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: amlodipine attending: chief complaint: dyspnea major surgical or invasive procedure: endoscopy colonoscopy mechanical ventillation history of present illness: 88 yo f with afib on coumadin, htn, pvd, h/o tia and colon ca, p/w 10 days cough, rhinorrhea, dyspnea and malaise. she was in her usual state of health until approx 10 days prior to admission when she noted onset of rhinorrhea, mild non-productive cough, and wheeze. she lost her appetite. of note, this was in the context of a known sick contact with an infant with viral symptoms. cough and wheeze were progressive until thursday night/friday morning prior to admission, when she became more dyspneic. she called pcp who prescribed albuterol nebs and chloracetin per son (? coracidin), which she took through the weekend with no notable improvement in respiratory status. also on thursday night/friday morning, she noted onset of diarrhea that persisted to admission. she did not note any brbpr, hematochezia, or melena until presentation in ed when she noted melena with some bright red blood. she notes that she had fevers to 101 at home, nausea, no vomiting. cough was non-productive and non-bloody. she presented to the hospital on the morning of admission for worsening respiratory status, dyspnea, and some visual hallucinations per her son on the night prior to admission. in the ed, initial vitals were: 97.8 81 153/50 rr30s 02: 95% on ra. initial abg was 7.48/36/79/28. she received 3 neb treatments (albuterol and ipratropium) without improvement. on nc, went down to 88%, but returned to 95% on nrb. she received 1 gm ctx for elevated wbc 18.5 and ct concerning for bilateral multifocal pneumonia. she received 2 units ffp and 10 mg iv vit k for inr 12.5. she received 40 mg iv pantoprazole for concern for gi bleed. gi was consulted and postponed gastric lavage as inr>8. on review of systems, pt denies cp, dysuria or other uti sxs. no neuro deficits. she reports nausea, no vomiting. of note, pt admitted for similar presentation in , also in context of contact with infant with viral symptoms, thought not to be pna at that time. past medical history: atrial fibrillation peripheral vascular disease carotid stenosis dyslipidemia h/o stroke () impaired glucose tolerance hypertension colon cancer s/p colectomy and chemo vestibular neuritis back pain colon cancer depression pulmonary nodule basal cell carcinoma macular degeneration osteopenia past surgical history: 1. status post colectomy for colon cancer - 2. status post hysterectomy at age 48 for fibroids 3. status post appendectomy at age 48 4. status post removal the upper lobe of the left lung in for an unidentified lung nodule 5. status post splenectomy - social history: the patient is widowed. she lives with her son, , in a single family home in . there are stairs to get to the cellar, but the patient does not utilize these. she does navigate the three stairs to enter the home. the patient has a total of three children and they all live in the area. she does not utilize an assistive device. the patient quit smoking in approximately and had smoked approx 1pack/day for 30years prior to quitting. no alcohol. family history: the patient reports that her father was an alcoholic and died of complications of this. her mother suffered from macular degeneration. the patient's brother had lung cancer. physical exam: physical exam on admission: vitals: t: 37.7 bp: 137/64 p: 98 r: 16 o2: 96% on 5l nc general: alert, oriented, no acute distress, audibly wheezing heent: sclera anicteric, mm dry, oropharynx clear, conjunctiva pink neck: supple, jvp not elevated, no lad, carotid pulses 2+ bilaterally, using accessory muscles to breathe. lungs: expiratory wheezes throughout, no rales or ronchi. cv: irregularly irregular rhythm, normal rate, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. midline laparotomy scar noted gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 09:20am blood wbc-18.5*# rbc-3.92* hgb-12.4 hct-35.8* mcv-91# mch-31.7 mchc-34.8 rdw-14.4 plt ct-342 04:25am blood wbc-20.3* rbc-2.97* hgb-9.7* hct-28.2* mcv-95 mch-32.5* mchc-34.2 rdw-14.4 plt ct-385 09:20am blood neuts-89.5* lymphs-6.1* monos-3.7 eos-0.4 baso-0.3 09:20am blood pt-87.9* ptt-53.7* inr(pt)-10.7* 10:30am blood pt-100.3* ptt-46.2* inr(pt)-12.5* 06:11pm blood pt-20.0* ptt-35.1* inr(pt)-1.8* 03:42am blood pt-14.7* ptt-22.8 inr(pt)-1.3* 04:25am blood glucose-117* urean-13 creat-0.5 na-140 k-4.0 cl-102 hco3-26 angap-16 09:20am blood glucose-164* urean-25* creat-0.8 na-132* k-3.7 cl-94* hco3-27 angap-15 09:20am blood alt-16 ast-33 alkphos-94 totbili-1.6* 04:14am blood alt-10 ast-18 ld(ldh)-247 alkphos-64 totbili-0.6 09:20am blood