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: no known allergies / adverse drug reactions attending: chief complaint: hypoxia major surgical or invasive procedure: none history of present illness: unable to obtain as on ventilator obtained history from nursing home records. called both hcp/guardians but unable to reach. patient unable to provide history as has developmental disabilities with good receptive language skills but non-verbal due to presence of tracheostomy placed on . 54f mr, tracheomalacia s/p tracheostomy in , pvd, multiple aspiration pneumonias, dm2 among other conditions who had low oxygen saturations at her nursing facility. she was noted to have thick yellow secretions from her trach tube on . she was started on zithromax. it was noted that today her pulse ox was low in 70s-80s on supplemental oxygen with no improvement with suction today. she was tremulous and bluish. she was transferred to the er for further care. of note, the patient has tracheomalacia. she was hospitalized at for evaluation of severe pvd in feburary at which time she went into respiratory distress from pulmonary edema. adequate intubation was not possible due to tracheomalacia, and she underwent open tracheostomy. she stabilized but remained ventilator dependent for severe week but eventually weaned at pulmonary rehab. because of tracheomalacia and subsequent trauma from tracheostomy (portex #7), she will likely remain teacheostomy dependent and not a candidate for decannulation. per the ip team, she is not a candidate for a pm valve. at baseline, she receives continuous humidifcation via trach mask and large volume nebulizer. the fio2 settings is from 21-40 % to keep o2 sat > 90 %. the patient also has a history of bipolar disorder with a long history of mood swings including agitation, assault, and depression. in the ed, initial vs were: triage 19:51 0 99 112 127/49 18 97% 10 l humidified labs were performed - wbc 19.1 hgb 10.8 (baseline ) plt 175 diff n 81 l 7.5 - coags within normal limits - na 129 k 4.2 cl 88 hco3 34 bun 23 cr 1 (baseline 0.8-1) glc 163 - lactate 3.4 - ua spg 1.008 ph 8.5 le lg nit neg wbc 12 bacteria few epi < 1 cxr showed limited lung volumes with no acute intrathoracic process detected although ? pneumonia. she was given vancomycin, zosyn, and levaquin. access was difficult with 20g peripheral iv in shoulder and failed attempt of right femoral line. patient was placed on a ventilator due to continued respiratory distress and tachycardia. vent settings were 350x20, peep 5, fio2 40 %. she was suctioned x 2. vs on transfer: 00:08 100.3 113 101/64 20 98% on arrival to the micu, patient was resting comfortably on the vent. review of systems: unable to obtain as on ventilator past medical history: past medical history: mental retardation tracheomalacia s/p tracheostomy h/o aspiration pneumonia e.coli bacteremia diabetes mellitus h/o c. difficile infection glaucoma hypertension hld osteoarthritis depression/anxiety, constipation psychosis past surgical history: tracheostomy and peg , r total knee replacement r hip replacement right common iliac artery stent placement and right external iliac recanalization with stent placement x2. social history: lives at nursing home father and brother are -guardians family history: unable to obtain physical exam: admission exam: vs 100.3 113 101/64 20 98% general: would state shake head "yes or no" to questions, follows commands, unable to speak due to ventilator and trach heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad, poor dentition cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops although exam limited due to coarse breath sounds lungs: diffuse coarse breath sounds, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly. peg tube located in luq gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact although disconjugate gaze especially with right eye skin: ? stage i pressure ulcer on sacrum pertinent results: 10:42pm blood wbc-19.1*# rbc-3.52* hgb-10.8* hct-31.6* mcv-90 mch-30.7 mchc-34.2 rdw-16.3* plt ct-175 10:42pm blood neuts-81.0* lymphs-7.5* monos-11.0 eos-0.2 baso-0.2 03:59am blood hypochr-2+ anisocy-normal poiklo-normal macrocy-1+ microcy-normal polychr-normal 10:42pm blood pt-10.0 ptt-26.4 inr(pt)-0.9 10:42pm blood glucose-163* urean-23* creat-1.0 na-129* k-4.2 cl-88* hco3-34* angap-11 04:00am blood calcium-8.6 phos-1.7* mg-2.0 10:59pm blood type-art po2-101 pco2-50* ph-7.47* caltco2-37* base xs-10 intubat-not intuba 10:59pm blood lactate-3.4* blood culture, routine (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. respiratory culture (final ): heavy growth commensal respiratory flora. pseudomonas aeruginosa. moderate growth. piperacillin/tazobactam sensitivity testing performed by . ciprofloxacin sensitivity testing performed by . pseudomonas aeruginosa. moderate growth. second morphology. