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 / tetracycline / sulfa (sulfonamides) attending: chief complaint: persistent respiratory failure major surgical or invasive procedure: was transferred already intubated history of present illness: 55 year old woman with hx of obesity presented to medical center on after falling down stairs while at home. she suffered a traumatic t5-8 fracture with retropulsion of fragments. per medical records and discussion with her brother, she was awake for the fall (no loc) and the fall was triggered by unsteady gait, potentially influenced by alcohol. her fracture was managed concervatively. she was placed in a torso brace but her course was complicated by respiratory failure requiring intubation. at that time a ct was negative for pe but showed bilateral bibasilar consolidations vs atelectasis. at that time an abg was 7.2/89/57 (unknown fio2 but likely >6l facemask). she was intubated on at 08:40. the respiratory failure was thought likely to be related to pain med induced hypoventilation, bronchospasm, or restricted breathing due to the back brace. the hospital course was complicated by difficulty weaning form the ventilator. her periodic agitation was managed with seroquel. prior to transfer her vent settings were: simv 12x600 fio2 0.45. the neurosurgery service evaluated her and recommended concervative management of her fracture including a back brace and outpatient neurosurgery followup. the ct chest showed notable narrowing of her central airways and the patient was referred for interventional pulmonary evaluation for airway stenting. past medical history: s/p tah s/p appendectomy remote benign breast mass social history: regional manager at insurance company. lived with boyfriend > 10 years. boyfriend has poa. has not been in contact with her brother in ~1 year, however, brother has visited her frequently while in the hospital. drinks etoh. unknown cigarrette smoking. family history: nc physical exam: general appearance: overweight / obese eyes / conjunctiva: perrl, sclera edema head, ears, nose, throat: normocephalic, endotracheal tube, og tube cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (percussion: resonant : ), (breath sounds: rhonchorous: bilaterally) abdominal: soft, non-tender, bowel sounds present, distended, obese extremities: right: trace, left: trace, cyanosis skin: warm neurologic: attentive, follows simple commands, responds to: verbal stimuli, movement: purposeful, sedated, tone: not assessed pertinent results: ******pertinent lab results******* 01:00am blood wbc-9.7 rbc-3.58* hgb-9.7* hct-30.7* mcv-86 mch-27.0 mchc-31.5 rdw-13.3 plt ct-333 03:23am blood wbc-5.1 rbc-2.77* hgb-7.2* hct-23.7* mcv-86 mch-26.0* mchc-30.4* rdw-14.8 plt ct-187 01:00am blood pt-13.8* ptt-22.4 inr(pt)-1.2* 05:01am blood pt-72.4* ptt-42.1* inr(pt)-9.0* 04:05am blood pt-13.3 ptt-32.4 inr(pt)-1.1 01:00am blood glucose-103 urean-6 creat-0.6 na-150* k-3.8 cl-109* hco3-30 angap-15 03:23am blood glucose-105 urean-17 creat-0.5 na-147* k-3.8 cl-108 hco3-35* angap-8 01:00am blood alt-30 ast-19 ld(ldh)-222 alkphos-149* totbili-0.7 07:34am blood alt-25 ast-19 ld(ldh)-192 alkphos-106 totbili-0.2 01:00am blood albumin-3.0* calcium-8.6 phos-4.1 mg-2.1 03:23am blood calcium-8.8 phos-3.5 mg-2.1 03:06pm blood fsh-4.1 prolact-48* 03:20pm blood prolact-37* tsh-0.39 07:34am blood fsh-28* 03:20pm blood t3-110 free t4-1.2 07:34am blood t4-7.4 03:01am blood cortsol-4.5 07:34am blood cortsol-13.7 05:01pm blood lactate-.8 11:00pm blood freeca-1.18 02:51am blood freeca-1.24 ******microbiology****** 8:10 am urine source: catheter. clinical significance of isolate(s) uncertain. interpret with caution. staphylococcus, coagulase negative. 10,000-100,000 organisms/ml.. lactobacillus species. 10,000-100,000 organisms/ml.. 7:05 am sputum source: endotracheal. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella oxytoca | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s legionella culture (final ): no legionella isolated. 11:20 am mini-bal bronchial lavage. sensitivities: mic expressed in mcg/ml ____________________________________________________ klebsiella oxytoca | klebsiella pneumoniae | | ampicillin/sulbactam-- 16 i 4 s cefazolin------------- 16 i <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 4 s 2 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s 8:55 pm sputum source: endotracheal. klebsiella oxytoca | klebsiella pneumoniae | | ampicillin/sulbactam-- 8 s 4 s cefazolin------------- 8 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 4 s 2 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s 2:00 am sputum source: endotracheal. respiratory culture (final ): moderate growth oropharyngeal flora. klebsiella oxytoca. moderate growth. identification and sensitivities performed on culture # ,. gram stain reviewed: 2+ (1-5 per 1000x field): gram negative rod(s). were observed . 