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: lasix / bentyl attending: chief complaint: shortness of breath major surgical or invasive procedure: endotracheal intubation left central line placement picc line placement history of present illness: the patient is a 79 yo woman with h/o moderate as (aortic valve area of 1.2 cm2), complete heart block s/p pmp, dm2, htn, and hl, who presented from home with shortness of breath. per the patient's family, she was in her normal state of health until approximately 4 days ago, when she developed a cough and worsening congestion, which was thought to be an upper respiratory infection. she started taking mucinex last night, which did not improve her symptoms. overnight, she did not wear her bipap, as she did not want to mess up her hair for mother's day. at 3 am this morning, she acutely developed shortness of breath. ems was called and she was brought to the ed for further evaluation. . in the ed, her initial vs were p 123, bp 183/93, r 36, o2 64% on nrb. she was urgently intubated (difficult airway, placed over a bougie) and was started on a nitro gtt for her hypertension. her sbp then acute dropped to the 50s in the setting of the nitro gtt, so she was given 1l of ns. two cvls were placed (subclavian and femoral, each requiring multiple sticks) and she was started on levophed. she had a bedside tte, which showed poor lv contraction (prior ef 55%), so she was given asa 325 mg. she then spiked a fever to 102, and wbc was elevated at 17, so she was cultured and was started on ctx, levoquin, and vancomycin for presumed sepsis. cxr at that time was consistent with pulmonary edema without evidence of an obvious infiltrate. ekg showed lad with v-pacing spikes. given the concern for flash pulmonary edema in the setting of septic shock, she was admitted to the ccu for further evaluation. her vs at the time of transfer were t 102, p 66, r 20, bp 125/38. in the ccu, the patient was initally given ethacrynic acid 50 mg iv for presumed flash pulmonary edema and her respiratory status improved. she then becamse febrile to 104 and required both ivfs and levophed for hemodynamic support. her blood pressures were incredibly labile, ranging from 60s to 240s systolic with minimal support. it was eventually determined that her blood pressure was heart-rate dependant, and she was unable to hold a stable blood pressure with a rate of < 70. her pacemaker was thus adjusted to a rate of 70, and she was weaned off pressors on . she had significant anxiety when weaning from the ventilator, so she was started on seroquel 25 mg po bid for agitation. despite this, during her pst/rsbi on , she developed hypercarbia and was unable to be extubated. given concern for an underlying respiratory etiology, she underwent a ct scan, which demonstrated bibasilar opacities, concerning for pna. she also had a viral dfa, which returned as positive for parainfluenza 3. given her ongoing respiratory issues, she was transferred to the micu for further evaluation. past medical history: dm2 hyperlipidemia hypertension complete heart block s/p pacemaker implant in at (st. ), with a revision in moderate aortic stenosis diastolic dysfunction anemia sleep apnea (cpap) vitamin d deficiency vitamin b12 deficiency hx of diaphragm paralysis social history: the patient is widowed and lives with her brother. she has three children. she is originally from but has lived here for 48 years. she does not smoke and does not drink etoh. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: on admission: vs: p 98, bp 139/60, o2 100% on cmv 50% fio2, tv 500, rr 22, peep 5 general appearance: well nourished eyes / conjunctiva: perrl, pinpoint pupils head, ears, nose, throat: endotracheal tube, og tube cardiovascular: (s1: normal), (s2: normal), (murmur: systolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : at bases bilaterally) abdominal: soft, non-tender, bowel sounds present extremities: right lower extremity edema: absent, left lower extremity edema: absent . on discharge: vs: t 96.6, bp 104-115/49-70, hr 76-90, rr 18, o2 sat 99% on ra. gen: well-appearing, nad heent: nc/at, anicteric neck: supple, no jvd cv: rrr, iv/vi holosystolic murmur lungs: b/l basilar rales, no wheezing abd: + bs, soft, non-tender ext: no edema pertinent results: admission labs: 06:25am wbc-17.4*# rbc-4.89 hgb-14.1 hct-45.6 mcv-93 mch-28.9 