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: fever, respiratory distress major surgical or invasive procedure: none history of present illness: 77 year-old woman with a medical history of htn, dm, ckd, who was transferred to the ed from -macu for fever to 102. she recently had a prolonged stay at -. she was previously independent until , when she was found down in her apt in feces for an unclear amount of time (max 1-1/2 days). she was initially unresponsive and hypothermic and after being warmed she was conscious but incoherent. her blood cultures from grew pneumococcus (4/4 bottles) and mrsa ( bottles). subsequent cx (, , ) were negative. sputum cx on grew mrsa and pneumococcus; subsequently sputum grew mrsa on . she was treated with a two and a half week course of vanco for the mrsa. vanco levels were mainly over her treatment course. it is unclear for how long she was treated with ceftriaxone but she was not discharged on it, so max of two and a half weeks. tte on and were without endocarditis. given her respiratory distress and acid base status she was intubated in and extubated on . she was given frequent nebs and placed on a steroid taper. she also was found to have rhabdomyolysis from being down for an unclear time. her ck trended from 3396 to 168 (). she was treated with fluids. her creatinine was also elevated during the last admit. she was given aggressive iv hydration (also for rhabdo) and although her cr initially improved it trended up again to 4.1. she became volume overloaded and developed anasarca and thus underwent 4 sessions of hd. her last hd sessoin was on and her cr was 2.4. given her change in mental status a ct head was done which was unrevealing. neuro was consulted and felt it was a metabolic encephalopathy. an mri was limited by motion, but did not reveal anything and an eeg did not show a seizure focus. her mental status improved with resolution of her pna and hd but she was still not oriented or able to verbalize. per report from the patient's sons, her ngt was pulled out last pm, unclear if tf were running at the time. then, the morning of admission, the patient was found to have a fever of 100.8 and was tachypneic with an o2 sat of around 87% on 2l nc (per ed report, not noted in transfer paperwork). she was therefore transported to the ed for further assessment. in the ed, initial vs were: 102 76 190/70 30 100 on nrb. her labs were notable for wbc count of 11, cr of 2.4, na of 148. an abg was done on nrb: 7.43/44/150. patient was given vanco, zosyn, levoflaoxacin. on the floor, the patient is non-conversant, but is occasionally able to nod appropriately. she is having occasional myoclonic jerking. she is on a nrb and appears to be in no acute distress. review of systems: unable to obtain. denies pain. past medical history: diabetes mellitus x 10 years hypertension hyperlipidemia chronic obstructive pulmonary disease spinal stenosis lower extremity claudication hypothyroid chronic kidney disease stage iii social history: prior to admit she was living alone, independent and functional with all her adls. she was still driving. she was independent of her shopping, accounting, cooking and cleaning her house. she did not have any memory problems. she had difficulty walking long distances secondary to her neuropathy. she did not walk with a walker or cane. after her admit she was discharged to -macu tob: few cigs per day. she first started when she was a teenager. she used to smoke a pack per day. etoh: she drank alcohol socially. no rec drug use. she was a homemaker at first but then went back as an administrator at the treasury and retired in her sixties. hsg. health-care proxy: (oldest son) next of : , , phone: family history: her mother lived to be 98 and died of natural causes. her father died of ?mi in his 60s. one brother died in his early 60s from an mi. her other brother died of pancreatic cancer at age 76. physical exam: exam when transferred out of icu t 99.7, bp 149/58, hr 71, rr 13, 98% on non-rebreather general appearance: well nourished, no acute distress cardiovascular: (pmi normal), (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : at bases, r>>l) abdominal: soft, tender: throughout skin: warm neurologic: attentive pertinent results: admission labs: wbc-11.1* rbc-3.56* hgb-9.7* hct-32.0* mcv-90 rdw-18.9* plt ct-212 neuts-94.9* lymphs-3.1* monos-1.5* eos-0.3 baso-0.2 