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: morphine / codeine attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: ms. is a 77yo f with history of numerous recent hospitalizations for aspiration pneumonia events presents with hypoxia at her rehabiilitation center. per nursing home/rehab reports, she had been on a day steady decline of respiratory status and found to be hypoxic to 85% on 8l nc. she was witnessed to choke on food while at rehab and became hypoxic. she has a history of poor glossopharyngeal coordination. . in the ed, initial vs were 99.4, 130, 135/86, 26, 91%, 12l non-rebreather. she received vancomycin, levaquin, flaygl for pneumonia coverage and lorazepam for anxiety. cxr showed bilateral infiltrates. patient was admitted to medicine for further workup. vitals prior to transfer 98.0 aux (100 rectal), 93sr, 108/52, 23, 95 6l. . on the floor, she reported difficultly breathing and believes she choked on some food but is not sure. she has a productive cough. she denies current sob, chest pain, fevers or chills. as per records, she had recently been on levaquin since . she has also received increasing doses of benzodiazepines for last week. pt is rn, who notes that she does still eat, however does get supplementation with tf. on ros, also notes recent 30 lb weight loss and loss of appetite. . ros: denies fever, chills, rhinorrhea, congestion, sore throat, current shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, dysuria, hematuria. past medical history: torticollis (s/p botox injections) h/o numerous aspiration events s/p g-tube placement tremor stress-induced cm hl osteoporosis vertebral fracture s/p vertebroplasty vitamin b12 deficiency hypothyroidism s/p surgery (grave's in ) - had thyroidectomy panic attacks mvp ibs social history: lives at nh, 70py smoking history but no longer smokes, occassional alcohol use, denies illicits. former nurse, has 3 children in the area very involved in her care. family history: brother died at 54 from mi, 2 others healthy. no major illnesses in parents. physical exam: admission physical exam vs: 98/55, 88, 95% 6l nc general: thin, elderly, female with tremor in nad. heent: nc/at, perrla, eomi, sclerae anicteric, mm slightly dry, op clear. neck: supple, no thyromegaly, no jvd. heart: rrr, unable to appreciate m/r/g over breath sounds, nl s1-s2. lungs: bilateral coarse breath sounds with rhonchi. abdomen: soft/nt/nd, g-tube in place without erythema, no masses or hsm, no rebound/guarding. extremities: wwp, no c/c/e, 2+ peripheral pulses. skin: no rashes or lesions. lymph: no cervical lad. neuro: awake, a&ox2 (knew year and month, not date), cns ii-xii grossly intact, bilateral hand tremor discharge physical exam vs: 97 139-146/70s, 99-110, 20, 95% 5l nc general: thin, elderly, female with tremor in nad. heent: nc/at, perrla, eomi, sclerae anicteric, mmm, op clear. neck: supple, no thyromegaly, no jvd. heart: rrr, no m/r/g over breath sounds, nl s1-s2. lungs: bilateral but r> l crackles, rhonchi much improved from admission abdomen: soft/nt/nd, g-tube in place without erythema, no masses or hsm, no rebound/guarding. extremities: wwp, 2+ peripheral pulses, no edema neuro: awake, ao&x3, cns ii-xii grossly intact, head and bilateral hand tremor unchanged from admission pertinent results: admission labs 05:57pm blood wbc-10.4 rbc-3.73* hgb-12.2 hct-36.6 mcv-98 mch-32.9* mchc-33.5 rdw-16.1* plt ct-290 05:57pm blood neuts-80.4* lymphs-15.8* monos-2.7 eos-0.9 baso-0.3 05:57pm blood pt-14.0* ptt-26.9 inr(pt)-1.2* 05:57pm blood glucose-103* urean-27* creat-0.6 na-136 k-4.8 cl-94* hco3-34* angap-13 07:05am blood calcium-9.1 phos-3.0 mg-1.8 iron-pnd discharge labs: 06:40am blood wbc-6.9 rbc-2.91* hgb-9.7* hct-29.8* mcv-103* mch-33.3* mchc-32.5 rdw-16.0* plt ct-417 04:10am blood pt-14.4* ptt-24.3 inr(pt)-1.2* 06:40am blood glucose-92 urean-14 creat-0.4 na-142 k-4.6 cl-100 hco3-37* angap-10 06:35am blood calcium-9.2 phos-2.7 mg-2.0 cardiac enzymes: 07:30am blood ck(cpk)-12* 05:18pm blood ck(cpk)-10* 04:10am blood ck(cpk)-11* 05:17am blood calcium-9.1 phos-2.7 mg-2.1 05:17pm blood calcium-9.1 phos-2.6* mg-2.0 iron studies: 07:05am blood caltibc-152* vitb12-385 folate-greater th ferritn-791* trf-117* thyroid studies: 