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: penicillins / ace inhibitors / losartan attending: chief complaint: respiratory distress major surgical or invasive procedure: endotracheal intubation tracheostomy tube placement peg placement oral surgery: dental extraction tongue nodule biopsy femoral cvl internal jugular cvl history of present illness: ms is a 75f with a pmh s/f subglottic edema from multiple intubations, htn, dm, and esrd, who was found unresponsive at her nursing home today. per the patient's daughter and nurse , she had been in her usoh, which included mild stridor since her recent discharge from . starting on sunday (), her daughter noticed she seemed more "out of breath" than usual. she was started on albuterol/ipratropium with good effect. on wednesday the patient became acutely uncomfortable, complaining that something was "stuck in her throat". she was noted to be restless, stridorous, and clutching her throat at the time. she was given a one-time dose of benadryl, and suddenly dropped her o2 sats to 87% on 6l nc, became unresponsive and "limp". she maintained a pulse throughout. ems was called and the patient was transferred to . of note, the patient was stopped on lisinopril/valsartan on her last admission for concern that angioedema may have contributed to her stridor. she was restarted on valsartan on when her symptoms worsenened. in the emergency department the patient was afebrile, sbps ranged from 198-240, hr in the 50s, rr 15. she was started on a labetalol drip for hypertension. she was intubated for airway protection and was noted to have a difficult airway. serum tox, cardiac enzymes, cbc were all wnl. a head ct, cxr, ct neck and torso were completed and were all grossly wnl, except for a non-perfusing left vertebral artery. she was given 1g of ctx, 1g of vancomycin, and 500mg of metronidazole despite not having fevers, leukocytosis or any focal signs of infection. she was pan cultured. she was noted to have coffee ground emesis through her og tube, with guiac negative stools, and was given 40mg of iv pantoprazole. past medical history: 1. end stage renal disease -on hd mwf -recently admitted in with pseudoaneurysm at lue fistula s/p excision. -now with a right subclavian tunneled hd line 2. vascular dementia s/p cva -mra with narrowing diffusely of bl mca's and left a1 -a+o x1 at baseline 3. htn 4. type 2 diabetes mellitus 5. osteoarthritis 6. subglottic laryngeal edema: confirmed on bronchoscopy social history: lives at the . no tobacco, etoh, or drug use. daughter is involved in care. family history: nc physical exam: per admit to the icu t=100.8... bp=187/79... hr=73... rr=14... o2=100% on ac 500x14, fio2 100% and peep of 5 general: intubated, sedated heent: ncat, pupils miotic bilaterally, macroglossia, edematous lips cardiac: regular rhythm, normal rate, no murmurs lungs: coarse ventilated breath sounds, no stridor heard at the upper airway abdomen: nabs. soft, nt, nd. no hsm extremities: cool, 1+ radial, dp, pt pulses skin: sacral decubitus ulcer pertinent results: labs on admission: cbc: wbc 6.6, hct 32.2, plt 265 glucose-155* lactate-1.9 na+-138 k+-4.9 cl--91* tco2-34* alt(sgpt)-22 ast(sgot)-26 ld(ldh)-243 ck(cpk)-113 alk phos-123* tot bili-0.2 lipase-18 ck-mb-5 ctropnt-0.17* asa-neg acetmnphn-neg tricyclic-neg pt-14.3* ptt-26.8 inr(pt)-1.2* urine blood-neg nitrite-neg protein-500 glucose-tr ketone-neg bilirubin-neg urobilngn-neg ph-9.0* leuk-tr urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0 . . . imaging: ct head (): 1. no acute intracranial hemorrhage. please note, mri is more sensitive for the detection of acute ischemia. 2. persistent, partial opacification of the mastoid air cells. . cta neck/chest (): 1. interval development of the left vertebral artery distal segment occlusion, with distal reconstitution just proximal to the basilar artery. 2. apparent thrombosis of the distal right subclavian vein around the cv catheter with extensive collateralization in the right chest. 3. no evidence of pulmonary embolism or aortic dissection. 4. interval worsening of right lower lobe consolidation and pleural effusions. 5. paranasal sinus disease better evaluated on the recent head ct. 6. chronic right internal jugular occlusion with extensive thoracic collaterals. patent left brachiocephalic stent. . ct sinus (): 1. pansinusitis with evidence of acute-on-chronic inflammatory change; the findings appear most marked involving the sphenoid sinuses and their lateralrecesses, bilaterally. the left ostiomeatal complex, and bilateral fronto-and spheno-ethmoidal recesses appear occluded. 2. there is no evident involvement of the intracranial or intraorbital compartments. 3. very poor dentition as described, with findings strongly suggestive of periapical abscess involving a left maxillary molar and, perhaps, right maxillary incisor with evident cortical breakthrough. these findings should be closely correlated with detailed oral examination (as performed by the dental service). 