mchc-31.0 rdw-15.0 06:25am plt count-311 06:25am neuts-47.7* lymphs-43.6* monos-4.9 eos-1.6 basos-2.1* 06:25am pt-11.9 ptt-22.1 inr(pt)-1.0 06:25am probnp-1140* 06:25am glucose-435* urea n-18 creat-0.9 sodium-134 potassium-7.6* chloride-101 total co2-20* anion gap-21* 06:25am alt(sgpt)-46* ast(sgot)-109* alk phos-46 tot bili-0.3 06:25am ctropnt-0.01 06:43am glucose-375* lactate-3.9* na+-135 k+-10.2* cl--102 tco2-20* 07:11am type-art tidal vol-500 peep-8 o2-100 po2-48* pco2-67* ph-7.17* total co2-26 base xs--5 aado2-609 req o2-98 -assist/con intubated-intubated 08:00am urine color-straw appear-clear sp -1.012 08:00am urine blood-tr nitrite-neg protein-30 glucose-300 ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 08:00am urine rbc-4* wbc-1 bacteria-none yeast-none epi-0 08:00am urine hyaline-8* 08:00am urine mucous-rare . discharge labs: 05:49am blood wbc-13.8* rbc-3.67* hgb-10.5* hct-32.1* mcv-87 mch-28.5 mchc-32.7 rdw-14.9 plt ct-449* 05:49am blood glucose-160* urean-34* creat-0.9 na-142 k-3.5 cl-100 hco3-32 . micro: 7:05 am blood culture arterial #2. gram positive rod(s). consistent with corynebacterium or propionibacterium species. blood cultures x2: pending (ngtd) urine culture: no growth. sputum: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): rare growth commensal respiratory flora. blood culture x2: ngtd (pending) sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): no growth. respiratory virus identification (final ): positive for parainfluenza type 3. 3:46 pm mini-bal negative grams stain and cx blood culture x 2 - no growth stool culture - negative for c. difficile. . studies: ekg: sinus tachycardia with atrial sensing and ventricular pacing. compared to the previous tracing of atrial pacing is no longer present. . cxr: 1. likely asymmetrical edema, but follow up radiograph after diuresis is recommened to ensure resolution of these findings and to exclude pneumonia. 2. satisfactory et tube positioning. 3. right hemidiaphragm elevation, which was present by report on prior atrius studies. small right effusion or pleural thickening. . echo: suboptimal image quality.the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. with normal free wall contractility. the aortic valve is not well seen. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). trace aortic regurgitation is seen. there is severe mitral annular calcification. there is moderate functional mitral stenosis (mean gradient 13 mmhg) due to mitral annular calcification. tricuspid regurgitation is present but cannot be quantified. there is severe pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the report of the prior study (images unavailable for review) of , the degree of as may have increased. poor image quality limits the accuracy of this study. . ct head: 1. somewhat limited by motion, but no acute intracranial findings. 2. parenchymal atrophy and small vessel disease. 3. ethmoid sinus opacification. sphenoid and mucosal sinus thickening. findings are likely related to patient's intubated status. . ct chest: extensive left more than right, predominantly basal parenchymal consolidations and opacities with air bronchograms, suggestive over a combination of pneumonia and atelectasis. no reticulation suggesting pulmonary edema. increase in lung density at the lung apices could be interpreted as an indirect sign for overhydration. reactive moderate mediastinal lymphadenopathy. coronary and valvular calcifications. bilateral mild-to-moderate pleural effusions. no pericardial effusion. pacemaker and monitoring and support devices in correct position. . pa & lat and lat decub cxr - there is significant improvement in pulmonary edema, almost completely resolved. right basal consolidation accompanied by pleural effusion as well as left basal atelectasis and effusion appears to be unchanged. no pneumothorax seen. brief hospital course: the patient is a 79 yo woman with a history of aortic stenosis (valve area 1.2 cm2), complete heart block s/p pmp, dm2, htn, and hl, who presented from home with acute hypoxemic respiratory failure. . #. hypoxemic respiratory failure: the patient presented with acute shortness of breath with preceding uri symptoms and was intubated in the ed for hypoxemic respiratory failure. it was initially believed that this was due to flash pulmonary edema and the patient was diuresed with ethacrynic acid (given her lasix allergy) with improvement in her respiratory status. echocardiogram showed relatively stable cardiac function. she remained difficult to wean from the vent, secondary to agitation and was started on seroquel to help address this. she underwent ct chest for further evaluation of pulmonary pathology given her persistent ventilator dependence (particularly in the setting of a fever to 104), which was concerning for a pneumonia. respiratory viral panel was positive for parainfluenza 3 and patient's presentation was felt to be consistent with a viral syndrome with superimposed bacterial pneumonia. she was started on vancomycin and levofloxacin and transferred to the micu for further management. . in the micu, her antibiotics were broadedned to vanco/cefepime/levoflox for concern for hap. she initially did improve but then spiked fever and had increasing sputum production so she was treated for a vap with vanc/meropenem/levoflox and mini-bal was performed which showed no growth. . the patient had difficulty weaning from the vent due to her delerium. seroquel was uptitrated with some effect and then decreased after extubation. of note, the patient is a difficult airway (grade 3) and required bougie on last attempt. once extubated on , the patient continued to have delirium which eventually resolved upon transfer to the floor. her oxygen requirement decreased and she maintained her o2 sats > 95% on room air on day of discharge. . #. hypotension: the patient had an episode of hypotension, with systolic blood pressures in the 50s in the emergency room. this occurred after the patient was started on a nitroglycerin gtt. she was given 1.5l of ns in the ed, and her sbp increased to the 130s by the time of arrival to the ccu. she then becamse febrile to 104 and required both ivfs and levophed for hemodynamic support. her blood pressures were incredibly labile, ranging from 60s to 240s systolic with minimal support. it was eventually determined that her blood pressure was heart-rate dependant, and she was unable to hold a stable blood pressure with a rate of < 70. her pacemaker was thus adjusted to a rate of 70, and she was weaned off pressors on . her home blood pressure medications of lisinopril and metoprolol were held. metoprolol was restarted at a low dose on day of discharge due to sbps 100s-115. her blood pressure medications should be restarted and gradually uptitrated as tolerated. . #. type 2 diabetes mellitus: the patient has a history of dm2, for which she takes metformin and a hiss at home. her glucose on arrival to the ed was 435, for which she was started on an insulin gtt. however, this was weaned to ssi. patient then transitioned to lantus with ssi. lantus uptitrated to 20 units daily. she is being discharged on insulin. if her kidney function remains stable, metformin may be restarted and insulin titrated down as tolerated. . #. anemia: ms. hct was 45 on admission and decreased to 35 five hours later in the setting of ivfs. her family does not endorse recent gib or changes in her stool. patient was guaiac negative and had stable hct. iron studies indicated iron deficiency anemia and patient was started on po iron repletion. . # transition of care issues: - patient will require follow-up with her cardiologist given pacemaker changes and appropriate diuretic titration. of note, she is allergic to lasix which is why she was started on ethacrynic acid. she was on ethacrynic acid 50 mg until the day of discharge when she was changed to 50 mg daily due to rising bun and improved volume status. she may be able to stop this medication eventually or transition to intermittent dosing. - hypertension: home metoprolol was restarted on day of discharge at a low dose. lisinopril continues to be held. if her blood pressure increases - patient should have chem7 checked on to ensure adequate potassium repletion and that she is not having renal failure from her diuretic. - patient likely has some degree of critical illness myopathy and would benefit greatly from physical therapy for deconditioning. she was independent prior to this hospitalization. . addendum: after patient was discharged, called regarding her picc line which had inadvertently not been discontinued. arrangements were made for the physician there to remove the picc line on monday. medications on admission: (per atrius website): alendronate (fosamax) 70 mg oral tablet take 1 tablet every week in the morning 30 minutes before food do not lie down for at least 30 minutes lisinopril 40 mg daily metoprolol tartrate 50 mg oral tablet 1 tab metformin 1,000 mg oral tablet take 1 tablet twice daily simvastatin 20 mg qhs insulin lispro (humalog kwikpen) sliding scale before meals- cyanocobalamin sr 1,000 mcg tab daily aspirin tablet ec 81mg po 1 tab po qd calcium carbonate tablet 1.25g po bid discharge medications: 1. alendronate 70 mg tablet sig: one (1) tablet po once a week. 