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: s/p fall major surgical or invasive procedure: endotracheal intubation left subclavian central line placement history of present illness: 62 yof w/ h/o asthma, morbid obesity prior mrsa pneumonia presents s/p fall. she has had 2 falls within the last week. 6 days prior to admission, she was unable to get up off the toilet and fell forward on her knees. she required assistance to climb to her feet. the day of admission, she again was unable to get off the toilet, because her legs "felt numb" she fell forward onto her elbows. no loc, no associated cp, shortness of breath, head trauma, palpitations. she presented to the ed and, given concern expressed by family members that she was not receiving apppropriate care at her current facilities, she was admitted to the medical service for pt evaluation and placement. of note, she developed a cough, rhinorrhea, and sore throat last week, at which time her pcp placed her on levofloxacin. she was also started on prednisone 10 mg po daily as she was unable to use her steroid inhaler adequately. currently, she reports bilateral shoulder pain with movement. she also notes non-productive cough, chills last night (no fever). pt is very sedentary at baseline, walking with a walker from one room of her apartment to another. sleeps on 2 pillows at night, no recent change. no pnd. . ros: no headache, myalgias, recent change in appetite, nausea, vomiting, abdominal pain. (+) chronic diarrhea, no brbpr/melena. last bm last p.m. no dysuria, hematuria, increased urinary frequency/urgency. past medical history: 1) asthma - pfts fev1 0.54 (27%), fvc 0.57 (21%), fev1/fvc 130% c/w restrictive defect 2) mental retardation 3) ?temporal lobe epilepsy: this diagnosis has been questioned in the past 4) h/o mrsa pna requiring intubation : pt was found down in respiratory failure; etiology was unclear, but possible contributors included osa-associated hypercapnia, aspiration, and congestive heart failure - cta (technically limited): no central/lobar pe. improvement in previously-noted opacities in right lung. 5) obstructive sleep apnea: - sleep study with titration of cpap to 19 cm with 4l o2. pt reports she is not regularly using cpap 6) bipolar disorder: currently on lithium and seroquel 7) hypertension 8) disease: diagnosis is unclear 9) osteoarthritis 10) gerd 11) h/o chf: - ef (limited): dilated, ra moderately dilated, asc aorta mildly dilated, 1+ mr, mod pulm artery systolic htn. 12) morbid obesity social history: lives in in brookeline with visiting services. ambulates with a walker. no tobacco, alcohol, or other drug use family history: cancer nos in mom and dad no htn no dm physical exam: tc 96.7, pc 76, bpc 132/81, resp 13, 100% 2l nc gen: pleasant female, alert, oriented x 3, breathing comfortably, nad heent: nc/at, perrl, eomi, anicteric, nl conjunctiva, ommm, op clear, neck supple, no lad, unable to assess jvp secondary to neck size cardiac: rrr, soft s1/s2, no m/r/g appreciated pulm: occasional ronchi, decreased ls at bases bilaterally abd: obese, soft, nt/nd ext: no edema, warm with good cap refill. no cyanosis. full range of motion of wrists and elbows bilaterally. unable to assess rom shoulders bilaterally secondary to body habitus. no point tenderness/crepitus over clavicles/shoulders bilaterally skin: abrasions with ecchymosis over right and left elbow. extensive fungal rash over groin area bilaterally. neuro: moves all 4 extremities, cn ii-xii grossly intact and symmetric bilaterally, sensation intact to light touch proximally and distally in upper and lower extremities bilaterally pertinent results: laboratory studies on admission: wbc-12.9*# rbc-3.73* hgb-10.3* hct-32.3* mcv-87 mch-27.8 mchc-32.1 rdw-17.4* neuts-83.8* bands-0 lymphs-13.0* monos-2.6 eos-0.1 basos-0.4 plt smr-normal plt count-355 glucose-86 urea n-17 creat-0.7 sodium-139 potassium-5.4* chloride-100 total co2-30 anion gap-14 probnp-753* tsh-3.0 lithium-0.9 ekg: nsr 68 bpm. diffuse twf, no sig change from prior . cxr : limited study. stable cardiomegaly, mild/mod chf . head ct w/o contrast : no acute intracranial process . bilateral shoulder films : exam is limited by patient body habitus. mild to moderate degenerative change, including marginal osteophyte formation is evident about the glenohumeral joints, bilaterally. there is anatomic alignment of the humeral head in the glenoid. the acromioclavicular joint is unremarkable. visualized lung and ribs are unremarkable . cxr the tip of the endotracheal tube is at the level of the aortic knob. there is a left-sided central venous catheter with the distal tip in the junction of the svc and left brachiocephalic vein, unchanged. the nasogastric tube is within normal limits for placement. there are markedly low lung volumes due to poor inspiratory effort. there is again seen opacity at the left retrocardiac region, which has not significantly changed since the previous. there is some mild prominence of the pulmonary vasculature, also unchanged. brief hospital course: a: 62 yof w/ morbid obesity, obstructive sleep apnea, restrictive lung disease presents s/p fall p: 1) recurrent falls: the patient had 2 falls within the week prior to admission. these falls are most likely mechanical, secondary to deconditioning in setting of morbid obesity. there was no evidence of syncope/presyncope to suggest orthostatic, vasovagal, or cardiogenic etiology. plain films of shoulders showed no fracture/dislocation. physical and occupational therapy were consulted, who recommended placement at a rehabilitation facility. 