4.3 m 3.7 e 0.1 bas 0.2 pt 41.8 ptt 63.7 inr 4.4 . ck 226 mb 3 trop 0.02 . na 143 cl 102 bun 13 gluc 128 k 3.7 bicarb 30 cr 1.0 ag 11 . lactate 1.7 . ua amber, 4 urobili, small bili, neg leuk, lg blood, nitrite neg, prot 30, tr ketones, rbc>50, wbc , few bacteria, 21-50 epis, hyaline casts . microbiology: blood cultures x 2: negative urine culture: no growth urine legionella: negative sputum cx: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. 2+ (1-5 per 1000x field): gram positive rod(s). respiratory culture (final ): sparse growth oropharyngeal flora. . cardiac markers: 01:40pm blood ck-mb-3 probnp-3784* 01:40pm blood ck(cpk)-226* 01:40pm blood ctropnt-0.02* 03:35am blood ck(cpk)-246* 03:35am blood ck-mb-3 ctropnt-0.02* . dig load: 05:20am blood digoxin-2.6* 04:16am blood digoxin-2.4* . abg trend: 03:31am blood type-art po2-74* pco2-65* ph-7.27* caltco2-31* base xs-0 11:28am blood type-art po2-77* pco2-64* ph-7.40 caltco2-41* base xs-11 02:43pm blood type-art po2-221* pco2-64* ph-7.40 caltco2-41* base xs-12 05:21pm blood type-art po2-82* pco2-70* ph-7.39 caltco2-44* base xs-13 12:27pm blood type-art po2-63* pco2-62* ph-7.39 caltco2-39* base xs-9 . studies: ekg: ? new rbbb, atrial fibrillation of 140s, nls axis, no acute q waves, twi, st changes. compared to previous in 10/. . portable cxr (my read): rml and lll infiltrates, perihilar lymphadenopathy. . cta (wet read): limited study due to motion artifact. within limitation, no e/o pe to the segmental level. multifocal peribronchial opacities concerning for multifocal pneumonia or aspiration. hilar and mediastinal adenopathy likely reactive, but some nodes measuring up to 12mm. recommend repeat scan when symptoms resolve and patient is able to perform breath hold to ensure resolution. . ct chest:impression: increased small bilateral pleural effusions and worsening bilateral lower lobe and lingular atelectasis. secretions are noted in the right main bronchus, right bronchus intermedius and segemental branches. . echo: the left atrium is mildly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild calcific aortic stenosis. moderate pulmonary hypertension. . echo with bubble study: the left atrium is elongated. no intracardiac shunt is suggested with intravenous saline contrast at rest x 2 (patient unable to cooperate with maneuvers). there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. compared with the prior study (images reviewed) of , the estimated pulmonary artery systolic pressure is lower. . eeg portable impression: abnormal portable eeg due to the disorganized and slow background throughout. this indicates a widespread encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. there were no areas of prominent focal slowing, but encephalopathies may obscure focal findings. there were no epileptiform features. . ct head: preliminary report !! wet read !! 1. minimally change of known encephalomalacia from prior r mca stroke. with ex vacuo effect. minimall rightwarded shift of normally midline structure. 2. no acute intracranial hemorrhage. 3. new sinus disease most evident in the right maxillary and ethmoid sinus. . chest x-ray - new left upper lobe opacity raises concern for aspiration pneumonia. persistent bibasilar opacities. . abdominal x-ray - unremarkable bowel pattern . chest x-ray - there is interval improvement of the left upper lobe opacity that may be suggestive of resolution of atelectasis or aspiration . . discharge labs: 05:30am blood wbc-11.5* rbc-4.36 hgb-9.7* hct-31.0* mcv-71* mch-22.2* mchc-31.2 rdw-19.7* plt ct-442* 05:30am blood pt-20.9* ptt-28.5 inr(pt)-1.9* 05:30am blood glucose-126* urean-13 creat-0.9 na-138 k-4.1 cl-101 hco3-30 05:30am blood calcium-8.7 phos-3.7 mg-2.4 brief hospital course: mrs. is a 78 year old female with hypertension, atrial fibrillation on coumadin, recurrent utis on suppressive therapy, s/p cva with residual l sided weakness, who presented with a multifocal pneumonia. # sepis secondary to pneumonia: on admission the patient met sirs criteria with leukocytosis, tachycardia, and tachypnea. no hypotension noted in ed. she was septic on presentation transiently requiring neosynephrine. most likely infectious etiology is multifocal pneumonia seen on both cxr and cta. patient reported subjective fevers at home, low grade temp on admission. sputum culture and legionella urinary antigen were negative. blood culture and urine culture also remained negative. she remained hypoxic despite good diuresis and antibiotics. it was thought she may have a shunt given po2 82% on 100% fio2 after treatment of pneumonia. she had increased thick secretions with sats improved by suctioning. no fever, wbc elevated but stable. bubble study was without intracardiac shunt. ct chest showed small bilateral pleural effusions and thick secretions. patient improved with frequent suctioning but had a weak cough. she completed a seven day course of ceftriaxone and levofloxacin for pneumonia. she was transferred to the floor on . once on the floor the patient still exhibited signs of infection/hypoxia. mental status remained below baseline. picc placed on . thereafter, her wbc started to rise again, and on , repeat cxr report mentioned a new lul opacity suggestive of a possible aspiration pneumonia on the final read. her hypoxemia remained. blood, urine, and sputum cx sent. lft were normal. c. diff was negative. on , vancomycin, levofloxacin, and metronidazole were started for possible pneumonia. on , the patient had a temperature to 100.1. wbc count was elevated from 13k to 20.4k. levofloxacin was switched to ciprofloxacin per id recommendations. flagyl and vancomycin remained for appropriate coverage of hospital acquired pneumonia. wbc began to trend down (11.5 on ). the patient remained afebrile while on the floor. urine cultures were negative. blood cultures showed no growth to date. the patient's mental status also improved tremendously. upon discharge, patient was afebrile with no leukocytosis and her mental