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: compazine / pepcid / nitroglycerin / dicloxacillin / neurontin / tape / detrol / ambien / methadone attending: chief complaint: altered mental status major surgical or invasive procedure: endotracheal intubation placement of dauboff tube lumbar puncture history of present illness: this is a 62 yo f with multiple medical problems including htn, dm, h/o one tonic clonic seizure in , h/o recurrent uti with e. coli and pseudomonas, chronic arachnoiditis, on chronic morphine pca, with multiple recent admissions for altered mental status related to either infection or opiate intoxication from her morphine pca. she was recently admitted at on for altered mental status and albicans growing in her blood culture bottles from . lp was unsuccessful during that admission and felt unlikely to be successful given her significant scarring. the pt at the time of that admission was septic, admitted to the icu, and treated for fungemia. her fungemia was treated with a 14 day course of caspofungin and her hickman line was discontinued. chest ct showed multiple nodular paranchymal lesions with tiny cavitations concerning for fungal infection, inflammatory process, or metastatic thyroid ca. picc line was placed prior to completion of abx, and was d/c'd on . . since the pts last discharge, she has been at . she completed her course of caspofungin on . on night of this admssion the pt was found with altered sensorium with jerking movements. her eyes were noted to be roving and there was question of seizure activity. she was given 0.4 m narcan without effect. she had noted neck stiffening and extension of the upper extremities, prompting administration of ativan 2 mg x1. she was then transferred to . she was intubated for airway protection. she received vanc, ctx. she was noted to have lactate of 5.5, tachycardia, and fever so code sepsis was called in the ed. head ct on admission was negative for any acute change. when patient intitially presented to the micu she was noticed to have tonic-clonic seizures which resolved after increased of propofol. past medical history: 1. mrsa 2. metastatic thyroid ca s/p iodine and xrt and now on synthroid 3. right lower extremity cellulitis 4. nuerogenic bladder: pt self catheterizes 5. chronic low back pain: pt is on continuous morphine pca. 6. depression 7. type 2 dm 8. chronic arachnoiditis 9. esophageal dysmotility 10. dvt and pe s/p placement of ivc filter. felt to be hypercoagulable 11. chronic utis with pseudomonas/klebsiella 12. obstructive sleep apnea 13. osteoarthritis 14. chf now recovered. lvef of 60%. 15. htn 16. anemia of chronic disease 17. right ankle graft 18. seizure 19. s/p klebsiella line infection 20. s/p ercp for retained stone 21. hospitalized at with r thumb/forearm cellulitis s/p several courses of vancomycin 22. splenic cyst 23. osteomyelitis of the right second toe with chronic ulceration s/p distal phalangectomy of the right second toe with ulcer excision 24. peripheral vascular disease 25. squamous cell carcinoma 26. s/p cholecystectomy social history: married. currently residing at after recent hospitalization. cared for by husband at home. pt has one son. worked as a research chemist. no etoh or tobacco use. family history: father has cad, mother with cva physical exam: pe: 99.1, 158/70, 112, 20, 98ra gen: nad, aox2 heent: mmm, r tongue lesion, perrla, eomi, nc neck: swollen, r hematoma, central induration , no jvd chest: reduced bs with limited effort, no w/r/r cv: tachy, rr, s1 and s2 nl, no m/r/g abd: obese, soft, nt, nd, +bs, well healed scars ext: relatively atrophic, r foot s/p resection toes ii,iii neuro: cn ii-xii intact, le strenght 2-3/5, decreased sensation feet b/l skin: dry pertinent results: admission labs: na 135/k 4.2/cl 97/hco3 20/bun 22/cre 0.8/gluc 314 alt 17 ast 16 ap 113 tbil 0.3 14 lip 13 wbc 17.6/hct 35.2/plt 394 . 06:45am blood wbc-6.6 rbc-3.34* hgb-9.5* hct-28.7* mcv-86 mch-28.5 mchc-33.2 rdw-15.8* plt ct-370 06:45am blood plt ct-370 06:45am blood glucose-155* urean-6 creat-0.5 na-137 k-3.9 cl-101 hco3-29 angap-11 06:45am blood tsh-0.65 06:45am blood free t4-1.4 04:13pm blood phenyto-13.4 . video oropharyngeal swallow : no aspiration demonstrated during the study. there is a mild amount of penetration before and during swallow. . barium esophagram : 1. nonspecific esophageal motility disorder characterized by weakened primary peristaltic waves and prominent tertiary activity also noted on study from . no strictures or masses are identified. moderate-sized hiatal hernia. suggestion of a schatzki's ring although a barium tablet was not administered per request of speech and swallow pathologist. . egd : the esophagus appeared normal. the scope was easily able to pass into the upper esophagus. there were no esophageal strictures. medium hiatal hernia. erythema and erosions in the antrum compatible with gastritis. normal egd to stomach antrum . urine culture (final ): pseudomonas aeruginosa. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 8 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 4 s meropenem------------- 0.5 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ =>16 r brief hospital course: # altered mental status/seizure: the pt presented with altered sensorium after what appeared to be tonic clonic seizure activity at her rehab. she was likely post-ictal in the er, and then presents with another witnessed tonic clonic seizure when in the icu. she was also found to have a uti which was felt that could have also contributed to her altered mental status. patient was seen by neurology and underwent both lp and eeg. the lp came back negative for infection and her eeg did not show any evidence of seizure activity. however since patient had witness seizures in the hospital it was decided to load patient with dilantin which was then transitioned to keppra. her mental status improved back to baseline as her uti was treated and she was loaded with dilantin. she was briefly intubated for airway protection but was quickly extubated once her mental status improved. - patient needs to contiue to be transitioned to keppra. she was started on keppra 500mg on , this should be increased to 1000mg on and the dilantin should be decreased to 200mg daily. on dilantin should be decreased to 100mg daily and then stopped on . the keppra should be continued at 1000mg . - she should