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: hypotension, fever, respiratory distress major surgical or invasive procedure: intubation with mechanical ventilation right ij central venous line placement foley catheter insertion history of present illness: ms. is a 59 year-old female with htn, type 2 dm on insulin, seizure disorder on dilantin, multiple sclerosis who is nonverbal at baseline who presents from nursing home with acute respiratory distress. she was reported to be "agonally breathing" at her nursing home with o2sat 91% on 2l; p 154-170, sbp 100/60, rr 30. unable to obtain a temperature . she was taken emergently to the ed. . in the ed, initial vs were: rectal temp 104, p 145-150, sbp 120-140, rr 20s, o2sat 99% breathing on her own with 100% bag mask on. pt was documented to be dnr without comment on dni status. the ed was unable to contact her family members on multiple attempts, so she was emergently intubated. labs notable for wbc 19.3 (92.1% n, 0% bands); na 150, bicarb 13, anion gap 13 with lactate 3, glucose 561, and cr 1.6 (baseline unknown). u/a showed 43 wbc and many bacteria, leuks large, nitrite negative; no ketones. her abdomen was distended, and she had 2l drained with foley placement. cxr with question of rul infiltrate vs. scarring. sbps declined to 90s, and patient was given 2liters of ns ivf. she was started on zosyn and ordered for vancomycin. she was given tylenol for her fever. initial access was intraosseous, but a right ij cvl was subsequently placed. of note, after line placement, patient was felt to have seizure-like movements of her eyes and given ativan 2mg iv with resolution. on transfer, vs were: p 120s, bp 92/66, vent set to rr 12 but overbreathing vent, o2sat 100% with abg 7.35/24/290/14 on ac. . on the floor, she is intubated, not opening eyes or responding to any commands. past medical history: multiple sclerosis, nonverbal at baseline seizure disorder type 2 diabetes mellitus on insulin dementia htn gerd dry eyes h/o paronoia, delusional ?h/o cva social history: resides in nursing home, reportedly in a persistant vegetative state. she is dnr. hcp is father, (), who is currently in rehab. her brother () is the secondary hcp in the interim. family history: unknown. physical exam: admission physical exam: general: intubated, non-responsive, not following any commands heent: sclera anicteric, dry mm neck: supple, jvp not elevated, r ij line lungs: no use access mm, coarse rhonchorous breath sounds anteriorly, no wheezes cv: rrr, difficult to appreciate heart sounds over coarse bs, but no appreciable murmurs abdomen: +bs, distended, non-tender, tympanic to percussion, no rebound tenderness or guarding, no organomegaly. peg tube present. gu: foley ext: dry, cool at distal extremities, faint pulses, no edema, no cyanosis; left tibial io line neuro: non-responsive, r eye deviated to right, pupils ~1mm, mimimally reactive, not moving any extremities, lower extremities with muscle wasting, no clonus, unable to elicit dtr's, does not withdrawal to pain discharge physical exam: t 97.9, p 78, bp 97/58, rr 20, o2sat 100% on 40% face tent general: extubated, non-responsive, not following any commands heent: sclera anicteric, dry mm neck: supple, jvp not elevated, r ij line lungs: basilar crackles cv: rrr, difficult to appreciate heart sounds over coarse bs, but no appreciable murmurs abdomen: +bs, distended, non-tender, tympanic to percussion, no rebound tenderness or guarding, no organomegaly. peg tube present. gu: foley ext: dry, cool at distal extremities, faint pulses, no edema, no cyanosis neuro: opens eyes to loud stimulus, perrl, ?tracking subjects, not moving any extremities, lower extremities with muscle wasting, no clonus, hyperreflexic, does not withdrawal to pain access: right ij central venous line pertinent results: 01:00am blood wbc-19.3* rbc-3.95* hgb-12.6 hct-37.9 mcv-96 mch-31.9 mchc-33.2 rdw-14.6 plt ct-516* 01:00am blood neuts-92.1* lymphs-4.2* monos-2.4 eos-0.5 baso-0.8 01:00am blood glucose-561* urean-95* creat-1.6* na-150* k-4.0 cl-124* hco3-13* angap-17 calcium-8.0* phos-3.5 mg-1.9 04:26am blood alt-51* ast-47* ld(ldh)-283* alkphos-98 totbili-0.6 04:26am blood osmolal-367* 04:26am blood05/01/11 01:08am blood lactate-3.0* 04:26am blood phenyto-7.8* 02:41am blood wbc-10.9 rbc-2.84* hgb-8.9* hct-26.5* mcv-94 mch-31.5 mchc-33.7 rdw-14.0 plt ct-226 02:41am blood pt-12.3 ptt-29.9 inr(pt)-1.0 02:41am blood glucose-186* urean-22* creat-0.5 na-140 k-4.1 cl-115* hco3-16* angap-13 02:41am blood alt-32 ast-22 alkphos-76 totbili-0.3 02:41am blood