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: penicillins attending: chief complaint: hypoxia major surgical or invasive procedure: tracheostomy g-tube intubation with mechanical ventilation right ij and central line placed and pulled history of present illness: 54 year old female with h/o copd, chf (ef 50%), pvd s/p grafting and r aka, ild, dm, and recent staph pneumonia requiring transient intubation who presents from rehab to osh, then sent here with respiratory distress. . of note, patient was recently hospitalized with staph aureus pneumonia with associated mssa bacteremia. discharged to complete a 4 week course of ceftriaxone to continue through . returned and was started on vancomycin, ceftriaxone and clindamycin on . changed to vancomycin/clinda/cefepime as well as oseltamivir for flu b on when decompensated. she was intubated from to for respiratory distress. cefepime and clinda were continued for 8 days and transitioned to cefazolin . pt had extensive workup for other sources which was unrevealing. she had a negative tee, cta of the right stump and no evidence of increased uptake on wbc scan. she was discharged to rehab with picc and completed cefazolin course through 3/31 per last id note. . on , she developed tremor, myoclonus and lethargy at rehab. amitryptilin was held. cxr with consolidation. pt was started on iv vanc, cefepime and flagyl. . on , she developed increased respiratory distress and her o2 sats were dropping to 80s. she received 40 iv lasix, 2mg iv morphine and was sent to osh ed on nrb. at hospital , abg was 7.39/53/49 (?on nrb). a cxr showed supposedly signs of chf. bnp was elevated >5000 and was sent to ed. . in the ed, her vs were t32 (rectally), 84, 160/90, rr in 40s, o2 sats in low 90s on nrb. exam notable for crackles 3/4th way up b/l. her temp came up to 35.1 on warming blanket. given her respiratory distress, she was intubated with etom and succ. her vs post-intubation were stable. it was felt that she also has a copd flare and received 125 iv solumedrol and combivent nebs. in addition she was empirically covered with vanc 1gm iv, cefepime 1gm iv and flagyl 500 iv(unclear if cefepime and flagyl given) b/o hypothermia and slight wbc elevation. a r ij was placed. cxr showed cvl and ett in good position. pt was admitted to icu for further care. . on arrival to the icu, pt was intubated, sedated on ac. past medical history: 1. s/p aka (right) 2. s/p vats and hypoxemia, biopsy c/w respiratory bronchiolitis-interstitial lung disease (rb-ild) -- now on intermittent supplemental oxygen 3. pvd - s/p rt. ileo-fem bpg complicated by lymphocele s/p drainage ,rt. ililac/femoral thrombectomy ,rt. ileo-fem graft thrombectomy with bovine patchangioplasty ,rt. ileofem bpg with ptfe , 4. chronic pancreatitis s/p puestow,j-tube,ccy1998,expl lap 5. etoh cirrhosis/chronic pancreatitis 6. l breast cyst s/p excision 7. gerd, pud 8. esophagitis with stricture 9. small bowel obstruction 10. pv,smv thrombosis; h/o dvt/pe 11. asthma/copd on inhalers 12. cervical ca s/p multiple d/c's 13. dm2 insulin dependent 14. entero-colonic fistula 15. cholecystectomy . cdiff colitis 17. acute renal failure social history: per last dc summary - currently at rehab. married and lives at home generally with her husband, no children. previously worked as a counselor in drug and alcohol programs. she quit smoking approximately with an over 80-pack year history of smoking. she quit drinking alcohol 23 years ago. she has no known exposure to tuberculosis. she was cleaning her husband's clothes during the time that he was working with asbestos for a three-month period. family history: noncontributory physical exam: t 95.8 bp 152/74 hr 84 rr 17 100% on ac 480x16, fio2 0.4, peep 5 gen - intubated, sedated. heent - perrl, ett in place neck - supple, r ij in place cv - rr, nl s1, s2, no murmurs appreciated. lungs - dry crackles b/l anteriorly, no wheezes, diffuse rhonchi. abd - nabs, soft, non-tender, non-distended. significant scarring on abdomen from pancreatic surgeries and feeding tubes. ext - no lower extremity edema. 1+ palpable pulse on l. r above knee amputation scar intact without ecchymoses or skin breakdown. skin: no rashes/lesions, ecchymoses. neuro - sedated, only opening eyes to command pertinent results: 151 112 42 ============ 319 5.1 28 1.1 . ck: 105 mb: 7 trop: 0.03 lactate 0.9 ca: 8.8 mg: 2.1 p: 4.2 probnp: > . wbc 11.3 hb 10.6 hct 33.2 plt 380 n:90.3 band:0 l:6.0 m:2.5 e:0.9 bas:0.2 . pt: 20.4 ptt: 34.1 inr: 1.9 . . studies: ekg: sr at 67, normal axis, nonspecific st changes . cxr in ed (prelim): ap view of the chest in semi-upright position. there is an ng tube with the tip within the stomach. right-sided picc with tip at the level of the mid svc. since prior exam, there has been worsening the right-sided pleural effusion and pulmonary edema. persistent wedge-shaped opacity in the left mid lung zone. impression: worsening right-sided pleural effusion and pulmonary edema. . previous studies: ct chest w/o contrast : 1. left upper lobe consolidation is minimally decreased compared to and smaller than . while the cavitation favors a necrotizing infectious etiology, the slow change in appearance raises the possibility of organizing pneumonia. 