9:55 am stool consistency: formed source: stool. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. 7:34 am stool consistency: formed source: stool. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. 5:52 am stool consistency: watery source: stool. clostridium difficile toxin a & b test (pending): ******imaging****** unilat up ext veins us right port study date of 11:50 am 1. non-occlusive right axillary deep vein thrombus. 2. non-occlusive right basilic superficial thrombosis. portable tte (complete) done at 3:37:45 pm final the left atrium and right atrium are normal in cavity size. suboptimal saline contrast study does not suggest an intracardiac shunt. left ventricular wall thickness, cavity size, and global systolic function are normal (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 leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. .the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild-moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. preserved global biventricular systolic function. mild-moderate pulmonary artery systolic hypertension. ct chest w/o contrast study date of 5:23 pm 1. improving bilateral consolidations and effusions. no loculated effusion identified. persistent atelectasis/consolidation at the lower lobes bilaterally with small effusions, possibly secondary to aspiration. 2. evidence of tracheobronchomalacia. 3. evidence of slight overinflation of the tracheostomy cuff. 4. cholelithiasis. 5. right thyroid nodule. ultrasound for further evaluation as clinically indicated would be recommended when patient is stable. ct abdomen w/contrast study date of 3:39 pm 1. no acute intra-abdominal process, without evidence of obstruction. 2. atelectasis of both lung bases, with suggestion of tracheobronchomalacia, which may be related to chronic tracheostomy. this can be further evaluated with a ct trachea. 3. cholelithiasis. 4. diverticulosis without diverticulitis. chest (portable ap) study date of 3:21 am chest radiographs from and . the study is limited due to motion artifact, but overall, there is no change in bilateral significant atelectasis involving lower lobes and right middle lobe. the upper lungs are ventilated. the tracheostomy is low with its tip projecting less than 2 cm above the carina. pleural effusion cannot be excluded. brief hospital course: 55 year old woman with history of etoh abuse presenting following mechanical fall and traumatic t spine fracture. she was intubated at an outside hospital for unclear etiology and was transferred while intubated. # respiratory failure and ventilator associated pna: upon transfer, the patietn was already intubated for initial unclear etiology. with further evaluation, the cause was likely multifactorial and she was found to have a significant pneumonia soon after transfer. initial blood and sputum cultures were negative. given poor status, patient was started on vancomycin, aztreonam, flagyl and levofloxacin. metronidazole was discontinued. aztreonam was discontinued. levofloxacin was discontinued. during this time, she continued to be diuresed and had stress-dose steroids and required vasopressor support. interventional pulmonology was consulted to perform bronchoscopy and provide further information regarding difficulty in weaning patient and bal was performed on . the pansensitive klebsiella oxytoca and klebsiella pneumoniae grew from bal. she was optimized with inhalers including albuterol and ipratroprium. she continued to be of a marginal respiratory status and given failure to wean from the vent, she underwent tracheostomy on . on she was restarted on vancomycin 1000 mg iv q 12h, aztreonam mg iv q8h, and levofloxacin 750 mg iv q24h for concern for recurrent vap and aspiration. aztreonam and vancomycin were stopped on . on levofloxacin was changed to ceftriaxone. ceftriaxone was discontinued . given concern for recurrent aspiration, ent was consulted to evaluate the patient. on vc exam, revealed an inability to adduct the true vocal cords posteriorly, raising concern for high aspiration risk. despite this, from that point on, ms. has continued to improve and has