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: spiriva attending: chief complaint: status epilepticus and fever major surgical or invasive procedure: central line ctap history of present illness: mrs. is a 71 year old female with a pmh significant for sle on chronic steroids, copd, cva, dm 2, and multiple admissions for left subdiaphragmatic abscess s/p exlap with diverting ileostomy complicated by prolonged mechanical ventilation, volume overload, and watershed cva with residual weakness discharged to rehab on broad spectrum antimicoribals re-admitted for altered mental status found to be in status epilepticus. . the patient initially presented in for fevers and rigors and was found to have a subdiaphragmatic abscess and underwent ir drain placement with cultures demonstrating polymicrobial growth including bacteroides and pan-sensitive pseudomonas treated with ciprofloxacin, metronidazole, and fluconazole subsequently changed to amox/clav. she was readmitted in mid- for persistent nausea, and cultures then demonstrated polymicrobial growth with budding yeast speciated as and krusei. on , she underwent open left colectomy with colorectal anastamosis and diverting loop ileostomy, with stool noted in the abscess. of note, no cultures were sent from the or. her post-operative course was then complicated by a prolonged stay for volume overload requiring mechanical ventilation and a left-sided watershed cva, and was ultimately discharged to rehab on with persistent weakness on vanco, meropenem, and micafungin with plan for continuation of antibiotics for at least 7 days after drain was pulled. . the patient was readmitted to under the -rectal service on for altered mental status. her current hospital course has been notable for intermintent delirium described as being ambulatory to being difficult to control. two nights ago, she received 12.5 trazodone, and eeg yesterday was noted to have persistent epileptiform activity concerning for status epilepticus. neuro is following, and the patient has received a total of 1500 mg fosphenytoin with most recent trough pending and standing ativan q6h. cultures during this admission including blood and urine have been ngtd. of note, picc line placed during prior admission has not yet been removed. the patient also underwent ctap on with stable ruq fluid collection, midline fluid collection, and improvement in luq fluid collection. luq drain was subsequently removed, and ct guided aspiration of midline and ruq fluid collections unsuccessful. also of note, the patient also developed a new 3l o2 requirement yesterday. transfer requested for status epilepticus and fevers. past medical history: -lupus -htn -h/o stroke x 3: 1st ~10 years ago cea with residual left-sided weakness, 2nd without new deficits, 3rd recently noted at last admission () resulting in likely gerstman's syndrome (agraphia, acalculia, right/left confusion and finger agnosia) -dm type 2 -copd -s/p cea -neurogenic bladder -hypercholesterolemia -diverticulosis -spinal stenosis -right rotator cuff injury/tear social history: married, lives in , nh. 1 etoh drink per day. no tobacco family history: father- esophageal ca, monther- cva, brother- cad physical exam: gen: nad, arousable, opens eyes/moves feet to command heent: nc in place, perrl, eomi, op clear cv: nl s1+s2, no m/r/g pulm: coarse bs anteriorly & laterally, no w/r/r abd: drains and ostomy c/d/i. soft, +bs, no tenderness to palp ext: no peripheral edema, 2+ dp pulses bilaterally neuro: intermittently following commands wiggles feet to command pertinent results: 10:40pm glucose-116* urea n-11 creat-0.7 sodium-136 potassium-4.3 chloride-99 total co2-26 anion gap-15 10:40pm estgfr-using this 10:40pm tot prot-5.6* albumin-3.1* globulin-2.5 calcium-10.1 phosphate-3.3 magnesium-1.5* 10:40pm wbc-12.6* rbc-3.92* hgb-11.9* hct-36.9 mcv-94 mch-30.4 mchc-32.2 rdw-16.6* 10:40pm plt count-409 10:40pm pt-12.5 ptt-25.0 inr(pt)-1.0 09:30pm urine color-straw appear-clear sp -1.008 09:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg lupus anticoag: pos aca igg/igm: pnd : neg dsdna: neg phenytoin: 13.3 (20.8 corrected) free phenytoin: 2.7 stool studies : neg bcx : pnd catheter tip : neg hsv pcr: neg ue ultrasound: no dvt brief hospital course: mrs. is a 71 year old female with a pmh significant for sle on chronic steroids, copd, cva, dm2, and multiple admissions for left sub-diaphragmatic abscess s/p exlap with diverting ileostomy