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) attending: chief complaint: dyspnea, sepsis major surgical or invasive procedure: none history of present illness: 74 yo f h/o wegeners disease with pulmonary and renal involvement, most recently course complicated by tracheobronchial disease in particular bilateral bronchial stenosis status post balloon dilation with intralesional steroid therapy by interventional pulmonology with recent increase in prednisone and addition of azathioprine by dr. for maintenance. . patient was doing well until one day prior to transfer when she developed shortness of breath and some lethargy. the day prior to admission, her daughter spoke to her on the telephone and noted dyspnea with speaking. on the evening of she became acutely dyspnic with difficulty speaking. in additiona she had fever, chills, diffuse myalgias, fatigue and overall weakness. she called ems and was taken to the center ed. . patient was taken to hospital. in the osh, initial vs were: t 98.6 p 136 bp 138/73 r 20 o2 100% on cpap. patient was admitted to the icu for acute hypoxic respiroty failure. she was weaned from cpap to a open face high flow of 70%. her blood gas was 7.29, pco2 58, po2 192. patient also was hypotensive on admission and required phenylephrine gtt, which was weaned off overnight. patient underwnet cta, which was negative for pe, but showed bilateral pleural effusions and diffuse bilateral pneumonia. a 3-d view of her trachea to evaluate for tracheal stenosis was obtained, but was not read prior transfer. labs were notable to wbc of 24.5 with 50% bands. no sputum culture was obtained. osh team was concerned for pcp (although patient is on pcp prophylaxis at home) and gave patient full-dose bactrim. patient was checked for influenza a and b, which were negative, but was started on tamiflu. . also, at osh, patient had an elevated troponin-i at 3.46, which trended down to 2.72. ekg showed no st elevations. cardiology consulted and recommended an echo, which showed no obvious wall motion abnormalities per report. . upon arrival to the micu, patient reports her dyspnea is improved from yesterday. no chest pain, shortness or breath, diaphroesis. no fevers, rigors. . review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - wegener's granulomatosis: followed by dr. ; recent history detailed in progress note by dr. , recently complicated by tracheobronchial disease in particular bilateral bronchial stenosis status post balloon dilation with intralesional steroid therapy by interventional pulmonology - hypothyroidism - osteoporosis - history of breast cancer: in , s/p surgery and chemo social history: lives with her son . quit smoking ~50 years ago. former social drinker, no alcohol in 2 years. family history: -brother with disease -mother passed from sudden cardiac arrest s/p "hand procedure" at age 75 -father passed at 89 from "old age" with parkinson's disease -hypertension in several family members - history of cancer, autoimmune diseases physical exam: on admission: vitals: t: 97.1 bp: 95/57 p: 97 97 r: 27 o2: 100% on 70% face mask general: alert and oriented, answers most questions appropriately heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: diffuse rhonchi, inspiratory and expiratory wheezing clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachy, s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, no clubbing/cyanosis/edema pertinent results: admission labs: 09:20pm blood wbc-18.1*# rbc-3.54* hgb-12.7 hct-38.8 mcv-110* mch-35.8* mchc-32.6 rdw-14.0 plt ct-178# 09:20pm blood pt-13.2 ptt-30.1 inr(pt)-1.1 09:20pm blood glucose-97 urean-23* creat-0.7 na-141 k-3.8 cl-104 hco3-30 angap-11 09:20pm blood alt-54* ast-42* ck(cpk)-65 alkphos-103 totbili-0.4 09:20pm blood albumin-2.8* calcium-7.7* phos-3.5 mg-1.9 cholest-176 trop/ck/mb: 09:20pm blood ck-mb-11* mb indx-16.9* ctropnt-0.29* 04:41am blood ck-mb-8 ctropnt-0.21* 03:20pm blood ck-mb-6 ctropnt-0.13* chest x-ray: right internal jugular line tip is at the level of mid svc. right lower lobe and left lower lobe consolidations are present. there are also focal opacities in the right upper lobe and to a lesser extent to left upper lobe, findings consistent with severe multifocal infection. heart size and the mediastinal silhouettes are unremarkable. healed fractures with callus formation are noted on the right. there is no pleural effusion or pneumothorax, small amount of pleural effusion cannot be excluded. microbiology: 5/5 blood culture: escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . gram negative rod(s). second morpology. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- 0.5 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii chest port. line placement study date of 8:46 am findings: as compared to the previous radiograph, the patient has received a new left-sided picc line. the course of the line is unremarkable. the tip of the line projects over the mid to low svc. there is no evidence of complications, notably no pneumothorax. borderline size of the cardiac silhouette. unchanged signs of overinflation, the pre-existing areas of parenchymal opacities have decreased in extent and severity. video oropharyngeal swallow study date of 1:50 pm impression: aspiration of thin barium, which did not fully resolve with chin tuck. ecg study date of 5:21:30 pm normal sinus rhythm with left atrial abnormality. q waves in iii and avf consistent with prior inferior myocardial infarction. peaked p waves in the inferior leads also suggest right atrial enlargement. compared to the previous tracing of no diagnostic interval change. brief hospital course: ms. is a 74 y/o f with a h/o wegener's who presented in respiratory distress, found to have multifocal hcap and e.coli bacteremia and complicated by