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: patient recorded as having no known allergies to drugs attending: chief complaint: transfer from osh for concerns with abdominal hematoma, pancreatitis, arf, hypovolemic shock,and pulmonary edema major surgical or invasive procedure: percutaneous tracheostomy placement (# 8 portex, cuffed, with inner cannula) past medical history: pmh: htn, dyslipidemia, hypothyroidism, diverticulitis, colon ca, large ventral and parastomal hernias, chronic renal failure (baseline cr 1.6-1.8), gout, nephrotic syndrome ?? . psh: l breast ca s/p lumpectomy ', now s/p needle guided lumpectomy and slnbx ; s/p appy, s/p cholecystectomy, s/p hysterectomy, s/p tonsillectomy. s/p l colectomy for colon ca, revision of colostomy, multiple ex laps for adhesions. social history: sochx: 30 pack year history but quit 30 yrs ago; 1 drink/week, no recreational drugs. lives at home with daughter family history: n/c physical exam: upon discharge pale, obese female in nad, a and o vs: 97.9 82 136/62 24 96% tm anicteric, no jvd, pale conjunctiva, eomi rrr no m/r/g ctab (ant) left breast well healed lumpectomy scar no sign infection abd large midline scar, massive left abdominal hernia, soft nt/nd + bs stoma is clean, protudes above skin, + gas and stool in bag, no signs infection, no parastomal hernias no c/c/e right first finger dip swollen, blanching erythema, + ttp right metatarsal 2nd/3rd + ttp , erythema neuro grossly intact, able to move all four extremities psych flattened affect pertinent results: 07:00am blood wbc-10.5 rbc-3.55* hgb-10.1* hct-31.1* mcv-88 mch-28.4 mchc-32.4 rdw-14.0 plt ct-579* 01:26pm blood wbc-16.3*# rbc-3.34* hgb-9.8* hct-30.8* mcv-92 mch-29.2 mchc-31.7 rdw-14.1 plt ct-606* 02:00am blood wbc-12.9* rbc-3.28* hgb-9.0* hct-29.6* mcv-90 mch-27.5 mchc-30.5* rdw-13.7 plt ct-570* 03:28am blood wbc-12.0* rbc-3.28* hgb-9.5* hct-29.6* mcv-90 mch-29.0 mchc-32.2 rdw-14.0 plt ct-517* 02:52pm blood wbc-10.3 rbc-3.47* hgb-9.9* hct-29.9* mcv-86 mch-28.5 mchc-33.1 rdw-13.6 plt ct-327 07:00am blood glucose-118* urean-55* creat-1.6* na-140 k-3.8 cl-106 hco3-23 angap-15 02:52pm blood glucose-126* urean-46* creat-2.7* na-137 k-5.5* cl-108 hco3-19* angap-16 11:06am blood glucose-89 urean-57* creat-3.1* na-139 k-4.4 cl-109* hco3-18* angap-16 01:50am blood glucose-146* urean-73* creat-2.5* na-146* k-4.5 cl-102 hco3-33* angap-16 02:33am blood lipase-68* 07:00am blood calcium-9.3 phos-4.2 mg-2.5 08:14pm blood triglyc-210* 11:06am blood tsh-0.80 11:06am blood free t4-0.64* 03:26pm blood cortsol-52.9* 02:15pm blood cortsol-39.8* 03:05pm blood cortsol-47.6* 04:19am blood type-art temp-37.7 po2-99 pco2-44 ph-7.40 caltco2-28 base xs-1 03:02pm blood type-art temp-37.5 rates-/20 tidal v-423 peep-10 fio2-50 po2-78* pco2-49* ph-7.47* caltco2-37* base xs-10 intubat-intubated vent-spontaneou 08:33am blood type-art temp-37.6 rates-/21 tidal v-474 peep-5 fio2-50 po2-60* pco2-50* ph-7.46* caltco2-37* base xs-9 intubat-intubated vent-spontaneou 05:31am blood type-art po2-95 pco2-53* ph-7.39 caltco2-33* base xs-5 02:07am blood type-art po2-105 pco2-50* ph-7.41 caltco2-33* base xs-5 01:57pm blood type-art po2-71* pco2-45 ph-7.45 caltco2-32* base xs-6 09:15am blood type-art po2-67* pco2-46* ph-7.45 caltco2-33* base xs-6 03:02pm blood type-art temp-37.5 rates-/20 tidal v-423 peep-10 fio2-50 po2-78* pco2-49* ph-7.47* caltco2-37* base xs-10 intubat-intubated vent-spontaneou 02:40am blood type-art po2-101 pco2-46* ph-7.44 caltco2-32* base xs-5 10:15pm blood type-art po2-100 pco2-36 ph-7.48* caltco2-28 base xs-3 08:37pm blood type-art po2-74* pco2-43 ph-7.48* caltco2-33* base xs-7 05:20pm blood type-art po2-74* pco2-40 ph-7.49* caltco2-31* base xs-6 11:16am blood type-art rates-/20 peep-10 fio2-60 po2-55* pco2-40 ph-7.48* caltco2-31* base xs-5 intubat-intubated vent-spontaneou 03:13am blood type-art po2-97 pco2-39 ph-7.44 caltco2-27 base xs-1 03:15pm blood type-art po2-95 pco2-50* ph-7.21* caltco2-21 base xs--8 05:04pm blood type-art po2-53* pco2-46* ph-7.21* caltco2-19* base xs--9 06:20pm blood type-art po2-69* pco2-46* ph-7.23* caltco2-20* base xs--8 brief hospital course: operations during admission cvl placement percutaneous tracheostomy placement (#8 portex, cuffed, inner cannula) consultations during admission sicu - nephrology principal diagnoses acute on chronic renal failure respiratory distress with pulmonary edema klebsiella pneumonia abdominal