pt-12.7 ptt-26.8 inr(pt)-1.1 glucose-363* urean-96* creat-2.4* na-148* k-3.8 cl-108 hco3-30 angap-14 alt-59* ast-30 ld(ldh)-472* alkphos-60 totbili-0.6 lipase-112* albumin-2.6* calcium-8.1* phos-4.9* mg-2.3 triglyc-170* type-art po2-150* pco2-44 ph-7.43 caltco2-30 base xs-4 intubat-not intuba lactate-1.2 urine color-straw appear-hazy sp -1.011 blood-mod nitrite-neg protein-30 glucose->1000 ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-mod rbc-2 wbc-26* bacteri-few yeast-many epi-1 08:59am blood vanco-17.3 micro: bcx: staphylococcus, coagulase negative. isolated from one set only ucx: yeast. >100,000 organisms/ml ulegionella: negative lyme serology: negative catheter tip cx: negative c. diff: negative bcx: negative studies: ecg: normal sinus rhythm. rsr' pattern in leads v1-v3 with a qrs duration of 116 milliseconds. moderate baseline artifact but there is t wave flattening in leads v3-v5. compared to the previous tracing of this non-specific t wave change is new. there is no other diagnostic interval change. intervals axes rate pr qrs qt/qtc p qrs t 63 146 116 442/447 46 12 55 cxr: left lower lung opacity may represent atelectasis although pneumonia cannot be ruled out; small bilateral pleural effusions. lenis: no evidence of deep venous thrombosis in the bilateral lower extremities. tte: mild mitral regurgitation with normal valve morphology. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. pulmonary artrery systolic hypertension. no valvular pathology or discrete vegetation seen. ct chest (prelim): 1. alveolar pattern of lung disease in right subpleural lung zone compatible with infectious process. as far it can be shown on a non-contrast examination, there is no evidence of associated empyema. bibasilar atelectasis. 2. nodular opacity is unchanged in size since examination from , though has increased in density, and based on this observation, malignancy cannot be excluded and delayed biopsy should be performed after treatment of acute condition. 3. relative distention of the gallbladder since prior examination with associated cholelithiasis. correlation with ultrasound is recommended to exclude the possibility of cholecystitis. 4. low-attenuation lesion within the right thyroid lobe, likely nodule, and this can be correlated clinically, and if further evaluation is deemed necessary, a thyroid ultrasound on a non-emergent basis can be considered. ruq u/s: distended gallbladder with intraluminal sludge and gallstones without definite evidence of acute cholecystitis. if clinical concern remains nuclear medicine hepatobiliary scan could be performed. cxr, portable: heart is mildly enlarged. aorta is calcified. there is patchy focal density in the right mid lung zone, which may represent aspiration or pneumonia. there is also left lower lobe atelectasis or infiltrate. findings are about the same as the prior study. there is mild underlying interstitial disease, may represent mild congestive failure. cxr, portable: the feeding tube is again seen and unchanged and within the fundus of the stomach. there is unchanged cardiomegaly. there is a left retrocardiac opacity. small bilateral effusions are again seen. there is mild atelectasis of the right mid lung field. overall, these findings are unchanged. brief hospital course: 77 year-old woman recently discharged from () for pneumonia/sepsis who presents from rehab with fevers and respiratory distress. she spiked a fever following the removal of her ng feeding tube which may have caused aspiration pneumonitis v. pneumonia. it is possible that her previous pneumonia may have been incompletely treated. admission cxr had lll infiltrate and possible rll infiltrate. other possible etiologies were thought to be wound infection, bacteremia, endocarditis, c. diff infection. one set of blood cultures did grow coagulase negative staph. she was initially treated with vancomycin, piperacillin/tazobactam, and levofloxacin. her antibiotics were narrowed to vancomycin alone on , given her prior known infection with strep pneumo and mrsa. tte was negative for valvular pathology. aside from urine with yeast, no other cultures were positive. the patient was stable to transfer to the floor. on the floor, the patient's mental status was more alert. she was able to engage in some mild conversation. each day on the floor, the patient would have one or more episodes of acute respiratory distress that was attributed to secretions that blocked the airway. suctioning and good nursing care usually was able to bring the patient back to her recent baseline. the lack of meaningful physical improvement and seeing the type of interventions that are required to suction secretions led to a family meeting where goals of care were discussed. 