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: levofloxacin / ciprofloxacin / codeine / erythromycin base / penicillins / sulfa drugs / tetracycline / theophylline attending: chief complaint: shortness of breath, myasthenic crisis major surgical or invasive procedure: r internal jugular line placement chest tube placement plasmapheresis history of present illness: the patient is an 87 year old woman with a recent diagnosis of myasthenia , cad s/p mi and stenting, htn, hl, and pulmonary embolism on warfarin presenting with two days of progressive weakness, bulbar symptoms, and respiratory distress. this limited history was provided by the patient just prior to intubation. she was diagnosed with myasthenia in and was started on prednisone and pyridostigmine, although she does not recall the doses. she reportedly had a dose change recently (possibly an increase). one day prior to admission, the patient felt it was very difficult to get out of bed. she does recall also finding it difficult to swallow and difficult to clear her throat of the mucus that was accumulating there. she noticed her voice was becoming more muffled. her breathing became progressively more difficult and was especially bad today, prompting her hospitalization at hospital. there, her nif was noted to be -18, and a transfer to was requested. her nif was -20 at arrival to . besides these aforementioned symptoms, she has also had some diplopia but it has not been as apparent in the past two days. she denies any recent fevers, chills, rigors, cold symptoms, nausea, diarrhea, chest pain, headache, or other infectious symptoms. she reports adherence to her medication regimen but does not recall all of the doses. she lives alone. the review of systems is pertinent for the findings above but was otherwise limited at this time. past medical history: neurologic - myasthenia (dx , likely followed by dr. , vs ) cardiovascular - cad/mi s/p stent, htn, hjl pulmonary - pulmonary embolism (on warfarin, unknown date) social history: lives alone. has at least one daughter , one son who is a project manager at . family history: non-contributory physical exam: physical examination on admission: vs t: not recorded hr: 90 bp: 150/108 rr: 17 sao2: 96% 2lnc general: seated in bed, mild respiratory distress. / head: nc/at, no conjunctival icterus, no oropharyngeal lesions / neck: supple, no nuchal rigidity / cardiovascular: rrr, no m/r/g / pulmonary: equal air entry bilaterally, shallow breaths, no crackles or wheezes, weak cough / abdomen: soft, nt, nd, +bs, no guarding / extremities: warm, no edema, palpable radial/dorsalis pedis pulses / skin: no rashes or lesions neurologic examination: - mental status - awake, alert, oriented x 3. recalls a coherent history. follows commands, midline and appendicular. language fluent with intact repetition and verbal comprehension. normal prosody. no paraphasic errors. mild dysarthria. no neglect. - cranial nerves - perrl 3->2 brisk. vf full to confrontation. eomi, no nystagmus. v1-v3 without deficits to light touch bilaterally. no facial asymmetry, but mild weakness with forced eye closure. palate elevation symmetric. ] scm/trapezius strength 5/5 bilaterally. tongue midline. - motor - normal bulk and tone. no pronation, no drift. = ] l 4- 5 4- 5 x 4- 4+ 4+ 5 5 x r 4- 5 4- 5 x 4- 4+ 4+ 5 5 x - sensory - no deficits to light touch bilaterally. - reflexes - deferred - coordination - unable to assess at the time of examination. - gait - unable to assess at the time of examination. physical exam on discharge: ************ awake, alert, oriented, speech fluent, no dysarthria, eomi without diplopia, no facial weakness/asymmetry, palate elevation and tongue protrusion midline, neck flexion 5-/5, neck extension , deltoids 5-/5, biceps , triceps 5-/5, iliopsoas 5-/5. pertinent results: admission labs: ph 7.5, pco2 31, po2 96, hco3 26, sao2 100% (intubated) wbc 98, hgb 14.8, plt 263, mcv 86, inr 1.9, ptt 48.3 na 141, k 3.8, cl 102, hco3 26, bun 16, cr 0.8, glu 115, ca 9.9, mg 1.9, phos 2.7, bnp 692, trop 0.02 ua - prot 30, otherwise negative ua : wbc >182, rbc 5, few bacteria, pos nitrite, lg leuk esterase urine culture: e. coli cxr : impression: 1. endotracheal tube tip projecting over the low trachea. 2. small left pleural effusion. 