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: history of present illness: this 69-year-old woman was admitted to the medical intensive care unit on with lethargy and fever. she was discharged from the hospital on after an admission for management of a loculated pleural effusion. during this admission she received a vats procedure with results suggestive of a postinflammatory pleural effusion. she was discharged home and felt well until . on this day she had increased lethargy, sleepiness and tremors. a home health aid noted these symptoms and the patient was transported to the emergency department. her fasting sugar was 73 and she was given one ampicillin of d50. she woke up slightly but was still somnolent. her initial vital signs were blood pressure 114/46, heart rate 88 and temperature 97.0. she was maintaining an oxygen saturation of 100% on room air. she had a urinalysis which was suggestive of a urinary tract infection and her creatinine had increased from a prior level of 0.9 to 1.9. then, her systolic blood pressure decreased into the 70s and her heart rate increased to between 100 and 110. the intensive care unit was called to evaluate the patient for possible urosepsis. she subsequently developed a fever of 102.3. the patient denies recent fever, chills, nausea, vomiting, abdominal or chest pain. she has chronic wheezing. she also has a history of dietary indiscretion and weight gain exacerbating her diastolic heart failure. in the emergency department the patient received three liters of normal saline, levofloxacin, metronidazole, and kayexalate for a potassium of 5.7. past medical history: 1. diastolic dysfunction causing class 3 heart failure, chronic atrial fibrillation, status post prior treatment with dofetilide (discontinued because of increased qt interval and diastolic dysfunction), amiodarone, and dc cardioversion. 2. coronary artery disease status post pci, status post most recent catheterization in . 3. hypertension. 4. hypercholesterolemia. 5. type 2 diabetes mellitus requiring insulin. 6. chronic stasis ulcers. 7. cellulitis. 8. hypothyroidism. 9. mrsa in the urine and vre in the blood. 10. obstructive sleep apnea. 11. boop. 12. painful peripheral neuropathy. 13. osteopenia. medications on admission: 1. coumadin 2.5 mg q. day. 2. metoprolol 25 mg b.i.d. 3. lidoderm patch q. day. 4. celexa 40 mg q. day. 5. multivitamin. 6. vitamin c. 7. lasix 60 mg p.o. q. day. 8. spironolactone 25 mg q. day. 9. aspirin 81 mg q. day. 10. calcium carbonate 1,500 mg t.i.d. 11. msir 15 mg q. 6 hours p.r.n. 12. lisinopril 5 mg q.h.s. 13. colace. 14. senna. 15. calcitriol 0.25 mcg q. day. 16. buspirone 15 mg t.i.d. 17. pantoprazole 40 mg q. day. 18. atorvastatin 10 mg q. day. 19. fosamax 70 mg q. week. 20. nph insulin 24 units q.a.m., eight units q.p.m. 21. synthroid 250 mcg q. day. allergies: childhood allergy to penicillin, but has received cephalexin without problems since; carbamazepine and beef/pork insulin. physical examination: temperature 100.0, heart rate 90, blood pressure 84/49, respiratory rate 16, oxygen saturation 100% on four liters. general: pleasant elderly woman in no acute distress. heent: pupils were equal, round, and reactive to light, extraocular motility intact. oropharynx dry. neck: normal jugular venous pressure. lungs: diffuse wheezes and bibasilar crackles. chest: pressure dressing over the right thoracotomy site with slight drainage, no tenderness. heart: irregularly irregular rhythm, mildly tachycardic, no murmurs. abdomen: soft, nontender, nondistended, normal active bowel sounds. extremities: right leg with a large 4 x 10 inch area of erythema, ulceration, with mild drainage. neurologic: awake, alert, conversant, mentating, moving all four extremities spontaneously, sensation intact to light touch in bilateral upper and lower extremities. laboratory data: white blood cell count 11.0, hematocrit 29.9, platelet count 354, sodium 129, potassium 5.7, chloride 87, bicarbonate 33, bun 39, creatinine 1.9, glucose 207, inr 1.6, ptt 42. urinalysis had small leukocytes, trace blood, white cells and few bacteria. ekg: atrial fibrillation at 106 beats per minute, no st and t wave changes. chest x-ray: persistent left pleural effusion, mild congestive heart failure, possible retrocardiac density. ct of head: negative for intracranial hemorrhage or edema. hospital course: 1. infectious disease: the patient was initially admitted to the medical intensive care unit and treated under a presumptive diagnosis of urosepsis. other infectious etiologies considered included pneumonia and lower extremity cellulitis, but none were proven. after her initial temperature spike the patient did not have any further fevers. she received iv fluids for her hypotension with increases in her systolic blood pressure to the 90s and low 100s. she initially received dexamethasone until a cortisol level returned at 31, suggesting that the patient did not have adrenal insufficiency. the patient received a total 10-day course of levofloxacin for her possible infection. of note, her blood and urine cultures from the early portion of her admission did not grow any organisms. 