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: sulfa (sulfonamide antibiotics) / compazine / tetanus / morphine / cefoxitin / codeine / lactose attending: chief complaint: diarrhea major surgical or invasive procedure: none history of present illness: pt is a 40 year old woman with all at age 4 s/p bmt and whole body radiation, left lobe transplant , c/b pulmonary fibrosis and radiation enteritis with multiple stents of the left main bronchus and esophagus presenting with 5 days of diarrhea and 3lb weight loss. the patient said she was recently admitted to in for respiratory failure in the setting of a multifocal pna, during that time she was patient was started on broad spectrum antibiotics (initially vanc/zosyn/levoflox/tobramycin/tamiflu-->subsequently naf/cipro/zosyn/azithro then naf/vanc/cipro/azithro); her final antibiotic regimen includes vancomycin and cefepime. she will finish a 14-day course of vancomycin and cefepime on . she had well formed stools, three times a day up until 5 days prior to admission when she started to have yellowish stools that were non-formed, sinking to the bottom of the toilet, non-odorous, occuring 6 times a day. she said she has been having some nausea, pain at her g-tube site and right sided cramping that is intermittent, but denies fever, diaphoresis, light headedness, dizziness, cough, chest pain, vomiting, muscle or joint pain. . pt does also note that over the last few days she has a sore throat because of dryness as well as cracking at the lips. . (as per gi note and verified with patient) complicated history-all - 2 chemo regimens for induction, vincristine, prednisone, mtx, adriamycin, 6mp, l asparagunase, cranial xrt, relapse in -coap therapy stopped because of toxicity, allogenic, father, bmt and whole body rtx. she needed laparoscopy for ovarian cysts,,was found to have radiation enteritis, had inadvertant enterotomies, needed prolonged tpn, npo, and months of antibiotics. in she had a bso for cysts, again had inadvertant enterotomies, developed an enterocutaneous fistula, needed an iliostomy, prolonged npo and tpn, and ultimately she had her iliostomy reversed and was managed po.over several years because of poor intake related to below, she was supplemented via g tube. that has been removed. she was managed with lactose containing feedings, had considerable diarrhea up to 6 times daily. lactose restricion brought her up to today's bowel function with only 2 movements per day, formed. past medical history: -all - , treated with vincristine, prednisone, methotrexate, adriamycin (total 450 mg/m2), 6mp and l-asparaginase, and cranial xrt. bone marrow relapse treated with coap, stopped secondary to toxicity. reinduced with prednisone, l-asparaginase and oral methotrexate in and underwent allogeneic bone marrow transplant with whole body radiation. -small bowel perforation - -pulmonary fibrosis and left lobe transplant - , complicated by pericardial and pleural effusion -staph aureus bronchitis - -left mainstem bronchomalacia, s/p stent placement -chronic sinus tachycardia -dyspnea on exertion and with lying supine -g-tube placement -esophageal strictures - s/p multiple dilations -moderate mr () -basal cell ca (back - upper chest) -edentulous with full dentures due to major dental work (now missing her lower dentures, as described above) . past surgical history: 1- surgical debridement of thigh abcess from im pentamidine 2- appendectomy 3- laparoscopy to remove ovarian cysts 4- s.p small bowel perforation complicated with candidal and bacterial paeritonitis requiring antifungals and antibiotics 5- cholecystectomy 6- pulmonary fibrosis s/p living related donor from father transplant) 7- post pericardiotomy syndrome 8- l ms bronchomalacia 9- bilat sah 10- ilesotomy and enterococcus fistula and reversed 10 months later at 11- closing of enterocutaneous fistula and ostomy 12- s/p port placement for iv access 13- lms granuloma debridement and mitomycin 14- esophageal dilatation - 15- debridement of granulation tissue around stent - pneumothorax post bronchoscopy with stent granulation tissue debridement