albumin-2.4* calcium-7.8* phos-2.0* mg-2.1 10:41pm blood osmolal-298 02:48am blood lactate-1.9 02:41am blood phenyto-11.3 1:28 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive rod(s). consistent with corynebacterium or propionibacterium species. respiratory culture (final ): moderate growth commensal respiratory flora. gram negative rod(s). rare growth. c. diff toxin a & b: neg. ecg: sinus tach, rate 142, left axis deviation, no st changes cxr: scattered subsegmental atelectasis, without acute cardiopulmonary process. the endotracheal tube should be withdrawn for optimal positioning. rij line extends into the right atrium. cxr: since extubation, there is little interval change, right lower lobe atelectasis is stable. the right internal jugular central venous catheter tip is projected over the expected location of the lower svc. the nasogastric tube has been removed. linear densities in the retrocardiac space at the left lower lobe are consistent with atelectasis, unchanged since . the cardiac size is normal. pulmonary venous congestion is stable. impression: bilateral subsegmental atelectasis, stable since . **pending results: - blood cultures: pending, no growth to date. - urine culture: preliminarily growing >100,000 enterococcus; sensitivities pending *** - urine culture: pending. brief hospital course: pt is a 59 year-old female with iddm, seizure disorder, and multiple sclerosis transferred from nursing home for acute respiratory distress and found to be in septic shock. # septic shock: patient borderline hypotensive with fever to 104, tachycardia, tachypnea, and leukocytosis. right ij cvl placed for cvp monitoring as well as for iv antibiotics. she responded to volume resuscitation and did not require pressors. infectious source likely uti based on ucx from now growing enterococcus, sensitivities pending. plan to complete a 14-day course of vancomycin and zosyn for urosepsis - to be continued until ; may be able to narrow down antibiotics based on sensitivities. blood cultures are also pending at time of discharge but negative to date. her sbps have ranged from 85 to 105 with patient requiring and responding to occasional 500cc lr ivf boluses; urine output maintained throughout. . # urinary retention: foley placed with urine output of 2l on presentation. likely related to uti. have component from ms as well although per nursing home, had not required consistent straight cathing. foley in place at time of discharge. rehab physician to change out foley in setting of uti. also recommend removing foley for voiding trial as soon as able and routine straight cathing as indicated, especially given multiple recent utis. . # seizure disorder: question of observed seizure in ed. pt was treated with one dose of ativan in ed. most likely due to lowered seizure threshold in setting of sepsis, fevers. possible also that significant leukocytosis due to seizure. pt having no movements on arrival to floors and did not have any during icu course. given phenytoin bolus and increased phenytoin regimen to 50 mg qam, 75 mg qpm, and 100 mg qhs) with therapeutic level on discharge. outpatient keppra dosing maintained. she was maintained on seizure precautions. . # hypoxic respiratory failure: pt was tachypneic with reported o2sat 89-91% on 2l at osh, but question of poor pleth in setting of peripheral vasoconstriction. she was intubated for airway protection here. abg not done until after intubated, which demonstrated pao2 290. cxr without clear pneumonia, and patient was extubated without complication. she was maintained on 40% face mask without any further oxygen desaturations. . # acute renal failure: bun 95 with cr 1.6; baseline cr appears to be 0.7. most likely pre-renal. this resolved with iv fluid resuscitation; cr 0.5 on discharge. . # metabolic acidosis: anion gap 13 and lactate 3, rising to 3.6 on presentation. glucose markedly elevated but no urinary ketones suggestive of dka in this patient with type 2 dm. the patient's metabolic acidosis and lactic acidosis improved with fluid resuscitation. . # hyperglycemia: pt with type 2 dm, on lantus 14 units qhs with gentle iss. most likely elevated infectious process as above. no e/o dka. the patient was initially started on an insulin gtt but weaned off this as better glycemic control attained. the patient was restarted on home lantus dose with regular insulin sliding scale after tube feeds restarted. . # hypernatremia: na corrected for hyperglycemia is 157. likely secondary to dehydration from infection and osmotic diuresis in setting hyperglycemia. treated with combination