2. cardiovascular: the patient's cardiac issues include severe diastolic dysfunction and chronic atrial fibrillation. her most recent echocardiogram revealed a left ventricular ejection fraction of greater than 75% and a dilated left atrium. at baseline, her systolic blood pressure runs in the 90s. she maintains mentation and organ perfusion at this systolic blood pressure. after the fluid resuscitation that the patient initially received for her presumed sepsis, the patient had an increased oxygen requirement of three to four liters and extensive third spacing of fluids in the peripheral tissues. she was transferred to the floor on . she was persistently tachycardic and hypotensive, which limited the ability to diurese or to control her heart rate with medications. she was initially placed on a furosemide drip and diuresed a total of approximately eight liters. the heart failure service was consulted, and she was thereafter transferred to the cardiac floor and placed on a nesiritide drip with further diuresis. she was symptomatically improved with decreased shortness of breath, decreased oxygen requirement, and decreased peripheral edema after this diuresis. her blood pressure improved with diuresis and resolution of tachycardia, presumably related to improved pump function and filling. after transfer to the floor the patient's metoprolol dose was changed to 50 mg p.o. t.i.d. her rate continued to exist mostly between 100 and 120 with periods of elevation into the 120s. her dose was subsequently increased to 75 mg p.o. t.i.d. with instructions to give 25 mg if her systolic blood pressure was under 90. this resulted in improved heart rate control with heart rate mostly between 90 and 100. dr. of the heart failure service, and dr. of electrophysiology were involved in the patient's care. on their recommendations, flecainide was initiated for her atrial fibrillation. the patient continued to be anticoagulated as well for her atrial fibrillation. as aforementioned, her inr on admission was subtherapeutic. she was placed on 2.5 mg of coumadin per day and her inr became supratherapeutic at a peak level of 4.1 on . several doses were held and her inr decreased to a level of 2.6 on . thereafter the warfarin was continued but flecanaide was discontinued with expection that this would be initiated in about one month for elective chemical cardioversion. 3. neurological: the patient has a painful peripheral sensory neuropathy. initially her analgesic medications were held because of hypotension. after her blood pressure improved, her regimen of gabapentin 300 mg t.i.d., fentanyl 25 mcg patch, msir 15 mg b.i.d. was reinitiated. the patient had improved pain control thereafter. 4. hematology: the patient has a chronic hypoproliferative normocytic anemia with prior iron studies consistent with anemia of chronic disease. she was transfused one unit of packed red cells on for intravascular volume repletion and anemia with resultant increase in her hematocrit to a level over 30 on . 5. nutrition: the patient had poor nutrition as evidenced by her albumin of 2.2 drawn on . she was placed on boost for protein supplementation three times a day and the nutrition service was consulted for education. 6. endocrine: the patient was continued on synthroid at 250 mcg q. day for her hypothyroidism. her nph insulin was titrated to a dose of 30 units q.a.m. and 10 units q.h.s. for improved glycemic control. the above is a summary of the hospital course from the time of admission through . for details regarding the remainder of the admission and discharge information, please refer to the discharge addendum. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation injection or infusion of nesiritide diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation acute on chronic diastolic heart failure hypotension, unspecified cellulitis and abscess of leg, except foot other specified alveolar and parietoalveolar pneumonopathies ulcer of calf 

Answer: The patient is high likely exposed to