social history: lives at home, but currently at rehab after prolonged admission. was recently cleared by pt at the rehab center. denies tobacco and etoh family history: father (66; aortic stenosis); mother (65 years; smoking, hyperlipidemia). she has 3 siblings. one brother with history of testicular cancer. physical exam: on admission: vs: t:98.6, bp:95/d, hr:107, rr: 18, o2: 100%ra, pain ga: aox3, cachectic women in nad heent: eomi. mmm. op clear with no lesions, no teeth, unable to fully open mouth, no lad. no jvd. neck supple, old tracheotomy site closed, no surrounding erythema or tenderness at site. cards: rrr s1/s2 heard. no murmurs/gallops/rubs. pulm: pt has bubbling/whistling sounds at the bases bilaterally, otherwise lung fields clear to ausculatation bilaterally, diagonal surgical scar at upper portion of left posterior lung field abd: g-tube in place c/d/i, no surrounding erythema or tenderness, soft, nt, +bs. no g/rt. midline surgical scar and punctate scar just to the left of midline. extremities: 2+ radial/pt/dp pulses b/l, no c/c/e neuro/psych: cns ii-xii intact. 5/5 strength in u/l extremities. sensation intact to lt, gait wnl. . on discharge: tm/c: 97/96.3, bp: 103/61 (100-105/61-64), hr: 94 (88-94), rr: 18, o2: 98%ra ga: aox3, cachectic women in nad heent: mmm. op clear with no lesions, no teeth, unable to fully open mouth, no lad. no jvd. neck supple, old tracheotomy site closed, mild pink erythema, no tenderness at site. cards: rrr s1/s2 heard. no murmurs/gallops/rubs. pulm: pt has bubbling/whistling sounds at the right base, otherwise lung fields clear to ausculatation bilaterally, diagonal surgical scar at upper portion of left posterior lung field abd: g-tube in place c/d/i, no surrounding erythema or tenderness, soft, nt, +bs. no g/rt. midline surgical scar and punctate scar just to the left of midline. extremities: 2+ radial/pt/dp pulses b/l, no c/c/e neuro/psych: cns ii-xii intact. 5/5 strength in u/l extremities. sensation intact to lt, gait wnl. pertinent results: cbc: 07:45pm blood wbc-11.7* rbc-2.90* hgb-8.8* hct-26.4* mcv-91 mch-30.2 mchc-33.1 rdw-15.5 plt ct-338 01:30am blood wbc-13.8* rbc-3.01* hgb-9.2* hct-27.5* mcv-91 mch-30.5 mchc-33.4 rdw-15.3 plt ct-277 04:04am blood wbc-14.1* rbc-2.97* hgb-9.1* hct-27.0* mcv-91 mch-30.8 mchc-33.9 rdw-15.2 plt ct-313 03:01am blood wbc-11.5* rbc-3.25* hgb-9.9* hct-29.1* mcv-90 mch-30.5 mchc-34.1 rdw-15.2 plt ct-360 06:30am blood wbc-7.8 rbc-3.38* hgb-10.4* hct-30.3* mcv-90 mch-30.8 mchc-34.4 rdw-15.1 plt ct-402 10:30am blood wbc-9.1 rbc-3.94* hgb-12.1 hct-36.1 mcv-92 mch-30.6 mchc-33.4 rdw-15.6* plt ct-516* . diff: 06:50am blood neuts-87.3* lymphs-6.2* monos-5.4 eos-0.8 baso-0.4 06:13am blood neuts-63.1 lymphs-26.1 monos-7.1 eos-2.7 baso-1.0 . coags: 05:00pm blood pt-14.5* ptt-33.9 inr(pt)-1.3* 03:01am blood pt-15.5* ptt-46.5* inr(pt)-1.4* 06:13am blood pt-15.1* ptt-27.9 inr(pt)-1.3* . bmp: 07:45pm blood glucose-109* urean-8 creat-0.3* na-138 k-3.6 cl-104 hco3-26 angap-12 06:50am blood glucose-131* urean-5* creat-0.3* na-141 k-3.1* cl-107 hco3-28 angap-9 05:00pm blood glucose-89 urean-9 creat-0.4 na-142 k-3.8 cl-103 hco3-32 angap-11 10:30am blood glucose-73 urean-10 creat-0.4 na-139 k-4.8 cl-98 hco3-34* angap-12 . lft: 06:50am blood alt-42* ast-33 ld(ldh)-155 alkphos-345* totbili-0.4 06:13am blood alt-23 ast-23 ld(ldh)-142 alkphos-320* totbili-0.2 10:30am blood alt-27 ast-36 ld(ldh)-182 alkphos-283* totbili-0.3 . minerals: 07:45pm blood calcium-8.7 phos-3.9 mg-1.6 05:45am blood calcium-7.6* phos-3.0 mg-1.9 05:00pm blood calcium-8.8 phos-2.6* mg-1.9 06:30am blood calcium-8.6 phos-4.8*# mg-1.7 10:30am blood albumin-3.5 calcium-9.2 phos-4.0 mg-2.0 ############################################################## imaging: . cxr there is no new, focal area of parenchymal consolidation. prominence of the pulmonary interstitium and a focal area of consolidation near the right lung apex persists. the right hemidiaphragm is mildly elevated as before, and there is right apical capping unchanged. mediastinal structures are stable. the patient has been extubated. a left subclavian catheter