3. bibasilar atelectasis or scarring. attention to right cardiophrenic angle opacity is recommended to exclude early infiltrate. cxr : 1. interval placement of right ij catheter, with tips over distal svc. 2. new moderate-to-moderately large right lung pneumothorax with some degree of collapse. mediastinum remains midline. cxr : 1. interval development of bilateral pleural effusions, greater on the right than the left. 2. endotracheal tube approximately 2.2 cm from the carina. 3. chest tube in position within the right chest. ct torso : 1. no evidence for retroperitoneal hematoma. 2. right chest wall hematoma along the chest tube. 3. high-density right pleural effusion concerning for hemothorax. please note that the chest tube does not appear to reach that aspect of the pleural effusion. 4. et tube with its tip at the carina. the tube should be retracted about 2 cm. 5. a 4-mm nonobstructing left renal stone. 6. extensive colonic diverticulosis without evidence for diverticulitis cxr : the pigtail catheter is in place as well as the right chest tube. there is no appreciable pneumothorax demonstrated on the right and minimal pleural effusions seen, substantially improved since the prior radiograph obtained earlier in the morning. the ng tube tip is in the stomach. the et tube tip is 2 cm above the carina. left retrocardiac consolidation is demonstrated, unchanged since the prior study. there is interval improvement of vascular engorgement. cxr : 1. stable moderate right and small left pleural effusions. 2. improvement in bibasilar atelectasis. cxr : indication: pigtail clamped for pneumothorax. findings: as compared to the previous radiograph, there is no relevant change. no right-sided pneumothorax is visible. the position of the right pigtail catheter is constant. unchanged extent of bilateral pleural effusions. unchanged bilateral areas of atelectasis and signs of mild fluid overload. ct torso impression: 1. new large right retroperitoneal hematoma, as detailed and described above, with anterior displacement of the right kidney and involvement of the right psoas muscle. 2. interval removal of right sided chest tube, with right decreasing and evolving hemorrhagic pleural effusion. slight increase in size of right simple pleural effusion. 3. bilateral, right greater than left, lower lobe atelectasis, with possible right lower lobe aspiration. 4. anemia. video swallow ndication: 82-year-old woman with myasthenia crisis status post plasmapheresis. evaluate swallowing ability. comparisons: none. technique: oropharyngeal swallowing videofluoroscopy was performed in conjunction with the speech and swallow division. multiple consistencies of barium were administered. findings: after mild swallowing delay, barium passes freely through the oropharynx and esophagus without evidence of obstruction. trace penetration was seen with thin liquids, but otherwise no gross aspiration or penetration. a barium tablet passes freely into the stomach without holdup. for details, please refer to speech and swallow division note in omr. impression: trace penetration with thin liquids. ct torso - impression: 1. large right retroperitoneal hematoma, stable from the most recent examination performed today. no definite source of bleeding is identified. 2. small bilateral pleural effusions with adjacent compressive atelectasis. the right pleural effusion measures slightly higher than simple fluid in hounsfield units suggesting complexity . 3. severe stenosis at the origin of the celiac axis. 4. right chest wall soft tissue lesion measuring 2.2 x 5.4 cm. findings are new from examination. soft tissue lesion may be resolving hematoma given interval chest tube placement and removal. attention on followup is recommended. hgb 9.8 (after 2 units prbcs transfused) hgb 9.3 hgb 10.4 hgb 9.3, hct 27.4 hgb 9.9, hct 29.6 hgb 9.3, hct 27.7 brief hospital course: 83yow h/o recent dx myasthenic , cad s/p stent, recent pe on warfarin who presents in myasthenic crisis with respiratory distress, dysarthria, and dysphagia progressing over at least two days likely related to a prednisone dose change (?initiation at 50mg daily). her nif was low at -18 to -20 and thus the patient was intubated in the ed and transferred to the neuro icu for further care. she was started on plasmapheresis on , and prednisone was increased to 70mg daily. myasthenia - she was initially intubated for respiratory support. she was treated with five days of plasmapheresis from /12. the neuromuscular service was consulted and made recommendations regarding prednisone and pyridostigmine uptitration. her