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: vomiting, hypoxia major surgical or invasive procedure: none history of present illness: ms. is an 80yo woman with h/o multiple cvas, laryngeal cancer s/p tracheostomy, with gj tube for failure to thrive and swallowing dysfunction who presents from rehab after vomiting tube feeds yesterday, today with temp to 102 and desat to 88%. per her daughter she has had chronic diarrhea with c diff alternately on and off flagyl or vanco, and has had some abdominal pain at her j tube site since it was placed. her baseline status is that she is not indepent of her adls, but can wash her face on her own and last week walked 50 feet wtih two person assist for the first time in quite a while. she requires two person assist for everything. goal of care is for pt to eventually go home, at this time the family is not thinking with hospice but rather with home nursing. . she was brought to the er where she refused a central line. ua was positive, although the patient has a chronic indwelling foley catheter. urine, blood and sputum cultures were sent and the patient was given vanco, levo, and flagyl for presumed aspiration pneumonia. cxr showed no evidence of acute cp process and ct abd/pelvis showed bowel thickening at the sigmoid-descending colon junction c/w diverticulitis versus c diff. . notably, the patient's hcp is her husband, who was recently diagnosed with melanoma and is having surgery tomorrow, so he cannot sign for her. her daughter is her second-in-line for hcp and she will sign during this stay. the patient is not aware of her husband's diagnosis, nor that he is having surgery tomorrow, as her family does not want to upset her. . past medical history: - temporal arteritis with l eye blindness - hypertension, hypercholesterolemia - polymyalgia rheumatica - laryngeal cancer s/p xrt 20y ago and open tracheostomy in - cvas - including pontine, r cerebellar x 2 - sigmoid adenoma resection in - multiple gi bleeds on anticoagulation - failure to thrive with gj tube placement in - hypothyroidism - afib - mrsa pneumonia in - appendectomy - hysterectomy for fibroids (age 25) - breast lump excision - r knee arthroscopy social history: she currently lives at health care center. she is married and has two children both of whom are involved in her care. 35 pack year smoker, quit 20 years ago. goal of care is for pt to return to home to be with her husband, who was recently diagnosed with melanoma. per outpt note, plan is to meet with representatives from hospice to discuss home hospice care. husband is hcp(). her daughter, (work , cell , home ) will be her hcp if anything happens to her husband. extensive notes, pt wishes to be dnr/dni as of long discussion with pcp last month. . family history: father died of lung ca, sister and brother died of mi. other brother had a stroke in his 80s, now 84. . physical exam: 96.9, 104/51, 74, 92% on 12l trach mask, 20 gen: nad, somnolent, difficult to arouse, denies pain heent: no sinus tenderness, ncat cor: decreased heart sounds, s1s2, rrr, no murmur pulm: ctab anteriorly, transmitted tracheal sounds abd: soft, tympanic, distended, decreased bs, nt ext: no c/c/e, venous stasis changes bilat, pt pulses palpable bilat neuro: pt somnolent and not cooperative with exam . pertinent results: wbc 28.5 with 92.9% neutrophils, cr 0.6, hct 34.4. others see below. ua positive nitrites, sm leuks, 21-50 wbcs, mod bacteria. . blood culture, urine culture and sputum culture pending . studies: cxr: no evidence of pneumonia, aspiration or chf . ct abdomen/pelvis: colonic thickening of sigmoid-descending colon junction possibly consistent with diverticulitis versus colitis. brief hospital course: the pt is an 80 yo woman with a history of several strokes, dysphagia s/p gj tube placement, laryngeal cancer s/p tracheostomy who presented from rehab after vomiting tube feeds, temperature as high as 102 and desaturation down to 88%. the pt was started on levofloxacin for aspiration pneumonia, in the setting of an episode of vomiting. she was maintained on an oral vancomycin dose given ct evidence of focal wall thickening at junction of sigmoid and descending colon and the pt's history of recurrent cdiff. the pt was also noted to have an ecoli uti. pt eventually also grew ecoli in her sputum. thus her antibiotic regimen was changed to bactrim. the pt is scheduled to complete a 10 day course of bactrim. the pt's stool cultures were noted to be negative for cdiff thus she can be restarted on the opium tincture on discharge. the hospital course was significant for the following events: . hypoxia: the pt was noted to have hypoxia in the setting of likely aspiration with vomiting. the pt's hypoxia gradually resolved with frequent suctioning. she was noted to have an opacification the left lower lobe which was noted to resolve on a follow-up x-ray. the pt's cxr showed no evidence of pneumonia, aspiration, or chf. the pt was noted to require frequent suctioning, especially at night and will need to be maintained on q4h suctioning to prevent desaturation. . fever: the pt was noted to have fever and an elevated white cell count in the setting of sputum and urine cultures that were positive for ecoli (resistant to levaquin bt sensitive to bactrim). it is possible that the pt may have aspirated while vomiting and that she had a concomitant uti. the pt's foley was replaced and her antibiotic regimen was changed to