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: patient recorded as having no known allergies to drugs attending: chief complaint: difficulty breathing, "i don't want to fall" major surgical or invasive procedure: s/p intubation history of present illness: ms is a 60 year old woman with past medical history significant for chronic obstructive pulmonary disease, diabetes mellitus, hypertension and schizophrenia, presenting with a 5-day history of worsening dyspnea and fear of falling. . over the past few days (since ), patient has noted increasing dyspnea both at rest and on exertion. she uses a cane. she is unable to provide a clear history regarding baseline ability to walk without dyspnea. however over the last few days her dyspnea has worsened to the point where it is difficult for her to get dressed in the morning. . during this time she has noted a worsening cough, productive of green non-bloody sputum. she denies fever or chills. she also notes feeling "flushed in the face" over the past several weeks. she uses two pillows to sleep. she denies peripheral edema or increasing abdominal girth. she endorses chest pain for three days which is sternal, constant, and exacerbated with palpation. she has no recent travel history and is not able to describe sick contacts. she denies nausea or vomiting. of note, the patient is a resident at house and was not able to provide a reliable history. . the patient also reports fear of falling over the past few days. she feels somewhat unstable and is afraid of falling unsupervised. she has not fallen yet. she denies headaches, light-headedness, blurred vision, or feeling faint. . in the ed, her oxygen saturation was 72% on room air. she was given aspirin and nitroglycerin, albuterol and ipratropium bromide nebs x2 and methylprednisolone, and started on azithromycin and ceftriazone for community-acquired pneumonia coverage. her saturation was 92% on 3l nasal cannula after nebulizer administration. pt was admitted to the medicine floor. past medical history: copd, 2 ppday smoking history hypertension diabetes mellitus ii schizophrenia, and ?mr breast mass, s/p l mastectomy oa, knees, b/l social history: the patient is from the area. she is a resident at house. she has several siblings in and in . she has smoked 2ppd for many years. she denies alcohol or drug use. family history: patient is not aware of any history of copd / asthma / atopy. physical exam: vs: t98.6f hr 100 bp 156/69 rr 20 o2 sat 90% ^lnc general: obese caucasian woman lying in ed cot, breathing with some difficulty heent: perrl, eomi, dry mm, hirsutism of chin neck: supple, no thyromegaly or lympadenopathy chest: + 15+ cm horizontal scar from l mastectomy, "buffalo hump", patient breathing with some difficulty and congestion, hyperinflated, diffuse wheezes bilaterally with bibasilar crackles cor: rrr, nl s1 and s2, no jvd abdomen: rotund, + bs, difficult to assess hsm due to size gu: not examined extremities: pulses in dp b/l, no c,c,e, sensation to lt and sharp object intact in lower extremities neuro: patient is awake, alert and oriented x3. she is cooperative, speaking in short sentences, concrete thinking, providing unreliable history pertinent results: admission laboratory data: wbc 9.1 hct 41.9 mcv 94 plt 243 n:85.4 l:9.1 m:5.3 e:0.2 bas:0 hypochr: 2+ anisocy: 1+ poiklo: 1+ macrocy: 1+ pt: 11.9 ptt: 21.7 inr: 1.0 . na 137 k 5.9 cl 98 hco3 34 bun 24 cr 0.9 glu 152 agap=5 repeat k 5.5 . probnp: lactate:0.7 . cardiac enzymes: negative x3 . microbiology: blood culture: no growth urine culture: now growth , , sputum: oropharyngeal flora . ekg: nsr@97, lad, lafb, twi 1/l/v6, jpt elevation v2-3, 1mm std v6 . imaging: cxr (admission): an endotracheal tube has been placed in the interval with the tip of the tube lying 4.9 cm from the carina. a nasogastric tube has been inserted in the interval with the tip below the diaphragm, off the inferior borders of the film. the heart is enlarged. there is continued perihilar haziness and vascular engorgement consistent with congestive heart failure which is slightly improved in the interval. a more focal opacity is seen in the right lower lobe likely representing pneumonia, which appears slightly improved in the interval. there is no pneumothorax. no effusions are seen. impression: 1. satisfactory placement of endotracheal tube and nasogastric tube. 2. minimal improvement in congestive heart failure. 3. slight interval improvement in right lower lobe pneumonia. . cxr (): impression: 1. widening of the left mediastinal contour lateral to aortic knob calcification, concerning for aortic dissection. cta of the chest is recommended for further evaluation. differential diagnosis includes lymphadenopathy and mediastinal lipomatosis. 2. improving chf and resolving right lower lobe process. . cta chest/abd/pelvis (): 1. consolidative opacities in the lower lobes dependently are suggestive of aspiration pneumonia. 2. mediastinal and bilateral hilar lymphadenopathy and pulmonary nodules. this could represent metastatic disease (possibly breast cancer given the patient's mastectomy), lymphoma, or an inflammatory process such as sarcoid. comparison with prior studies would be helpful for further evaluation. 3. splenic artery aneurism. . echo (): 1. the left atrium is normal in size. the left atrium is elongated. 2.left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is at least mild global left ventricular hypokinesis. overall left ventricular systolic function is at least mildly depressed but images are suboptimal and ef could be lower. 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. 