lipase-24 10:30am blood ck-mb-notdone probnp-1758* 10:30am blood ctropnt-<0.01 03:28pm blood type-art po2-79* pco2-36 ph-7.48* caltco2-28 base xs-3 03:37am blood type-art temp-36.7 rates-/9 tidal v-550 peep-10 fio2-40 po2-105 pco2-35 ph-7.46* caltco2-26 base xs-1 intubat-intubated vent-spontaneou 10:47am blood lactate-1.9 12:45pm blood lactate-2.2* 11:25pm blood lactate-1.2 microbiology: blood cx negative dfa for influenza negative urine cx negative urine legionella negative blood cx pending sputum cx negative 10/7,8, afb stain negative urine cx negative . studies: ct head - no acute intracranial process. no hemorrhage. cxr - stable prominence of the right pulmonary hilum dating back to . chest (portable ap) study date of 5:44 pm since the patient developed severe multifocal pulmonary consolidation beginning in the left posterior lung on the cta. there is probably a contribution of mild pulmonary edema, but presumption should be multifocal pneumonia due to aspiration is responsible for most of the abnormality. small bilateral pleural effusions are new. moderate cardiomegaly with particular enlargement of the main pulmonary arteries is chronic. et tube in standard placement. nasogastric tube ends in the stomach. no pneumothorax. chest (portable ap) study date of 5:19 am heart is mildly enlarged. aorta is tortuous and calcified. endotracheal tube has been removed. nasogastric tube has also been removed. there is mild congestive failure superimposed on underlying interstitial disease. little change since prior study. cta chest 1. multifocal ill-defined areas of consolidation within the lungs, most compatible with multifocal pneumonia. post-treatment followup ct is advised to assess resolution. 2. multiple prominent mediastinal and hilar nodes which may be reactive. followup ct post-treatment is advised in this patient with history of colon malignancy and left lower lobe resection. 3. cardiomegaly with biatrial enlargement and evidence of mitral annular calcification, coronary artery disease. egd. . small hiatal hernia erythema in the antrum compatible with gastritis (biopsy) otherwise normal egd to third part of the duodenum colonscopy. . diverticulosis of the sigmoid colon normal appearing side to end ileo-colonic anastomosis of the ascending colon otherwise normal colonoscopy to ileo-colonic anastomosis gi tissue biopsy pending ecg study date of 8:18:30 pm atrial fibrillation. findings are as outlined on previous tracing of same date and are without significant change. labs at discharge: 06:25am blood glucose-93 urean-17 creat-0.7 na-141 k-3.5 cl-104 hco3-29 angap-12 06:25am blood calcium-8.1* phos-3.1 mg-2.2 06:25am blood wbc-17.6* rbc-3.31* hgb-10.5* hct-33.1* mcv-100* mch-31.7 mchc-31.8 rdw-14.4 plt ct-430 brief hospital course: 88 yo woman with a history of atrial fibrillation on coumadin, hypertension, peripheral vascular disease, history of tia and colon ca was admitted with gi bleeding and hypoxic respiratory failure. 1. hypoxic respiratory failure. on presentation, the patient was audibly wheezing with significantly increased work of breathing. patient's respiratory distress thought to be secondary to a viral infection with subsequent exacerbation of her underlying copd. she did not have a diagnosis of copd in the past but has a remote smoking history and likely has copd. the patient did have a remote history of tuberculosis from over 40 years ago, after which she had a left upper lobectomy. she was ruled out for reactivation of her tuberculosis with three negative afb stains of her sputum. sputum culture did not grow anything. her influenza swabs and legionella urinary antigen were negative. though she was thought to have a viral pneumonia, she was started on ceftriaxone and azithromycin for empiric coverage of community acquired pneuonia due to her worsening respiratory distress; she also received standing nebulizers and an intravenous rapid steroid taper for treatment of underlying reactive airway disease. on , the patient was intubated for increasing delirium and altered mental status in the setting of worsening hypoxemia. after some diuresis, she was extubated successfully on . she was transferred to the floor alert, pleasant, and fully oriented on 4l nasal canula on . she was rapidly weaned to room air on the medical floor. patient continued to improve on the floor and was discharged on with a clear lung exam. she was oxygenating well on room air, but did demonstrate deconditioning requiring support to walk. 2. gi bleed: the patient did have melena in the ed but did not have further melanotic stools upon admission to the icu; her hematocrit had dropped from 35.8 to 29.4, also in the setting of iv fluids. the patient received vitamin k for an inr >12 on presentation; by the next day, her inr had dropped to 1.6. she may have been vitamin k deficient in the setting of poor po intake for several days prior to admission. the patient does have a remote history of colon cancer, but the melenotic stools suggest an upper gi bleed. she may have some gastritis or peptic ulcer disease. after discussion with the gastroenterology team and the patient's son, egd and colonoscopy were performed which revealed gastritis and diverticula. no active lesions were found. a intestinal biopsy is pending. 