2. improvement in pulmonary edema and anasarca. 3. increase in size of moderate right pleural effusion and decrease in small left pleural effusion. 4. slight increase in mediastinal adenopathy. . chest ap : cardiac, mediastinal and hilar contours are unchanged. endotracheal and nasogastric tubes have been removed. right-sided picc tip is in the svc. the left pulmonary opacities are not significantly changed from prior exam. there continues to be right lower lobe atelectasis. there are moderate bilateral pleural effusions which accounting for differences in technique are not significantly changed. re-distribution of effusion along the left lateral chest is likely positional in nature. impression: accounting for differences in technique, the bilateral pulmonary opacities and moderate pleural effusions are not significantly changed. . tee : no 2d echocardiographic evidence of endocarditis or abscess. mild to moderate mitral regurgitation. depressed lv function. . tte : compared with the prior study (images reviewed) of , trace aortic regurgitation and low normal left venticular systolic function are seen on the current study (c/w diffuse process - toxin, metabolic, etc.). a pda is not seen on review of the prior study nor on the current study. brief hospital course: summary: ms. is a 54 year old female with h/o interstitial lung disease (cop), copd, diastolic chf (ef 50%), pvd s/p grafting and r aka, dm, and recent staph pneumonia requiring transient intubation who presented from rehab to an osh, then sent here with respiratory distress. she was initially intubated, started on empiric antibiotics for possible pna, although cultures returned negative and these were stopped. she was also felt to have an acute on chronic diastolic chf exacerbation, responding well to having her transudative pleural effusion tapped and gentle diuresis as needed. she was found to have c diff colitis and is being treated with flagyl. she was given tracheostomy and g-tube on . . # respiratory failure: most likely multifactorial with known copd, rb-ild, chf exacerbation, recent necrotizing staph aureus pneumonia with mssa bacteremia. given all cultures have remained negative, this is unlikely to be infection and antibiotics were stopped and bal on with no wbc. given rapid response to thoracentesis, unlikely to be purely her underlying lung disease and steroids were discontiued after a few days. she responded well to high volume thoracentesis (1.2l), with ability to wean on vent settings after this. thoracentesis consistent with transudate - likely due to chf. her rate was well controlled iwht metoprolol. goal ins/outs were to remain even and the patient received lasix 40mg iv on a prn basis, although she began autodiuresing well with net negative 500cc for the last three days of her stay with out medications. notably, her bnp on admission was greater than 70,000. she was extubated on and re-intubated for persistent respiratory distress. pt self extubated , but reintubated early morning due to respiratory distress. the patient did well on pressure support of . on she had tracheostomy and g-tube. since then she has been maintained on 50% trach collar with psv 5/5 available on a prn basis only. . # c dificile colitis: the patient was found to have c dificile colitis and was started on flagyl po 500mg po tid for planned 14 day course. day 1 was and the patient should continue this medication until . . # h/o arterial and venous thrombi s/p thrombectomy: the patient was maintained on a heparin drip with goal of ptt 60-70 (this was tightened after she had some bloody ogt contents at higher ptt levels). her coumadin dose on admission was 3mg po qday, and she was restarted on coumadin 5mg on after trach/peg. her inr jumped in one day from 1.4 to 2.0, so this was decreased to 3mg po qday on . she was continued on heparin drip until her inr was therapeutic at goal of . her inr should be monitored frequently to alter her coumadin dose as needed for inr (current dose 4mg po qday). interactions with flagyl discontinuation should be considered. . # altered mental status: the patient was initially altered at her rehab, likely due to hypoxia and hypercarbia with rapid shallow breathing (she demonstrated this repeatedly early on in her stay whenever her ventilator settings were changed to psv. this breathing pattern resolved after large volume thoracentesis.) off sedation the patient has been alert and interactive. she does become quite anxious/agitated, especially at night, and especially while lying in bed as she prefers to sit in a chair. she is also quite disoriented in the early morning and immediately after waking. when