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: cefepime attending: chief complaint: respiratory distress/hypoxia major surgical or invasive procedure: intubation picc placement history of present illness: 41f with no pmh who presented to c/o high spiking fevers (104 tmax)and joint pain, achyness, rigors, no swelling. she c/o frontal ha not relieved by tylenol and motrin. eventually she became overwhelmed with cough, weakness, and fatigue and presented to ed. she also c/o corryza, increased mucousy phlegm and doe. she had poor po intake. ros was positive for 10lb weight loss. she denied rashes, travel. . outpatient lyme and flu were sent and were negative. she did not have a flu shot this year or ever. . in the er, initial vital signs were 103.1, 100, 108/70, 18 and 95% room air. she received 5 liters of normal saline with approximately 500 ml of urine output. cxr was performed and revealed an rll and she received robitussin ac and levaquin 750 mg iv. while in the er, her saturation dropped to 91% on room air and with supplemental 2 liters of oxygen it came up to 96%. initial laboratory eval was notable for pancytopenia, with 18% bands and 65% neutrophils. esr was 14, crp was 108. she was started on ceftriaxone and azithromycin. . . hospital course: ct chest was performed revealing extensive dense consolidation predominantly involving the right lower lobe and in decreasing order of severity at the left lower lobe, and left upper lobe. essentially multifocal pneumonia without lung abscess and no pe. suggestion of pulmonary arterial hypertension. oxygen requirements never exceded 6l to maintain 95%. . blood cultures from the er eventually returned 3/4 bottles staph epi, pan sensitive which cleared on hd#2. no further surveilance cultures were performed. she is being treated with vancomycin for this. id recomended echocardiogram which is being preliminarily read as ?mitral valve endocarditis. . on the day of transfer creatinine was noted to be 2.4 from 0.7 3 days after cta and rtc ibuprofen. per report urine output remained "good." . past medical history: anxiety and depression. history of c-section. social history: lives at home with her husband. independent of adl. no smoking or drug abuse. occasionally drinks alcohol. works as a jewelry buyer for mfa. family history: noncontributory physical exam: admission exam: vitals: t: bp:117/71 p:88 r: 40 o2: 91-99% on high flow oxygen general: alert, oriented, tachypneic, anxious though this is likely respiratory distress heent: sclera anicteric, dry mm greenish discoloration, oropharynx clear neck: supple, carotid hyperdynamic jvp not elevated, no lad lungs: right base to right mid back rhonchorous, left base rhonchourous. no wheezes, rales cv: regular rate and rhythm, normal 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, 2+ pulses, no clubbing, cyanosis or edema . pertinent results: admission labs: 02:23pm blood wbc-8.1 rbc-4.58 hgb-13.9 hct-39.1 mcv-86 mch-30.3 mchc-35.5* rdw-11.8 plt ct-249 02:23pm blood neuts-81.0* lymphs-12.1* monos-6.1 eos-0.5 baso-0.3 02:23pm blood pt-13.3 ptt-30.9 inr(pt)-1.1 02:23pm blood glucose-98 urean-25* creat-2.7* na-142 k-4.2 cl-110* hco3-20* angap-16 02:23pm blood alt-55* ast-120* ld(ldh)-555* ck(cpk)-112 alkphos-95 totbili-0.3 02:23pm blood albumin-2.7* calcium-8.2* phos-5.6* mg-2.3 03:17am blood ret aut-0.6* 10:27am blood hapto-325* 02:23pm blood anca-negative b glomerular basement membrane <1.0 tee: no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 40 cm from the incisors. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve or chordae. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: normal valve morphology without echo evidence of discrete vegetation/abscess or pathology flow. cxr: findings: as compared to the previous radiograph, the extent of the pre-existing pleural effusions has slightly decreased but parenchymal opacities with air bronchograms are still visible at both lung bases. moderate areas of atelectasis at both lung bases. the patient has been extubated and the nasogastric tube has been removed, explaining in part for the slightly lower lung volumes. unchanged size of the cardiac silhouette. blood cx, bal cx, stool cx, resp viral culture ngtd bronchial washings: 2:54 pm bronchoalveolar lavage bronchial lavage . gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (preliminary): no legionella isolated. potassium hydroxide preparation (final ): test cancelled, patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. viral culture: r/o cytomegalovirus (preliminary): no cytomegalovirus (cmv) isolated. 2:54 pm rapid respiratory viral screen & culture bronchial lavage . **final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): less than 60 columnar epithelial cells;. specimen inadequate for detecting respiratory viral infection by dfa testing. interpret all negative results from this specimen with caution. negative results should not be used to discontinue precautions. refer to respiratory viral culture results. recommend new sample be submitted for confirmation. reported to and read back by 1145. 9:34 am stool consistency: not applicable source: stool. fecal culture (pending): campylobacter culture (pending): clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). time taken not noted log-in date/time: 4:10 pm blood culture blood culture isolate from for id/s. **final report ** isolate for mic (final ): staphylococcus epidermidis. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus epidermidis | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin-------------<=0.25 s tetracycline---------- <=1 s vancomycin------------ 2 s isolate for mic (final ): pseudomonas fluorescens. sensitivity testing performed by microscan. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas fluorescens | cefepime-------------- 2 s ceftazidime----------- 4 s ceftriaxone----------- <=4 s ciprofloxacin--------- <=0.5 s gentamicin------------ <=1 s imipenem-------------- 8 i levofloxacin---------- <=1 s meropenem------------- 4 s piperacillin---------- 16 s piperacillin/tazo----- <=8 s tobramycin------------ <=1 s trimethoprim/sulfa---- s legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. brief hospital course: 41 yo f previously healthy presented with multifocal pneumonia requiring intubation; also with staph epidermidits and staph capitis bacteremia. # acute resp failure/multifocal pneumonia: patient was admitted with hypoxia and found to have multilobar pneumonia on chest xray. she was initially started on vanc/ceftriaxone/azithro for empiric coverage, however this was changed to vanc/cefepime/cipro when sputum cultures from grew pseudoamonas florescans. all cultures here have been negative to date. patient also had bronch to evaluate for possible other etiologies. all cultures from bronch are negative to date as well. the patient was extubated and transferred to the floor. while on the floor the patient developed a rash, thus her antibiotics were changed to vanco/cipro. the rash was presumably due to cefipime. the patient's antibiotics were discontined on (10 days course). she should follow up with her pcp regarding pneumonia resolution. she will be discharged on albuterol and mucinex for symptomatic relief for her cough. . # bacteremia: cultures on presentation to grew staph capitis and staph epidermidis. she had a tte at which suggested a vegetation on the chordae of the mitral valve. however, repeat tee here not c/w endocarditis. all cultures here have been negative. she was continued on vancomycin for a total of 10 days. it is unclear whether the staph epidermidits and capitis were true infection or contaminant. id followed the patient and initially recommended 14 days of antibiotics but given that overall it appeared that the patient had a superimposed pneumonia on top of a viral illness, that treating for a pneumonia for 10 days was adequate and that 14 days was not necessary. . #drug rash the patient intially had a rash developed on her left inner thigh which was treated with miconazole. this rash progressed on to her abdomen as erythematous macules that coalesced the following day and spread to her chest arms and legs. she intermitently complained of pruritis which was treated with benadryl and . she had some hoarseness on but no sob or other respiratory issues. she was observed for 24 hours and remained stable prior to discharge. . # acute renal failure: pt had sudden increase in creatinine from baseline 0.6 to 2.5 prior to transfer here. creatinine continued to increase for several days before trending down. her acute kidney injury was likely contrast nephropathy c/b nsaid overuse in setting of hypovolemia. her urine output remained good, 50-75cc/hr. fena is 2.7% which is consistent with atn/intrinsic process. urine eosinophils negative. her antibiotics were renally dosed. her cr trended down by discharge. she will need follow up creatinine. . # metabolic acidosis: mixed gap and non-gap acidosis, likely secondary to renal failure and nacl resuscitation. this has been improving and gap has closed. . # anemia, nos: pt was noted to have hct decrease from 39 to 32 on admission, likely hemodilutional in setting of fluid resuscitation and possible marrow suppresion from infection. she remained stable with no signs of active bleeding. no signs of active bleeding. trending down slowly presently. . # anxiety/depression: pt was continued on home dose of wellbutrin . # liver lesions incidentally noted on ct chest: likely simple cysts given hounsfield units similar to water, however her lfts remain midly elevated. pt should have outpatient work-up for etiology of elevated lfts and liver lesions with imaging once her renal function recovers. . pt was full code. addendum: id recommended one more dose of vancomycin iv today prior to discharge so she received 11 days of vancomycin. medications on admission: wellbutrin 100 sr discharge medications: 1. bupropion hcl 100 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). 2. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day): to groin. disp:*1 bottle* refills:*0* 3. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob/cough. disp:*30 puffs* refills:*0* 5. guaifenesin dm 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed for cough. disp:*100 ml(s)* refills:*0* 6. outpatient lab work please draw a cbc and basic metabolic panel prior in 1 week and fax to dr. discharge disposition: home discharge diagnosis: multifocal pneumonia respiratory failure acute kidney injury/atn acidosis liver lesions of unknown significance cefipime induced drug rash discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with multifocal pneumonia causing respiratory failure and requiring intubation. you also had a bacteremia. with antibiotics your symptoms have improve. you will stop your antibitoics prior to discharge. your kidneys were also injured during your illness and will need close monitoring to ensure proper recovery. please do not use nsaid medications during this time. you also developed a antibiotic induced drug rash. this shoudl improved over time. you should not take keflex or other antibiotics in that family again. finally, you were found to have liver lesions of unknown significance. once your kidneys recover, we recommend ct scan to further evaluate. medication changes: miconazole powder to groin four times per day until rash resolves prn albuterol prn guafenesin prn followup instructions: pcp: , . - as soon as possible follow up with liver specialist following repeat imaging of liver procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified acidosis anemia, unspecified acute kidney failure with lesion of tubular necrosis hypopotassemia dysthymic disorder acute respiratory failure other specified cardiac dysrhythmias bacteremia dermatitis due to drugs and medicines taken internally unspecified accident diarrhea staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus other abnormal blood chemistry cephalosporin group causing adverse effects in therapeutic use unspecified analgesic and antipyretic causing adverse effects in therapeutic use other specified disorders of liver 

Answer: The patient is high likely exposed to