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: history of present illness: the patient is a 34-year-old woman with a history of cerebral palsy and seizure disorder since birth, who was brought to the emergency department on by the emts after being reportedly lethargic in the morning and being found unresponsive by her caretakers. the patient was in her usual state of health until the night prior to admission, when she had a single episode of watery diarrhea. at baseline, the patient had the cognitive and verbal communication skills of a 3-year-old and was normally interactive and conversational. however, she did have waxing and mental status, depending on her degree of fatigue and lethargy. on the morning of admission, the patient was noted to have a significant yellow mucous discharge coming from her nose and a minimal cough. she was also noted to be more lethargic than usual. she vomited times one. she ate breakfast as usual. at about 9:30, she was found with her eyes closed and unresponsive by a caretaker. she was breathing, but not arousable, and emts were called to bring her into the emergency department. while en route to the hospital, the patient vomited an additional time. the caretakers indicated that this episode was unlike past seizures. her last mal seizure was in . the only recent medicine change was a reduction in her lamictal dose from 175 mg a day to 150 mg a day. this change was to decrease her degree of lethargy. in the emergency department, the patient was responsive only to pain and had decreased communication and reduced arousal. her temperature in the emergency department was 100.2??????f. a neurology consultation was obtained and they suggested a head ct scan and a toxic metabolic screen. she was empirically treated with 2 gm of ceftriaxone for meningitis and was hydrated with fluids. past medical history: 1. mental retardation diagnosed at birth. 2. cerebral palsy with inability to walk or move her legs. 3. seizure disorder with a history of grand mal seizures and mal seizures. 4. cataracts. 5. glaucoma. 6. recurrent aspiration pneumonia. 7. spinal surgery for brace insertion. 8. legally blind. allergies: there were no known drug allergies. she did have food allergies to chocolate, tomato and caffeine. medications on admission: lamictal 75 mg p.o. q.a.m. and 75 mg p.o. q.p.m. keppra 1500 mg p.o. q.a.m. and 1500 mg p.o. q.p.m. cosopt one drop o.d. b.i.d. albuterol 0.5 mg nebulizer p.r.n. clotrimazole p.r.n. klonopin 0.5 mg p.o. p.r.n. after two seizures. multivitamin one tablet p.o. q.d. vege laxative two tablets q.a.m. and two tablets q.p.m. social history: the patient lives in a group home in an apartment with approximately three other people. she has caretakers. mother is , who visits her occasionally. family history: the patient's paternal grandfather died of a myocardial infarction. there was no family history of strokes, seizures, mental retardation of diabetes. physical examination: on admission, the patient had a temperature of 101.2??????f, a blood pressure of 111/60, a heart rate of 100, a respiratory rate of 16 and an oxygen saturation of 99% on room air. generally, the patient appeared somnolent with spontaneous movements of all four extremities, in no acute distress. on head, eyes, ears, nose and throat examination, there was a dilated right surgical pupil; the left pupil was round and reactive to light. the oropharynx was moist. there was poor dentition. the pharynx was clear. the neck was supple and nontender with no lymphadenopathy, no bruits and no jugular venous distention or thyromegaly. the cardiovascular examination was a regular rate and rhythm with a normal s1 and s2 and no rubs. there was a ii/vi holosystolic murmur at the left second intercostal space. the chest had coarse breath sounds on inspiration in the anterior chest bilaterally with poor inspiratory effort. the abdomen was mildly obese with decreased bowel sounds and no masses or organomegaly. in the extremities, the skin was warm and moist. there was no edema. there were 2+ dorsalis pedis pulses bilaterally. on neurological examination, the patient had 5/5 strength throughout in the upper extremities. the patient did not comply with examination of the lower extremities. the upper extremity reflexes were 2+ and symmetric. the lower extremity reflexes were 0/5. there were positive babinski signs. laboratory data: on admission, the patient had a white blood cell count of 11,000, hematocrit of 34 and platelet count of 170,000. there was a sodium of 138, potassium of 3.5, chloride of 103, bicarbonate of 22, bun of 12, creatinine of 0.4 and glucose of 97. prothrombin time was 12.6, partial thromboplastin time was 23.6 and inr was 1.1. the urinalysis revealed yellow, clear urine with negative nitrates, protein and glucose; it was positive for ketones. the toxicology screen was negative. radiology data: the chest x-ray on admission showed the heart to be within normal limits. there was a patchy opacity at the left lung base. the head ct scan showed hydrocephaly with no interval changes. hospital course: 1. pulmonary: on admission, the patient had a slightly elevated white blood cell count and a low grade temperature with a chest x-ray showing an opacity in the left lower lobe. she was started on ceftriaxone times one dose and then changed to levaquin to cover for community acquired pneumonia. on hospital day #2, the patient desaturated into the 80s and a repeat chest x-ray showed worsening pneumonia in the left lower lobe and a new right upper lung opacity. arterial blood gases revealed a ph of 7.47, a pco2 of 33 and a po2 of 63. the patient was intubated early in the morning of for hypoxic respiratory distress and was admitted to the intensive care unit. a central line was placed in the right internal jugular