she initially wakes up, she complains of total body pain and seems quite distressed. once she is awake, by mid-morning, she is again alert and able to give a true report of her status. she was treated with olanzapine 10mg qhs and 5mg qam. she also recieved ativan 0.5mg q6h prn anxiety. generally speaking she is more agitated at night, and by day sits up in chair without problem. . # acute on chronic diastolic chf: ef of 50% on last echo. as above, the patient had likely diastolic chf exacerbation on admission with crackles, veyr elevated bnp and cxr with edema. she improved with prn iv lasix (last needed several days prior to discharge), and had a transudative effusion that was tapped for 1200cc. we continued her metoprolol and captopril for diastolic chf and continued home asa 325. home lasix was restarted eventually and uptitrated to 80 mg po daily, to be titrated as needed. . # h/o copd: the patient's copd was stable during her stay. we continued the patient's nebulizers and inhaled steroids while in-house. these should be continued as an outpatient as well. . # anemia: hct was stable between 23-26. she had bloody gastric content from ogt on and guaiac + stool, but no frank blood. in preparation of her trach/gtube placement she was given 1uprbc . . # diabetes mellitus type ii: the patient was admitted on iss and nph 4 . due to her initial pulse steroids, hte patient had very elevated fs to the 300s and was maintained on an insulin drip for better glucose control. she was eventually restarted on nph at 6 units qam and 6 units qpm and insulin slide scale and should continue this dosing on discharge; to be adjusted as needed per fs. . # peripheral vascular disease: ms. is s/p right aka for non-healing leg ulcer. her skin remained intact throughout her stay. . # etoh cirrhosis: ammonia and lfts were normal. although it is unclear when the patient last had alcohol, she has been between hospitals and rehab for the past four months. she was treated with mvi, folate, thiamine. . # h/o pancreatic insufficiency: s/p chronic pancreatitis. while the patient is on tube feeds or eating she should be maintained on viokase tid. . # h/o gerd: we continued her on a ppi throughout her stay. . # fen: the patient was not deemed ready for a swallow study at the time of discharge. she remains npo with meds crushed through g-tube. tube feeds were intitiaed through her gtube on in the afternoon, 24 hours after it was placed. she was initially admitted with hypernatreia requiring free water boluses, but this resolved and they were stopped. . # prophylaxis: ms. was maintained on ppi and heparin drip throughout her stay. . # access: ms. had a right ij central venous catheter placed in ed on , and removed on in preparation for tracheostomy. she has a right picc which was placed in early at . this is still present and used as access. this does not appear to be infected. however given the high infection risk, this should be pulled as soon as her heparin drip is discontinued. . # code - full code per her husband and health care proxy, . phone number . # disposition: the patient is stable for discharge to an acute rehab facility where her trach can be managed (psv prn, in future evaluate for passy-muir valve), her heparin drip can be continued as a bridge to coumadin anticoagulation with goal inr , and she can continue flagyl for her c difficile colitis. her leg should be monitored for possible cellulitis, but as of discharge patient has no white count, no fevers, no tenderness. antibiotics should be started in conjuction with flagyl as patient is high risk for antibiotic-associated c diff infection. medications on admission: cefepime 1 gm iv daily vanco 0.75 gm daily flagyl 250 iv q8h viokase 1 tab tid lipitor 20 daily dulcolax 10mg supp daily atrovent nebs q2h prn nicotine lozenge prn medium chain tg oil tid thiamine 100 dialy coumadin ?1 dose daily colace 100 hiss nph 4u atrovent nebs q6h lactulose 20 gm tid lansoprazole 30 daily lidocaine patch daily lopressor 75 tid mvi . per last dc summary, pt was also in recent past on: lisinopril 20 mg qd tiotropium bromide 18 mcg qd fexofenadine 60 mg gabapentin 400 mg tid aspirin 325 mg qd amitriptyline 50 mg qhs oxycodone 5 mg q4 prn discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily). 2. hexavitamin tablet : one (1) cap po daily (daily). 3. folic acid 1 mg tablet : one (1) tablet po daily (daily). 4. captopril 12.5 mg tablet : one (1) tablet po tid (3 times a day). 5. amylase-lipase-protease 30,000-8,000- 30,000 unit tablet : one (1) tablet po tid (3 times a day): tid while having tube feeds or eating. 6. metoprolol tartrate 50 mg tablet : one (1) tablet po tid (3 times a day). 7. aspirin 325 mg tablet : one (1) tablet po daily (daily). 8. olanzapine 5 mg tablet, rapid dissolve : two (2) tablet, rapid dissolve po qhs (once a day (at bedtime)). 9. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po qam (once a day (in the morning)). 