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: respiratory distress major surgical or invasive procedure: intubation/extubation history of present illness: ms. is an 81f h/o dermatomyositis, htn, dchf, copd presents with sob. her daughter notes that she had developed a uri 2 days ago w/ rhinorrhea and mild cough. she was sent from nursing home for evaluation as today at 10am developed sob and desats to the 70s. no documentation in chart from nursing home. . in the ed, initial vitals were 99.6, 95, 160/85, 87% on nrb. exam with decreased bilat breath sounds with basilar rales. abg 7.3/86/199. labs notable for wbc 73 (no bands), k 2.8, lactate 2.4, ck 81, tnt 0.03. u/a negative. blood cultures sent. initially thought chf exacerbation. bipap, lasix 40mg, and nitro gtt with good urine output response but decrease in sbp to 50s that improved to 90s after nitro discontinued. decadron 10mg iv also given as on chronic prednisone. review of cxr then did not appear to be chf but rather possible infiltrate consistent with pneumonia so gave ceftriaxone 1g, vancomycin 1g, and levofloxacin 750mg. finally, they did not believe that the pneumonia on cxr could explain her hypoxia, thus a cta chest was performed to r/o pe which showed no pe but multifocal pna. after some discussion, the family decided to reverse dnr status and therefore she was intubated for respiratory distress and hypercarbia, with post-intubation abg 7.62/38/487 (550x18/5/1.0). admit icu. past medical history: htn dchf copd right hemidiaphragm paralysis dermatomyositis spinal stenosis gerd right leg gangrene asceptic bone necrosis pancreatic disease aortic stenosis social history: former smoker, rare etoh, lives in . not ambulatory and uses a wheelchair family history: nc physical exam: vitals 96.9, 76, 113/72, 17 on ac 450/12, 1.0 fio2 and peep 5 gen: awake, alert heent ett/ogt in place, perrla pulm: distant breath sounds bl cv distant heart sounds, rrr, no g/m/r appreciated abd soft, nt, nd, nabs, no hsm extrem no edema, areas of skin removal for skin graft on r thigh neuro able to write answers to questions appropriately pertinent results: labs on admission: 10:40am blood wbc-7.3 rbc-3.91* hgb-11.6* hct-35.0* mcv-90 mch-29.8 mchc-33.2 rdw-14.8 plt ct-270 10:40am blood neuts-84.9* lymphs-10.7* monos-3.4 eos-0.6 baso-0.5 10:40am blood plt ct-270 03:23pm blood pt-14.6* ptt-34.4 inr(pt)-1.3* 10:40am blood glucose-163* urean-9 creat-0.5 na-139 k-2.8* cl-88* hco3-42* angap-12 03:23pm blood glucose-155* urean-10 creat-0.3* na-137 k-3.6 cl-92* hco3-38* angap-11 10:40am blood ck(cpk)-81 02:59am blood ck(cpk)-53 10:40am blood ctropnt-0.03* 10:40am blood calcium-9.5 phos-4.4 mg-1.7 02:59am blood %hba1c-6.4* 11:23pm blood tsh-0.68 11:23pm blood free t4-1.1 11:23am blood type-art fio2-60 po2-199* pco2-86* ph-7.30* caltco2-44* base xs-12 intubat-not intuba 10:51am blood lactate-2.4* 02:56am blood lactate-0.7 discharge labs: 07:15am blood wbc-6.7 rbc-3.75* hgb-11.5* hct-33.5* mcv-89 mch-30.7 mchc-34.5 rdw-15.0 plt ct-310 07:15am blood plt ct-310 07:15am blood glucose-79 urean-19 creat-0.5 na-140 k-4.0 cl-97 hco3-41* angap-6* 07:15am blood calcium-9.3 phos-4.5# mg-1.8 studies: cxr: impression: no displaced rib fracture. right lower hemithorax opacity with unusual configuration. findings do not suggest atelectasis. there may be a component of pleural effusion, and if present, likely loculated. recommend repeating the study with pa, lateral and decubitus views, if patient can tolerate. . cta chest: impression: 1. no evidence of pulmonary embolism. 2. left lower lobe consolidation, right upper lobe bronchiolar pattern and peribronchial opacity in the posterior segment of the right upper lobe suggest multifocal aspiration or multifocal pneumonia. collapse right middle/lower lobes without obstructing mass. 3. main pulmonary artery enlargement, suggesting pulmonary hypertension. 4. aortic, mitral annulus, and coronary artery calcifications. aortic valvular calcifications, of unknown hemodynamic significance. . echo: the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70-80%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis). the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: hyperdynamic left ventricle with significant diastolic dysfunction; mild aortic stenosis . cxr: limited assessment of left lower lobe - left lower lobe consolidation cannot be excluded. bibasilar atelectasis. doubt chf. brief hospital course: ms. is an 81 f w/ pmh of dermatomyositis (on steroids), htn, as (unknown valve area), presents w/ hypoxic, hypercarbic respiratory failure. . # respiratory failure: initially thought to be secondary to bilateral ll pna seen on ct scan, and given vanc/ceftriaxone/levofloxacin in the ed, however the patient did not have clinical evidence of pneumonia. she did not have a cough, leukocytosis, increased sputum production. more likely the etiology of the respiratory failure was multifactorial with underlying low lung volumes from elevated hemidiaphragm, uri, respiratory muscle weakness and +/- aspiration pneumonitis. the icu team decided to hold antibiotics on given negative sputum and blood cx. she was extubated after two days on the ventilator without difficulty. her