07:05am blood tsh-8.3* 07:05am blood free t4-1.0 pending neurologic studies at discharge: 02:30pm blood gq1b igg antibodies-pnd 02:30pm blood acetylcholine receptor antibody-test 02:30pm blood ganglioside ab panel, serum (gm1, asailo-gm-1 and gd1b)-pnd cxr impression: hazy opacities in both lungs, which could represent pulmonary edema, but a superimposed infectious process is not excluded, particularly given the more focal opacities within the right upper lobe and left lung base. moderate-sized right pleural effusion. given the limited nature of the study, consider a followup pa and lateral view when the patient is more cooperative. cta : impression: 1. no pulmonary embolism. 2. confluent consolidation predominantly within the lung bases, right greater than left. in the right middle lobe and posterior segment of the right upper lobe . findings are consistent with aspiration pneumonia and large atelectasis as described above. 3. healed right anterior third rib fracture and sclerotic left eighth and ninth ribs, likely secondary to prior trauma. cxr : findings: again seen is opacity obscuring the right hemidiaphragm and right heart border consistent with the known right lower lobe and middle lobe consolidation. patchy areas of increased opacity in the right upper lung and left lower lung as well that are similar in appearance compared to prior. ct head noncontrast : impression: no acute intracranial process. cxr : the right picc line tip is at the cavoatrial junction. there is slightly improved atelectasis of the right lower lobe, but there is still present pulmonary edema, asymmetric, right more than left associated with bilateral pleural effusions and with bibasilar atelectasis. old fractures of the left humerus as well as vertebroplasty and percutaneous gastrostomy are demonstrated. brief hospital course: primary reason for hospitalization: ms. is a 77yo f with history of numerous recent hospitalizations for aspiration events who presented with hypoxia at rehab, found to have pneumonia. active diagnoses: # pneumonia: likely due to aspiration event. cxr shows bilateral infiltrates and diffuse rhonchi on exam. given her recent residence in a nursing home, treat for hcap and aspiration with vanc/cefepime/metronidazole. patient initially maintained oxygen saturation around low 90s on 5-6l, but on hd3 triggered for hypoxia to low 80s unresolved with nebulizers. she was given oxygen by non-rebreather, diuresed and given chest physical therapy, and sent to the icu. in the icu, she was given high flow oxygen and her antibiotics were continued. she was transferred back to the floor, where she has maintained o2 sats in the mid-90s on 5l. pulmonary exam was much improved by discharge, but still showed r>l crackles/rhonchi 2/3 up both lung fields. she will need to complete 6 more days of vancomycin, cefepime and flagyl after discharge. # dysphagia. patient has decreased oropharyneal muscle tone and trouble swallowing, causing her to aspirate. she has a g-tube in place, which provides nutrition in the absence of swallowing, but does not prevent aspiration. on a previous admission, she failed speech and swallow study. neurology team was consulted to see if there is an underlying cause for her dysphagea. motor neuron disease was ruled out by emg. was ruled out by emg and antibody tests. mri cspine could not be obtained as patient is unable to tolerate lying flat due to aspiration risk. family meeting was held to discuss the irreversibility of dysphagea, and patient is allowed to take small sips for comfort. discussed with patient and family unless they are willing to accept the aspiration risk she will need to remain npo. # tachycardia: pt still frequently tachycardic with hr 105-110. she reports feeling anxious, and benzodiazepines have consistently decreased her hr, but make her more somnolent, and hence more hypoxic. she has responded well to ativan 0.25mg. # depression/anxiety: she was written for ativan when she felt acutely anxious. during her admission, the medical team tried to balance benzos for anxiety with alertness for respiratory status. when anxious, she was given ativan po 0.25mg, but no standing or prn orders were placed so the physician was always aware when she received