3. atrial fibrillation once her blood pressures were stable and there was no concern for further gi bleed, the patient was started on short-acting metoprolol, which was effective in controlling her ventricular rates. her coumadin was held due to possible upper endoscopy as an inpatient. patient's coumadin was held at discharge with instructions to restart on , 7 days after the egd and colonoscopy plus biopsy. patient has close follow-up. 4. hypertension: her home medications of metoprolol succinate, hctz, and amlodipine were initially held in the setting of tenuous blood pressures. metoprolol and amlodipine were added back, albeit with amlodpipine at half her home dose. patient was discharged on her normal dose of metoprolol xl and amlodipine, but her hctz was held given adequate blood pressure control on a lower regimen without it. patient will follow up with pcp in one week to consider readjustment. medications on admission: acetaminophen-codeine - 300 mg-30 mg tablet - 1 tab qhs prn amlodipine - 10 mg tablet daily atorvastatin - 20 mg tablet daily hydrochlorothiazide - 25 mg tablet daily metoprolol succinate - 100 mg daily warfarin - 2 mg tablet - --- tablet(s) by mouth daily -- take as directed by clinic based on inr. discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. discharge disposition: home discharge diagnosis: primary diagnoses: -respiratory failure secondary to pneumonia -gastrointestinal bleeding secondary diagnoses: -atrial fibrillation -dyslipidemia -impaired glucose tolerance -hypertension discharge condition: good. she is not requiring supplemental oxygen and her hematocrit is stable. she has an unsteady gait but has declined home pt. discharge instructions: you were admitted for shortness of breath and gastrointestinal bleeding. you were mechincally ventillated and treated for a pneumonia. your respiratory status improved and you were breathing comfortable on room air at the time of discharge. additionally, you were noted to have gastrointestinal bleeding and an elevated inr (your blood was too thin). an endoscopy showed mild inflammation in the stomach and a colonoscopy showed only diverticulosis without any active bleeding. biopsy results are pending, but no active bleeding source was visualized. please resume all medications as you were previously taking with the following exceptions: *please stop taking coumadin for one week. you may resume coumadin on wednesay, at your prior dose. you should continue to have your blood drawn to evaluated for proper dosing thereafter. we have notified the coumadin clinic of this change. -stop taking hydrochlorothiazide until you follow-up with dr. . continue all other medications as previously prescribed. because you were unsteady on your feet, the physical therapists recommended that you get home physical therapy or outpatient physical therapy for gait and stability training, but you declined this. please call your primary care doctor or come to the emergency department if you develop difficulty breathing, chest pain, fevers, chills, lightheadness, or any other concerning symptoms. followup instructions: please follow up in clinic with dr. on monday at 9am. his office is located in the on the . ph. . please follow up with your primary care physician . . you have an appointment on monday at 10am. the appointment is at: division of gerontology department of medicine , medical office building #1b , please have your coumadin monitored frequently starting 3 days after you restart your coumadin medication on at the . dr. has been made aware of this. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: pneumonia, organism unspecified acidosis abnormal coagulation profile congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation peripheral vascular disease, unspecified hypopotassemia other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits anticoagulants causing adverse effects in therapeutic use hemorrhage of gastrointestinal tract, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage diverticulosis of colon (without mention of hemorrhage) benign essential hypertension 

Answer: The patient is high likely exposed to