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: s/p cardiac arrest major surgical or invasive procedure: diagnostic thoracentesis history of present illness: the pt is a 74y/o f with a pmh of cad, dm, cva with recent diagnosis of cholangiocarcinoma with metastasis to the transverse colon, presenting s/p cardiac arrest. pt sent from nh to for evaluation of altered mental status. per report the pt was recently started on bactim on for pna. today she became letharic with no verbal response. t 96.5. sat 94-96% on 4l nc. fs 325. . at osh, the patient presented in cardiac arrest. per report inital bp at 850 unable to obtain, given 1amp atropine and transcutaneous pacing started. she was intubated and dopamine started. given additional 1amp atropine and 1 amp epi, 1am calcium gluconate and 2mg glucagon with return to perfusing rhythm at approx 915. per er physician report ct head with w/o bleed, abd with free fluid, no free air, + gallbladder stent, and right sided effusion. no formal read available at time of transfer. per report she also received "broad spectrum antibiotics" . in the ed, initial vs were: t 98.2 p 82 bp 122/77 r 17 o2 sat 100%. on levophed 0.03mcg/kg/min. ct torso demonstrated large right pleural effusion with right lower lobe collapse, rml atelectasis, and possible superimposed pneumonia. patient was given albuterol neb. sedation with fentanyl and versed. . on arrival to the icu, the patient was intubated and sedated with stable hemodynamics. . review of sytems: unable to obtain . past medical history: cholangiocarcinoma with metastasis to the transverse colon, unresectable - diagnosed complicated by post ercp pancreatitis mrsa bacteremia - received course of vancomycin bowel obstruction s/p r colectomy c/b wound dehiscence - received course of linezolid, ceftazidime and flagyl r pleural effusion g tube placement cad s/p cabg diabetes mellitus htn pvd r femoral tibial grast cva with residual r sided weakness hyperlipidemia osteoarthritis . social history: the patient is originally from , moved to us 30 years ago. spanish speaking. she previously lived with her husband, daughter and in jp, most recently in nh. no tobacco/etoh history. family history: father - cad physical exam: vitals: t: 99.8, hr 93, bp 115/72, rr 25, sat 100% general: intubated, sedated, chronically ill-appearing heent: sclera anicteric, mmm, oropharynx clear, ngtube and et tube in place neck: supple, jvp 10, no lad, l sc lungs: clear to auscultation anteriorly, decreased r base to up lung field, dull to percussion, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, midline inscision well healed, peg tube site c/d/i, ostomy with liquid stool, guaiac +, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: cool, 1+ pulses, no edema, multiple scars lower ext b/l . pertinent results: : wbc 19.0 hct 37.9 plt 238 bnp 4330 trop 0.61 inr 2.05 na 136 k 6.0 cl 107 hco3 16 bun 35 cr 1.2 abg 7.18/39/181/15 . ct torso - large right pleural effusion with right lower lobe collapse, rml atelectasis, and possible superimposed pneumonia. endotracheal tube terminates just < 1 cm above carina, requires retraction. ascites. no evidence of bowel obstruction. atherosclerotic disease . ekg: osh: - r 96bpm, nl intervals, nl axis, st dep ii, avf, v3-v6 - nsr 81bpm, nl axis/nl interval, twi i, ii, avf, v3-v6 . neck u/s history: soft tissue calcifications noted on video swallow. findings: calcifications are seen in the soft tissues of the left neck measuring up to 11 mm in greatest diameter. these are separate from the spine and are of unclear etiology. degenerative changes are noted of the cervical spine, most marked at c5-6 with sclerosis, disc space narrowing, and anterior osteophytes. . 