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: augmentin attending: chief complaint: respiratory failure transfer from osh major surgical or invasive procedure: - esophagastroduodenoscopy . - trach per osh - peg tube per osh - l sc central line per osh history of present illness: 71 y.o. female with a h/o t2dm c/b pnp, systolic chf (ef 40% in ), cri (cr baseline around 1.2-1.6), copd, pvd s/p femoral bypass and r great toe amputation in , hypothyroidism p/w ams and respiratory distress to osh, was intubated, now transferred to after trach/peg. . pt was in usoh several weeks ago until she went on a cruise in the carribean. one day prior to docking in , the patient became confused. she was sent to osh ed on , was found to be in respiratory distress and with continued ams, intubated and transferred to osh icu. cns w/u only showed a questionable 3mm r ica aneurysm but no acute process. however, she was found to have chf exacerbation with pulmonary edema, was diuresed but still could not be weaned from the vent. her course was c/b an nstemi and acute on chronic renal failure that has resolved. she spiked at the osh and was empirically treated with zosyn and vanco but was off any abx on transfer. cultures were unrevealing. due to continued failure to extubate, pt received trach () and peg (). she was transferred for further management to . . ros: not obtained due to sedation of pt. past medical history: - cad, s/p nstemi on , s/p nstemi with cath - systolic chf, ef 40% in - cri (cr baseline around 1.2-1.6) - dm type ii c/b pnp - pvd s/p femoral bypass and r great toe amputation in - morbid obesity - hypothyroidism on synthroid - gout social history: - lives in with husband. - moves around with electronic chair, but can walk to bathroom. - retired, but former bank administrator. - occ etoh, smoking 1.5 ppd for over 50 yrs, now only 3 cig per day. no illicits. family history: - no heart or lung diseases. - father with dm died of infectious complications at age 55. - mother died at age . physical exam: vs: t98.8, 115/55, 89, 21, 96% on ac 500x15, fio2 40%, peep 5 gen: sedated, trach ventilated heent: pupils constricted but equal and reactive to light, neck: trach in place, l ij cv: rrr, nl s1, s2, no m/r/g resp: ctab anteriorly abd: soft, +bs, morbidly obese, peg in place ext: no c/c/e on le, 2+ pitting edema b/l on ue neuro: moves extremities to painful stimuli skin: abdominal striae, no overt rash pertinent results: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 28.1 04:00pm 27.0* 10:06pm 24.8* 06:43pm 5.8 2.17* 6.9* 21.3* 98# 32.0 32.7 18.3* 398 . differential neuts bands lymphs monos eos baso atyps metas 06:43pm 74.1* 12.5* 9.2 3.9 0.3 . renal & glucose glucose urean creat na k cl hco3 angap 04:52am 194* 28* 1.5* 142 4.4 102 31 13 06:43pm 160* 27* 1.4* 142 4.2 102 31 13 . hematologic caltibc ferritn trf 03:49am 300 107 231 . pituitary tsh 06:43pm 35* . thyroid t4 t3 free t4 06:43pm 5.3 80 0.71* . imaging cxr : findings are consistent with chf and pulmonary edema. interval placement of a left-sided ij approach central venous line with its tip at the level of the proximal svc. interval tracheostomy tube placement. . egd : study showed medium hiatal hernia, nodularity in the antrum, ulcer in the stomach body brief hospital course: . the following is her hospital course by problem: . # respiratory failure: pt was admitted from the osh with a tracheostomy (placed on ) for respiratory failure and difficulty weaning off of the ventilator. respiratory failure was thought likely multifactorial in etiology, including chf with pulmonary edema and bilateral pleural effusions, ? hx of copd, hypothyroidism. infectious process thought unlikely given that she has been afebrile and without leukocytosis. she was admitted on assist control ventilation and during the course of admission was weaned to pressure support with ps 5 and peep 5. she was also treated with standing albuterol and atrovent nebs as well as fluticasone. she was gently diuresed with iv lasix and responded well. . # gi bleed: she has chronic anemia with baseline hct around 27-30 but trended down to 21 on admission. she was transfused with one unit prbcs and her hct bumped appropriately. egd on found oozing ulcer in stomach. no intervention was performed. hct stable, 28 at discharge. on iv ppi . initially held asa and plavix for bleeding. re-started asa on discharge. hematocrit should be checked 2 days after discharge. . # new onset atrial