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: respiratory distress major surgical or invasive procedure: none history of present illness: ms. is a year old chinese speaking lady, baseline non-verbal, non-moving, current resident of health has been experiencing increasing work of breathing per her family. per her daughter (via translator) she has been experiencing increasing work of breathing with a low growl that is not typical. while at the nursing home, she was administered nebs per report which were not effective. despite receiving all of her regular care at (recently discharged ), ems brought her to for further evaluation. . in the ed, vital signs were initially: t: 97.7, hr:108 bp: 154/84 rr: 26 o2 sat:100% @ room air. pt appeared uncomfortable with paroxysms of redness and difficulty breathing. she was started on levofloxacin for hcap, but after her iv infiltrated, she was changed to vanc/ctx/azithro. nebs did provide some relief. asa given for elevated troponin. the patient was admitted to the micu for respiratory distress. . on arrival to the micu, the patient was non-verbal and had a low growling sound when examined. in the micu, the patient was treated with nebulizers. ent evaluated her and did not see any upper airway obstruction, though they could not exclude the lower respiratory tract. she had a ct of the chest which did not show pneumonia. since she has a firm abdomen, she had a ct of the abdomen and pelvis. for unknown reasons, the patient had an elevated lactate to 4.0. on telemetry, the patient was having short intervals of sinus tachycardia to 120. . per family/records: no fevers, chills, weight loss (actually report weight gain), vomiting, diarrhea, melena, pruritis. + constipation past medical history: - hip fx after fall in with l hip replacement, subsequent dislocation - 3 subsequent cvas leaving her non-verbal and with very limited function. unsure of territories. - g tube placement ~ - paroxysmal atrial fibrillation social history: lives at health, chinese speaking, non verbal at baseline. prior to fall/fx/strokes, patient was at home and independent. family history: non-contributory physical exam: admission physical examination: vs: t: 99 (ax) hr: 90 bp: 102/85, o2 sat: 94% ra. gen: reacts to all exam maneuvers with low non-verbal growl. has auditory wheezing, not reacting to external stimuli. skin: no rashes or skin changes noted heent: no jvd, neck supple, no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. unable to open mouth or eyes for examination chest: upper airway sounds, wheezes anteriorly. cardiac: rrr. normal s1, s2. without murmur appreciated. abdomen: g tube in place. tense, presumable tender to palpation. extremities:no peripheral edema, warm without cyanosis neurologic: nonverbal. does withdraw to painful stimuli. pertinent results: admission laboratories: 07:55am blood wbc-8.8 rbc-3.24* hgb-10.4* hct-32.9* mcv-102*# mch-32.1*# mchc-31.6 rdw-14.1 plt ct-239 07:55am blood neuts-71.5* lymphs-19.4 monos-4.8 eos-3.9 baso-0.3 07:55am blood pt-11.4 ptt-24.0 inr(pt)-0.9 07:55am blood glucose-99 urean-34* creat-1.4* na-139 k-5.1 cl-101 hco3-29 angap-14 probnp-3350* calcium-8.3* phos-3.3 mg-2.0 04:22pm blood alt-25 ast-54* alkphos-82 totbili-0.3 albumin-3.5 04:46pm blood lactate-4.0* 05:37pm blood lactate-2.7* k-4.5 cardiac enzymes: 07:55am blood ck(cpk)-53 ck-mb-notdone ctropnt-0.05* 04:22pm blood ck(cpk)-83 ck-mb-notdone ctropnt-0.04* discharge laboratories: 06:15am blood wbc-4.2 rbc-3.22* hgb-10.2* hct-31.4* mcv-98 mch-31.8 mchc-32.7 rdw-14.0 plt ct-233 06:15am blood glucose-125* urean-28* creat-1.3* na-137 k-4.5 cl-99 hco3-26 angap-17 05:45am blood alt-20 ast-30 alkphos-77 totbili-0.3 ekg: sinus tachycardia. modest non-specific st-t wave abnormalities. no previous tracing available for comparison. rate pr qrs qt/qtc p qrs t 107 0 64 0 ------------------- imaging: ct head (): impression: extensive hypodensity involving the right frontal, parietal, and temporal lobes consistent with large vascular territory infarct. no shift of normally midline structures. mri is recommended for further evaluation. ct abd/pelvis (): impression: 1. no evidence of free air or free fluid in the abdomen and pelvis. 2. left superior posterior hip dislocation. 