06:55am blood wbc-8.9 rbc-3.29* hgb-10.3* hct-31.5* mcv-96 mch-31.3 mchc-32.6 rdw-15.8* plt ct-276 06:00am blood wbc-9.1 rbc-3.20* hgb-9.9* hct-30.6* mcv-95 mch-30.9 mchc-32.4 rdw-15.6* plt ct-233 07:30am blood wbc-11.2* rbc-3.39* hgb-10.6* hct-32.8* mcv-97 mch-31.1 mchc-32.2 rdw-15.9* plt ct-264 06:45am blood wbc-9.6 rbc-3.11* hgb-9.7* hct-30.0* mcv-96 mch-31.2 mchc-32.4 rdw-15.9* plt ct-193 10:25am blood wbc-9.3 rbc-3.27* hgb-10.2* hct-31.9* mcv-98 mch-31.3 mchc-32.1 rdw-15.7* plt ct-169 07:40am blood neuts-82.0* lymphs-13.1* monos-3.7 eos-1.1 baso-0.2 06:15am blood neuts-87.5* lymphs-6.4* monos-5.2 eos-0.3 baso-0.5 05:22am blood neuts-84* bands-5 lymphs-4* monos-5 eos-2 baso-0 atyps-0 metas-0 myelos-0 06:55am blood plt ct-276 06:00am blood plt ct-233 07:30am blood plt ct-264 06:55am blood glucose-222* urean-14 creat-0.6 na-132* k-4.9 cl-100 hco3-26 angap-11 06:00am blood glucose-246* urean-15 creat-0.6 na-133 k-5.2* cl-101 hco3-23 angap-14 07:30am blood glucose-158* urean-17 creat-0.6 na-133 k-5.0 cl-99 hco3-21* angap-18 06:45am blood glucose-115* urean-18 na-132* k-5.1 cl-101 hco3-23 angap-13 07:40am blood alt-17 ast-23 alkphos-272* totbili-0.5 05:22am blood alt-18 ast-29 alkphos-324* totbili-0.7 06:21am blood alt-45* ast-28 ld(ldh)-237 alkphos-279* totbili-0.7 05:15am blood alt-57* ast-33 ld(ldh)-236 alkphos-278* totbili-0.6 06:55am blood mg-2.2 brief hospital course: the pt is a 74y/o f with a pmh of cad, dm, recent diagnosis of cholangiocarcinoma with metaseses to the transverse colon s/p resection and peg placement admitted s/p pea arrest. . # pea arrest: unclear precipitating event. possible causes of pea included pneumonia +/- mucuous plug causing transient hypoxemia or possible primary cardiomyopathy. patient has decreased ef to 15-20% unlcear primary or secondary to recent code. patient also had hyperkalemia (k 6) on presentation, another possible factor. ruled out pe with negative pe-cta. she was promptly extubated without complication. . # healthcare-associated pneumonia: on admission, patient had leukocytosis and rll effusion. she was afebrile, and blood cultures were negative. she was initially treated with vanc/zosyn. diagnostic thoracentesis demonstrated a transudative process, thought to be parapneumonic vs chf-related. mini-bal grew esbl-producing klebsiella. antibiotics were changed to meropenem, and she received 7 days or meropenem. on , nearly one week after completing meropenem therapy, patient was found to have an elevated wbc count. patient's picc line was discontinued and cultures periperally and from picc were obtained. cultures on grew out gnr, eventually speciated to klebiella pneumoniae. patient was started again on meropenem on . paitent's wbc count has been trending down since. paitent remained afebrile throughout the second course and vitals were stable. - continue meropenem 500mg ib q6hrs for total 14 day course . # acute renal failure: creatinine on admission was 1.1 and rose to 2.0 in the days after the arrest. most likely prerenal due to poor forward flow in the pericode period. fena was 0.6% initially. there was likely also a component of atn secondary to contrast. urine output also decreased to ~10 cc/h with poor response to iv lasix. the renal consult service was involved and recommended conservative management. urine output increased, and creatinine fell back to baseline .8-1.0. . # acute on chronic systolic congestive heart failure: ef 15-20%, newly decreased this admission. after resuscitation patient appeared total body overloaded. diuresis was limited by arf, as above. despite cxr findings of significant pulmonary edema and bilateral pleural effusions, her o2 sat was 98% on ra. her outpatient dose of furosemide 20 mg daily was restarted and she was kept net negative daily. effusions and peripheral edema decreased. . # pleural effusion: diagnostic thoracentesis showed a transudative process. differential included parapneumonic process, metastatic disease, and/or effusion secondary to cardiomyopathy. now resolving. . # metastatic cholangiocarcinoma: patient with recent diagnosis and complicated course including mets to transverse colon s/p resection. tumor unresectable, felt to have poor likelihood of tolerating chemotherapy per osh oncology notes. lfts were stable. . # guaiac + stools: the pt was found to have grossly bloody stool from ostomy site. hct was stable. ppi was continued. . # bowel obstruction s/p r colectomy ?????? tube feeds were continued. s&s evaluation was done and diet advanced to ground solids and subsequently to regular. tube feeds were held for 3 days to do a calorie count. because she was only taking ~500 calories daily, tube feeds were re-instituted. . # cad s/p cabg - beta blocker was continued, acei held given arf, lasix given as above, statin held. acei was restarted prior to discharge. patient started