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | pseudomonas aeruginosa | | cefepime-------------- 2 s 2 s ceftazidime----------- 4 s 4 s ciprofloxacin--------- s 0.5 s gentamicin------------ 2 s 4 s meropenem------------- 1 s 1 s piperacillin/tazo----- s s tobramycin------------ <=1 s <=1 s 04:00am blood wbc-7.5 rbc-3.36* hgb-10.1* hct-31.4* mcv-94 mch-30.1 mchc-32.2 rdw-15.2 plt ct-154 04:00am blood glucose-72 urean-14 creat-0.9 na-141 k-3.9 cl-106 hco3-33* angap-6* 11:32am blood type-central ve po2-37* pco2-61* ph-7.35 caltco2-35* base xs-5 = = = = = = = = = = ================================================================ imaging: frontal chest radiograph: a tracheostomy tube is appropriately positioned. low lung volumes result in bronchovascular crowding. the central pulmonary vessels are engorged, however, no overt edema is seen. there is no definite consolidation, pneumothorax, or pleural effusion. renal u/s findings: the study is markedly limited due to patient body habitus, edema and portable technique. the right kidney is 8.6 cm and the left kidney is 10.1 cm. there is no obvious hydronephrosis. we cannot evaluate for stones or masses. the bladder is not seen. chest ct findings: there are no pulmonary arterial filling defects to suggest the presence of pulmonary embolism. there is no aortic dissection. there are small bilateral non-hemorrhagic pleural effusions as well as large areas of atelectasis bilaterally. on the left, most of the posterior basal segment is collapsed. there are also multiple areas of airspace consolidation consistent with multifocal pneumonia. there are multiple enlarged lymph nodes within the mediastinum. the largest are a 19 x 12 mm right paratracheal lymph node (3:19) and a 20 x 11 mm paraesophageal lymph node further inferiorly (3:34). severe tracheomalacia is again identified beginning just distal to the endotracheal tube and continuing through the carina (3:10). this is similar in extent and severity to the prior examination from . no focal osseous lesions are identified. there is extensive atherosclerotic calcification within the thoracic aorta and coronary arteries. a small pericardial effusion is present, without evidence of tamponade as well as a probable edematous lymph node in the epicardial fat pad (4:112). impression: 1. no evidence of pulmonary embolism or acute aortic syndrome. 2. multifocal pneumonia and segmental atelectasis, with small bilateral non-hemorrhagic pleural effusions. 3. severe tracheomalacia. 4. mediastinal lymphadenopathy, likely reactive hypertrophy in the setting of pneumonia. brief hospital course: 53f history of mental retardation, tracheomalacia s/p tracheostomy with multiple aspiration pneumonias, dm2 among other conditions who presented with tachypnea, increased oxygen requirement, and thick secretions from tracheostomy concerning for sepsis from a pulmonary source. was found to have sputum positive for pseudomonas and blood culture positive for e. coli. both organisms were sensitive to ciprofloxacin. # sepsis from a pulmonary and/or urinary source, initially treated with broad coverage with vancomycin and cefepime. received fluid resuscitation. initial lactate was 3.4, which cleared with resuscitation. pt. had episode of hypotension to sbps of 70s requiring placement of femoral cvc, and brief use of ne for less than 24 hours. cvc was then pulled and a picc line was placed. blood cx showed e. coli, and suputum culture showed pseudomonas, both of which were sensitive to ciprofloxacin. when this data was obtained, antibiotic coverage was narrowed to just ciprofloxacin. as patient was also on large doses of seroquel, ekg was obtained, which showed normal qtc. she is to continue a 15 day course of antibiotic coverage for pseudomonas vap/e. coli bacteremia with ciprofloxacin. end date for cipro is . # respiratory failure patient may have respiratory failure secondary to pulmonic process such as pneumonia or tracheobronchitis with some component of mucous plugging per reports in er. pt. was able to be weaned off the vent, saturating well with trach mask. the evening before discharge she was placed on pressure support ventilation to see if this would improve her tachycardia. she was able to come off of vent on day of discharge. would likely benefit from cpap at night and albuterol nebulizer. # anemia: likely multifactorial acd, acute blood loss, and dilutional. admitted at baseline hgb ~ 10. crit dropped after placement of fem line with bleeding noted at fem site, concern for retroperitoneal bleed at that time but responded appropriately to 4 units with no evolving signs of bleeding. remained stable, then dropped two days later in context of 2l fluid bolus, bumped appropriately to 2 units prbc. hematocrit stable at discharge. # altered mental status: patient waxed and waned. initially attributed to sepsis and respiratory distress, the patient was eventually decreased on seroquel from 250mg tid to 125mg tid. she became alert and oriented at discharge. # tachycardia: etiology unclear, developed tachycardia to 120's after sepsis resolved. responded to cpap at night, ivf, and resumption home metoprolol. # rash: likely drug reaction to cefepime-erythematous blanching over abd and torso, nonpruritic, no swelling, no pustules, evolved two days after cefepime started and one day after vanc dc'd. rash resolved with narrowing to ciprofloxacin. the patient had some relief with hydrocortisone cream. # hyponatremia: hypovolemic hyponatremia, admitted na 130, rose to 141 with ivf. chronic issues: # peripheral vascular disease: lower extremity pulses are evidence by doppler on admission. continued asa 325 mg po qd, held fenofibrate, restarted