hematoma likely heparin gtt at osh s/p left breast lumpectomy s/p tracheostomy acute gouty attacks (r dip 1st finger, r 3rd mtp) brief hospital course the patient was transferred from osh with concern for pancreatitis, abdominal luq hematoma in the setting of heparization for sob in concern with pe (negative v/q scan), abdominal pain, and hypovolemic shock with acute on chronic renal failure (chronic likely from possible nephrotic syndrome) and paradoxically, respiratory distress with b/l large pulmonary effusions. - the patient was admitted on in the late evening. she was intubated for respiratory distress and had an a-line and cvl placed. her labs were significant for an elevated creatinine of 3.1, and a bicarb of 19 concerning for metabolic acidosis in the setting of arf. she did, however, have a normal alt, ast, amylase, and lipase, so we had very low clinical concern for pancreatitis - oddly enough, the primary reason for her transfer. the patient underwent a renal consult for her renal failure, who felt that she had oliguric arf atn from underesucitation in the setting of retroperitoneal bleeding. she was given 2 units of prbc, a bicarbonate drip, albumin, and multiple boluses of ivf, albumin, and her creatinine eventually improved to 1.6 (near her baseline) on . blood cultures throughout her stay have been negative (, , ). she also underwent a hydrocortisol stress stim test to evaluate her cortisol function, which was normal. - the patient's uop improved. she underwent a ct scan of the abdomen to further assess the question of peri-splenic hematoma and her respiratory distress. the ct scan was noteable for a heterogeneous perisplenic hematoma that tracked into the left anterior pararenal space and was slightly increased in size when compared to the prior outside ct scan from center; l > r mod b/l pleural effusions w/ atelectasis of post r ll, complete atelectasis of lll; worse from prior studies; left axillary and left breast hematomas measuring 4.2 cm and 3.2 cm; stable midline infraumbilical and large left lower quadrant parastomal hernias containing non- obstructed loops of bowel, and extensive colonic diverticulosis. the ct scan supports a diagnosis of actue on chronic renal failure in the setting of underresuscitation for breast and retroperitoneal hematomas to heparinization for a non-existent pe, though her v/q scan was negative, complicated by pulmonary effusions given her low albumin and proteinuria, triglyceridemia, and hypertension likely from her nephrotic syndrome. the patient was diuresed. she remained intubated. she was also started on tube feeds via dophoff given her normal lfts and need for nutrition. she was seen by the ostomy nurse and her colostomy tube changed regularly. - the patient spiked a fever and was pan-cultured. she remained hemodynamically stable without signs of sepsis. her diuresis was increased with lasix and diamox as repeat cxrs remained with significant b/l effusions. her ventilatory settings improved. the patient was started on ciprofloxacin for a pan-sensitive klebsiella pneumoniae. given her improved vent settings, the patient was extubated. unfortunately, the patient later that morning became progressively short of breath with inspiratory, and expiratory wheezes, tachypneic, and hypoxic, and so she was reintubated without difficulty. her abg at the time was: 7.46/50/60/37. given her failed extubation, the patient underwent an echocardiogram to assess for cardiac dysfunction contributing to her failued extubation. the echo revealed a mildly dilated la, nl left ventricular wall thickness, cavity size and regional/global systolic function (lvef >55%), and right ventricular chamber size and free wall motion, trace ar, mild mr, and mild pulmonary artery systolic hypertension. - given her continued need for ventilatory support, the patient had a percutaneous tracheostomy tube placed on . she tolerated the procedure well. interestingly, only 1-2 days later she was able to tolerate trach mask without need for ventilation. the patient remained hemodynamically stable, tolerating her tube feeds, and so she was transferred to the floor on . she underwent placement of a passy-muir valve on , which she has been tolerating well. she also underwent a swallow-study, that revealed dysphagia scale 4 (mild-moderate), she was noted to have "aspiration on large, consecutive sips of thin liquids alone (x1) and after ground