vein. the patient was treated for aspiration pneumonia with ceftriaxone, flagyl and vancomycin. the patient continued to have lots of secretions, but was oxygenating and ventilating well on assist-control ventilation. she was rapidly weaned to pressure support on and was extubated on . she was transferred to the floor on , saturating well with decreasing suction requirements. the patient did well from a respiratory standpoint until , when she looked poorly and had increased work of breathing. she required lots of suctioning that morning, which induced some nasal trauma. by mid afternoon, her oxygen saturations had dropped into the 80s and she was having increasing respiratory distress. a repeat chest x-ray showed white-out of the right lung. arterial blood gases revealed a ph of 7.49, a pco2 of 35 and a po2 of 49. the patient was reintubated and brought to the medical intensive care unit. a post intubation bronchoscopy revealed copious secretions in her lungs and a friable bronchus. the patient was arrested on assist-control ventilation for a day and a half with good ventilation and oxygenation. she was then changed over to pressure support and did well, but still required frequent suctioning and was felt to be unable to handle her secretions. a tracheostomy was placed on after discussions with her primary care physician and family. post tracheostomy, the patient did well and remains now on pressure support of 8 with peep of 5. 2. infectious disease: the patient was originally admitted with lethargy, thought to possibly be due to meningitis. she was treated with meningeal doses of ceftriaxone until a lumbar puncture was obtained by the interventional radiologist on around , which showed no infection. also, during the hospitalization blood cultures were positive for enterococcus and aerococcus viridans. an abdominal ct scan ruled out any abdominal source of this pathogen, but she was treated with a 14 day course of ceftriaxone and ampicillin intravenous. the patient was also treated with vancomycin, flagyl and ceftriaxone over a 14 day course for aspiration pneumonia. at the time of discharge, the patient was without fever, white count or infiltrates on chest x-ray. she will require three more days of intravenous antibiotics to finish the course of ceftriaxone and ampicillin. 3. neurology: on admission, the patient was lethargic and had decreased responsiveness. a lumbar puncture revealed no infection and a head ct scan was normal. the patient was continued on her anti-seizure medications. an electroencephalogram was obtained to rule out subclinical seizures. however, this was done while the patient was sedated with propofol on . the electroencephalogram showed right posterior quadrant slowing consistent with possible vascular etiology, but no epileptiform activity. 4. gastrointestinal: the patient was given tube feeds throughout her hospitalization for nutrition. she had several episodes of loose stools thought to be due to the tube feeds. clostridium difficile toxin was negative. after the tracheostomy on , the patient underwent a peg procedure on , to ensure a route of adequate enteral nutrition, as her diminished respiratory status was believed to be due to both recurrent aspiration and poor p.o. intake with resulting weakness secondary to her inability to take adequate p.o. intake prior to admission. condition on discharge: the patient has been stabilized, but has three main active issues at this point: 1. regarding her ventilatory status, the patient is currently on pressure support of 8 with peep of 5 and the goal is to wean her to tracheostomy mask as tolerated. the patient will require frequent suctioning to help handle her secretions. otherwise, she has been oxygenating well. 2. the patient is one day status post peg tube placement on . this peg tube can be used for medications today, but tube feeds should not be started until . prior to reinstituting tube feeds, her abdomen should be examined. she also may need adjustment of the tightness of the peg tube. her goal for tube feed is promote with fiber at a rate of 50 cc/hr. 3. the patient is on day 12 of 14 of ceftriaxone and day 11 of 14 of ampicillin to treat her enterococcus bacteremia. she has a right internal jugular central venous line, which will be left in until the course of the antibiotics is finished and then that can be removed. discharge status: the patient will be discharged to hospitalization and rehabilitation center. discharge medications: ampicillin 1 gm intravenous every six hours for three more days. ceftriaxone 1 gm intravenous every 24 hours for two more days. cosopt one drop to each eye b.i.d. heparin 5000 units subcutaneous b.i.d. lamictal 75 mg per peg b.i.d., to be weaned gradually. keppra 1500 mg per peg b.i.d. ranitidine 150 mg per peg b.i.d. colace 100 mg per peg b.i.d. promote with fiber with a goal of 50 cc/hr to start on . metamucil one pack per peg t.i.d. p.r.n. for loose stools. miconazole powder to affected areas t.i.d. follow up: the patient should follow up with dr. for her seizure disorder and dr. , her primary care physician. discharge diagnoses: 1. aspiration pneumonia. 2. enterococcus septicemia. 3. copious secretions. 4. poor nutritional status. 5. status post tracheostomy. 6. status post peg tube. , m.d. dictated by: medquist36 d: 15:12 t: 17:05 job#: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances other bronchoscopy other lavage of bronchus and trachea percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy diagnoses: other convulsions hypopotassemia acute respiratory failure pneumonitis due to inhalation of food or vomitus streptococcal septicemia legal blindness, as defined in u.s.a. mild intellectual disabilities other specified infantile cerebral palsy 

Answer: The patient is high likely exposed to