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 is a 67-year-old female with a history of chronic obstructive pulmonary disease, emphysema (forced expiratory volume 0.59) on home oxygen 2 liters nasal cannula and smokes two packs per day who infection symptoms for three days including a cough at baseline and sputum eight days prior emergency room admission on peep. the patient was lethargic, somnolent, and had increased work of breathing with an oxygen saturation in the 60s and wheezing bilaterally. her arterial blood gas demonstrated a respiratory acidosis and hypocarbia. she was placed on nasal bipap, albuterol and atrovent emergency room, and her oxygen saturation increased to 90% to 91%, and her arterial blood gas revealed a ph of 7.42, pco2 of 74, and po2 of 120. she also complained of nonexertional/nonradiating chest pain with no ischemic changes on electrocardiogram. additionally, her code status was discussed in the emergency room, and the patient was made do not intubate, but she still desired to defibrillated. she was transferred to the medical intensive care unit where she was febrile with a temperature of 102.5, and 85% on bipap. her chest x-ray was clear, hyperinflated lungs, no signs of congestive heart failure but a nasal swab that was positive for influenza. she was treated with amantadine and levofloxacin. she was weaned from bipap to 2 liters nasal cannula with an oxygen saturation of 90% to 91% at rest, but had decreasing oxygen saturations to 70% with activity. she was continued on her flomax, albuterol, and atrovent nebulizers, and prednisone 20 mg q.d. to improve her respiratory condition. she ruled out for myocardial infarction with negative creatine kinases, ck/mb, and c troponin. on admission, her hematocrit was 55.4 and was 55.4 secondary to her history of polycythemia, and was due for a blood removal the day after admission. due to various blood draws, her hematocrit decreased to 44.1 by the time the patient was transferred from the medical intensive care unit to the floor. when the patient was transferred to the floor, the patient continued to have shortness of breath but was improving and became less dyspneic with activity such as moving in the bed and having bowel movements. her cough had decreased, but she was having difficulty coughing up her sputum. when able to expectorate her sputum, it was tan in color without bright red blood. the night before transfer to the floor, she had nonexertional chest pain for a couple of hours located to the right of the midline and also in the midline of her back. the pain did not radiate, was constant, was relieved by zantac. serax helped alleviate some of the pain. additionally, she reported abdominal pain the night before admission that was relieved by having a bowel movement, and she currently has a baseline intermittent constipation and diarrhea due to irritable bowel syndrome. she was nauseated and wanted to vomit but has been unable to do so since her hernia repair. her strength is slowing progressing. there was a re-discussion of her code status, and the patient desired to be do not resuscitate/do not intubate. review of systems: dizziness when having a bowel movement, no visual changes, no headaches. denies tingling and numbness. past medical history: 1. chronic obstructive pulmonary disease/emphysema; on home oxygen, smokes two packs per day, forced expiratory volume 0.59. 2. polycythemia. 3. bipolar disorder. 4. anxiety. 5. hypercholesterolemia. 6. history of tuberculosis; childhood, has had no reactivation, plus purified protein derivative, status post treatment at age of five years old, multiple sputum negative for acid-fast bacillus. 7. hiatal hernia. 8. irritable bowel syndrome. past surgical history: 1. cholecystectomy. 2. appendectomy. 3. hysterectomy. 4. hernia repair. 5. glomectomy. 6. treatment for asthma in . 7. arterial repair of left arm laceration. 8. disk operations. medications on transfer: levofloxacin 250 mg p.o. q.d., navane 2 mg p.o. q.h.s., volmax 4 mg p.o. q.h.s., enteric-coated aspirin 325 mg p.o. q.d., zantac 150 mg p.o. b.i.d., serax 10 mg p.o. t.i.d., atrovent meter-dosed inhaler 1 nebulizer q.4h., albuterol 1 nebulizer q.4h., prednisone 40 mg p.o. q.d., atrovent nebulizers one treatment q.1-2h. for dyspnea, albuterol 2 puffs inhaler q.3-4h., tegretol 200 mg p.o. q.i.d. allergies: codeine (stomatitis), phenobarbital (temperature variations), lithium (increase in creatinine). social history: smokes two pack per day. no ethanol. no intravenous drug use. lives at home with a very supportive husband. married for 42 years. physical examination on presentation: vital signs were temperature maximum of 98.1, temperature current 98.1, blood pressure 100/60, pulse 100, respiratory rate 32, 80% on 3 liters with activity, 93% on 3 liters at rest. the patient was alert and oriented times three with labored breathing, and had difficulty in talking due to shortness of breath. normocephalic. pupils were equal, round, and reactive (3 mm to 2 mm). normal extraocular movements. anicteric. oropharynx was nonerythematous without exudate. mucous membranes were dry with a small amount of thrush. no lymphadenopathy. heart was regular in rate and rhythm with distant first heart sound and second heart sound. no third heart sound or fourth heart sound, with a question of a systolic ejection murmur at the left upper sternal border. no gallops or rubs. pulmonary examination demonstrated coarse breath sounds with diffuse expiratory wheezes resonant on percussion extended bilaterally. abdomen had positive bowel sounds, was soft and nondistended, with mild tenderness in the epigastrium and right upper quadrant. the patient was unable to lay flat for palpation of liver and spleen. extremities