nif/fvcs gradually improved to the -30 to -42 range and 1.4-1.7l range, respectively. she remained stable from a myathenia standpoint after her icu course. hemothorax/chest wall hematoma - the patient had a right-sided cvc placed which resulted in a right chest wall hematoma and right hemothorax with partial lung collapse. the thoracic surgery service was consulted and placed a thoracostomy to drain the hematoma. she was mechanically ventilated from to with successful extubation. the hemothorax/hematoma issue resolved with stable hgb/hct; the chest wound was frequently reevaluated by thoracic surgery. she was transfused multiple units of prbcs. retroperitoneal hemorrhage - the patient on experience an acute drop in blood pressure and lightheadedness/dizziness which occurred with a 2 point drop in hgb; a right sided rp hematoma was identified. this occurrd while on enoxaparin for anticoagulation for her prior dvt/pe. this medication was stopped. acute care surgery was consulted and followed her for the rp hematoma, but the bleed tamponaded spontaneously and did not result in any further drop in hgb. she was transfused 4 units of prbcs. controlled. occult blood positive stools - while her hemothorax was addressed, her hgb/hct continued to drift and she was found to have occult blood positive stools. gi was consulted and deferred inpatient endoscopy and colonoscopy at this time given her prior results and the unlikely possibility of acute intervention. she was started on ferrous sulfate for iron repletion with suspicion for iron deficiency anemia. her prior endoscopy/colonoscopy at hospital in showed gastritis, diverticulosis, and internal hemorrhoids, all of which could be sources of gib. this could be reevaluated as an outpatient if indicated. anticoagulation - she was anticoagulated for about 4 months for a dvt/pe provoked suspected to be provoked by immobility and has suffered multiple life-threatening bleeding complications, the decision was made to stop all anticoagulation but to continue aspirin for her coronary artery disease/coronary stent. urinary tract infection - ua on was grossly positive with culture growing pan-sensitive e. coli. she was started on ceftriaxone iv on . she had one fever to 101.9 on the evening of and was subsequently afebrile without leukocytosis. blood and sputum cultures were negative. she completed the course of ceftriaxone. nutrition - she initially had dysphagia, but on repeat evaluation she could tolerate regular consistency diet and thin liquids. pending studies: none transitional care issues: hemoglobin/hematocrit - consider checking a cbc every days to monitor her blood counts given her recent complication of hemothorax/chest wall hematoma and retroperitoneal hematoma and her prior positive fecal occult blood tests. nif/vc - have respiratory monitor her nif and vc as indicated to measure for improvement in her respiratory status. anticoagulation - anticoagulation has been stopped due to her multiple bleeding complications; she received about 4 months of anticoagulation for a dvt/pe believed to be provoked by immobility from her myasthenia. she was evaluated for ivc filter placement which was deemed not beneficial in her case. neuromuscular followup - the patient needs to followup with dr. at in for close monitoring and management of her myasthenia . the current recommendation from dr. is to continue prednisone 70mg daily until , then decrease to 60 mg daily for two weeks, and then decrease to 40 mg daily for two weeks (and continue at that dose until additional assessments are made). she should continue pantoprazole and bactrim. she may continue to require an insulin sliding scale for glycemic control. ambulation/pt/ot - she has a good chance of functional recovery and achieving some degree of independence. please pursue pt/ot and evaluate her for home services. medications on admission: warfarin (alternating 3mg and 4mg, patient unsure which days) pyridostigmine (taking 6x daily, q2h, unknown dose), prednisone (3 tabs qam and 2 tabs qnoon, unknown dose), duloxetine (unknown dose) atorvatastin 10 metoprolol succinate 100 daily aspirin discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or fever. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. duloxetine 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours): for ulcer prevention and gerd. 7. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily): for pneumocystic infection prevention. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. prednisone 20 mg tablet sig: 3.5 tablets po daily (daily): 70mg daily, for treatment of myasthenia . 11. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 12. insulin regular human 100 unit/ml solution sig: one (1) injection injection asdir (as directed): q6h, dose according to sliding scale, glucose 0-70 mg/dl proceed with hypoglycemia protocol, 71-150 mg/dl give 0 units, 151-200 mg/dl give 4 units, 201-250 mg/dl give 6 units, 251-300 mg/dl give 8 units, 301-350 mg/dl give 10 unit, > 350 mg/dl notify m.d. 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 14. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po tid (3 times a day): for suspected iron deficiency. 15. pyridostigmine bromide 60 mg tablet sig: 0.75 tablet po q6h (every 6 hours): for relief of myasthenia symptoms. 16. dextrose 50% in water (d50w) syringe sig: one (1) intravenous prn (as needed) as needed for hypoglycemia protocol. 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). discharge disposition: extended care facility: - ( hospital of and islands) discharge diagnosis: primary diagnosis: myasthenia (acute exacerbation) secondary diagnosis: chest wall hematoma, hemothorax, coronary artery disease, retroperitoneal hematoma, hemorrhagic shock, urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). neurologic: awake, alert, oriented, speech fluent, no dysarthria, eomi without diplopia, no facial weakness/asymmetry, palate elevation and tongue protrusion midline, neck flexion 5-/5, neck extension , deltoids 5-/5, biceps , triceps 5-/5, iliopsoas 5-/5. discharge instructions: dear ms. , you were admitted to on with difficulty breathing and swallowing due to an acute exacerbation of your myasthenia . you were intubated and placed on a breathing machine for the first several days to help support your breathing. you were treated with prednisone (corticosteroids) and plasmapheresis and improved on this treatment. during your hospitalization, there were multiple complications including bleeding into the right side of your chest (treated with a chest tube or "thoracostomy"), a urinary tract infection, and bleeding into the "retroperitoneal space" on the right side of your back/hip. your anticoagulation (warfarin and lovenox) were stopped due to these bleeding complications; at this time, the benefits of this treatment do not exceed the considerable risks. you will continue to take your aspirin, however. we made the following changes to your medications: 1. discontinue warfarin 2. change prednisone to 70 mg daily on a tapering schedule. 3. change pyridostigmine to 45 mg every 6 hours. 4. start bactrim ss 1 tablet daily for prophylaxis against pneumocyistic jirovecii infection (while taking prednisone, a recommendation of our neuromuscular physicians). 5. start pantoprazole 40 mg twice daily for protection of your stomach from possible ulceration or reflux disease. otherwise, continue your other prescribed medications. if you experience any of the below listed danger signs, please call your doctor or go to the nearest emergency department. please followup with dr. and dr. as listed below. it was a pleasure taking care of you during your hospital stay. followup instructions: neurology/neuromuscular provider: . & phone: date/time: 2:30, building, , , , neurology: dr. ( health care, neurology), phone , appointment: at 11:00am (you also have a appointment still scheduled; if your time at the rehabilitation center at extends beyond , you can call the office to reconfirm the appointment time.) primary care physician: . , appointment: at 10:30 am, phone md, procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis therapeutic plasmapheresis central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension long-term (current) use of steroids percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia hemorrhage complicating a procedure acute respiratory failure iatrogenic pneumothorax other shock without mention of trauma old myocardial infarction long-term (current) use of anticoagulants nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use hemorrhage of gastrointestinal tract, unspecified hemoperitoneum (nontraumatic) personal history of pulmonary embolism other and unspecified escherichia coli [e. coli] dysphagia, unspecified myasthenia gravis with (acute) exacerbation other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to