on asa 81mg . # diabetes mellitus - lantus and riss were continued. lantus was decreased for hypoglycemia in the setting of holding tube feeds. this will need to be titrated. . # nutrition - patient was getting tube feeds. these were stopped temporarily and a calorie count demonstrated inadequate intake. tubefeeds were re-instituted. speech and swallow saw her and cleared her initially for pureed solids and later for regular solids as mental status improved. she was also cleared for thin liquids but preferred to continue nectar-thickened. . # access: patient is being discharged with a picc line in place, placed by ir on . medications on admission: tylenol 650mg q 4 prn milk of magnesia 30ml po daily prn bisacodyl arixtra 2 gram daily lantus 24u qhs riss colace atarax 10mg 1 tab q 8 prn senna duragesic 25mcg q 72 bactrim ds 2 tab daily x 10 days stop promod oxycontin 10mg po bid reglan lopressor 50mg mvi prilosec 20mg daily zocor 40mg daily zestril 40mg daily lasix 20mg daily discharge medications: 1. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 2. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 3. insulin please given lantus 10 units and humalog insulin sliding scale, attached. 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po three times a day. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. lisinopril 40 mg tablet sig: one (1) tablet po daily (daily). 7. multivitamin tablet sig: one (1) tablet po once a day. 8. tylenol 325 mg tablet sig: one (1) tablet po every four (4) hours as needed for fever or pain. 9. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q6h (every 6 hours). 12. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 13. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 14. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing. 15. humalog 100 unit/ml solution sig: one (1) subcutaneous four times a day: per sliding scale . 16. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain: please do not exceed 4g/24hrs. discharge disposition: extended care facility: health care - discharge diagnosis: primary: cardiac arrest, hospital acquired pneumonia, acute renal failure, congestive heart failure secondary: metastatic cholangiocarcinoma, coronary artery disease, diabetes discharge condition: stable discharge instructions: you were admitted to the hospital after a cardiac arrest. cpr was given, and you were revived. it is thought that you cardiac arrest was secondary to hypoxia from pneumonia. you were also treated for a pneumonia. you were found to have bateremia a week prior to discharge and are going to a rehab facility with plan for continued meropenem for a full 14 day course. . many of your medications were changed, please take as directed. . . please return to the hospital or call your doctor if you experience chest pain, shortness of breath, high fevers and chills, or other symptoms that are concerning to you. followup instructions: please follow up with the physician at your rehabilitation faciity. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances thoracentesis closed [endoscopic] biopsy of bronchus diagnoses: other primary cardiomyopathies hyperpotassemia acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site hyposmolality and/or hyponatremia other specified intestinal obstruction coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified pleurisy with effusion, with mention of a bacterial cause other than tuberculosis other and unspecified hyperlipidemia bacteremia diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin insulins and antidiabetic agents causing adverse effects in therapeutic use other late effects of cerebrovascular disease osteoarthrosis, unspecified whether generalized or localized, site unspecified nonspecific abnormal findings in stool contents acute on chronic systolic heart failure pneumonia due to klebsiella pneumoniae gastrostomy status colostomy status other and unspecified mycoses other drugs and medicinal substances causing adverse effects in therapeutic use personal history of sudden cardiac arrest malignant neoplasm of biliary tract, part unspecified site secondary malignant neoplasm of large intestine and rectum other musculoskeletal symptoms referable to limbs 

Answer: The patient is high likely exposed to