had no edema, 2+ dorsalis pedis pulses bilaterally and warm. cranial nerves ii to vii, ix, and x were intact with 2+ reflexes bilaterally in the upper and lower extremities. strength was not tested due to dyspnea. pertinent laboratory data on presentation: white blood cell count of 9.4 (with a differential of 84.4 neutrophils, 4.9 lymphocytes, 7.8 monocytes on ). white blood cell count had decreased to 6.8 on the day of transfer (), hematocrit 55.4 on admission (decreased to 44.1 on ), platelets of 174 on admission (decreased to 139 on transfer). sodium of 145, potassium 4.2, chloride of 102, bicarbonate of 33, blood urea nitrogen of 22, creatinine of 1.3, glucose of 82. calcium 7.7, magnesium 2, phosphorous 6. pt of 13.3, ptt of 28.6, inr of 1.2. creatine kinases were 100, 250, 259. ck/mb of 2, c troponin of less than 0.3. urinalysis and urine sedimentation were negative for infection. sputum on demonstrated sparse growth or oropharyngeal flora. blood cultures from demonstrated no growth. urine cultures from demonstrated no growth. radiology/imaging: chest x-ray on demonstrated no pneumonia, no congestive heart failure, and no pneumothorax. hospital course: the patient is a 76-year-old female with severe chronic obstructive pulmonary disease, emphysema, who smokes two packs per day, and is on home oxygen, who was admitted to the medical intensive care unit for respiratory failure due to a chronic obstructive pulmonary disease flare secondary to influenza infection and is now transferred to the medicine service after being weaned from bipap for continued management of her chronic obstructive pulmonary disease flare. 1. pulmonary: the patient apparently on levofloxacin to prevent secondary bacterial pneumonia, status post influenza infection, and is on prednisone for treatment of chronic obstructive pulmonary disease flare. the levofloxacin was discontinued on hospital day two, and the patient continued to have baseline cough with baseline slight tan sputum. the patient was continued on her atrovent and albuterol nebulizers p.r.n., albuterol inhaler, and prednisone taper. the patient continued to have decreased oxygen saturations with activity, in which she varied between approximately 90% to 93% on 2 liters and 3 liters at rest, and decreased to 80% on 3 liters with movement. by the time the patient was discharged she was 92% on 3 liters at rest and 80% on 3 liters with activity. her arterial blood gas on discharge demonstrated a ph of 7.35, a pco2 of 58, a po2 of 66, a co2 of 33, and a base excess of 3 on 3 liters of oxygen. although she continued to be dyspneic on activity, she was able to ambulate and use the bathroom on her own. a physical therapy evaluation thought it was safe for the patient to be discharged home with her husband's assistance and to have home physical therapy. 2. cardiovascular: the patient had cardiomegaly on chest x-ray. an echocardiogram was obtained to assess pulmonary arterial pressures as well as to determine if there was a right or left ventricular hypertrophy. echocardiogram demonstrated mild dilatation of the left atrium, mild symmetric left ventricular hypertrophy, with an ejection fraction of greater than 55%, a mildly dilated right ventricle with depressed systolic function, a mildly dilated abdominal aorta, and questionable impaired relaxation of the left ventricle. pulmonary artery pressures could not be assessed on this echocardiogram. 3. hematology: the patient's hematocrit increased from 55.4 to 47.2. withdraw of blood was not considered necessary unless her hematocrit increased to 50. 4. genitourinary: the patient was at her baseline creatinine of approximately 1.1 to 1.3. she was continued on her premarin. 5. gastrointestinal: the patient had constipation and alternating diarrhea due to her irritable bowel syndrome. 6. psychiatry: the patient was continued on her psychiatric medications for her bipolar disorder. additionally, she was placed on serax t.i.d. p.r.n. for anxiety. the patient tended to become anxious when she had difficulty breathing, and serax helped improve her symptoms of dyspnea. condition at discharge: condition on discharge was stable. discharge status: the patient was discharged to home with a nebulizer machine from which she would take atrovent and albuterol nebulizers in the a.m. and atrovent and albuterol inhalers p.r.n. during the day. she was also continuing her prednisone taper. the patient was referred for home physical therapy and . discharge followup: the patient was to follow up with dr. in approximately eight weeks. medications on discharge: 1. home oxygen; 3 liters to 4 liters at rest, 4 liters with exertion. 2. premarin 0.625 mg p.o. q.d. 3. serax 10 mg p.o. t.i.d. 4. atrovent nebulizers and albuterol nebulizers times one q.a.m., atrovent meter-dosed inhaler 2 to 4 puffs q.4-6h. p.r.n. for dyspnea, albuterol meter-dosed inhaler 2 to 4 puffs q.4-6h. p.r.n. for dyspnea. 5. prednisone taper 20 mg p.o. q.d. on ; to 15 mg p.o. q.d. on . 6. navane 2 mg p.o. q.h.s. 7. volmax 4 mg p.o. q.h.s. 8. enteric-coated aspirin 325 mg p.o. q.d. 9. zantac 150 mg p.o. b.i.d. 10. tegretol 200 mg p.o. q.i.d. 11. flovent 100 mcg meter-dosed inhaler 4 puffs b.i.d. 12. colace 100 mg p.o. b.i.d. 13. protonix 40 mg p.o. q.i.d. , m.d. dictated by: medquist36 procedure: non-invasive mechanical ventilation diagnoses: pure hypercholesterolemia tobacco use disorder obstructive chronic bronchitis with (acute) exacerbation diaphragmatic hernia without mention of obstruction or gangrene acute respiratory failure bipolar i disorder, most recent episode (or current) unspecified influenza with other respiratory manifestations personal history of tuberculosis polycythemia vera 

Answer: The patient is high likely exposed to