4. opacified mastoids, bilaterally, with fluid in the right middle ear cavity, which may relate to the combination of prolonged intubation and supine positioning; however, an inflammatory component cannot be excluded. . cxr on admit: right perihilar consolidation, likely pneumonia. moderate right pleural effusion. f/u cxrs do not confirm pna. . micro: blood, urine, sputum cx ngtd cdiff neg x1 . trends: wbc: 6.6-> 7.8 hct: 32->29 discharge chem panel: 08:45am blood esr-85* 08:45am blood glucose-263* urean-34* creat-5.6*# na-134 k-4.2 cl-95* hco3-24 angap-19 brief hospital course: 1)respiratory distress: the patient has a history of subglottic laryngeal edema of unclear etiology, and likely causes included angioedema from ace/ vs. history of multiple intubations. this episode occured temporally after being restarted on valsartan so angioedema was on the differential but given history of multiple recent intubations, laryngeal edema was thought to be the most likely etiology. cta chest was negative for pe or any other acute process. she was started on steroids on admission which were stopped after a brief course. decision was made for tracheostomy and peg tube placement. family was in agreement with this plan and the patient tolerated the procedure well; she was able to be weaned to a trach collar over the following two days. patient was transferred to the floor and continued to do well from respiratory standpoint, satting 100% on the trach collar with supplemental oxygen. speech and swallow saw her in consult and she was fitted for a pm valve with good results. there was no further respiratory distress noted during her hospital course. - we recommend avoiding arbs and acei in the future given possible contribution to resp issues - will complete antibiotic course for ? pneumonia although no culture data or cxr data to clearly support this. - trach collar care to be continued at rehab - can use pm valve as tolerated to assist with speech - followup with pulmonary to assess trach and eval for any edema . 2)fevers/leukocystosis: a few days into admission, the patient started spiking temperatures with a mildly elevated wbc. there was concern for line infection given r femoral line that was placed in the emergency room. vap was also on the differential but was thought to be unlikely given short duration of intubation. the femoral line was d/c'ed and sent for culture which was negative. she was empirically started on vancomycin for a planned 8 day course. several days later, the pt spiked again and was noted to develop loose stools. her covereage was broadened to emperic flagyl for possible c.diff as well as levaquin. c. diff cultures were negative x1. patient had a ct scan of the sinuses which showed extensive sinusitis as well as possible dental abscesses. she was seen in consult by omfs who felt that she would benefit from extraction of the diseased teeth. she was taken to the or on and 10 teeth were extracted; a small tongue nodule was also biopsied. after transfer from the micu to the floor, the patient remained afebrile. vancomycin was continued for an 8-day course (finished ), and levo/flagyl were continued for a planned 10 day course (to be finished ). . 3)hypertensive urgency: patient initially presented with elevated blood pressures in the emergency room. she was transiently started on a labetolol gtt and then transitioned to an oral regimen of po labetolol and clonidine (hydralazine also used transiently). low dose amlodipine was added to her regimen as well. her blood pressure was well controlled on these agents throughout her hospital stay. - recommend avoiding and acei . 4)coffee ground emesis: patient presented with coffee ground emesis on admission which quickly resolved. stools were guiac negative. the pt has prior history of gastritis resulting in an ugib, however no further intervention was persued on this admission. hematocrits remained stably low at the patient's baseline (around 30) throughout her hospital stay. - continued on h2 blocker during stay . 5)esrd: renal was consulted during patient's admission. she was continued on hd on her regular schedule (tu/th/sat). the pt is known to have thrombosis around the distal portion of her hd line, for which renal has currently elected not to treat. there is a possibility the pt may be anticoagulated in the future, pending further evaluation by the renal team. - discuss with outpt nephrologist regarding indication for anticoagulation for thrombosis. . 6)type ii dm: she was continued on nph at half dose while npo as well as insulin sliding scale. her blood sugars were well controlled. . 7)fen: patient was started on tube feeds after she was intubated. nurses noted high residuals so she was started on standing reglan with mild improvement. she then had a peg tube placed and tolerated subsequent feeding well. speech and swallow saw her in consult and she passed a po trial and was started on a diet of pureed solids and thin liquids in addition to tube feeds per s/s recommendations. . 