and drainage catheter in the left upper quadrant of the abdomen remain in place. . impression: no acute change. the lungs are now clear, and acute or subacute infectious process cannot definitely be excluded. ct may be helpful if further evaluation is clinically indicated. . findings: as compared to the previous radiograph, the paramediastinal opacity seen on the previous radiograph has completely resolved. at the right lung base, there is an unchanged scar after vats. normal size of the cardiac silhouette. no focal parenchymal opacity suggesting pneumonia. no pneumothorax. no other abnormalities . the left venous infusion catheter ends in the low svc. partial collapse of the right upper lobe is unchanged. decreased heterogeneous opacification of the right middle and lower lung is a combination of decreased right pleural effusion and improved pulmonary edema or atelectasis. fluid in the pleural space at the right apex is unchanged. heart size is normal. prominence of the right paratracheal mediastinum is engorgement of the mediastinal vasculature. there is no pneumothorax. an abdominal drain ends in the left upper quadrant of the abdomen. .############ video swallow exam swallowing videofluoroscopy: oropharyngeal swallowing videofluoroscopy was performed in conjunction with the speech and swallow division. multiple consistencies of barium were administered. barium passed freely through the oropharynx without evidence of obstruction. residue on the vallecula and piriform sinuses was seen with multiple consistencies of barium. penetration of thin liquids and nectar was seen with trace aspiration of thin liquids. impression: penetration of thin liquids and nectar consistencies with trace aspiration of thin liquids. brief hospital course: # respiratory distress: on admission, the patient's respiratory status was stable. she spiked a fever to 103.8 on and became hemodynamically unstable that evening. she was given ivf and her respiratory status declined. there was initial concern for infection given her leukocytosis, worsening dyspnea and cxr findings. she was started on broad spectrum abx and initially managed on the floor, but her declining respiratory status required she get transferred to the micu. while in the micu she diuresed well with iv lasix. interventional pulmonology did bedside ultrasound to see if her pleural effusion should be tapped, however her pleural effusions were not large enough to tap. she was weaned to 1lnc and was transferred back to the floor on . the patient was easily weaned off of oxygen and her respiratory status was stable for the remainder of her hospital stay. . # abdominal pain. concentrated in llq. patient has been complaining of irritation at g-tube site that had been controlled with dilaudid at outside facility. per recent progress notes, pain has been positional, more when leaning on left side. us on for this pain showed no evidence of ascites or fluid collection at site of tube placement. seen by ir for evaluation of peg tube, they found no problems with the tube. the pain persisted and she thought that it was secondary to the buttons around the tube site. ir came back and removed the buttons, however, the pain persisted. it was controlled with dilaudid and she was sent home with a prescription to help with the irritation. the patient's abdominal pain around the tube site should be re-evaluated in the outpatient setting. there could be some skin and tissue irritation at that site that may take some time to resolve. . # anemia. small brown bm on arrival, no melena. however, was noted to be guaiac positive on/off during last admission with no clear source found. no evidence of active bleeding. transfused 1 with appropriate response. hct stable around 29. the patient's hemoglobin and hematocrit remained stable for the rest of her hospital stay and she was discharged without further need for transfusions. . # diarrhea: found to be c. difficile positive on and started on flagyl. pt also has radiation enteritis and had been having recurrent diarrhea and weight loss likely secondary to exacerbation of enteritis