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: belladonna alkaloids attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: ms. is an 81 year old speaking female with a history of anemia and thrombocytopenia, crohn's disease on chronic steroids, pe, returned from rehabilitation for somnolence. found to be hypoxic and somnolent in the emergency room (vs t 98, bp 132/53, hr 92, rr 24, 95% on nrb). new infiltrate on cxr in the left upper lobe, and abg showed hypercarbia. she was admitted to the icu and started on meropenem and vancomycin. she was given iv fluids for hypotension and responded appropriately. she was started on bipap in the icu which improved her somnolence, and mental status returned to baseline. past medical history: past medical history: -anemia cri, chronic disease -mds dx 3 yrs ago -crohn's disease -cad s/p nstemi ' -cri w baseline cr 1.5-1.8 -bl dvts and saddle embolus in , previously on warfarin now on lovenox -chronic bl le edema -breast cancer s/p lumpectomy & xrt -gerd -intracranial bleed and fx after pedestrian vs car 20 yrs ago -cataracts -venous stasis dermatitis -tinea pedis -?arrhythmia unspecified which daughter says is tx with metoprolol -dhf with ef 60-70% . past surgical history: -ccy 10 yrs ago -lumpectomy 13 yrs ago social history: married; lives with her husband who is demented, her daughter , husband and 6 granddaughter. presently in temporary housing while awaiting renovations on their which was damaged during a fire last winter. is the caretaker for both of her parents. very stressed and overwhelmed. her mother-in-law in died this past month which required her husband to leave for . she is in the midst of trying to place her father in nursing care facility and is quite guilty about this decision. ms. y recieves near daily rn visits from suburban home care. is reliant on "sitters" to bring her mother to appointments. family history: non-contributory physical exam: vs: t hr 84 bp 112/41 rr 15 o2 86% on 4l nc general: nad, pleasant and interactive, nc in place : ncat mmm anicteric pink conjunctiva neck: no jvd appreciated, supple lungs: crackles at lll cv: rrr 2/6 sem at lusb, pmi nondisplaced abd: soft, nt, nd, bowel sounds present, palpable non-moveable mass c/w ventral hernia ext: + anasarca, lle cellulitis - warm, erythematous, tender skin: numerous ecchymoses and sites of skin breakdown over torso and extremities pertinent results: 05:56am pt-13.2 ptt-25.0 inr(pt)-1.1 05:56am plt smr-low plt count-82* 05:56am wbc-11.8* rbc-2.86* hgb-9.6* hct-29.5* mcv-103* mch-33.7* mchc-32.6 rdw-18.8* 05:56am calcium-7.9* phosphate-3.9 magnesium-1.6 05:56am estgfr-using this 05:56am glucose-110* urea n-67* creat-2.5* sodium-143 potassium-5.2* chloride-109* total co2-27 anion gap-12 10:11am urine mucous-rare 10:11am urine rbc-4* wbc-3 bacteria-none yeast-none epi-0 10:11am urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 10:11am urine color-yellow appear-clear sp -1.012 03:00pm urine rbc-* wbc- bacteria-few yeast-none epi-0-2 03:00pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 03:00pm urine color-yellow appear-clear sp -1.010 03:00pm urine gr hold-hold 03:00pm urine uhold-hold 03:00pm urine hours-random 03:00pm urine hours-random 03:45pm pt-14.2* ptt-29.3 inr(pt)-1.2* 03:45pm plt smr-low plt count-104* 03:45pm hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-1+ microcyt-occasional polychrom-occasional stippled-1+ 03:45pm neuts-74* bands-12* lymphs-6* monos-7 eos-0 basos-0 atyps-0 metas-0 myelos-1* 03:45pm wbc-15.9* rbc-3.19* hgb-11.0* hct-33.8* mcv-106* mch-34.4* mchc-32.5 rdw-19.2* 03:45pm ck-mb-notdone ctropnt-0.07* 03:45pm ck(cpk)-18* 03:45pm glucose-107* urea n-58* creat-2.3* sodium-144 potassium-5.3* chloride-110* total co2-25 anion gap-14 05:27pm freeca-1.15 05:27pm hgb-10.9* calchct-33 o2 sat-92 carboxyhb-1 05:27pm glucose-137* lactate-1.0 na+-143 k+-5.4* cl--107 05:27pm type-art po2-69* pco2-73* ph-7.18* total co2-29 base xs--2 brief hospital course: # pneumonia: the patient was admitted to the medicine service for new left upper lobe pneumonia thought to be consistent with aspiration. she was started on vancomycin and meropenem. given she was afebrile, no leukocytosis and was hemodynamically stable vancomycin was discontinued two days into admission meropenem was continued for a 10 day course. on day 10 of admission she was found to be somnolent in the morning. per her daughter she received valerian root overnight for insomnia and anxiety. abg indicated respiratory acidosis, with pco2 at 81 (baseline high 50s to 60). she was transferred to the icu for further management. she was started on bipap until her blood gas improved. she was able to come off to eat her dinner. she was put back on bipap overnight to get some rest. in the morning, she again came off and continued to do well. patient did receive one 250cc bolus for hypotension and an appropriate increase in her blood pressure. she completed her 10 days of meropenem. prior to discharge she was scheduled for a sleep study to further evaluate for home bipap. . # diastolic heart failure: echo done on previous discharge showed mild lvh, hyperdynamic systolic function (ef>75%), right ventricular pressure/volume overload, 2+tr, and moderate pulmonary artery hypertension. her lasix was continued at 10mg daily and intake/output was monitored as well. she continued to do well without need for further intervention. prior to discharge she was restarted on her home beta blocker (metoprolol succinate 12.5mg po bid) with good bp control. . # ckd: admitted with cr of 2.3, which was near her baseline. with conservative treatment creatinine improved to 1.4. nephrotoxins were avoided. . # crohn's disease: she did not experience