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: ace inhibitors / amlodipine / hydralazine / augmentin / codeine attending: chief complaint: hypercarbic repiratory failure major surgical or invasive procedure: none history of present illness: mrs is a yo woman with hx of recurrent utis, chf with ef 50% who presented from nh with tachypnea following one day of n/d/abd pain/chills. per nursing home report ems was called for hypertension however on arrival the patient was found to be tachypnic and in respiratory distress. per patient and daughter, the pt was in last weekend and doing well. over the last couple of days, she had poor po intake, generalized weakness, crampy, waxing and abd pain and one episode of non-bloody, non-tarry diarrhea this morning. she also had one episode of vomiting in the ed. she denies any worsening sob, cp, cough. denies any recent aspiration events. . on arrival to the ed, initial vitals were: 97.7 75 138/95 96% ra. pt was tachypnic, denied cp, tightness. exam was notable for rrr, tachypneic to ~32 but ctab, mild epigastric tenderness, soft, non-distended no c/c/e. ekg was v-paced, cxr showed mild to moderate pulm edema. bipap was started with clinical improvement in her tachypnea. blood gas was 7.27/32/206. urine was notable for +leuks, nitrites, blood, wbcs, bacteria. labs were notable for creatinine of 2.2, lactate of 3.8, wbc of 12.9, inr of 1.8. she was given vanc, levofloxacin and anti-emetics as well as 1 l ns. blood and urine cxs were sent. ekg showed paced rhythm. vitals on transfer were 64, bp 155/75, rr 24, 97% on fio2 100%, bipap. . ros: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -hx dvts in (daughter denies) -sinus node dysfunction s/p pacemaker -recurrent utis -paf on coumadin -htn -chf (ef 50%) -mr (baseline creatinine 1.6-2.0), likely hypertensive nephropathy -urinary incontinence, followed by urology -anemia chronic disease -hx c. diff colitis -hx breast cancer, s/p lumpectomy and tamoxifen -hypertensive retinopathy -? hx of lacunar infarcts -multiple mechanical falls -l distal radius fracture -right hip fracture s/p orif -l knee arthroplasty -s/p cataract surgery -s/p tah bso -appy -ccy social history: lives in manor nursing home. uses walker to ambulate. born and raised in but lived in for 30 yrs. retired secretary. no etoh, tobacco, drugs family history: mother with chf, children with hld physical exam: on admission: vs: temp:97.9 bp: 138/69 hr:83 rr:14 98% sat on 6 l nc gen: pleasant, tachypnic, unable to complete sentences tachypnea heent: perrl, eomi, anicteric, mmm, op without lesions, jvp at 10 cm, cv: distant heart sounds rr, s1 and s2 wnl, no m/r/g resp: tachypneic, faint -basilar crackles abd: nd, +b/s, soft, diffusely ttp to palpation, worse in suprapubic region, no masses or hepatosplenomegaly ext: cool, no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox2. cn ii-xii intact. unable to assess strength due to pt fatigue. . on discharge: tachycardic, sedated, minimally responsive, otherwise unchanged from admission. pertinent results: admission labs: 08:04pm type-art o2-60 po2-167* pco2-27* ph-7.32* total co2-15* base xs--10 06:32pm lactate-2.0 05:15pm urine color-yellow appear-cloudy sp -1.016 05:15pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-lg 05:15pm urine rbc-6* wbc->182* bacteria-mod yeast-none epi-0 05:00pm glucose-166* urea n-60* creat-2.1* sodium-138 potassium-5.3* chloride-109* total co2-13* anion gap-21* 05:00pm alt(sgpt)-15 ast(sgot)-25 ld(ldh)-245 ck(cpk)-74 alk phos-101 tot bili-0.2 05:00pm ck-mb-10 mb indx-13.5* ctropnt-0.34* probnp-greater th 05:00pm albumin-3.9 calcium-9.4 phosphate-4.9* magnesium-1.8 03:05pm wbc-12.9* rbc-4.24 hgb-12.8 hct-37.6 mcv-89 mch-30.2 mchc-34.1 rdw-16.1* micro: 5:15 pm urine site: catheter **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 32 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s blood cx : pending studies: cxr : impression: mild-to-moderate pulmonary edema with small bilateral pleural effusions. cxr : chest, single ap portable view. a left ij central line is present, tip over proximal/mid svc. no pneumothorax is detected. a dual-lead pacemaker is present, with lead tips over right atrium and right ventricle. there is cardiomegaly with a tortuous calcified aorta. the right hilum and ? left hilum is prominent. there is upper zone redistribution and diffuse vascular blurring suggesting chf. there is increased retrocardiac density and obscuration of the left hemidiaphragm consistent with left lower lobe collapse and/or consolidation. there is a small left and probable small right effusion. compared with earlier the same day, and allowing for differences in patient positioning, i doubt significant interval change. tte : conclusions the left atrium is mildly elongated. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with apical dyskinesis and near akinesis of the remaining ventricle. the basal inferior and inferolateral walls contract best (lvef <20%).. no masses or thrombi are seen in the left ventricle. the right ventricular cavity is mildly dilated with focal hypokinesis of the apical half of the free wall. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal left ventricular cavity size with extensive systolic dysfunction c/w multivessel cad or other diffuse process. right ventricular free wall hypokinesis. moderate pulmonary artery systolic hypertension. mild-moderate mitral regurgitation. mild aortic regurgitation. ruq u/s : impression: intra- and extra-hepatic biliary ductal dilatation without an obstructing mass or stone seen. these findings might represent ampullary stenosis or post-cholecystectomy change. if clinically indicated, mrcp might provide a different perspective on this, and definitively rule out an obstructive mass. ct head w/o : read pending eeg: 1. no hemorrhage, ct evidence of infarct, or other acute process. 2. global atrophy, with extensive periventricular and subcortical white matter hypodensity, likely sequelae of chronic small vessel ischemic disease. brief hospital course: yo woman with hx of chf, afib on coumadin, recurrent utis, now presenting from nh with dypnea concerning for chf exacerbation and also with abdominal pain and pyuria concerning for uti, made cmo this admission and discharged on hospice. . # goals of care: given chf, worsening mental status, seizures, recurrent urinary tract infections and worsening renal failure, family meeting was held at which point decision was made to focus on comfort. pt was discharged to hospice. . #. acute on chronic chf: presented with dyspnea, and given history of chf, elevated bnp, pulmonary edema on cxr, crackles on exam her presentation is most concerning for chf exacerbation. pt was diuresed with iv lasix. tte demonstrated ef 20%, and hypokinesis suggestive of multi-vessel disease. cardiac enzymes were trended to peak. per cardiology consult, she was started on atorvastatin 80mg daily in addition to asa 325mg. given that she was already anticoagulated on coumadin, heparin gtt was not recommended. lasix was held on hod#2, given arf (see below). elecrophysiology was consulted in regards to turning of the pts pacemaker when she was made cmo, however noted that she did not have an icd and they did not recommend making any changes to pacemaker settins. . # respiratory distress: likely acute on chronic chf as above, in addition to possible pna as evidenced by fever and lll infiltrate seen on cxr. she was diuresed as above, and oxygen was able to be weaned down from face mask to nasal cannula. she was started on vanc/cefepime/levo/flagyl to cover for hcap, atypicals, and anaerobes. antibiotics were dc'd when the pt was made cmo. . #. uti: pt with hx of recurrent utis, now presenting with dysuria and pyuria suggestive of uti. also with abd pain which is likely due to uti as well given mainly suprapubic tenderness. per last evaluation at , pt was seen by urology and id who recommended no abx unless pyuria and sxs, given desire to not breed resistance. she was started on oxybutinin, vagifem to decrease colonization and probiotics to help prevent recurrent infx. pessary was removed by ogbyn. urine culture grew pan-sensitive klebsiella. antibiotics were dc'd when the pt was made cmo. . #. abd pain/diarrhea: pt states only one episode of diarrhea, however given non-gap acidosis, concern for more diarrhea than reported. pt also with history of c. diff which could be causing current presentation. lft's and lipase were wnl. ctap was unremarkable, except for intrahepatic