status had returned to her previous baseline. #. hypoxia: most likely hypoxia was due to a combination of heart failure and her previous pneumonia. patient initially came to the floor requiring fm at 35%. she was satting well and denied any sob except for on exertion. patient required frequent diuresis with iv lasix with a fluid balance of -1l in 24hrs. 40mg iv lasix was the dose that provided the best effect. nephrology was on-board and agreed with the plan to diurese. as her condition improved and mental status cleared up, she was weaned. on discharge she was on ra satting 91-93% with no complaints of shortness of breath. # altered mental status: in the icu the patient was intermittently somnolent and delerious. no evidence of elevated co2 above her baseline hypercarbia. she does have a history of partial complex seizures for which she takes keppra, but eeg in the icu showed widespread encephalopathy without focal seizures. a head ct showed encephalomalacia from prior r mca stroke but was without new bleed or other acute intracaranial process. ams remained upon transfer to the floor for the first 5 days. it began to improve as her hypoxia improved. there was an episode on the morning of when the patient was difficult to arouse in the morning. a trigger was called. however, her vital signs were stable, she had a normal blood glucose, and her abg was without significant hypercarbia. she eventually did awake to painful stimulus and remained alert the rest of the day and had no further difficulties thereafter. # atrial fibrillation / diastolic chf: the patient was diuresed in both the icu and on the floor. after extensive diuresis in the icu, her creatinine bumped to 1.2. diuretics were held and then resumed on the floor. her creatinine had returned to 0.9 on discharge. in the icu the patient had afib with rvr and was started on diltiazem for rate control. she was also briefly loaded on digoxin, but the latter was stopped in the setting of acute decompensation. her other blood pressure medications were held. # rash: the patient developed a rash in the icu that was concerning for a drug rash. she has known allergies to both penicillins and sulfa drugs. ceftriaxone discontinued. # depression: cymbalta was held in the setting of altered mental status and resumed on discharge. # seizure disorder: eeg in the icu was without signs of seizures. keppra was continued. lyrica was temporarily held, but continued on discharge. # recurrent utis: initial ua contaminated with epithelial cells. the patient was restarted on nitrofurantoin for suppresive therapy after her initial antibiotic course was completed # hypercholesterolemia: the patient was continued on simvastatin medications on admission: amlodipine 5 mg po daily betamethasone dipropionate 0.05% cream cymbalta 30 mg po daily keppra 500 mg po bid lisinopril 20 mg po daily nitrofurantoin 25 mg po daily pantoprazole 20 mg po bid potassium chloride 20 meq po daily lyrica 75 mg po bid simvastatin 40 mg po daily coumadin 3 mg po daily dulcolax 5 mg po daily spironolactone 25 mg po daily discharge medications: 1. betamethasone dipropionate 0.05 % ointment sig: one (1) appl topical (2 times a day). 2. cymbalta 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. levetiracetam 100 mg/ml solution sig: five (5) ml po bid (2 times a day): 500 mg twice a day. 4. nitrofurantoin macrocrystal 50 mg capsule sig: 0.5 capsule po hs (at bedtime). 5. warfarin 1 mg tablet sig: three (3) tablet po once a day. 6. pantoprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. dulcolax 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day: do not give if having diarrhea or loose stool. 9. outpatient lab work cbc with diff, chem 7, and inr on . please fax results to dr. 10. outpatient lab work chest x-ray, pa and lateral images, the week of . please fax report to dr. . 11. diltiazem hcl 60 mg capsule, sust. release 12 hr sig: one (1) capsule, sust. release 12 hr po every twelve (12) hours. disp:*60 capsule, sust. release 12 hr(s)* refills:*2* 12. lyrica 75 mg capsule sig: one (1) capsule po twice a day. discharge disposition: home with service facility: vn & community health discharge diagnosis: primary diagnoses: 1. community acquired pneumonia 2. aspiration pneumonia 3. acute on chronic diastolic congestive heart failure secondary diagnoses: 1. status-post stroke 2. atrial fibrillation 3. hypertension 4. seizure disorder 5. glaucoma discharge condition: vital signs stable, afebrile, mental status at baseline. discharge instructions: you were admitted to the hospital for evaluation of fevers and shortness of breath. you were treated for pneumonia in the icu and again on the hospital floor. your white blood cell count, breathing, and alertness all improved. the following changes were made to your medications: 1. amlodipine, lisinopril, and spironolactone were all stopped. 2. you were started on diltiazem to better control your heart rate. 3. potassium was stopped please call your physician or return to the hospital if you develop fevers, shortness of breath, chest pain, or other concerning symptoms. followup instructions: please get your blood counts, electrolytes, and inr checked in 3 days. please follow-up with your primary care physician . in weeks (). please get a repeat chest x-ray in weeks to ensure resolution of your pneumonia. md, procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia atrial fibrillation acute on chronic diastolic heart failure personal history of tobacco use unspecified glaucoma sepsis other persistent mental disorders due to conditions classified elsewhere pneumonitis due to inhalation of food or vomitus right bundle branch block long-term (current) use of anticoagulants late effects of cerebrovascular disease, hemiplegia affecting unspecified side dermatitis due to drugs and medicines taken internally epilepsy, unspecified, without mention of intractable epilepsy cephalosporin group causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to