frequent bouts of diarrhea on this admission. prednisone was initially continued, but changed to a slower per daughters request. ciprofloxacin and mesalamine was continued. . # mds and related anemia: she was given 1u prbc for hct 24, and weekly epogen was restarted on this admission. she will need further follow-up with hematology. . # dvt/pe: patient had chronic dvt/pe in the past for which she was on lovenox. the patient's daughter refused heparin (previous history of worsening thrombocytopenia w/use although hit ab negative) and pneumoboot to arm given patients poor skin condition. given her anemia and thrombocytopenia, her previous bloody stools, it was felt the risk of bleeding with anticoagulation was highter than her risk for worsening dvt or pe at this time. this should be re-evaluated by her pcp in the future. . # wound care: the patients skin looked much improved since her last admission, with decreased extremity edema. nursing wound care was continued per previous recommendations. . # gerd: omeprazole 20mg twice daily was continued . # prophylaxis: calcium and vitamin d were continued, bactrim was added for pcp . # social/psych: during this admission, social work and ethics were called to assist in determining what was the appropriate level of care for the patient (rehabilitation or home with services). a family meeting was held, and the medical team and family were in agreement that the patient can be cared for at home with 24h care to assist her daughter. she did not want to consider rehabilitation, although this would have been the ideal setting for the patient at this time. . # code: dnr/dni medications on admission: acetaminophen prn pain vitamin d 800 u q day mesalamine 1200 camphor-menthol lotion prn miconazole powder prn atrovent q 6 hours albuterol q2 prn ciprofloxacin 250 mg loperamide 2 mg po qid calcium carbonate 1000 mg tid timolol maleate 0.5 drops daily polyvinyl alochol-povidone drops prn predinosone 60 mg lasix 10 mg daily discharge medications: 1. semi-electric bed hospital bed for diagnosis of respiratory failure and congestive heart failure 2. bipap bipap machine: st pressures , with backup rr of 10 3. picc flushes picc heparin flushes: per neht protocol 4. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 5. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po bid (2 times a day). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed: apply up to 4 times daily to affected area. disp:*qs 1* refills:*2* 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 9. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*2* 11. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. prednisone 10 mg tablet sig: 3.5 tablets po daily (daily): 35mg daily until ; take 30mg daily then follow your outpatient doctors orders for . disp:*10 tablet(s)* refills:*0* 14. epoetin alfa 10,000 unit/ml solution sig: one (1) injection once a week. 15. cyanocobalamin 1,000 mcg/ml solution sig: one (1) injection once a month. 16. folic acid 1 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 17. triamcinolone acetonide 0.025 % cream sig: one (1) topical twice a day: for venous stasis. 18. saline flush 0.9 % syringe sig: ten (10) ml injection once a day: on going daily flush for picc line and prn. disp:*30 syringes* refills:*2* 19. calcium 500 mg tablet sig: two (2) tablet po three times a day. 20. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po once a day. discharge disposition: home with service facility: , discharge diagnosis: hypercarbic respiratory failure diastolic heart failure discharge condition: hemodynamically stable and afebrile discharge instructions: you were admitted to the hospital for increasing shortness of breath and somnolence. you were treated for high bicarbonate levels with bipap and oxygen supplementation. you were also found to have a new pneumonia with was treated with meropenem for 10 days and vancomycin for 2 days. you will need to make an appointment with dr. at your convenience to follow your anemia and other symptoms. please make sure that you use your bipap machine at home and continue your medications as ordered. if you experience increasing shortness of breath, chest pains, fevers, chills or any other concerning symptoms please call your doctor or return to the emergency room. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction:2l followup instructions: provider: , md phone: date/time: 10:20 provider: , md phone: date/time: 3:30 provider: , rn phone: date/time: 3:30 provider: , md phone: date/time: 2:45 please make sure to attend your sleep study on at 12:45pm in the building. please call for questions on directions or if you need to reschedule. md, procedure: venous catheterization, not elsewhere classified diagnoses: anemia in chronic kidney disease other and unspecified noninfectious gastroenteritis and colitis coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified long-term (current) use of steroids acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of breast myelodysplastic syndrome, unspecified chronic kidney disease, stage iii (moderate) acute respiratory failure pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot old myocardial infarction long-term (current) use of anticoagulants personal history of venous thrombosis and embolism personal history of irradiation, presenting hazards to health other specified hypotension chronic diastolic heart failure other alteration of consciousness venous (peripheral) insufficiency, unspecified mixed acid-base balance disorder antiallergic and antiemetic drugs causing adverse effects in therapeutic use dermatophytosis of foot cardiac dysrhythmia, unspecified 

Answer: The patient is high likely exposed to