the medication. we continued remeron and paroxetine for depression. # stage ii pressure ulcer: wound care provided dressing changes and care. chronic diagnoses: # anemia: iron studies show anemia of chronic disease, stable since baseline. # hypothyroidism: she was continue on her home levothyroxine. transitional issues: #she should continue vanc, cefepime, flagyl for pneumonia for 6 more days. #she should not receive the standing orders of valium and ativan she was taking when she was admitted, as these make her somnolent and compromise her respiratory status. # code: dnr/dni (confirmed with patient, daughter and sons) # contact: , , , -, , medications on admission: duonebs qid valium 2.5-5mg po tid ativan 0.25 mg po q8h prn anxiety/sleep levaquin 500mg daily (start ) cefazolin 1 g iv q8h x 3 days acidopholus synthyroid 100mcg daily colace 100mg simvastatin 40mg daily paroxetine 20mg daily remeron 7.5mg daily lasix 40mg daily lisinopril 2.5mg daily aspirin 325 mg po daily oscal 500 with vitamin d 1 tab pobid flexeril 5 mg po daily dalteparin sq jevity tf discharge medications: 1. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 2. acidophilus capsule sig: one (1) capsule po twice a day. 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. paroxetine hcl 10 mg/5 ml suspension sig: two (2) po daily (daily). 6. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 7. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 8. aspirin 325 mg tablet sig: one (1) tablet po once a day. 9. os-cal 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po once a day. 10. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for pain/fever. 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 12. oxycodone 5 mg/5 ml solution sig: one (1) po q3h (every 3 hours) as needed for dyspnea, pain. 13. cefepime 2 gram recon soln sig: one (1) recon soln injection q12h (every 12 hours). 14. metronidazole (flagyl) 500 mg iv q8h 15. vancomycin 750 mg iv q 12h discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: primary healthcare associated pneumonia secondary diagnoses dysphagea aspiration pneumonitis/pneumonia anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: dear mrs. , it was a pleasure taking care of you during your hospitalization. you were admitted to with shortness of breath and found to have pneumonia. you were started on antibiotics for your pneumonia and given nebulizer treatments and oxygen to help your breathing. we realized that the cause of your pneumonias is aspiration because of your trouble swallowing (dysphagea). our neurology team came by and evaluated you and feel that there is no underlying neurologic cause of your dysphagia and no treatment options. please make the following changes to your medications: - please continue to take your antibiotics (cefepime, flagyl, vancomycin) as indicated below until your are re-evaluated by a physician for improvement in your pneumonia - please discontinue the previous antibiotics (levoquin, cefazolin) that you were taking before admission. - please discontinue taking standing doses of valium and ativan, and only take small doses (0.25mg iv ativan works well) when extremely anxious, as taking too many sedatives makes you sleepy and your breathing more difficult. followup instructions: you will be discharged to a rehabilitation center. please follow-up with your outpatient primary care provider after discharge from the rehabilitation center. procedure: enteral infusion of concentrated nutritional substances electromyography diagnoses: pneumonia, organism unspecified anemia of other chronic disease other pulmonary insufficiency, not elsewhere classified dysthymic disorder other and unspecified hyperlipidemia other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified pressure ulcer, lower back do not resuscitate status metabolic encephalopathy gastrostomy status pressure ulcer, stage ii nutritional marasmus postsurgical hypothyroidism anisocoria history of fall essential and other specified forms of tremor personal history of traumatic fracture other dysphagia torticollis, unspecified smooth muscle relaxants causing adverse effects in therapeutic use other acquired torsion dystonia 

Answer: The patient is high likely exposed to