complicated by prolonged mechanical ventilation, volume overload, and watershed cva with residual weakness discharged to rehab on broad spectrum antibiotics re-admitted for altered mental status found to be in status epilepticus with multiple strokes on mri. . # status epilepticus: extubated successfully. no seizure activity since at 18:00. likely secondary to chronic or new infarcts seen on mri (ischemic vs. embolic from carotids vs. lupus vasculitis). changed anti-epileptic meds to po, dosing per neuro. on discharge the patient is on 200mg of phenytoin (suspension) every 8 hours at set times. she will need a dilantin level on with an albumin for a corrected dilantin level. # stroke: tee ruled out endocarditis. also multiple strokes and seizure bring up the possibility of a cns vasculitic etiology such as lupus cerebritis or acla syndrome ?????? lupus anticoagulant positive which explains hypercoaguability. anti-cardiolipin igg/igm pending. c3/c4 wnl, dsdna negative. neuro recommends anticoagulation then d/c plavix (surgery okay with this). carotid dopplers showed no change from prior. leni??????s negative. heparin started with plan to bridge to coumadin. however, given no iv access in the icu was changed to plavix bridge to coumadin. the patient had been therapeutic on the inpatient with a goal inr of , had been therapeutic however since we have needed to titrate the warfarin dose. neurology agreed that it was appropriate to start the patient on 325mg of aspirin therapy daily and continue coumadin. today on discharge her inr is 1.8 and she is written to recieve 7.5 mg of warfarin today which is an increase from when she recieved 5mg of warfarin for an inr of 1.4. she will need a repeat pt/inr on for dose adjustment. please see neurology note attached to this summary for further details. # fever/leukocytosis: leukocytosis 11.3 and 13.2. potential sources include: evolving pneumonia, abdominal source given recent history and temporal association with drain removal. tee negative for endocarditis, and hsv pcr neg. vancomycin, meropenem, and micafungin discontinued on . the patient was noted to have some increased adjitation and a urinalysis and urine culture was sent on which showed possible vre, infectious disease was consulted and it seemed as though the specimen was possibly contaminated, her foley catheter was removed and a repeat ua was then sent which again showed enterococus. it was decided that at the recommendation of infectious disease to give the patient a one time dose of fofomycin 3gm by mouth and follow-up in 48 hours with a urinalysis and culture. on discharge urinalysis continued to show small amount bacteria moderate leukocytes. the patient was started on linezolid by mouth for possible vre in the urine. when results of the urine culture are obtained we will follow-up with you so that the antibiotic can be stopped if it is not needed. #nutrition: speech & swallow cleared her for pureed diet with thin liquids. given that she will not be able to take in adequate nutrition po, surgery requested that we place a dobhoff. ir guided dophoff placed. the patient was again seen by speech and approved for regular mechianical soft diet which she tolerated well. because she was unable to maintain her nutrition with food, she was started on supplemental tpn. after close follow-up with nutrition and calorie counts the patient was unable to maintain enough calories and a peg tube was surgically placed. she was taking all medications by mouth at discharge with cycled tube feedings overnight. # sle: patient on chronic steroids, unclear history. anti dsdna & negative, but lupus anticoagulant positive. continue prednisone 10mg daily. . # bp: patient has been progressively more hypertensive so we restarted beta blocker. given complete r carotid occlusion and l partial occlusion, pt likely needs the blood pressure for cerebral perfusion so we will maintain sbps 120. restarted metoprolol 25mg qd by mouth . . # copd: albuterol mdi prn . # dm 2: per recommendation by geriatrics the patient was started on the following insulin regimen. ensure pt receives no insulin on sliding scale if blood sugar <160, and then 2u for 160-180, 4u 180-200, etc. continue regular 6u q6 x2 during tube feeds and lantus 8u standing at bedtime. ensure sliding scale is only used q6h, as yesterday pt received doses off the sliding scale <2h apart. please adjust sliding scale as needed. # anemia: hct stabilized. adgitation: the patient has serious waxing and adjitated delerium. she has required seroquel at 8pm. last dose on was 37.5mg and she needed an addition 6.25mg with minimal effect. she has not required additional medication during the day. medications on admission: medications (on transfer): 20 meq potassium chloride / 1000 ml d5 1/2 ns continuous at 100 ml/hr albuterol inhaler 2 puff ih q4h:prn sob aspirin 300 mg pr daily fosphenytoin 1000 mg pe iv once fosphenytoin 500 mg pe iv once heparin 5000 unit sc tid hydralazine 5 mg iv prn sbp>160 hydrocortisone na succ. 15 mg iv q8h lorazepam 1 mg iv q6h meropenem 500 mg iv q6h metoprolol tartrate 10 mg iv q4h micafungin 100 mg iv q24h pantoprazole 40 mg iv q24h vancomycin 1000 mg iv q36h . medications (on admission): -albuterol 90 mcg 1-2 puffs q 4hrs prn -asa 325mg daily -prednisone 10mg daily -pantoprazole 40mg daily -dronabinol 2.5mg -simvastatin 10mg daily -metoprolol 25mg tid -micafungin 100mg iv q daily -meropenem 500mg iv q 8hrs -vancomycin 1000mg iv q 36hrs -insulin ss discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: three (3) ml inhalation q6h (every 6 hours) as needed for wheezing or sob. 2. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po q6h (every 6 hours). 5. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for peri-stoma skin irriation. 6. phenytoin 125 mg/5 ml suspension sig: eight (8) ml po q4pm (): 200mg of phenytoin at 1600 daily. 7. phenytoin 125 mg/5 ml suspension sig: eight (8) ml po qmidnight (): 200mg of phenytoin at midnight daily. 8. phenytoin 125 mg/5 ml suspension sig: eight (8) ml po qam (once a day (in the morning)): 200mg of phenytoin daily at 0800. 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 10. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for pink eye. 11. oxcarbazepine 150 mg tablet sig: three (3) tablet po bid (2 times a day). 12. quetiapine 25 mg tablet sig: 1.5 tablets po qhs (once a day (at bedtime)). 13. warfarin 5 mg tablet sig: 1.5 tablets po once (once): please give 7.5mg of warfarin on at 1600. pt will need pt/inr check am of . goal inr . 14. insulin regular human 100 unit/ml solution sig: six (6) units injection when tube feeds start at 8pm, repeat 2am (). 15. insulin regular human 100 unit/ml solution sig: one (1) unit injection per sliding scale: please see sliding scale. 16. regular insulin sliding scale breakfast lunch dinner bedtime regular regular regular regular glucose insulin dose insulin dose insulin dose insulindose 0-70mg/dl proceed with hypoglycemia protocol 71-100mg/dl 0 units 0 units 0 units 0 units 101-120mg/dl 0 units 0 units 0 units 0 units 121-140mg/dl 0 units 0 units 0 units 0 units 141-160mg/dl 2 units 2 units 2 units 2 units 161-180mg/dl 4 units 4 units 4 units 4 units 181-200mg/dl 6 units 6 units 6 units 6 units 201-220mg/dl 8 units 8 units 8 units 8 units 221-240mg/dl 10units 10units 10 units 10 units 241-260mg/dl 12units 12units 12 units 12units 261-280mg/dl 14units 14units 14 units 14units 281-300mg/dl 16units 16units 16 units 16 units > 300 mg/dl notify m.d. notify m.d. 17. lantus 100 unit/ml solution sig: eight (8) units subcutaneous at bedtime. 18. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 19. linezolid 600 mg tablet sig: one (1) tablet po every twelve (12) hours for 14 days. discharge disposition: extended care facility: discharge diagnosis: electrical status on eeg.she was given pht and keppra and was found to have new strokes. stroke with positive lupus anticoagulant. based on her multiple strokes and the fact that they appear embolic we started coumadin. discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). frequently out of bed to char with walker, using bedside commode to void. discharge instructions: you were admitted to the hospital after being discharge to rehab from your long hospitalization after your laparoscopic converted to open extended left colectomy with colorectal anastomosis and diverting loop ileostomy for surgical managment for perforated diverticulitis with abscess. when you were admitted to the hospital, you were being watched closely and there was a morning that you became unresponsive and you were found to be having siezures. you were transferred to the intensive care unit and after many images and tests of your brain and neurologic work-up it was determined that you had a stroke, and this was the cause of your siezures. you have been followed closely by the neurology, geriatric, and