5.the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 6.there is no pericardial effusion. . brief hospital course: assessment and plan. ms is a 60 year old woman with history of copd, hypertension, diabetes mellitus and schizophrenia who was initially admitted to the medicine floor with a 6-day history dyspnea, cough and fear of falling. on admission to the floor, pt developed hypercarbic/hypoxic respiratory failure requiring intubation and transfer to the micu. . 1. respiratory failure: secondary to copd exacerbation and bilateral lower lobe pneumonia. pt's oxygenation and dyspnea initially improved with nebulizers, steroids, and antibiotics given in the ed. on arrival to the floor, pt was noted to somnolent and barely able to open eyes to verbal stimuli. pt was noted to be in respiratory distress with o2 sats 83-89% on 6l nc and rr of 51. she was tachycardic with hr 90-100s and bp 120-130s/60s. given albuterol/atrovent nebs. abg was 7.17/96/63. pt was transferred to the micu. brief trial of bipap for hypercarbic/hypoxic respiratory failure was unsuccessful and pt was electively intubated. in the unit, pt was continued on around the clock albuterol and atrovent nebulizers. pt was given iv solumedrol. pt was continued on ceftriaxone and azithromycin for treatment of cap/atypical pneumonia. pt received iv lasix for diuresis, for possible component of chf. echocardiogram revealed mildly depressed ef of 40-45%, but not other abnormalities. while intubated, pt's pulse o2 sats ranged from 90-94%, with pao2 range from 72-100; her hypoxia was consistent with underlying copd and new pna. on , pt had a bronchoscopy for pulmonary toilet, because of secretions. bronchoscopy was normal without any secretions. pt was successfully extubated on . pt's antibiotics were switched to levofloxacin; she completed 7/10 days of antibiotics. solumedrol was switched to prednisone on ; pt should complete a 12 day taper. . chest pain: pt reported chest pain at group home for 3 days. the pain was somewhat reproducible on physical examination. ekg showed twi and lateral st depression. cardiac enzymes were negative x3 and pt was ruled out for mi. pt was continued on aspirin, statin. pt had one episode of nsvt (8beat), hemodynamically stable. pt should have a stress test as an outpatient to evaluate for possible cad/ischemia. pt didn't have any chest pain while hospitalized. . mediastinal lymphadenopathy: cxr on was noted to have mediastinal widening. pt was cp-free with equal bp bilaterally. cta was performed for further evaluation and found hilar lymphadenopathy - ddx includes reactive, malignancy, sarcoid. 2 small pulmonary nodules were noted in rml and rul. pt needs a repeat chest ct as an outpatient. . hypertension: bp meds initially held. lopressor and lisinopril were restarted and titrated up. . diabetes mellitus: metformin and glyburide was held during this admission. pt was given insulin ss. metformin and glyburide will be restarted on discharge. . hyperkalemia: pt was given kayexalate for k of 5.9. potassium remained normal. . schizophrenia: pt was continued on olanzapine. . history of breast cancer: pt was continued on anstrozole. . code: full medications on admission: acetaminophen 500 mg - 2 tab po q8h prn pain or temp multivitamin 1 tab po daily lisinopril 10mg po daily glyburide 5mg po daily metformin hcl 500 mg po daily anastrozole 1 mg po daily colace 100mg po bid ibuprofin 800 mg po bid w/ food ranitidine 150 mg po bid senna 2 tabs po qhs atorvastatin 20mg po daily olanzapine 10mg po qhs loperamide 2mg po q4h prn magnesium hydroxide 30ml po qhs robitussin 16 ml po q4-6h prn cough discharge medications: 1. nicotine 21 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. anastrozole 1 mg tablet sig: one (1) tablet po qd (). 5. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 8. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 9. multivitamins tablet, chewable sig: one (1) cap po daily (daily). 10. olanzapine 10 mg tablet sig: one (1) tablet po hs (at bedtime). 11. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 14. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day). 15. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days. 16. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 17. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 18. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 19. albuterol sulfate 0.083 % solution sig: one (1) inhalation q2h (every 2 hours) as needed. 20. prednisone 10 mg tablets, dose pack sig: one (1) tablets, dose pack po once a day for 10 days: please continue on steroid taper: : 60mg qd (3days): 40mg qd (3 days): 20mg qd (3 days): 10mg qd . 21. glyburide 5 mg tablet sig: one (1) tablet po once a day. 22. metformin 500 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnoses: respiratory failure requiring intubation copd exacerbation pneumonia chf hilar lymphadenopathy chest pain nsvt . secondary diagnoses: schizophrenia hx breast cancer dm discharge condition: stable, o2 sats in mid 90s, no respiratory distress discharge instructions: call your doctor or return to the emergency room immediately, if you develop fevers, chills, difficulty breathing, chest pain, or any other concerning symptoms. followup instructions: follow up with your pcp 2 weeks of discharge. call , to schedule an appointment. please have a repeat chest ct in weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube other bronchoscopy diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of breast unspecified schizophrenia, unspecified acute respiratory failure chronic obstructive asthma with (acute) exacerbation 

Answer: The patient is high likely exposed to