nstemi/demand ischemia, now improving. # pneumonia/bacteremia: the patient has a complicated history of wegner's with pulmonary involvement, most recently complicated by bilateral bronchial stenosis status post balloon dilation with intralesional steroid therapy by ip. she was also recently started on high-dose prednisone. she presented with fever, respiratory distress, and hypotension and was found to have bandemia, diffuse bilateral infiltrates on a ct scan at an outside hospital. there was primarily concern for hospital acquired pneumonia but also pcp given her long standing steroid use, though she was on pcp . she initially needed pressors (phenylephrine) prior to transfer to . upon arrival, her bp stabliized and she was treated empirically with vancomycin and zosyn and transitioned to vancomycin/cefepime to also cover his bacteremia. she was also initially treated with bactrim for pcp empirically but this was stopped after negative studies. she will complete an 8 day course of vancomycin on and a 14 day course of cefepime on . # nstemi/demand ischemia: she was found to have elevated troponin on presentation and ruled in for nstemi with elevated ck, ck-mb, and mbi. she was chest pain free and has no known coronary artery disease but ekg demonstrated < elevation in v3 and evidence of prior inferior mi (inferior q-waves also seen on old ekg). she was initially treated with a heparin gtt, aspirin, and atorvastatin and transitioned to full dose aspirin and simvastatin alone. an echo was performed at the outside hospital and demonstrated 65% ef, mild inferoseptal hypokinesis, no vegetations. # wegener's granulomatosis: patient with history of recent wegner's flare and bronchial stenosis status post balloon dilation with intralesional steroid therapy by ip. recently started on azathioprine 50 mg . her respiratory status stabilized with treatment of her pneumonia. she was continued on prednisone 20 mg and azathioprine was held because of her acute infection. this will need to be restarted as an outpatient. # hypothyroidism: continued home dose of levothyroxine 150 mcg daily. # osteoporosis: continued calcium and vitamin d. weekly alendronate. # communication: patient, hcp/friend ( # code: dnr, okay to intubate (discussed with hcp and patient's daughter) transitions of care: - restart azathioprine in the outpatient setting after patient follows-up with rheumatology - pulmonology follow-up (cannnot currently schedule because patient's former pulmonologist, dr. , no longer be at ) - cardiology follow-up medications on admission: home medications: albuterol sulfate 90 mcg hfa 2 puffs alendronate 70 mg weekly atovaquone 1500 mg po daily azathioprine 50 mg diazepam 5 mg q12 prn fluticasone 250 mcg 2 puffs levothyroxine 150 mcg daily nystatin 10 ml tid omeprazole 20 mg qhs prednisone 20 mg vitamin b complex calcium carbonate cholecalciferol fish oil vitamin c/e complex . transfer medications: combivent nebs heparin 5000 units sq q12 hydrocortisone 60 mg iv q6h insulin sliding scale synthyroid 75 mcq qam omeprazole 20 mg daily tamiflu 75 mg zosyn 3.375 g iv q6 bactrim 300 mg iv q8 vancomycin 1 giv discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day) as needed for constipation. 3. levothyroxine 75 mcg tablet : two (2) tablet po daily (daily). 4. ipratropium bromide 0.02 % solution : one (1) solution inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. fluticasone 110 mcg/actuation aerosol : four (4) puff inhalation (2 times a day). 6. calcium carbonate 200 mg calcium (500 mg) tablet, chewable : two (2) tablet, chewable po bid (2 times a day). 7. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 8. b complex vitamins capsule : one (1) cap po daily (daily). 9. diazepam 5 mg tablet : one (1) tablet po q12h (every 12 hours) as needed for anxiety. 10. atovaquone 750 mg/5 ml suspension : ten (10) ml po daily (daily). 11. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 12. prednisone 20 mg tablet : one (1) tablet po bid (2 times a day). 13. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q4h (every 4 hours) as needed for sob, wheezing. 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 16. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 17. aspirin 325 mg tablet : one (1) tablet po daily (daily). 18. therapeutic multivitamin liquid : five (5) ml po daily (daily). 19. vancomycin 500 mg recon soln : 1.5 recon solns intravenous q 12h (every 12 hours) for 2 days: last day . 20. cefepime 2 gram recon soln : one (1) recon soln injection q8h (every 8 hours) for 7 days: last day . 21. alendronate 70 mg tablet : one (1) tablet po once a week. discharge disposition: extended care facility: rehab discharge diagnosis: primary: pneumonia bacteremia nstemi secondary: wegner's granulomatosis discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted for pneumonia and bacteremia, an infection in your bloodstream. we treated you with antibiotics and your breathing and infection improving. during your acute illness, you also had a heart attack, but your heart function was checked and is normal. please take all of your medications as prescribed. please keep all of your follow-up appointments. followup instructions: department: rheumatology when: tuesday at 4:30 pm with: , md building: lm bldg () campus: west best parking: garage department: when: tuesday at 10:50 am with: building: campus: east best parking: garage md, procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care urinary tract infection, site not specified unspecified acquired hypothyroidism personal history of malignant neoplasm of breast anxiety state, unspecified acute respiratory failure bacteremia osteoporosis, unspecified diarrhea do not resuscitate status wegener's granulomatosis 

Answer: The patient is high likely exposed to