surgical teams. you have not had any additional siezures and you are now taking medications that prevent siezures and you need to continue taking these and your blood must be monitored as prescribed by neurology. you have had aggitated delerium, it is unclear at this time how this will improve however we are hopeful that with continued medical managment that your mood, sleep-wake cycle, and mental status will improve. you will be given medications to assist you to sleep and help your mood. you should have your dilantin level checked in three days on at rehab. today and should have your inr checked tomorrow your goal inr is . attached to your discharge summary will be details of your neurologic process. from a surgical standpoint, you are much improved. the wound in your left lower quadrant continues to improve with vac dressing therapy which will continue to be changed every 3 days. the wound above your umbilicus has improved with wet to dry dressing changes and these should continue. on , you were diagnosed with a urinary tract infection, we treated this with one dose of an antibiotic called fosfomycin. you need to have a repeat urinalysis and urine culture on . you should be monitored for signs and symptoms on urinary tract infection including: increased adjitation or confusion, pain with urination, increased urinary frequency, if you develop a fever, or if you have foul smelling urine. you will be treated with linezolid by mouth. a peg tube was placed in your stomach to supplement your nutrition. this should continue at night as ordered. please continue to eat small frequent meals and take all of your medications by mouth. there should be a nutritionist following you at the rehabilitation facility. you will recieve your tube feedings over night and get insulin during this time to control your blood sugar. the peg tube will be cared for daily per the nursing protocol at the rehabilitation facility. please continue to care for your ostomy as instructed by the wound/ostomy nursing team. monitor your ileostomy output, this should be no less than 500cc or more than 1200cc daily. keep yourself well hydrated. please monitor yourself for the following abdominal symptoms and call dr. clinic if you develop any of these symptoms or go to the emergency room if they are severe: increased abdominal pain, increased abdominal distension, nausea, vomiting, or inability to tolerate foods or liquids. please continue to take all of your medications by mouth, you have done well swallowing. you have required some magnesium supplements through the iv. we will sned you to rehab with some supplements by mouth. also your sodium have been borderline and you should restrict your water intake to 1 liter daily. you will have your electrolytes monitored periodically at the rehabilitation hospital and they will manage your lab values appropriately. followup instructions: please make an appointment to see dr. in weeks. call to make this appointment. it is very important that you make an appointment at the neurology clinic to be followed for your dilantin level and other siezure medications in 3 weeks with dr. epilepsy clinic (, you have an appointment at 3pm, building 4rd here at . if delirium continues in dr. cognitive neurology clinic (, you may call to make this appointment. please update your primary care doctor and notify your other providers of your hospitalization. provider: , md phone: date/time: 10:00 geriatrics clinc. provider: , md phone: date/time: 3:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous [endoscopic] gastrostomy [peg] removal of other device from thorax central venous catheter placement with guidance diagnoses: systemic lupus erythematosus urinary tract infection, site not specified unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition chronic airway obstruction, not elsewhere classified fever, unspecified other encephalopathy primary hypercoagulable state streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] cerebral embolism with cerebral infarction dehydration ileostomy status pseudomonas infection in conditions classified elsewhere and of unspecified site other conditions of brain body mass index 29.0-29.9, adult epilepsia partialis continua, without mention of intractable epilepsy unspecified persistent mental disorders due to conditions classified elsewhere unspecified local infection of skin and subcutaneous tissue 

Answer: The patient is high likely exposed to