3 of the patient's 4 sons were able to meet. there consensus is that the patient should only receive care that will add to her comfort. they decided that a clogged ng feeding tube should not be replaced so as to not subject the patient to another somewhat uncomfortable procedure. the family ultimately decided to transition the patient to hospice care. she was made comfort measures only, and she passed away on . problem list # fever: aspiration pneumonitis vs transient bacteremia. one set of blood cultures revealed coagulase negative staph. antibiotics were narrowed to just vancomycin (10-day course) which would cover both staph and strep. cxr does not look worse. # respiratory distress: difficult to determine how hypoxic she was based on nursing home notes. spo2 was 82% on ra in the ed, then 100% on nrb. she has copd and per her sons she was on o2 at baseline (unclear how much). ct findings as above. she was started on antibiotic therapy for pneumonia as above. she was also continued on her steroid taper. repeat cxr showed no obvious worsening throughout the hospitalization. with her copd at baseline, her pulmonary function likely took a big hit during her 3-wk bout of pna at the osh. # copd: the patient was treated with steroids, nebulizers, antibiotics, and supplemental oxygen. now only on steroids and nebulizers. # altered mental status/delirium: per family, patient's mental status improved slowly during her stay in the . possible etiologies for delirium were felt to include infection, fevers, uremia, hypernatremia, cva. now that patient has started receiving as needed morhphine and ativan, the mental status is a bit less attentive and less alert. # ckd: had 4 sessions of hd at due to severe , now with adequate urine output and off hd. creatinine progressively decreased to <2.0. # diabetes: on low dose lantus and sliding scale insulin. increase as po intake increases. # hypertension: on iv hydralazine and metoprolol. can consider clonidine patch or crushed po meds if taking some pos. # hypothyroidism: synthroid po vs iv. # nutrition/fluids: iv fluids low rate, pos as tolerated. speech and swallow recommends pureed diet and nectar-thickened liquids. reassess as pt's mental status and physical condition improves. # dvt prophylaxis: heparin subcutaneous # code status: the patient's dnr/dni status was confirmed with her hcp (son on . medications on admission: prior to : alendronate 70 mg tablet weekly amlodipine 7.5 mg tablet daily calcitriol 0.25 mcg daily epoetin alfa fluticasone-salmeterol 250 mcg-50 mcg/dose 1 puff daily gabapentin 300 mg daily hydrocodone-acetaminophen 5 mg-500 mg q12 prn pain levothyroxine 25 mcg daily lisinopril 20 mg daily aspirin 81 mg daily nph insulin human recomb 16 u insulin aspart sliding scale . medications from rehab: omeprazole solution 20 mg daily norvasc 10 mg daily aspirin 81 mg daily levoxyl 25 mcg daily ipratropium nebs tid albuterol nebs tid brovana nebs b.i.d. (per dc summary, not listed in nh meds) pulmicort nebs 0.5% b.i.d. (per dc summary, not listed in nh meds) lantus 70 units daily (per dc summary, not listed in nh meds) heparin subcu 5000 units daily prednisone 30 mg daily tapering down by 10 mg every 3 days then off metoprolol 25 mg t.i.d. epogen injection q.2 weeks lasix 40 mg every other day (per dc summary, though not listed in nh meds) ng tube with nepro tube feeds at a goal of 33 ml/h discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: tobacco use disorder toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atherosclerosis of native arteries of the extremities with intermittent claudication hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) pneumonitis due to inhalation of food or vomitus bacteremia long-term (current) use of insulin fever, unspecified hyperosmolality and/or hypernatremia staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus spinal stenosis, unspecified region delirium due to conditions classified elsewhere stridor acute gouty arthropathy 

Answer: The patient is high likely exposed to