dilation. ruq u/s was done to further characterize, and again showed intra- and extra-hepatic dilatation but not clear mass or obstruction. . # leukocytosis: likely uti/pna as discussed above. # renal failure: slightly worse then baseline of 1.6-2.0. concern for poor forward flow in the setting of chf exacerbation vs. atn in setting of sepsis as discussed above. creatinine worsened during the admission. . # altered mental status: likely due to infection and seizure. ms worsened during the admission and given low likelyhood of recovery, patient was made cmo. she was continued on standing ativan on discharge to help minimize seizure activity and maximize comfort. . #. mixed non-gap/gap metabolic acidosis: gap acidosis likely due to elevated lactate and renal failure which may be contributing as well. lactate improved with fluids administered in ed. continuing acidosis likely acute renal failure. . #. afib on coumadin: rhythm pn admission appeared v-paced but without underlying atrial fib. on hod#1, pt had afib with rvr during her micu stay, requiring iv lopressor and dilt. rvr likely infection as above. she required a dilt drip, which was dc'd when the patient was made cmo. coumadin was initially held due to supratherapeutic inr. . # gerd: continued omeprazole. . # htn: continued clonidine. held diovan given arf as above. . # depression: continued citalopram. medications on admission: -warfarin 3 mg daily -ondansetron 1 mg daily prn nausea -senna 8.6 mg daily prn constipation -dulcolax 10 mg pr daily prn constipation -fleet enema pr prn constipation -acetaminophen prn -prilosec 20 mg tab daily -diovan 40 mg tab -vitamin c daily -docusate 100 mg tid -trazodone 50 mg daily -clonidine 0.3 mg patch q tues -vagifem 10 mcg vaginally on mon/thurs -acidophillus 1 cap daily -81 mg aspirin daily -ca/vit d 500/200 daily -citalopram 40 mg daily -furosemide 10 mg daily -lidoderm patch to neck daily (12 hrs on, 12 hrs off) -mv daily -oxybutynin chloride 2.5 mg daily -metamucil daily -polyehtylene glycol daily -metoprolol 100 mg discharge medications: 1. ipratropium bromide 0.02 % solution sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob, wheezing. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob, wheezing. 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 4. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea/vomiting. 5. ativan 1 mg tablet sig: one (1) tablet po three times a day: please give sl ativan. 6. ativan 1 mg tablet sig: one (1) tablet po every six (6) hours as needed for anxiety. 7. morphine 20 mg/5 ml solution sig: 1-2 mg po q2 hours as needed for shortness of breath, pain, discomfort. 8. levsin/sl 0.125 mg tablet, sublingual sig: one (1) sublingual every four (4) hours as needed for excessive secretions. 9. acetaminophen 650 mg suppository sig: one (1) rectal every six (6) hours as needed for fever or pain. discharge disposition: extended care facility: healthcare center - discharge diagnosis: primary: heart failure secondary: pneumonia, sepsis discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were admitted for respiratory distress and belly pain and were found to have fluid on your lungs, pneumonia and seizures. you did not improve significantly with treatment and the decision was made to focus on comfort and you were discharged to your nursing facility with hospice. . the following changes have been made to your medications: -stop all prior medications except for lidocaine patch for neck pain -take 1 mg sl ativan tid to help control seizures amd additional doses as needed for anxiety -take morphine as needed for pain -take tylenol as needed for fever/pain -take albuterol and ipratroprium nebs as needed for wheezing/shortness of breath -take levsin as needed for secretions -take zofran as needed for nausea/vomiting followup instructions: none procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified acidosis anemia of other chronic disease mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation sepsis chronic kidney disease, unspecified grand mal status long-term (current) use of anticoagulants cardiac pacemaker in situ personal history of venous thrombosis and embolism encounter for palliative care acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to