tolerated her tubefeeding with minimal residuals. she continues to have intermittent mucous plugging with appropriate desaturations, but these resolve with deep suctioning. the patient had further evaluation for passe-muir valve. they left the following recommendations including always deflate cuff prior to placing the passy-muir valve; monitor o2 sats / respiration while valve is in place; do not allow the patient to sleep with the valve in place; patient must be supervised wtih valve in place; and requires frequent suctioning via yankauer with pmv in place. ultimately, the pmv wear schedule is up to the discretion of then nurse and/or respiratory therapist. scopalomine was started to decrease secretions but was later discontinued due to possible etiology of delirium. # hypotension. patient was hypotensive upon presentation and throughout a large portion of her hospital course. this was intially concerning for hypovolemia and she was responsive to transfusion. there was also concern for sepsis, and she was treated with broad spectrum antibiotics as above. ultimately, she was successfully weaned from her pressor support on . # oliguria: initially patient was oliguric, which was likely secondary to hypotension. initial bun:cr was 6:0.6. her oliguria improved with fluid resuscitation and her renal function continued to be stable throughout her stay. # rue dvt: noted soon after arrival as site of prior picc. started on heparin gtt on . she was then transition to warfarin po. initially she was therapeutic in one day; may be related to poor nutritional status. her inr ultimately increased to 9 on and was difficult to maintain within the appropriate range. thus, she was transitioned to sq lovenox and will be discharged on this medication. given the provoked dvt, patient should remain anticoagualated for at least 6 months. # abdominal distention: noted on admission, presumed to be chronic condition not requiring immediate medical attention. ct abdomen only showed appendiceal mucocele without inflammation, not concerning, most likely chronic. no concern for acute intra-abdominal process. originally constipated then began having regular and somewhat loose bowel movements. c. diff toxin was checked three times and was negative with each screen. all abdominal labs inculding lfts, amylase and lipase were within normal limits. # anemia: patient with initial hct 30.7 but then dropped to 25 for unclear etiology. given 1 unit prbc with good results. original and ongoing anemia attributed partially to chronic disease, as well as malnutrition. stool was guaiaced and negative. upon discharge, her hct was stable with results as above. # spine fracture: neurologically intact distal to the lesion. prior notes from mmc neurosurgeons indicated no surgical procedure needed and would continue with spine brace. orthopedic spine service continued to follow and recommended no surgical intervention. ms. is to continue to wear her current brace while out of bed or upright. upon discharge, the follow-up plan is for ms. to see dr. in 6 weeks and remain in tlso until then. no further imaging given extubated and asymptomatic except for back pain over mid t-spine. she should have new brace fitted upon discharge as she has lost significant weight during hospital stay. # hypernatremia: noted to be 150 on presentation secondary to free water deficit. g-tube flushes were increased and her sodium normalized appropriately. # concern for secondary adrenal insufficiency: the patient's cortisol while intubated and on vasopressors only 2-4 range. question secondary adrenal insufficiency from a central source, which could be further worked up at a later time. after trach and weaning from pressor support, steroids were weaned without changing eiter blood pressure or electrolyte balance. # ileus/vomiting: intially, patient tolerated tubefeeding but later developed an ileus as seen on imaging and demonstrated with decreased stool output. given the duration of her ileus, she was started on tpn . this was discontinued on . upon discharge we were continuing to increase her tf goal to full strength replete with fiber at 60cc/hour. she was also on reglan 20mg iv q 8 hours until she obtained goal rates for tubefeeding. ideally, reglan should be discontinued as soon as possible given his potential for delirium. # atrial tachycardia: developed during hospital course. initially thought to be sinus tachycardia. she was evaluated for pe with cta, fluid challenged, thryoid was assessed and pain medication