2) hypercarbic respiratory failure: on a.m., the patient was found to be hypoxic - 87% 2l nc, with diffuse wheezing, congestion and non-productive cough. there was no improvement with alb nebs/oxygen, or nasal bipap (abg: 7.21/89/141). she was transferred to micu with hypercarbic respiratory failure. she was initially placed on bipap 15/5 with improvement in pco2s to 62. however, ~ 30 minutes after it was discontinued, she became more somnolent, with repeat pco2 of 93. she was intubated on at 9 p.m and started on vancomycin/levofloxacin/metronidazole for presumed aspiration. micu course notable for multiple temperature spikes attributed to aspiration pneumonia for which abx were broadened to ceftazidime/vancomycin . she was extubated without complication. her hypcarbic respiratory failure wasm most likely secondary to aspiration pneumonia superimposed on underlying osa and obesity/hypoventilation syndrome. a) aspiration pneumonia (mrsa): the patient was continued ceftazidime/vancomycin for 14 day course (to complete ). fiberoptic endoscopic swallowing evaluation showed a functional oral and pharyngeal swallow mechanism without evidence for aspiration. the patient should be maintained on strict aspiration precautions. b) osa: the patient will be continued nasal bipap 15/5 with 4l nc from 8 pm to 8 am. pulmonary service was consulted, who recommended follow-up in sleep disorder clinic, and goal o2 sat no higher than 92% during the day. c) copd: the patient carries this diagnosis, although pfts more c/w restrictive physiology (nonoptimal study). she will continue on flovent (to be changed to budesonide nebs on discharge), albuterol/atrovent, and singulair. 2) congestive heart failure: tte (suboptimal) showed a presumed preserved ef. she was continued on an ace inhibitor. her home dose of furosemide was resumed following transfer back to the general medical floor. she was continued on a 1.5l fluid restriction. her weight should be monitored daily, to ensure stability. 3) hypotension: following transfer to the micu on , she was noted to be hypotensive sbp 80s, with a transient requirement for pressors (levophed). this transient hypotension was most likely sepsis/sirs related to aspiration pneumonia with possible contributor of medications/sedation. cortisol stimulation test was normal, indicating that adrenal insufficiency was not a contributor, and her ekg showed no evidence of myocardial ischemia. currently, her sbp is stable 110-130. 4) microcytic anemia: the patient had an unexplained drop in her hematocrit from 30 to 25 while in the icu. she remained guaic negative, and there was no clear evidence of bleeding. iron studies were not consistent with iron deficiency, vitamin b!2 and folate levels were normal, and hemolysis labs were negative. the cause of the drop in her hematocrit remains unclear, however her hematocrit remains stable at 26.2. she will need to have her hematocrit monitored as an outpatient to ensure stability. colonoscopy showed only small, non-bleeding internal hemorrhoids. egd showed antral gastritis, but was otherwise normal. she was continued on pantoprazole throughout her hospital stay. repeat colonoscopy may be considered by the patient's primary care physician as an outpatient. 5) arf: creatinine increased from 0.7 to 1.9 while in the intensive care unit, however rapidly improved to 0.8. this brief episode of renal failure was likely pre-renal in etiology vs atn from brief hypotension. 6) bipolar disorder: she was continued on lithium and seroquel. 7) disease: this diagnosis is unclear. the patient is morbidly obese with history of hypertension and left adrenal mass noted on ct , however she has not had documented high cortisol levels, a dexamethasone suppression test or a 24 hr urine cortisol. work-up of disease is not advisable during hospital stay given acute illness/elevated cortisol levels. an appointment has been arranged for outpatient evaluation by endocrinology (24 hr urine cortisol/dexamethasone suppression test) 8) contact: sister 9) full code medications on admission: 1) prednisone 10 mg po daily 2) levoquin 500 mg po daily (at least 1 week) 3) prilosec 20 mg po bid 4) seroquel 100 mg po bid, 400 mg po qhs 5) furosemide 20 mg po daily 6) flovent 4 puff 7) lisinopril 10 mg po daily 8) ibuprofen 600 mg po tid prn 9) albuterol mdi prn 10) lithium 150 mg po tid 11) singulair 10 mg po daily discharge medications: 1. lithium carbonate 150 mg capsule sig: one (1) capsule po tid (3 times a day). 2. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 4. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 8. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed. 11. budesonide 0.5 mg/2 ml solution for nebulization sig: one (1) neb inhalation four times a day. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 14. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours). 15. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 16. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed. 17. quetiapine 100 mg tablet sig: one (1) tablet po bid (2 times a day): 8 a.m. and 1 p.m. 18. quetiapine 100 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 19. vancomycin 500 mg recon soln sig: 1250 (1250) mg intravenous q 12h (every 12 hours) for 4 days. 20. ceftazidime 1 g recon soln sig: one (1) g intravenous every twelve (12) hours for 4 days. 21. quetiapine 25 mg tablet sig: two (2) tablet po at bedtime: for a total of 250 mg po qhs. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: hypercarbic respiratory failure secondary: obstructive sleep apnea, aspiration pneumonia, fastroesophageal reflux disease, diastolic congestive heart failure, morbid obesity, bipolar disorder, mental retardation discharge condition: good discharge instructions: please follow-up with your primary care physician or come to the emergency room if you develop shortness of breath, lightheadedness, or other symptoms that you find concerning. followup instructions: 1) pulmonary provider: . & dr. phone: date/time: 3:00 2) sleep clinic provider: & dr phone: date/time: 9:00 3) primary care dr. () 2:40 p.m. 4) endocrinology provider: , md phone: date/time: 3:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation infusion of vasopressor agent diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis acute respiratory failure pneumonitis due to inhalation of food or vomitus morbid obesity bipolar disorder, unspecified adult failure to thrive unspecified intellectual disabilities dermatophytosis of groin and perianal area history of fall 

Answer: The patient is high likely exposed to