3. bilateral moderate pleural effusions. ct chest (): ct chest without contrast: the study is limited by insufficient inspiratory effort and motion artifacts. allowing for the limitations, there are mild-to-moderate bilateral pleural effusions, with associated bibasilar relaxation atelectasis. the lungs are grossly symmetric in size. assessment of the pulmonary parenchyma is markedly limited. nonspecific ground-glass and consolidative opacities are likely secondary to bronchovascular crowding but infectious etiology cannot be excluded. there is no pneumothorax. the trachea is tortuous with a moderate right-sided buckle. the bilateral main bronchial diameter is moderately diminished, measuring approximately 3 mm on the right and 4 mm on the left. the descending aorta is also tortuous with vascular calcification most severe along the aortic arch. the heart is normal in size, and without pericardial effusion. there is coronary artery calcification. the remaining great mediastinal vessels are within normal limits. there is no mediastinal, hilar, or axillary lymphadenopathy. the esophagus is also tortuous. the study is not designed for subdiaphragmatic diagnosis. retained oral contrast is seen in the visualized loops of bowel from the ct abdomen study yesterday. bone windows: no suspicious lytic or sclerotic lesion is noted. there are mild-to-moderate multilevel degenerative changes. impression: 1. limited exam. no evidence of aspirated object. 2. tortuous trachea, with moderately diminished caliber of the bilateral main bronchi, concerning for tracheobronchomalacia. 3. bilateral small-to-moderate pleural effusions with associated atelectasis. infection cannot be excluded. 4. tortuous descending aorta and tortuous esophagus. brief hospital course: summary: year old lady with respiratory decline for three days who initially presented to the micu and transferred to the floors. assessment/plan # tracheobronchomalacia causing wheezing: this finding was seen on ct scan. there was concern for upper airway obstruction, but no foreign object or edema seen on ent scope exam. there was no pna on cxr but she did have bilateral pleural effusions and very mild pulmonary edema. she recieved a couple doses of broad abx but this was stopped as low concern for pna (no fever, leukocytosis). she was given a couple doses of iv lasix 10mg with -1.5l diuresis total with mild improvement (note from , echo showed normal lvef 55%, no dd). in addition, she was found to have episodes of afib rvr while here so she may have mild dchf leading to her effusions. we suspect she may have had a viral syndrome leading to reactive airways in setting tbm. there was no foriegn object in her lower airways. she will be treated with 5days of prednisone 40mg and nebs q3 atc. by day of discharge (after steroids and gentle diuresis), her breathing was much improved and she no longer appeared in distress. she will continue nebulizers until her wheezing resolves. . acute exacerbation of diastolic heart failure: the patient was noted to have pulmonary edema, however recent echo from showed no diastolic or systolic dysfunction. the patient most likely episodes of atrial fibrillation with rvr which caused fluid to be retained in her lungs. she was diuresed with lasix and her atrial fibrillation was rate controlled as below. . atrial fibrillation with rapid ventricular rate: the patient has a history of atrial fibrillation. she was noted to have an irregular heart rate with vitals and started on diltiazem. she should be weaned to a lower dose of diltiazem as tolerated. another issue is that she has a h/o afib and several strokes. we are not sure if coumadin was ever addressed, she is currently on asa 325mg only. given her poor prognosis and unlikely she can have further loss of function beyond where she is now, coumadin may not be entirely beneficial, but will defer this to outpatient. g tube leaking: the patient's g tube was found leaking. the leakage stopped with tubefeedings. surgery evaluated the g tube and thought there was no infection around it. wound consult evaluated the patient and suggested to "cleanse the peri g-tube tissue with normal saline. pat the tissue dry. apply critic aid clear moisture barrier ointment to the periwound tissue daily. secure the tube with flexitract -change flexitract every days or prn. apply allevyn foam trach sponge over the g-tube site to absorb