of ns for fluid resuscitation d5w ivf with slow correction of this over several days. she was continued on free water flushes 200 cc q4h. . # ms: lives in nursing home, and is nonverbal at baseline, reportedly for years. nursing home records note persistent vegetative state. we tried to obtain medical records from regarding prior neurologic evaluation to better ascertain her cognition (?locked-in syndrome) but did not receive any information prior to her discharge. would recommend further neurologic evaluation as outpatient if no previous work-up has been done. . # ppx: heparin sc tid started and recommended to be continued for dvt ppx. . # access: right ij central venous line placed for access. . # code status: patient confirmed to be dnr but ok to intubate and hospitalize per brother # 2). would recommend further discussion of goals of care as an outpatient. medications on admission: ranitiine 10 ml qhs dilantin infatab 50 mg 9am, 50 mg 5pm, 100 mg 9pm levetiracetam 100 mg lactulose 30 ml bisacodyl 10mg pr daily refresh eye drops os daily refresh ointment os qhs mvi 15 ml daily vitamin c 500 mg cranmax drink mix daily prosource protein liquid 30 ml glucerna 1.0 cal 240 ml 5x/day 150 cc h2o flush 5x/day guaituss 15 ml q4h prn acetaminophen 650 mg q4h prn prochlorperazine 25 mg daily prn ipratropium-albuterol 1 neb q4h prn discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. levetiracetam 100 mg/ml solution sig: five (5) ml po bid (2 times a day). 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic hs (at bedtime): in left eye. 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic every four (4) hours as needed for dry eye: in both eyes. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po bid. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. phenytoin 50 mg tablet, chewable sig: as directed tablet, chewable po three times a day: one tablet in am, one and one-half tablet in pm, two tablets at bedtime. 11. insulin glargine 100 unit/ml solution sig: fourteen (14) units subcutaneous at bedtime. 12. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: 4.5 gram intravenous q8h (every 8 hours): to be continued until . 13. vancomycin 500 mg recon soln sig: seven y (750) mg recon soln intravenous q 12h (every 12 hours): to be continued until . 14. ranitidine hcl 15 mg/ml suspension for reconstitution sig: ten (10) ml po at bedtime. 15. bisacodyl 10 mg suppository sig: one (1) supp rectal once a day. 16. multi-vitamin w/minerals capsule sig: one (1) capsule po once a day. 17. vitamin c 500 mg tablet sig: one (1) tablet po twice a day. 18. -max 500 mg capsule sig: one (1) capsule po once a day. 19. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation every four (4) hours as needed for shortness of breath or wheezing. 20. prochlorperazine 25 mg suppository sig: one (1) supp rectal once a day as needed for nausea. 21. guiatuss 100 mg/5 ml liquid sig: fifteen (15) ml po every four (4) hours as needed for cough. 22. guiatuss 100 mg/5 ml liquid sig: fifteen (15) ml po every four (4) hours as needed for cough. 23. regular insulin sig: as directed subcutaneous every six (6) hours: per sliding scale. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: septic shock urinary tract infection secondary: acute kidney injury multiple sclerosis seizure disorder discharge condition: level of consciousness: lethargic and not arousable. activity status: bedbound. discharge instructions: you were admitted to the hospital with fevers and low blood pressure indicating a severe infection. this infection was likely a urinary tract infection. you are currently being treated with broad spectrum antibiotics. we are waiting for the bacteria to grow so we know which antibiotic will be best for you. it is likely that your urinary tract infection was a result of urinary retention. we are discharging you with a foley catheter and would like for you to be assessed for urinary retention in the future. medication changes: started vancomycin and zosyn for total 14 days (until ) increased dilantin to 50 mg in am / *75 mg in pm* / 100 mg at bedtime started subcutaneous heparin injections for dvt prophylaxis. followup instructions: with rehab physician md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: acidosis esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis acute respiratory failure long-term (current) use of insulin long-term (current) use of other medications septic shock epilepsy, unspecified, without mention of intractable epilepsy multiple sclerosis hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to