follow up with her neurologist dr. on @ 1:30pm; . # urosepsis: when patient presented she had elevated wbc, fever, and was hypotensive. she was breifly on pressors for blood pressure support but this was stopped as patient was treated with antibiotics. she was initially treated with vancomycin and ceftazidime for empiric coverage. her blood cultures came back negative but her urine culture came back positive for uti with pseudomonas that was sensitive to ceftaz. the vancomycin was discontinued and the ceftaz was continued which should be completed on . she had a picc line that was removed upon admission. a new picc line was placed on once patient was being treated for infection and no longer had fevers. . #tachycardia: she had episode of svt, responded to 5mg lopressor iv. the patient then continued to have low grade tachycardia. she was put on loppressor 10mg iv q4 as patient was not taking po meds. once patient able to take po meds her iv lopressor was stopped and she was given po metoprolol. . #esophageal dysmotility: patient with history of esophageal dysmotility and appeared to be aspiration risk when she arrived. however when patient's mental status improved it appeared her swallowing also improved. there was concern for upper esophageal stricture so she underwent egd which showed normal esophagus with no stricture. she also had video swallow as well as braium swallow which was consistent with esophageal dismotility. patient did not want peg tube at this time and wanted to try taking po food. she was started on a diet that was recommended by speech and swallow and her po pills were restrarted. her egd did show gastritis and patient was given ppi . . # dm: she was initially kept on insulin sliding scale, when she was able to take po meds she was restarted on her metformin. . # metastatic thyroid ca with recurrence s/p iodine and xrt: patient was followed by endocrine while in the hospital. while she was unable to take po medication she was put on levothyroxine 100mcg iv which was then switched back to levoxyl 150mcg when she was again able to take po meds. her tfts were monitored as there was concern that she would require more levothyroxine since she was started on dilantin. however now that she is being transitioned to keppra she will most likely remain on levoxyl 150mcg . - she should have her tfts monitored once weekly and if trending toward hypothyroidism her levoxyl dose should be adjusted. a tsh and free t4 should both be checked. she should be done until she is off dilantin. . # hisotry of dvt and pe: patient with ivc filter on lifelong coumadin. coumadin was held as patient's inr supratheraputic. her inr continued to trend up most likely secondary to malnutrition and being on dilantin. her inr should be checked regularly and once < 2 her coumadin should be restarted with careful monitoring while still on dilantin. . medications on admission: -ferrous sulfate 325 mg daily -amitripytiline 50 mg qhs -hctz 12.5 mg qd -ssi -synthroid 150 mcg -metformin 850 mg -lopressor 50 mg tid -ms contin 15 mg -coumadin 6 mg daily -docusate sodium 100 mg twice daily -morphine 1mg q 3hr prn -hydralazine 50 mg po q6 hr -senna 8.6 mg prn -folic acid 1 mg daily -clonidine 0.2 mg/24 hr patch weekly (thursday) discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 4. hydrochlorothiazide 25 mg tablet sig: 0.5 tablet po daily (daily). 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 6. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day): this medication is to be increased to 1000mg po bid on . 7. dilantin 100 mg capsule sig: three (3) capsule po once a day for 4 days: on wed : decrease dose to 200mg po qday . on wed : decrease dose to 100mg po qday . d/c on . 8. pantoprazole 40 mg iv q24h 9. ceftazidime-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) grams intravenous q8h (every 8 hours) for 5 days. 10. hydralazine 50 mg tablet sig: one (1) tablet po every six (6) hours. 11. insulin regular human 100 unit/ml solution sig: as directed units injection asdir (as directed): see sliding scale. 12. morphine 2 mg/ml syringe sig: 1-2 mg injection every 2 hours as needed as needed: please give for breakthrough pain. 13. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 14. amitriptyline 50 mg tablet sig: one (1) tablet po at bedtime. 15. levothyroxine 150 mcg tablet sig: one (1) tablet po bid (2 times a day): to be adjusted by endocrinologist with follow up tsh and t4 levels. 16. metformin 850 mg tablet sig: one (1) tablet po twice a day. 17. warfarin 2 mg tablet sig: three (3) tablet po daily (daily). discharge disposition: extended care facility: & rehab center - discharge diagnosis: seizure disorder altered mental status urinary tract infection esophageal dysmotility diabetes mellitus discharge condition: tolerating pos with swallowing instructions. sating well on room air. discharge instructions: please take all medications as prescribed. please attend all follow up appointments. you should contact your health care providers if you develop fever, nausea, vomitting, or if you develop altered mental status including seizures and confusion. it is important that you practice the swallowing techniques outlined by the speech and swallow therapists. followup instructions: it is recommended that you see your primary care doctor - . please call to schedule an appointment @ . . you have a neurology follow up appointment with provider: , md, phd: date/time: 1:30 . endocrine provider: , m.d. phone: date/time: 11:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: acidosis anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia unspecified protein-calorie malnutrition depressive disorder, not elsewhere classified sepsis diaphragmatic hernia without mention of obstruction or gangrene ulcer of other part of foot acute respiratory failure long-term (current) use of anticoagulants epilepsy, unspecified, without mention of intractable epilepsy personal history of venous thrombosis and embolism primary hypercoagulable state dehydration encephalopathy, unspecified lumbago tachycardia, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage pseudomonas infection in conditions classified elsewhere and of unspecified site arthrodesis status postsurgical hypothyroidism personal history of malignant neoplasm of thyroid neurogenic bladder nos dyskinesia of esophagus 

Answer: The patient is high likely exposed to