drainage as needed, change daily." the area on ct scan did not look infected. surgery felt that the erythema was likely due to irritation from gastric contents. acute renal failure: the patient was found to have an elevated cr to 1.4 on admission (per records her baseline cr was 0.6). her admission creat was 1.3 and remained stable 1.2-1.3 for the 4days she was here despite diuresis. her baseline creat as of is 0.6 so we are not sure if this was a progressive increase (ckd) or whether she has arf. given it is stable, likely plauteau phase of atn, but we dont have an etiology for this (no recent contrast at that we know of, no nsaids (except asa) or nephrotoxins, etc). her creatinine should be monitored as an outpatient. constipation: the patient had bowel movements while in the hospital. she has a history of constipation and should be on bowel medications. goals of care: after discussions with the health care proxy, , the patient was made "do not resusitate" but can still intubate. medications on admission: - aspirin 325 mg per peg daily -jevity plus 1.2 cal oral liquid oral 45 ml liquid(s) for 20 hours/day at 1400 - off at 1000 am -folic acid 1 mg tab per peg daily -multivitamin 1 tab per peg daily -prevacid 24h unknown strength per peg daily -vitamin c 500 mg po per peg daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): hold for loose stools. 3. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily) as needed for constipation: hold for loose stools. 4. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day): hold for loose stools. 5. prevacid 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 6. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 3 days. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily:prn as needed for constipation. 8. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q3h (every 3 hours) as needed for shortness of breath or wheezing. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q3h as needed for shortness of breath or wheezing. 10. diltiazem hcl 60 mg tablet sig: one (1) tablet po four times a day: hold for sbp<100 or hr<60. 11. folic acid 1 mg tablet sig: one (1) tablet po once a day. 12. multivitamin tablet sig: one (1) tablet po once a day. 13. vitamin c 500 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: discharge diagnosis: primary: -reactive airway diseae -paroxysmal atrial fibrillation -acute renal failure -tracheobronchomalacia . secondary: -cerebral vascular accident discharge condition: mental status: confused - always level of consciousness: lethargic but arousable activity status: bedbound discharge instructions: it was a pleasure taking care of you at . you were admitted to the intensive care unit with increased respiratoray rate and wheezing. you had an image of your chest (ct scan) which showed fluid in your lungs and a narrow trachea and bronchi. you were given lasix, a medication that helps move water out of your lungs. you were also given prednisone (to help decrease inflammation in your lungs, trachea and bronchi) as well as nebulizers (to help open your airways). . you were also found to have acute renal failure. your creatinine, a test of kidney function, rose from your baseline of 0.6 to 1.2. it will be monitored at your nursing home. . you have a history of atrial fibrillation and your heart rate increased while in the hospital. you were given diltiazem to help decrease your heartrate. . your g tube was at first thought to be infected, but it was just leaking. surgery evaluated you and felt that the area was not infected. your tubefeeds were restarted without any problems. . during this hospitalization, , your health care proxy, was informed of your clinical status. with guidance of the medical team, it was decided to not resusitate you if your heart stopped. . your medications have changed: -start prednisone -start diltiazem -start ipratropium/albuterol nebulizers -start colace/senna/bisacody/miralax for constipation followup instructions: you should followup with your primary care doctor in weeks. the discharge summary will be faxed to him. procedure: enteral infusion of concentrated nutritional substances diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation acute diastolic heart failure other diseases of trachea and bronchus 

Answer: The patient is high likely exposed to