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. humalog 100 unit/ml solution sig: as directed per sliding scale subcutaneous qidachs. 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): until mobile to prevent dvts. 7. ethacrynic acid 25 mg tablet sig: two (2) tablet po daily (daily). 8. b-12 dots 500 mcg tablet sig: two (2) tablet po once a day. 9. calcium carbonate 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po twice a day. 10. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous at bedtime. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. dextromethorphan-guaifenesin 10-100 mg/5 ml liquid sig: five (5) ml po q6h (every 6 hours) as needed for cough. 14. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 15. potassium chloride 10 meq capsule, extended release sig: two (2) capsule, extended release po once a day: while on ethacrynic acid. 16. outpatient lab work please check chem7 on . please adjust potassium repletion and diuretic dose as necessary. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: parainfluenza acute on chronic congestive heart failure . secondary diagnoses: type 2 diabetes mellitus hyperlipidemia hypertension complete heart block s/p pacemaker moderate aortic stenosis anemia sleep apnea on cpap vitamin d deficiency vitamin b12 deficiency discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the intensive care unit for shortness of breath. this was likely due to fluid accumulation in your lungs and pneumonia. you were treated with antibiotics and diuretics and your breathing improved. you remain very weak, which sometimes happens after being as sick as you were. you are going to to receive physical therapy and get stronger. . the following changes were made to your medications: - start ethacrynic acid 50 mg daily. this is a diuretic. if you become dehydrated or your kidney function worsens, this medication should be stopped. - start potassium supplement. please get your electrolytes checked in 2 days and have the dose adjusted as needed. you can stop this medication when you stop the ethacrynic acid. - stop lisinopril. your blood pressure is low. if your blood pressure recovers this medication can be slowly restarted - decrease metoprolol to 12.5 mg twice a day. your blood pressure remains low. if it improves, you may slowly increase to your prior home dose. - stop metformin and start insulin therapy. if your blood sugars remain elevated and your kidney function remains good, you may restart metformin and decrease your insulin dose. - start heparin to decrease your risk of blood clots until you are more mobile. - start albuterol as needed for shortness of breath - start dextromethorphan and guiafenesin as needed for cough . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please follow-up with your primary care provider, . , when you are ready to leave . . please also follow-up with your cardiologist within the next weeks. 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 arterial catheterization other diagnostic procedures on lung or bronchus artificial pacemaker rate check central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute on chronic diastolic heart failure aortic valve disorders other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure iron deficiency anemia, unspecified other vitamin b12 deficiency anemia other and unspecified special symptoms or syndromes, not elsewhere classified diarrhea hyperosmolality and/or hypernatremia ventilator associated pneumonia tachycardia, unspecified delirium due to conditions classified elsewhere other abnormal blood chemistry fitting and adjustment of cardiac pacemaker leukocytosis, unspecified critical illness myopathy unspecified vitamin d deficiency mixed acid-base balance disorder pneumonia due to parainfluenza virus 

Answer: The patient is high likely exposed to