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: zestril attending: chief complaint: hypoxia, lethargy, tachycardia major surgical or invasive procedure: none history of present illness: ms. is an 84 year-old female with a history of htn, dm, cad, chf, copd, afib, mr, ckd, alzheimers dementia who presents today with lethargy. since the beginning of this year, she has had 4 admissions. she was most recently admitted to the from /10 for shortness of breath and ams in the setting of a chf exacerbation. she was diuresed with improvement and was discharged on an increased dose of lasix 40mg (from daily) and metoprolol 37.5mg (from 25mg ). . today, she was noted to be more lethargic at her nh with decreased interaction and clarity of speech. she has had a cough for 1 week and congested sounding but nonproductive per daughter. she did complain of feeling cold today. later in the day, she was noted to be more wheezy by her daughter and found to to be hypoxic to the 83 on ra, tachypneic, and tachycardic, fsbs 232. vs t 97.9 (ax), bp 125/89, p 148, rr 20, o2sat 83%ra. she was transferred here. . in the ed, initial vs were: t 99.6, p 128, bp 123/85, rr 24, o2sat 100 on nrb. pt awake but lethargic and poorly cooperative with exam. exam notable for increased wob and cardiac wheezes. cxr initially concerning for chf. patient given nitro 0.4mg sl, asa 600mg pr, and lasix 40mg iv. however, subsequently found to have rectal temp found to be 103, very concentrated apperaing urine (100cc uop after lasix), and persistently tachycardic, so then clinical picture thought more consistent with pna on review of cxr. labs without leukocytosis; hct, cr at baseline. inr subtherapeutic at 1.5. bcx were drawn. pt was given 1l ivf, ceftriaxone and levofloxacin in the ed with vancomycin hung en route. hr improved to 120-130s. vs on transfer: p 125, bp 135/87, rr 20, o2sat 100% on bipap (). . patient currently on bipap, lethargic, and not responsive to questions. . ros: unable to obtain due to ms. past medical history: 1. obesity 2. hypertension 3. diabetes mellitus, type ii 4. hyperlipidemia 5. coronary artery disease, s/p 2 anterior mi - 3 vessel disease: refused cabg - s/p stent of left circumflex, lad, rca 6. ischemic and possibly valvular cardiomyopathy: ef 26%, 3+ mr on echo in 7. chronic atrial fibrillation 8. chronic kidney disease with baseline creatinine of 1.9 9. anemia. 10. multiple myeloma: monoclonal igg kappa, being observed by heme-onc. 11. osteoarthritis. 12. gastroesophageal reflux disease 13. seizure disorder, on dilantin 14. chronic bronchitis/copd 15. detrusor instability 16. frequent utis: in klebsiella pneumonia social history: currently living at . per prior discharge summary, requires wheelchair for mobility. no tobacco or alcohol use. family history: per prior d/c summary, sister with coronary artery disease. physical exam: general: lethargic, opens eyes sporadically to voice, speech unintelligible, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, ej elevated - ij difficult to assess, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, obese, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 09:00pm urine rbc-21-50* wbc- bacteria-mod yeast-none epi-21-50 09:00pm urine blood-lg nitrite-neg protein-150 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 09:00pm urine color-yellow appear-hazy sp -1.012 09:00pm pt-16.8* ptt-27.5 inr(pt)-1.5* 09:00pm plt count-354 09:00pm neuts-68.6 lymphs-21.4 monos-5.2 eos-3.9 basos-0.8 09:00pm wbc-4.7 rbc-2.94* hgb-9.3* hct-28.2* mcv-96 mch-31.7 mchc-33.1 rdw-14.7 09:00pm phenytoin-8.7* 09:00pm digoxin-0.4* 09:00pm albumin-2.6* calcium-7.9* phosphate-2.8 magnesium-1.8 09:00pm probnp-* 09:00pm ctropnt-0.05* 09:00pm glucose-145* urea n-43* creat-1.8* sodium-146* potassium-4.7 chloride-109* total co2-27 anion gap-15 09:14pm lactate-1.6 09:14pm comments-greentop 05:58am blood wbc-4.3 rbc-2.76* hgb-8.8* hct-26.8* mcv-97 mch-32.1* mchc-33.0 rdw-14.8 plt ct-309 05:58am blood plt ct-309 05:58am blood pt-18.9* ptt-38.1* inr(pt)-1.7* 05:58am blood 05:58am blood glucose-113* urean-35* creat-1.5* na-139 k-4.4 cl-106 hco3-24 angap-13 05:58am blood calcium-7.3* phos-3.3 mg-2.1 . ecg : atrial fibrillation. right bundle-branch block with left anterior fascicular block. compared to the previous tracing of . portable cxr : impression: nearly nondiagnostic study due to respiratory motion and artifacts projecting over the right hemithorax. repeat radiography, if clinically feasible in the radiology suite, are recommended for more sensitive evaluation. overlying pulmonary edema and pneumothorax cannot be excluded on the basis of this exam. ecg : atrial fibrillation. right bundle-branch block. left anterior fascicular block. compared to the previous tracing there is no change. portable cxr : impression: 1. decreased pulmonary edema. 2. increased left retrocardiac density consistent with consolidation or atelectasis. portable cxr : there is a left retrocardiac opacity with obscuration of the left hemidiaphragm. there is also left-sided pleural effusion which is slightly increased from previous. no overt pulmonary edema or pneumothoraces are seen. the cardiac silhouette is prominent but unchanged. portable cxr : impression: increased cardiogenic edema. chest, ap: lung apices are obscured by overlying soft tissues. no focal consolidation is present. venous congestion and bilateral layering effusions are increased. moderate cardiomegaly persists. impression: increased cardiogenic edema. brief hospital course: 84 y/o f with hx of dm, cad, chf, copd, afib, mm, htn and ckd who presents from nh with increased lethargy and hypoxia. # hypoxia: the patient has had multiple prior admissions for hypoxia in the setting of chf exacerbation, although on this admission did not appear significantly volume overloaded clinically or by initial chest film. she reported cough x1 week, fever of 103.4 rectally in the ed, poor clearance of secretions