solids as evidenced by a reflexive wet cough, though she appeared to tolerate single sips of thin liquid alternated with small bites of puree without overt coughing." she was thus recommended to have a po diet of thin liquids and puree with supervision to ensure she is alternating bites and single sips of liquids. the patient walked out of bed to the chair with nursing. she was started back on her home medications. unfortunately, on the patient developed pain in her first right finger (dip) and midfoot on the right; xr of her foot revealed proximal 2nd, 3rd, 4th metatarsal chronic fractures (likely neuropathic), no signs of acute fracture. given her history of gout she was thought to have gouty attacks in the setting of stress, and was started on renally dosed colchicine. she also had some mild peristomal pain but history and exam showed no evidence of infection, parastomal hernia, or obstruction; she had no nausea, vomiting, and there was plenty of gas and stool in her stoma bag. on her cvl was removed. her foley catheter is to be removed after discharge. on the time of discharge she is afebrile, tolerating her dysphagia, diet, alert, oriented, and stable for discharge. she needs follow-up with her primary care doctor and dr. . medications on admission: meds at osh: amlodipine 5', temazepam 15-30 qhs, synthroid 50', simethicone 80'''p, tylenol prn, zofran prn, esomeprazole 40', morphine prn, lopressor 2.5-5 prn . discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. levothyroxine 25 mcg tablet sig: two (2) tablet po daily (daily). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 7. esomeprazole magnesium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 8. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheeze, sob. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days: for pna. 12. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 13. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily) for 5 days. 14. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. discharge disposition: extended care facility: medical center - discharge diagnosis: acute on chronic renal failure respiratory distress with pulmonary edema klebsiella pneumonia abdominal hematoma likely heparin gtt at osh s/p left breast lumpectomy s/p tracheostomy acute gouty attacks (r dip 1st finger, r 3rd mtp) pmx: nephrotic syndrome, gout, htn, dyslipidemia, hypothyroidism, diverticulitis, large ventral and parastomal hernias, chronic renal failure (baseline cr 1.6-1.8); l breast ca s/p lumpectomy ', now s/p needle guided lumpectomy and slnbx ; s/p appy, s/p cholecystectomy, s/p hysterectomy, s/p tonsillectomy. s/p l colectomy for colon ca, revision of colostomy, multiple ex laps for adhesions. discharge condition: stable discharge instructions: 1. ***consider changing to a un-cuffed tracheostomy tube, and then down-sizing, and eventual decannulization as patient tolerates *** 2. please remove the patient's foley catheter upon arrival. 3. please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain in not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. 4. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. 5. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. 6. please take the colchicine for five days for your gouty attacks. your xr did not show any acute fractures of your right foot, though you do have chronic fractures in that foot. followup instructions: 1. please call your primary care doctor a follow-up appointment for your gout, your pulmonary issues, and your renal failure. if your foot pain does not improve, consider orthodics or follow-up with a podiatrist as you likely have chronic fractures in your foot. 2. please call dr. office at for a follow-up appointment in weeks. 3. consider downsizing, uncuffing the tracheostomy tube and then eventual decannulation pending improvement of your respiratory status with supervision of a doctor. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of breast chronic kidney disease, unspecified pulmonary collapse acute respiratory failure other shock without mention of trauma personal history of malignant neoplasm of large intestine accidents occurring in other specified places nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use acute pancreatitis pneumonia due to klebsiella pneumoniae other colostomy and enterostomy complication nephrotic syndrome with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to