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 the present illness: the patient is a 76-year-old white female with a past medical history significant for end-stage multiple sclerosis, decubitus ulcers, atrial tachycardia, who presents with hypoxia from center. the patient was recently admitted for sepsis secondary to decubitus ulcers. she was discharged on with an extended course of broad spectrum antibiotics. she presents the day after discharge with an episode of hypoxia at her rehabilitation facility. the patient was noticed to have an aspiration event by the husband who was at the bedside. following this, she had some coughing and was found to be hypoxic with 02 saturation at 47% on room air by the medical staff. the patient was placed on a nonrebreathing with improved saturations to 96%. however, the patient remained tachypneic and was transferred to for further workup and management. upon arriving in the emergency department, the patient was initially on a 100% nonrebreather with good oxygenation at 98%. however, she then developed significant tachypnea with respiratory rate into the 40s. she maintained her respiratory rate for some time; however, then began to have decreased rate, eventually dropping to less than ten. she was finally noticed to be apneic and was intubated. approximately 30 minutes after the intubation, the patient became severely hypotensive with systolic blood pressure at 40. the patient responded to 1 liter of normal saline and a dopamine drip at 10 micrograms. central venous access was obtained. a subsequent chest x-ray showed a small to moderate right-sided pneumothorax. a chest tube was placed at this time with withdrawal of 800 cc of clear yellow pleural fluid. on mechanical ventilation, the patient initially had oxygenation and was hemodynamically stable. admission medications: 1. ceftriaxone 1 gram q. 24 hours. 2. flagyl 500 mg t.i.d. 3. vancomycin 1 gram q.d. 4. regular insulin sliding scale. 5. ambien 5 mg q.h.s. 6. subcutaneous heparin. 7. multivitamins. 8. senna. 9. colace. 10. vitamin c. 11. morphine sulfate 2-4 mg q. four hours p.r.n. allergies: the patient has no known drug allergies. social history: no history of tobacco or alcohol use. the patient is a -speaking female, although she has been nonverbal secondary to her multiple sclerosis. she had been living with her husband until her recent admission and transfer to the facility. physical examination on admission: vital signs: temperature 98.6, blood pressure 122/99, pulse 118, respiratory rate 15, 02 saturation 97% on assist control ventilation with tidal volume of 500 cc, respiratory rate of 12, positive end-expiratory pressure of 5, fi02 of 100%. general: the patient was flaccid and extremely cachectic and ill appearing. the patient had a significant blanching rash in a reticular pattern over the anterior torso and bilateral upper extremities. heent: the patient was normocephalic, atraumatic. her pupils were equally round, and reactive to light. lungs: the patient had right basilar rales with decreased breath sounds at the left base, otherwise clear. cardiovascular: tachycardiac with a regular rate, distant heart sounds. abdomen: soft, nontender, nondistended, normoactive bowel sounds, no hepatosplenomegaly. extremities: the patient had 2+ pitting edema of the bilateral upper and lower extremities. there is a left picc line in place. skin: the patient has stage iv decubitus ulcers at the sacrum and at the thoracic spine. neurologic: the patient is completely flaccid with no muscle tone. laboratory/radiologic data: cbc revealed a white blood cell count of 9.2, hematocrit 30.2, platelets 514,000. chemistries of significance were a chloride of 99, bicarbonate 30, bun 19, creatinine 0.4, calcium 7.4, phosphate 1.7. microbiology studies: the patient had positive blood cultures from a previous admission on . she had one out of two bottles positive for prevotella and one out of two bottles positive for pepto streptococcus. her urine cultures from previous admission were negative. repeat blood culture on was also negative. chest x-ray: the patient had a moderate right-sided pneumothorax, as previously mentioned. there were moderate bilateral pleural effusions. ekg showed tachycardia with rate in the 130s with t wave inversions in ii, iii, v4 through v6 and no st changes. hospital course: 1. hypoxic respiratory failure: initially, the patient was intubated due to her respiratory failure. she did well initially on mechanical ventilation and was able to be weaned off without difficulty. the patient was extubated on hospital day number two and subsequently had good respiratory function and oxygenation. she was continued on her previous broad spectrum antibiotics for a history of sepsis as well as for a possible new aspiration pneumonia. 2. hypotension: the patient was hypotensive after her intubation. this was likely secondary to initiation of positive pressure ventilation, perhaps in combination with medications that she received prior to the intubation. she was quickly weaned off the dopamine and maintained good blood pressure off the pressors. she had no further hemodynamic instability. 3. pneumothorax: the patient had a small right pneumothorax likely secondary to placement of her central venous line. chest tube was placed and discontinued after two days. the pleural fluid that was drained and analyzed during the placement of the chest tube showed that the effusion was transudative. once the patient was transferred from the icu to the floor, she had an episode of hypoxia which was likely secondary to reaccumulation of the pleural fluid. she had a repeat thoracentesis done for drainage of the fluid and subsequently had good respiratory function. 4. decubitus ulcers: the patient was found to have decubitus ulcers on her previous admission. she continued to have wet-to-dry dressing changes b.i.d. the plastics team was consulted and recommended continuing the dressing changes. the patient was also continued on her antibiotics with ceftriaxone, vancomycin, and flagyl for a total of a six week planned course. on this admission, there were no clinical signs or symptoms of bacteremia or sepsis secondary to her decubitus ulcers. 5. multiple sclerosis: the patient has end-stage multiple sclerosis and was given supportive care. 6. fluids, electrolytes, and nutrition: the patient was placed on aspiration precautions and tube feeds were advanced as tolerated. 7. code status: the patient was full code on admission and at discharge. discharge status: the patient is to be discharged back to center. condition on discharge: the patient is in good condition, afebrile, hemodynamically stable, tolerating tube feeds. discharge diagnosis: 1. hypoxic respiratory failure secondary to aspiration. 2. decubitus ulcers. 3. end-stage multiple sclerosis. 4. pneumothorax: right-sided pneumothorax resolved. discharge medications: 1. ceftriaxone 1 gram q. 24 hours. 2. vancomycin 1 gram q. 24 hours. 3. metronidazole 500 mg t.i.d. 4. vitamin c. 5. colace. 6. senna. 7. subcutaneous heparin. 8. regular insulin sliding scale. 9. multivitamins. 10. magnesium sulfate. discharge instructions: the patient will be discharged to center where she will continue her broad spectrum antibiotics for a total of six weeks. she should also continue q.d. to b.i.d. wet-to-dry dressing changes for her decubitus ulcers. the patient should be placed on aspiration precautions and tube feeds should be continued. follow-up: the patient should follow-up with her primary care provider. , md dictated by: medquist36 procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis thoracentesis percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells debridement of nail, nail bed, or nail fold injection or infusion of oxazolidinone class of antibiotics diagnoses: congestive heart failure, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax other specified septicemias multiple sclerosis quadriplegia, unspecified nutritional marasmus 

Answer: The patient is high likely exposed to