and aspiration risk (although no consolidation on film); she was therefore covered for hospital-acquired pna with vanco and zosyn. blood cultures and urine cultures were negative and her mrsa screen was negative. the patient was unable to provide a satisfactory sputum sample. legionella ua was negative. the patient was low risk by criteria for pe so no cta. she underwent speech and swallow evaluation given concern for possible aspiration, but was cleared for thin liquids and regular-consistency food (this study was done on hospital day 3 when she was more alert than on admission). she received iv furosemide prn to maintain euvolemic volume status and then returned to her home dose of lasix. she was monitored in the micu for 3 days, during which time os was weaned to 3 l by nc (from initial facemask/nrb) and she eventually was weaned to room air. she remained afebrile after the initiation of abx. a picc line was placed for continued antibiotic therapy as an outpatient. she ultimately expired on . # ams/lethargy: this was felt to be likely multifactorial, with contributions from infection, hypoxia, and electrolyte imabalance in the setting of a severe underlying alzheimer's dementia. ms followed a waxing and course consistent with delirium. given h/o seizure disorder, it is possible that she had ictal or postictal events, although there was no clear evidence of seizure. she was at times borderline unresponsive (non-verbal, withdrawing to pain but not orienting to voice) and at other times awake, conversant, and able to communicate needs. after discussion with patient's daughter, it appeared that this was not an acute event but she may have baseline waxing/ mental status that has been going on for weeks to months in the setting of frequent exacerbations of illness. treatment was aimed at underlying infection, hypoxia and electrolyte imbalances with apparent improvement in ms. # fever: to 103 rectally in ed per report. patient was started on broad spectrum antibiotics for presumed pulmonary source with resoultion of fevers. lactate remained wnl, and wbc was not elevated. # hypernatremia: na was elevated on admission to 146. this ultimately normalized with control of volume status to 140 by hospital day #3. # chf: the patient has known chf with lvef of 25% and 3+ mr o. given her recent admission for presumed chf exacerbation, it is likely that some degree of volume overload contributed to her symptoms of hypoxia. . # copd: the patient was continued on home medications, although albuterol nebs were held in the setting of tachycardia. # suprapubic swelling: the patient was noted to have right suprapubic swelling involving the right labia majora which was somewhat mobile but there was no defined mass. this may be due to a hernia or soft tissue mass such as a lipoma or fibroma. malignancy was also considered. the patient did not experience any discomfort from the swelling and did not have any obstructive physiology. this was discussed with her daughter who was the primary medical decision maker and a plan was made not to pursue this further diagnostically. . # seizure disorder: phenytoin level was initially subtherapeutic. the patient was started on phenytoin 100mg iv q8h with and was then converted to po home dose when able to tolerate oral medications. # atrial fibrillation: initially patient had rvr to 150s, but rate was better controlled s/p ivf. ce baseline. inr was subtherapeutic but coumadin was held given concern that antibiotics may augment these levels. metoprolol and digoxin were continued; coumadin was ultimately restarted and her inr was 1.8 on last check. # chronic renal failure: at baseline. creatinine was trended daily. # coronary artery disease: ekg stable, elevated trop (at baseline) likely related to crf. she was continued on aspirin, statin, bb. # anemia: be related to crf, multiple myeloma. hct stable at baseline. # multiple myeloma: trend creatinine and electrolytes. no treatment at this time. # diabetes: patient was maintained on an insulin sliding scale. code: she was a dnr/dni during this hospitalization. palliative care was consulted and in discussion with her daughter , who has been the primary medical decision maker, a plan was made for the patient to return to under guardianship, with a plan to become hospice care. however the patient ultimately expired on in the hospital before this plan could be executed. her cause of death was pneumonia in the setting of chronic congestive heart failure and alzheimer's dementia. medications on admission: 1. senna 8.6 mg prn constipation 2. docusate sodium 100 mg prn constipation 3. aspirin 81 mg daily 4. ergocalciferol (vitamin d2) 50,000 unit 1x/week 5. montelukast 10 mg daily 6. ferrous sulfate 300 mg (60 mg iron) daily 7. multivitamin,tx-minerals 1 tab daily 8. warfarin 5mg qpm 9. hiss 10. phenytoin 250mg 11. metoprolol tartrate 37.5mg 12. digoxin 125 mcg 2x/week (tu, sat) 13. ipratropium bromide 0.02 % solution q6h 14. furosemide 40 mg (planned increased to 60mg qam, 40mg qpm on ) 15. atorvastatin 20mg daily 16. zantac 150mg daily (planned to start ) 19. mucinex 600mg x 7 days (planned to start ) 20. guaifenesin 10ml q4-6h prn cough 21. mom 30ml daily prn constipation 22. fleet enema pr daily prn constipation 23. bisacodyl 10mg supp prn constipation discharge medications: none -patient expired discharge disposition: expired discharge diagnosis: primary health care associated pneumonia . secondary acute on chronic heart failure discharge condition: patient expired discharge instructions: none followup instructions: patient expired procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified hypocalcemia coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, unspecified old myocardial infarction multiple myeloma, without mention of having achieved remission epilepsy, unspecified, without mention of intractable epilepsy alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to