vs. change in diet with recent introduction of tf. tube feeds started per nutrition. she was initially treated with iv flagyl that was then transitioned to po flagyl. her diarrhea never truly resolved and it is likely due to in part her resolving infection vs. her underlying radiation enteritis. she has chronic issues with diarrhea and they have been adjusting her tube feeds to manage this issue. she will be followed by gi and nutrition for these problems. . # pulmonary fibrosis s/p lll lung transplant: pt has long history of fibrotic lung disease s/p left lower lobe transplant and multiple stents placed to left mainstem bronchus that have required frequent degranulation cleaning. this was not an active issue during this admission. . # swallow: pt having difficulty swallowing in outpatient setting and was initially npo getting all nutrition via her g-tube. history of esophageal stricture with mid-esophageal stents placed. evaluted by speech and swallow, who recommended pureed liquids (dysphagia diet). upon further evaluation speech and swallow bedside evaluation showed significant improvement, but video swallow showed she could not tolerate even a pureed liquids. after the video swallow, speech and swallow recommended tube feeds for the majority of her nutrition with nectar thickened liquids in very small amounts (4oz max). she will be re-evaluated by speech and swallow in 1 month. medications on admission: - lisinopril 2.5 mg daily - lovastatin 40 mg qpm - coumadin 5mg daily - calcium carbonate - vitamin d2 - vitamin c- vitamin e - copper - znox - lutein - oxycodone prn - asa discharge medications: 1. amitriptyline 10 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*0* 2. cholecalciferol (vitamin d3) 400 unit tablet sig: 2.5 tablets po daily (daily). 3. fentanyl 50 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 4. acetaminophen 325 mg/10.15 ml suspension sig: twenty (20) ml po q6h (every 6 hours) as needed for fever. 5. culturelle 10 billion cell capsule sig: one (1) capsule po bid (2 times a day). 6. vagifem 10 mcg tablet sig: one (1) tablet vaginal three times a week (): place intra-vaginally. 7. climara pro 0.045-0.015 mg/24 hr patch weekly sig: one (1) patch transdermal weekly (). 8. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for dry eyes. 10. codeine sulfate 30 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain/cough. 11. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for itching. 12. other tube feeds cycling from 1900 to 0900 with peptamen 1.5@ 50cc/hr. 1 months supply . refills: 2 13. zofran 4 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. disp:*30 tablet(s)* refills:*0* 14. ativan 1 mg tablet sig: 0.5-1 tablet po every four (4) hours as needed for anxiety. disp:*30 tablet(s)* refills:*0* 15. medium chain triglycerides 7.7 kcal/ml oil sig: fifteen (15) ml po bid (2 times a day). disp:*900 ml(s)* refills:*0* 16. flagyl 500 mg tablet sig: one (1) tablet po every eight (8) hours for 9 days. disp:*27 tablet(s)* refills:*0* 17. famotidine 20 mg tablet sig: one (1) tablet po every twelve (12) hours. 18. vitamin k 100 mcg tablet sig: one (1) tablet po once a day. 19. dilaudid 2 mg tablet sig: 0.5 tablet po every four (4) hours as needed for pain. disp:*20 tablet(s)* refills:*0* discharge disposition: home with service facility: healthcare discharge diagnosis: primary diagnosis radiation enteritis . secondary diagnosis: 1- all since age 4 2- s/p bone marrow transplant, and lung transplant from radiation fibrosis. the both of them were donated by her father. 