bactrim ds; she will need to complete a 14 day course of this antibiotic. her repeat urine culture was negative. the pt also had blood cultures drawn in the ed that will need to be followed up by the physicians at the rehab as results becaome available. . diarrhea: the pt was noted to have chronic diarrhea which, per pt's daughter, is recurrent. the pt underwent a ct abdomen which showed focal wall thickening at junction of sigmoid and descending colon. these findings were thought to be consistent with acute diverticulitis, or possibly colitis given patient's history of c. diff colitis in past. the pt had been started on oral vancomycin for (presumed) flagyl-resistant cdifficile. however, two sets of stool were negative for cdiff. the pt did complete her 10 day course of po vancomycin while in the hospital. the pt was started on octreotide and tinctiure of opium that were held during the hospitalization, given possible cdiff and propensity towards toxic megacolon if given antidiarrheals. . . perirectal yeast infection: the pt was noted to have a perirectal yeast infection in setting of frequent soiling seconondary to diarrhea. the pt's rash was treated with topical clotrimazole cream perirectally. a rectal tube was place to allow the perirectal area to heal, this tube should be removed once the pt's diarrhea resolves. . hypertension: the pt was maintained on her admission dose of lopressor. . history of cvas: the pt was maintained on her out-pt dose of coumadin; her goal inr is . she will need to have her inr checked daily with uptitration of her coumadin dose at the rehab. of note, the pt does have a history of gi bleeds while on anticoagulation. . hypothyroidism: the pt has a history of hypothyroidism for which she was maintaintained onher out-patient dose of synthroid. . polymyalgia rheumatica: the pt was maintained on her out-patient dose of prednisone for pmr. . fen: thept was maintained on her outpatient regimen of tube feeds. her electrolytes were repleted as needed. . prophylaxis: the pt was maintained on prophylaxis with a proton pump inhibitor, scheparin and a bowel regimen. . code status: dnr/dni confirmed by daughter, also in notes documenting extensive discussions with pcp . communication: pt and her daughter (work , cell , home ); husband (hcp, ) medications on admission: - prednisone 5 mg daily - lopressor 50 mg t.i.d. - aspirin 81 mg daily - zoloft 50 mg daily - lipitor 20 mg q.h.s. - synthroid 125 mcg daily - tylenol with codeine 30 mg p.r.n. - combivent nebs q4 p.r.n. - clotrimazole powder to groin q12 hrs - folate 1 mg daily - prevacid 30 mg daily - tincture of opium four drops t.i.d. - octreotide 100 mcg subcu t.i.d. - multivitamin liquid 5cc daily - zantac 150 daily. - water bolus per gt 230ml tid - isosource tube feeds 75cc/hr - coumadin 2mg daily - vancomycin 250 mg via gt tid x 10d (today d9) discharge medications: 1. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 2. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 8. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed. 9. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day): to groin. 10. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 11. therapeutic multivitamin liquid sig: one (1) cap po daily (daily). 12. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 13. warfarin 2 mg tablet sig: one (1) tablet po daily (daily). 14. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 15. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 11 days: 10 day course to end . 16. opium tincture 10 mg/ml tincture sig: four (4) drops po three times a day: given for diarrhea. hold for constipation. . discharge disposition: extended care facility: center - discharge diagnosis: primary: aspiration pneumonia e.coli uti recurrent c.difficile colitis secondary: - temporal arteritis with l eye blindness - hypertension, hypercholesterolemia - polymyalgia rheumatica - laryngeal cancer s/p xrt 20y ago and open tracheostomy in - cvas - including pontine, r cerebellar x 2 - sigmoid adenoma resection in - multiple gi bleeds on anticoagulation - failure to thrive with gj tube placement in - hypothyroidism - afib - mrsa pneumonia in - appendectomy - hysterectomy for fibroids (age 25) - breast lump excision - r knee arthroscopy discharge condition: stable. discharge instructions: please report to the nearest emergency room if you have fever, chills or vomiting. . there has been a change in your medications. . you will be seen by dr. for a follow-up appointment at center. you will need to ask your pcp to schedule you for an out-patient colonoscopy. . you have scheduled for an appointment with a gastroenterologist for your chronic diarrhea. followup instructions: **rehab will need to arrnage for transportation of patient to her appointments in a bls ambulance*** . primary care provider: will be seen by dr. at the center rehab. . gastroenterology: provider: . . date/time: at 2:30pm. , . office phone: . md procedure: enteral infusion of concentrated nutritional substances diagnoses: polymyalgia rheumatica pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation pneumonitis due to inhalation of food or vomitus long-term (current) use of anticoagulants pneumonia due to escherichia coli [e. coli] tracheostomy status giant cell arteritis status of other artificial opening of gastrointestinal tract personal history of malignant neoplasm of larynx 

Answer: The patient is high likely exposed to