8) ppx: patient was kept on bowel regimen, heparin sc. . 9) contact: daughter (. patient is creole speaking; daughter speaks . . 10) psych/neuro: pt's home meds of celexa, namenda, and risperdal were not continued while in the icu given use of other sedating meds. we restarted the risperdal on the floor and recommend monitoring for delirium/psychosis. consider restarting namenda and celexa after d/w pcp. does become slightly delirious on occasion at nights and even needed restraints at one point. . 11) access: difficult iv access. has hd line for dialysis . 12) code: full, discussed with daughter (hcp) . 13) wound care: has sacral decubitus. wound care per nursing. medications on admission: amlodipine 5mg daily labetalol 200mg diovan 40mg daily- re-started on simvastatin 40mg daily prilosec 20mg daily nph 6 units celexa 10m daily risperdal 0.25mg daily cinacalcet 50mg daily namenda 5mg qhs albuterol/ipatropium nebs bowel regimen phoslo 667 two tabs tid discharge medications: 1. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qthur (every thursday): please hold for sbp <100 or hr <55. disp:*4 patch weekly(s)* refills:*2* 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. labetalol 200 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 4. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 6. insulin nph human recomb 100 unit/ml cartridge sig: six (6) units subcutaneous once at breakfast, once at dinner: please take 6 units at breakfast and 6 units at dinner once every day. 7. metoclopramide 10 mg tablet sig: 0.5 tablet po q6h (every 6 hours). disp:*60 tablet(s)* refills:*2* 8. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 6 days: please take one tablet on , and . disp:*3 tablet(s)* refills:*0* 9. metronidazole 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days: please take one tablet twice a day from . disp:*10 tablet(s)* refills:*0* 10. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 11. insulin regular human 300 unit/3 ml insulin pen sig: variable units subcutaneous four times a day: routine insulin sliding scale as needed. 12. risperdal 0.25 mg tablet sig: one (1) tablet po once a day. 13. heparin (porcine) 5,000 unit/ml syringe sig: one (1) injection injection three times a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: laryngeal edema causing acute respiratory failure dental infection now s/p extraction thrombosis of hd line - plan to hold on anticoagulation for now hypertension: s/p new medication regimen possible and acei allergies secondary: esrd on hd qtues, thurs, sat type ii diabetes mellitus vascular dementia s/p cva osteoarthritis discharge condition: stable, satting well on trach collar, afebrile discharge instructions: you were admitted to the hospital because of unresponsiveness and difficulty breathing. we think this is likely due to a combination of swelling in your airway from previous times when you had a breathing tube as well as possible medication side effect of swelling from one of your diuretics. in the hospital, we needed to put in a breathing tube so that your airway would function properly. we did a surgery to insert a tube through your airway (tracheostomy tube) so that you would not need to be on the ventillator, and also placed a feeding tube so that you would get adequate nutrition. you had some fevers and were put on several antibiotics. we think the cause of the fevers was most likely a dental infection, and the oral surgeons did an operation to remove some diseased teeth which may have been causing you to have these fevers. after your operation, you did well and had no more fevers, and you did well with breathing on the trach collar. please take all medications as directed. please call your pcp if you have any difficulty breathing, notice your neck is swelling up, have any mouth or tooth pain, or have high fevers/chills or other symptoms which are concerning to you. if your pcp is not available, please come to the nearest emergency room. followup instructions: please follow up with your pcp 1 week; please f/u results of tongue nodule biopsy with your pcp at this appointment please follow up with drs. and in interventional pulmonary on tuesday at 8:30am. office in / 116, patient will need transportation from rehab to . phone: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy other surgical extraction of tooth excision or destruction of lesion or tissue of tongue diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease end stage renal disease acute respiratory failure pressure ulcer, lower back other complications due to renal dialysis device, implant, and graft edema of larynx diabetes with renal manifestations, type ii or unspecified type, uncontrolled acute apical periodontitis of pulpal origin benign neoplasm of tongue cellulitis and abscess of oral soft tissues 

Answer: The patient is high likely exposed to