10. lorazepam 1 mg tablet : one (1) tablet po bid prn as needed for anxiety. 11. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 12. beclomethasone dipropionate 80 mcg/actuation aerosol : one (1) puff inhalation (2 times a day). 13. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 14. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 15. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 6 days: last day is . 16. warfarin 3 mg tablet : one (1) tablet po daily16 (once daily at 16): please titrate does to goal inr . 17. heparin lock flush (porcine) 100 unit/ml syringe : one hundred (100) units intravenous daily (daily) as needed: flush each lumen of picc with 10ml ns followed by 100 units heparin (1ml) qday and prn. 18. morphine 15 mg tablet : 1-2 tablets po q4hrs prn as needed for pain. 19. sodium chloride 0.65 % aerosol, spray : sprays nasal qid (4 times a day) as needed for dry nose. 20. heparin iv drip please titrate as needed for goal ptt 60-70. please stop heparin iv drip when pt's inr is greater than 2. (bridge to anticoagulation with coumadin only) 21. insulin please give insulin nph 5units qam and 5 units qpm. please check fs q6 hours and treat with regular insulin by slide scale (starting dose 2 units if fs 151-200, increase by 2 units for every increase of fs by 50) 22. albuterol sulfate 1.25 mg/3 ml solution for nebulization : one (1) nebulization inhalation every six (6) hours as needed for shortness of breath or wheezing. 23. ipratropium bromide 0.02 % solution : one (1) nebulization inhalation every 4-6 hours as needed for shortness of breath or wheezing. discharge disposition: extended care facility: & rehab center - discharge diagnosis: interstitial lung disease congestive heart failure c dificile colitis anxiety etoh cirrhosis peripheral vascular disease s/p aka anemia copd pancreatic insufficiency gerd discharge condition: blood pressure stable, o2 sat high 90s on 50% trach collar, sitting up in chair, interactive discharge instructions: patient had trach/g-tube placed on . g-tube ok to use as of 2pm on . patient was able to tolerate an oral diet of nectar thick liquids and ground solids. will likely need nutrition consult for calorie counts and for supplemental tube feedings. patient has known arterial/venous thrombi. we restarted her coumadin on at 5mg po qday and adjusted as needed. her prior dose was 3mg po qday. coumadin dose should be adjusted for goal inr after discharge. the patient is currently on 50% trach cuff. we anticipate that she will need to return to psv 5/5 as needed, potentially overnight or intermittently throughout the day. patient is tolerating passy-muir valve. the patient has c difficile colitis and is taking flagyl per gtube. she should continue this until for a total of 14 days. the patient has a r sided picc that was placed in on her last admission at . please pull this picc as soon as not needed anymore in order to prevent infection. patient needs to have her l leg monitored for possible cellulitis - it is slightly erythematous on day of discharge. no white count, no fevers, no tenderness. given her tendency to have anti-biotic associated c diff infections, please be sure she has cellulitis before starting antibiotics and consider concurrent flagyl. patient has waxing and mental status. in the mornings immediately upon wakening she is often disoriented and complains of total body pain. by mid-morning her mental status has cleared and she is able to give a true self-assessment. followup instructions: please evaluate oxygen needs by trach. currently on 50% trach collar, anticipate may need psv 5/5 prn. please call dr. for a follow up appointment in infectious disease in 2 weeks. please call your primary care physician for follow up appointment in the next 2 weeks. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube thoracentesis percutaneous [endoscopic] gastrostomy [peg] insertion of other (naso-)gastric tube temporary tracheostomy closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: pneumonia, organism unspecified abnormal coagulation profile anemia, unspecified esophageal reflux unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver acute kidney failure, unspecified acute on chronic diastolic heart failure anxiety state, unspecified acute respiratory failure intestinal infection due to clostridium difficile postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants hypoxemia chronic obstructive asthma, unspecified esophagitis, unspecified hyperosmolality and/or hypernatremia chronic pancreatitis other candidiasis of other specified sites personal history of malignant neoplasm of cervix uteri other specified diseases of pancreas other and unspecified alcohol dependence, continuous stricture and stenosis of esophagus atherosclerosis of native arteries of the extremities with ulceration above knee amputation status ulcer of other part of lower limb 

Answer: The patient is high likely exposed to