fibrillation: mostly likely due to chf, has a hx of cad, also had nstemi at osh. pt was also found to be profoundly hypothyroid (freet4 of 0.71, tsh 35) so her levothyroxine dose was increased from 50 to 100 mcg daily and then decreased to 75 with plans to increase slowly. converted to sinus rhythm. she was rate-controlled on metoprolol 50 mg tid. anticoagulation was deferred given recent gi bleed, however this will need to be addressed as an outpatient. . # ams: it remains unclear what caused her initial change in ms upon admission to the osh. neuro w/u at the osh was unrevealing except for questionable cns aneurysm, which is unlikely to be related. hypothyroidism possibly contributed. pt was treated for uti with a 7-day course of cipro based on a dirty ua at the osh. on discharge, she is mentating well and stable. . # systolic chf: ef of 40% from , low ef on echo from . initially with pulmonary edema, pleural effusion, and anasarca. volume status improved with gentle diuresis with iv lasix. cxr showed persistent pleural effusions but peripheral edema resolved. continued bb and therapy while in house. she was discharged on 40mg po lasix with the goal of continued gentle diuresis. the need for diuresis should be reassessed by her primary care physician as an outpatient. would check electrolytes 2 days after discharge while on diuresis. . # cad with h/o nstemi at osh; also old hx of nstemi with cath : her bb, crestor, and were continued. asa and plavix were held initially for gi bleed. asa was re-started on discharge. it is unclear when she was started on plavix, likely at the osh. plavix should be held for now until she follows up with her primary care provider. . # presumed uti from osh: she had a dirty u/a at the osh, urine cx here was negative. this is also in the setting of chronic foley. she was treated with a 7-day course of ciprofloxacin. this may also have contributed to her altered mental status. . # hypothyroidism: on admission here she was found to be profoundly hypothyroid-- freet4 of 0.71, tsh 35. she was on synthroid 88 mcg daily at home and transferred here on 50 mcg daily. her dose was increased to 75 mcg on discharge. her dose will likely need to be further increased and tfts should be monitored as an oupatient. . # dmii: covered with lantus and riss. she was discharged on this regimen. . # chronic kidney disease: likely secondary to dm, htn. she has remained at her baseline creatinine level (1.5 from osh records). . # code: full (confirmed with husband) . medications on admission: - lasix 20mg po daily - allopurinol 300mg po daily - nph 26units qam, 46units qpm - humalog sliding scale - lipitor 10mg po daily - trental 400mg po tid - avapro 150mg daily - cymbalta 60mg daily - glucotrol xl 10mg - metoprolol 37.5mg po bid - zyrtec 10mg po daily - synthroid 88mcg daily - gabapentin 300mg tid - simvastatin 10mg qdaily (? taking both lipitor and simvastatin) - lidex topical - triamcinolone topical discharge disposition: extended care facility: - discharge diagnosis: ventilator-dependent respiratory failure chf exacerbation bleeding stomach ulcer atrial fibrillation uti hypothyroidism dmii discharge condition: stable o2 sat 98-100% on cpap/pressure support-- ps 5/peep 5, fio2 40% discharge instructions: you were admitted to the hospital for respiratory failure secondary to chf exacerbation. during the course of your admission, your ventilation requirements have decreased but you still require the ventilator machine to help you breath. you were started on new medications on this admission and also some of your home medication doses have been changed. please take your medications as prescribed until you see your primary care doctor. followup instructions: follow-up with gastroenterology for repeat upper gi endoscopy. please call the clinic at (. they will tell you when your appointment is. follow-up with your primary care provider, . , after you have been discharged from rehab. recommend to check hematocrit and electrolytes frequently given recent gi bleed and patient being diuresed. procedure: other endoscopy of small intestine enteral infusion of concentrated nutritional substances diagnoses: anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation systolic heart failure, unspecified acute respiratory failure chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction subendocardial infarction, subsequent episode of care tracheostomy status 

Answer: The patient is high likely exposed to