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 attending: chief complaint: shortness of breath major surgical or invasive procedure: et intubation. r ij central line. history of present illness: ms. is a year old woman with a history of chf and moderate as/mr who presented to the ed with vague complaints of shortness of breath, abdominal pain, and "just not feeling right". she hit her life line button, and was found by ems to be bradycardic and "cyanotic". her hr was in the 40s, and her bp was 60/palp. the patient was given atropine, and hr came up to the 80s. in the emergency department the patient was found to be in a junctional rhythm, for which the cardiology fellow was called to evaluate, and felt that it was a separate issue. cardiac enzymes were negative. the patient's blood pressure intermittently dropped to systolic of 80s from 110s. a rij was placed, the patient was volume resuscitated and started on dobutamine in the setting of bradycardia. no cvp's were available secondary to agitation. the patient was found to have a lactic acidosis, hyponatremia, a lll pna, and a uti. the patient was treated with ceftriaxone and azithromycin for presumed uti and cap. given her vague abdominal symptoms, diarrhea, elevated lactate, and guaiac positive stools; the ed wanted to rule out an intra-abdominal source for her sepsis picture. she was unable to tolerate a ct secondary to movement, and was intubated for the study. she was transferred to the micu for further evaluation and management. past medical history: thyroid ca s/p thyroidectomy moderate aortic stenosis moderate mitral regurgitation chronic diastolic dysfunction -ef >55% on echo with normal wall motion moderate pulmonary hypertension osteoporosis hypertension cataracts social history: she lived most of her life in , . she has two siblings, one older and one younger, who were still alive. she had a brother who died this last 1/. after her brother died, she moved to to live near her daughter. she has another daughter who lives in . she currently lives in senior independent housing. her daughter is a radiation oncologist at and is very involved with her care (doctor's appt, grocery shopping, frequent meals, walking to temple) family history: non-contributory physical exam: admission physical exam: vitals: t=96.1 bp 70-120/30-50 hr=105 rr=18 o2= 99% on pressure support fio2 40% general: intubated, sedated heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. cardiac: jvd to her ears, regular rhythm, normal rate. systolic murmur at rusb and apex lungs: coarse ventilated breath sounds abdomen: nabs. soft, nt, nd. no hsm extremities: cool, with 1+ distal pulses skin: no rashes/lesions, ecchymoses. rectal: guaiac positive pertinent results: admission labs: 06:43am pt-16.6* ptt-32.6 inr(pt)-1.5* 06:12am type-mix po2-31* pco2-41 ph-7.33* total co2-23 base xs--5 06:00am alt(sgpt)-269* ast(sgot)-175* ld(ldh)-323* alk phos-146* amylase-49 tot bili-0.6 06:00am probnp-8117* 03:56am lactate-2.2* 03:45am glucose-162* urea n-23* creat-0.8 sodium-129* potassium-4.7 chloride-98 total co2-20* anion gap-16 03:45am wbc-12.7* rbc-3.68* hgb-10.4* hct-32.1* mcv-87 mch-28.3 mchc-32.4 rdw-15.3 08:51pm ck-mb-notdone ctropnt-<0.01 08:51pm digoxin-<0.2* 08:45pm glucose-188* lactate-5.9* na+-126* k+-5.0 cl--95* tco2-18* complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:10am 10.6 4.14* 11.8* 35.8* 86 28.6 33.0 15.4 389 06:05am 9.6 4.47 12.5 38.8 87 27.9 32.1 15.2 403 06:10am 8.7 4.03* 11.5* 35.0* 87 28.4 32.8 15.4 366 05:17am 8.8 3.68* 10.8* 32.0* 87 29.3 33.6 15.6* 302 source: line-rij 05:11am 12.5* 3.79* 10.9* 33.2* 88 28.8 32.9 15.7* 310 source: line-r ij 03:56am 11.4* 3.63* 10.6* 31.5* 87 29.2 33.6 16.1* 263 source: line-ctl 04:20am 12.5* 3.65* 10.6* 31.6* 87 29.1 33.6 15.9* 272 source: line-ctl 03:45am 12.7* 3.68* 10.4* 32.1* 87 28.3 32.4 15.3 237 source: line-r ij multi lumen 08:51pm 12.1* 3.78* 11.3* 33.4* 88 29.9 33.8 15.6* 265 imaging: cxr (admission): 1. cardiomegaly with mild pulmonary edema, which was also noted on the prior exam.2. focal left basilar consolidation could be consistent with pneumonia in the appropriate clinical setting. 3. additional consolidation/opacity in the right upper lung, possibly infectious in etiology as well. ct of the chest, however, is recommended to exclude underlying mass. ct abdomen/pelvis : 1. moderate bilateral pleural effusions with right upper and bilateral lower lobe consolidations could reflect multifocal pneumonia. 2. no evidence of pulmonary embolism or acute aortic syndrome. 3. markedly thickened gallbladder wall with edema, cholelithiasis, indicating acute cholecystitis 4. large periportal soft tissue density mass with mass effect on portal vein, measures similar to liver attenuation however not definitely arising from liver, could be mesenchymal or stromal in origin. characterize with mr once patient is stable. 5. possible right heart failure with enlarged right atrium and distended ivc. liver/gallbladder ultrasound : 1. acute cholecystitis. 