breathing has remained stable since that time. she was afebrile without cough or sputum production. the patient explicity reported that she does not want to be reintubated. . # dermatomyositis: diffuse muscle weakness contributing to respiratory failure. most likely worsened by deconditioning. she received decadron 10 mg iv x 1 in ed and was continued on prednisone 15mg (home dose). both rheumatology and neurology were consulted in house. aldolase level was checked which was normal. both teams recommended intensive physical therapy but no other changes in her regimen. neurology did not feel emg would be helpful with management. continue ppi given steroid use. . # left hip dislocation: the patient does not have pain from her hip dislocation that has probably been present for at least months. attempted to get x-rays however the patient refused. the patient refused ortho consult. she was continued on calcium and d and instructed to follow up with her primary care doctor regarding this. benefit from bisphosphonate. . # urinary tract infection: positive ua with catheter in place. foley changed. urine culture pending at time of discharge. plan for 7 day course of ciprofloxacin. ua also notable for large blood with no rbcs - this was attributed to underlying dermatomyositis. . # diastolic chf: the patient did not require diuresis. continued lisinopril, metoprolol initially at lower doses, but eventually titrated up to home dose. . # htn: initially held amlodipine, metoprolol and lisinopril given questionable sepsis. however, once it was clear that bp was stable metoprolol, amlodipine and lisinopril were continued at home regimen. . # aortic stenosis: echo done here showed mild aortic stenosis, valve area 1.2-1.9cm2. . # anemia: remained stable . # hyperglycemia: no diagnosis of dm2. hyperglycemia is likely from steroids. would continue to monitor . # osteopenia: continued calcium/vit d. consider starting bisphosphonate as outpatient with pcp. level pending at time of discharge. . # chronic pain: continued oxycontin, lidoderm patch, nortriptyline . fen: regular diet, repleted lytes prn access: pivs ppx: sc heparin (refused), bowel regimen prn code: dnr/dni - discussed extensively with patient. medications on admission: norvasc 10 daily mvi lactinex 1 tab c 500 colace 100 gabapentin 600 tid calcium + d 250-125 tid nortriptyline 10 daily cipro 500 x 5 days (day2) b12 1000 mcg im qmonth atenolol 25mg daily detrol la 2mg daily lisinopril 20mg daily prednisone 15mg daily oxycontin 10mg daily mom prn bisacodyl prn fleet enema prn tylenol prn compazine 25mg pr q6h prn senna prn restoril 7.5 qhs prn insomnia lidoderm patch discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily). 2. prednisone 5 mg tablet sig: three (3) tablet po daily (daily). 3. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. gabapentin 300 mg capsule sig: two (2) capsule po tid (3 times a day). 5. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 6. cholecalciferol ( d3) 400 unit tablet sig: two (2) tablet po daily (daily). 7. nortriptyline 10 mg capsule sig: one (1) capsule po hs (at bedtime). 8. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po daily (daily). 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 10. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 12. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. 13. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 14. tolterodine 1 mg tablet sig: one (1) tablet po bid (2 times a day). 15. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 16. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 18. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 19. insulin lispro 100 unit/ml solution sig: one (1) insulin sliding scale subcutaneous asdir (as directed). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: hypercarbic respiratory failure dermatomyositis urinary tract infection avn of left hip diastolic heart failure, compensated hypertension aortic stenosis anemia osteopenia discharge condition: stable on baseline o2 requirements. discharge instructions: you were admitted with difficulty breathing. you required a breathing tube to help with this. it was felt that this was likely related to underlying weakness of the diaphragm and possibly an upper respiratory infection. you were also found to have a urinary tract infection. you were treated with ciprofloxacin. you will need to complete a 7 day course of antibiotics. if you have any further chest pain, shortness of breath, lightheadedness, dizziness, or other concerning symptoms please call your doctor or go to the emergency room. followup instructions: you should follow up with your primary care doctor, dr. , once you are discharged from rehab. his phone number is . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: other chronic pain anemia, unspecified esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use chronic airway obstruction, not elsewhere classified aortic valve disorders acute respiratory failure toxic myopathy aseptic necrosis of head and neck of femur chronic diastolic heart failure disorder of bone and cartilage, unspecified other abnormal glucose dermatomyositis 

Answer: The patient is high likely exposed to