3- pneumocystis jiroveci pneumonia in 4- herpes simplex 2 (oral) 5- tmj ankylosis with small oral opening 6- bilateral cataracts 7- esophagel stricture 8- ll pneumonia () 9- intestinal adhesions 10- basal cell ca (back - upper chest) 11- edentulous with full dentures due to major dental work (now missing her lower dentures, as described above). discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you are being discharged from . it was a pleasure taking care of you. you were admitted to the hospital from rehab because you had increased loose stools and abdominal cramping. while at the rehab they sent tests off for c. diff that were negative. you were admitted for further work up. while you were here stool cultures were sent to look for infection and they came back positive for c. dificile. on the second night you were here, your blood pressure dropped and you were given lots of fluids. this continued into the following day and as a result your blood pressures were doing better, but you started to have difficulty breathing. a chest x-ray was done and it seemed that your lungs were filled with fluid. you were transferred to the icu for closely monitored care. you were also started on antibiotics for your c. dificile infection. you will receive a 14 day course of antibiotics that will finish on . we effectively removed most of the fluid off you. you were doing better, your blood pressure was stable and so you were transferred back to the floor and eventually you were breathing well without the nasal cannula. . while on the general medicine floor we continued your antibiotics and had speech and swallow, nutrition and interventional radiology come to see you. speech and swallow evaluated you at the bedside as well as with a video swallow study and felt that there was not much change in your swallowing function. they felt that you are not yet ready to take all your food my mouth and continue to require tube feeds. in addition, nutrition came and made recommendations as a result of your speech and swallow results. you will receive interval feeds as described in the discharge diet section. the information was faxed to the company and will be available for you when you return home. you will need outpatient follow up for speech and swallow in order to re-evaluate your functioning in the future. in addition, interventional radiology came to look at your g-tube site. they did not feel that the buttons were causing the pain and they thought they would fall off since they were put in with absorbable sutures. however, because of the uncontrollable pain, we had them come back in order to remove the buttons and make sure this was not the cause of your pain. you have follow up appointment with dr. , dr. and dr. as detailed below. please also call and make an appointment with speech and swallow clinic so they can continue to follow you. . the following medication was started: flagyl 500mg by mouth every 8 hours until . please take your other medications as prescribed. . please continue tube feeds as described below. peptamen 1.5 50cc/hr from 1900 to 0900 daily . instructions for swallowing nectar thickened liquids: also nectar thickened pureed solids. -only take in small amounts (4oz/day maximum) -take small sips - swallows per sip -remain upright for greater than 30minutes after taking food by mouth -may swish and spit thin liquids if you desire -regular oral care -follow up with speech and swallow in weeks followup instructions: department: when: thursday at 10:30 am with: post clinic building: sc clinical ctr campus: east best parking: garage department: west clinic when: thursday at 10:00 am with: , md building: de building ( complex) campus: west best parking: garage department: div. of gastroenterology when: monday at 9:30 am with: , md building: ra (/ complex) campus: east best parking: main garage . department: cardiac services when: thursday at 11:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: medical specialties when: tuesday at 11:00 am with: dr & dr. building: sc clinical ctr campus: east best parking: garage department: when: tuesday at 11:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified acute on chronic diastolic heart failure bone marrow replaced by transplant acute respiratory failure intestinal infection due to clostridium difficile postinflammatory pulmonary fibrosis hypoxemia methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site acute lymphoid leukemia, without mention of having achieved remission dysphagia, oropharyngeal phase attention to ileostomy gastroenteritis and colitis due to radiation lung replaced by transplant 

Answer: The patient is high likely exposed to