2. rounded 5 cm heterogeneous mass inferior to the liver could represent bowel loop however real-time peristalsis was not seen. it is unclear if this corresponds to the periportal mass seen on ct. as suggested in concurrently obtained ct, correlation with mr when the patient is stable recommended. echo : mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. moderate calcific aortic stenosis. mild aortic regurgitation. mild calcific mitral stenosis. mitral valve prolapse with partial leaflet flail and moderate to severe mitral regurgitation. moderate tricuspid regurgitation. severe pulmonary hypertension. compared with the prior study (images reviewed) of , mitral regurgitation severity and aortic stenosis severity have slightly increased, and pulmonary pressures are higher. the other findings are largely similar. cxr : significant interval improvement in parenchymal consolidation suggesting resolution of edema and/or aspiration with still present residual atelectasis. no evidence of failure on the current study. the right internal jugular line tip is in the cavoatrial junction. brief hospital course: ms. is a y/o f with a chronic diastolic chf, as and mr, and severe pulmonary htn admitted to the micu on for pneumonia and septic shock. she was transferred to the medical floor on and discharged to her daughter's home with physical therapy services on . . #.septic shock: the patient was treated with mechanical ventilation, large volume resuscitation and vasopressors (discontinued on ). she is completing a 7 day course of levofloxacin ending . urinary legionella antigen and urine and blood cultures were negative. . #.respiratory status: intubated for agitation in the ed so that ct torso could be performed. extubated successfully on . she briefly required bipap on for volume overload, and was subsequently transitioned to 2l nc after a 5+ liter diuresis. on the floor she was diuresised with goal -0.5 to -1l and was weaned off oxygen. patient was discharged on room air with o2 sats in the upper 90's. . #. chronic diastolic heart failure: volume overloaded following aggressive volume resuscitation for shock. echo was performed on which compared with the prior study of , mitral regurgitation severity and aortic stenosis severity were slightly increased, and pulmonary pressures were higher. she was diuresed and on the floor was given po lasix for goal negative -0.5 to -1l. she was discharged on lasix 40 mg qd. patient will follow up with her outpatient cardiologist dr. . she was changed from metoprolol 12.5 mg to home dose carvedilol 3.125 mg prior to discharge. she was also discharged on aspirin 81 mg. #. cholecystitis: evidenced on ruq ultrasound. surgery was consulted and the patient was felt not to be a candidate for a laparascopic cholecystectomy, as this was an unlikely source of her sepsis. she was taken off flagyl on . lfts wnl, and clinically, no sign during admission. # transaminitis: thought to be from hypotension/shock liver on presentation. decreased steadily during admission. wnl upon discharge. . #. abdominal mass: periportal mass noted on abdominal ct and u/s. she will need a dedicated mri to further evaluate as an outpatient. #.hypothyroidism: continued home regimen of levothyroxine #.htn: held home flomax during admission due to hypotension initially and low-normal blood pressures subsequently; may be restarted by outpatient provider at their discretion #.osteoporosis: alendronate/vitamin d will be restarted upon discharge . #.prophylaxis: given sqh for dvt ppx. . # nutrition - given a low salt, heart-healthy diet pending issues for follow-up: (1) question of periportal mass noted on abdominal imaging (see reports in omr for further details). needs a dedicated mri as outpatient to evaluate further. (2) flomax was held upon discharge due to the risk of orthostatic hypotension. be restarted at the discretion of an outpatient provider. (3) patient's daughter expressed concern regarding interval worsening of pulmonary hypertension on tte between (pasp 54) and (pasp 66), although the clinical significance of and therapeutic options for this remain unclear. require repeat tte as an outpatient as the exam was performed while the patient was receiving treatment for septic shock in the icu. medications on admission: alendronate-vitamin d3 - 70 mg-5,600 unit weekly carvedilol 3.125 mg levothyroxine 75 mcg daily tamsulosin 0.4 mg daily aspirin 81 mg daily ferrous sulfate 325 mg daily omeprazole 20mg daily senna discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 2. levothyroxine 75 mcg tablet sig: one (1) tablet po once a day. 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. alendronate-vitamin d3 70-5,600 mg-unit tablet sig: one (1) tablet po once a week. 5. carvedilol 3.125 mg tablet sig: one (1) tablet po twice a day: please hold if sbp<100, hr<55. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: primary: septic shock pneumonia secondary: diastolic heart failure hypertension primary: septic shock pneumonia secondary: chronic diastolic heart failure hypertension osteoporosis discharge condition: good. discharge instructions: you were admitted to the hospital for pneumonia and low blood pressure. you were treated for a short time in the intensive care unit with mechanical ventilation and medicine to raise your blood pressure. you were then tranferred to the regular hospital floor where your antibiotics were continued. you do not need to take any additional antibiotics. please refrain from taking tamsulosin (flomax) due to concerns about low blood pressure. one of your outpatient care providers may decide to restart this medication at a later date. please continue taking your other medications as directed. please call your doctor if you experience any difficulty breathing, fever, chills, or any other concerning symptoms. please return to the emergency department if you cannot reach your doctor or if you feel severely short of breath or have chest pain. followup instructions: please follow up at your primary care doctor's office with nurse practitioner on tuesday, , at noon. the office phone number is . please follow-up with your cardiologist dr. on monday, , at 2:00 pm. the office phone number is . procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified acidosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver unspecified septicemia hyposmolality and/or hyponatremia severe sepsis other chronic pulmonary heart diseases septic shock mitral valve insufficiency and aortic valve stenosis chronic diastolic heart failure personal history of malignant neoplasm of thyroid cholecystitis, unspecified 

Answer: The patient is high likely exposed to