at discharge. # bipolar disorder she had no active signs or symptoms of psychiatric decompensation. continued seroquel 250 mg po tid initially, then decreased to 125mg tid in the setting of altered mental status. continued valproic acid syrup 500 mg po qam and 750 mg po qpm. # dm2: blood sugars were stable, lantus decreased from 48 to 35 units at bed time. # hypothyroidism: continued home levothyroxine # hypertension: after sepsis resolved, pressures stabilized. # glaucoma: continued latanoprost drops qam # osteoporosis: continued calcium and vitamin d after sepsis stabilized transitional issues medication changes stopped metoprolol for hemodynamic instability, resume at outpatient facility started ciprofloxacin iv 500mg , last day for total of 15 days coverage started hydrocortisone cream 0.5% 1 appl tp :prn pruritis started albuterol 0.083% neb soln 1 neb ih q2h:prn wheeze changed seroquel 250mg tid to 125mg tid -ventilator support as needed, may trial cpap at night -iv ciprofloxacin administration until -wound care for buttocks and inner thighs -seroquel dose was downtitrated from home dose of 250mg tid to 50mg tid while in hospital. patient did well on this dose and on discharge was not agitated. if agitated, may uptitrate dose of seroquel as needed if there is no qtc prolongation -monitor hemodynamics: if tachycardic and blood pressure tolerates, please restart metoprolol and uptitrate as needed (this had been held in the hospital due to hypotension and concern for sepsis; her home dose prior to hospitalization was 150mg ) -speech & swallow evaluation: 1. pt is not safe to wear the pmv at this time 2. discuss safety of trach cuff deflation trials to allow intermittent periods where pt can try to speak 3. remain npo with tube feeds 4. q4 oral care as pt allows medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from nursing home records. 1. aspirin 325 mg po daily 2. calcium carbonate suspension 1250 mg po daily 5 ml (1 tsp) = 1250 mg calcium carbonate = 500 mg of elemental calcium 3. fenofibrate *nf* 54 mg oral daily 4. glargine 48 units bedtime insulin sc sliding scale using hum insulin 5. levothyroxine sodium 50 mcg po daily 6. metoprolol tartrate 150 mg po bid 7. multivitamins 1 tab po daily 8. polyethylene glycol 17 g po daily 9. quetiapine fumarate 250 mg po tid 10. valproic acid 500 mg po qam 11. valproic acid 750 mg po qhs 12. lorazepam 1 mg po q6h:prn agitation 13. vitamin d 400 unit po daily 14. azithromycin 250 mg po q24h 15. latanoprost 0.005% ophth. soln. 1 drop both eyes qam 16. lactobacillus acidophilus *nf* oral 17. amoxicillin mg po preop prior to dental exams discharge medications: 1. aspirin 325 mg po daily 2. latanoprost 0.005% ophth. soln. 1 drop both eyes qam 3. levothyroxine sodium 50 mcg po daily 4. lorazepam 1 mg po q6h:prn agitation 5. quetiapine fumarate 50 mg po tid adjusted for ms 6. valproic acid 500 mg po qam liquid form 7. valproic acid 750 mg po qhs liquid form 8. amoxicillin mg po preop prior to dental exams 9. fenofibrate *nf* 54 mg oral daily 10. lactobacillus acidophilus *nf* 0 capsule oral 11. multivitamins 1 tab po daily 12. polyethylene glycol 17 g po daily 13. vitamin d 400 unit po daily 14. miconazole powder 2% 1 appl tp qid:prn fungal infection 15. ipratropium bromide neb 1 neb ih q6h:prn wheeze 16. hydrocortisone cream 0.5% 1 appl tp :prn pruritis 17. ciprofloxacin 400 mg iv q12h started gram-negative bacteremia coverage on days ending 18. albuterol 0.083% neb soln 1 neb ih q2h:prn wheeze 19. glargine 35 units bedtime insulin sc sliding scale using reg insulin 20. calcium carbonate suspension 1250 mg po daily 5 ml (1 tsp) = 1250 mg calcium carbonate = 500 mg of elemental calcium discharge disposition: extended care facility: - discharge diagnosis: sepsis with gram negative bacteria discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure taking care of you in the hospital. you were admitted with a blood infection and placed on antibiotics for this. this infection was likely from a urinary source, and will require ciprofloxacin iv 5000mg twice daily up to and including . in addition, you lost some blood after placement of a line in your groin through which to administer fluid. you received a blood transfusion to bring your blood levels back up. followup instructions: follow up with physicians at your rehabilitation facility. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube central venous catheter placement with guidance diagnoses: anemia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism peripheral vascular disease, unspecified unspecified glaucoma dysthymic disorder other and unspecified hyperlipidemia acute respiratory failure pneumonia due to pseudomonas osteoporosis, unspecified septic shock osteoarthrosis, unspecified whether generalized or localized, site unspecified pressure ulcer, lower back dermatitis due to drugs and medicines taken internally septicemia due to escherichia coli [e. coli] bipolar disorder, unspecified knee joint replacement tachycardia, unspecified tracheostomy status hip joint replacement other diseases of trachea and bronchus pressure ulcer, stage i cephalosporin group causing adverse effects in therapeutic use mild intellectual disabilities 

Answer: The patient is high likely exposed to