was modified to alleviate her presumed sinus tachycardia. finally, ep was consulted, adenosine was given and she was diagnosed atrial tachycardia rather than sinus tachycardia. her initial hr was was in the 160s but then improved to the 120s. she was loaded with amiodarone . upon discharge, patient is well controlled on po amiodarone 200 tid and po metoprolol 37.5mg tid. the plan will be to continue continue amiodarone 200 tid for three weeks and then switch to qday for 1 week and then discontinue amiodarone. the date of discontinuation is . upon discharge she will follow-up with dr. . she was originally seen by dr. while inpatient. at this appointment, they may decide to discontinue her metoprolol as well as her amiodarone. # sedation/altered mental stats: several days into hospital course, patient developed delirium and agitation most likely secondary to long hospital course and multiple psychotropic medications as well as history of etoh abuse. she was initially treated with benzodiazepines and haldol without appropriate effect. given continued problems, psychiatry was ultimately consulted. they recommended holding all benzodiazepines, opiates and antihistamines and using both scheduled risperdal and risperdal 0.5mg po bid prn. her delirium improved greatly after this point. given continued risperdal, her ekg was monitored approximately every other day to assess for qtc prolongation. at the time of discharge the patient was oriented to person, time and year, but not location. # tracheomalacia. noted on ct scan . reevaluation bronchoscopy by ip was performed and it was determined the patient was not a candidate for stent. there was no continuing issues and patient should follow-up with pulmomonary as an outpatient. # thyroid nodule: noted on ct as a right thyroid nodule. ultrasound for further evaluation as clinically indicated would be recommended when patient is stable. this should be followed up as an outpatient. # glycemic control: no history of diabetes mellitus. given initial steroids, then tpn and tubefeeding, patient was kept on a insulin sliding scale with appropriate control. medications on admission: home medications: ativan prn prilosec otc medications on transfer: dexmedetomidine senna 2 tabs qhs zofran 4 mg iv q6hr:prn tinzaparin 4500 units q24 acetaminophen 650 mg q6prn famotidine 20 mg iv daily colace 100 mg albuterol/ipratropium inh q4 seroquel 50 mg lactated ringer's @75cc/hr discharge disposition: extended care facility: - discharge diagnosis: respiratory failure, spinal fracture, tracheomalacia, status-post tracheostomy discharge condition: stable followup instructions: you have an appointment with an otolaryngologist (ent), dr. , on tuesday, at 3:30pm for evaluation of your vocal cords. his office is located at the medical center, , , suite 6e, , ma. if you need to reschedule this appointment, please call . you have an appointment with a cardiologist, dr. , on at 1:20pm at in the building, floor 7. if you need to reschedule this appointment, please call . you have an appointment with interventional pulmonary, dr. , on monday, at 1pm followed bronchoscopy at 2pm. this office is on the of in the buliding, 116. if you need to reschedule this appointment, please call . as you are having , not eat for 8 hours prior to your appointment. you will also have sedation at this appointment, and will need someone else to safely drive you home. you have an appointment on wednesday, at 1:15pm with dr. , a spinal orthopedist. his office is located on the , of the building. if you need to reschedule this appointment, please call . md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] laryngoscopy and other tracheoscopy temporary tracheostomy closed [endoscopic] biopsy of bronchus percutaneous (endoscopic) jejunostomy [pej] diagnoses: anemia of other chronic disease esophageal reflux urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site unspecified protein-calorie malnutrition alcohol abuse, unspecified pulmonary collapse acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus accidental fall on or from other stairs or steps other complications due to other vascular device, implant, and graft paralytic ileus closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation obesity, unspecified glucocorticoid deficiency hyperosmolality and/or hypernatremia ventilator associated pneumonia drug-induced delirium other diseases of trachea and bronchus nontoxic uninodular goiter parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to