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: cephalosporins attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: mrs is a 89f with history of copd, chf, aortic stenosis who was transferred from for low oxygen levels and increased work of breathing, rr of 44. patient is unable to recount history well however in the ed did deny fever, chills, n/v/d. she was being treated with levofloxacin at rehab, presumably for cap. . in the , report, initial o2 sats were in the 80s, pt was started on bipap and vitals were 119/76 110 18 95% on with 40% bipap. abg showed 7.37 68 76. labs were notable for a k of 6.4, trop of 0.13. cxr consistent with failure, abx broadened to vanc, levofloxacin and patient was given nebs, asa, 40iv lasix with 900 ccs uop. blood cultures were sent. course complicated by afib with rvr to 140s, came down to 110s without medical intervention. ekg showed no acute st/tw changes, however cards was consulted for elevated trop, thought to be due to demand ischemia. on transfer, pt was 97 % on bipap 10/5 with 40% fio2, with a rr of 15-20. two pivs. . on the floor, pt appears comfortable on bipap, opens eyes to voice however incoherent and drowsy. . review of systems: unable to complete due to somnolence, however pt is able to state that she is not having any pain past medical history: - afib on coumadin - copd, chronic sob and wheezing - moderate (noted as severe by nf) as, valve area 1-1.2 cm on echo) - cad - hypertension - traumatic brain injury concentration camp torture, per son, pt is very "frontal" at baseline - hypercholesterolemia - post-traumatic stress disorder - hearing loss - sigmoid polyps - holocaust survivor - urinary incontinence - dementia, with delusions - pulmonary nodules - +ppd, family refused treatment - h/o colonic polyps - oa - anemia - h/o cataract surgery social history: resident of rehab, uses wheelchair. she is full code; hcp is son dr. . home and cell . family history: she has one sister who is alive and well. one brother has bipolar disorder. one brother died of colon cancer. one brother was murdered. both her parents were murdered. physical exam: admission physical exam: vitals: t:96.1 bp:91/68 p:116 r: 22 o2: 92% general: alert, appears comfortable, opens eyes to voice heent: sclera anicteric, mmm, oropharynx clear, unable to assess pupilary reflex due to pt compliance neck: supple, jvp not visualized due to obesity, no lad lungs: coarse breath sounds anteriorly, no wheezes, rales, ronchi cv: tachycardic, irregular rhythm, unable to assess murmurs given prominent breath sounds abdomen: obese, soft, non-tender, non-distended, + bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, 1+ pedal edema bilaterally, no clubbing, cyanosis, pneumoboots in place. feet inverted. neuro: aaox1, unable to assess cranial nerves, moves all extremities pertinent results: labs on admission: 12:27pm blood wbc-10.3 rbc-3.71* hgb-11.5* hct-36.4 mcv-98 mch-31.0 mchc-31.7 rdw-14.7 plt ct-211 12:27pm blood neuts-86.1* lymphs-7.7* monos-5.5 eos-0.3 baso-0.4 12:27pm blood pt-22.3* ptt-26.7 inr(pt)-2.1* 06:14pm blood glucose-122* urean-30* creat-1.1 na-144 k-4.8 cl-100 hco3-38* angap-11 06:14pm blood ck(cpk)-46 12:27pm blood probnp-7495* 12:27pm blood ctropnt-0.13* 06:14pm blood ck-mb-5 ctropnt-0.24* 03:09am blood ck-mb-4 ctropnt-0.27* 12:27pm blood calcium-9.2 phos-3.9 mg-2.3 03:09am blood triglyc-65 hdl-32 chol/hd-4.4 ldlcalc-95 01:55pm blood type-art rates-/22 tidal v-340 peep-5 fio2-40 po2-76* pco2-68* ph-7.37 caltco2-41* base xs-10 intubat-not intuba vent-spontaneou 12:42pm blood lactate-1.3 . labs on discharge: 06:05am blood wbc-7.0 rbc-4.17* hgb-12.9 hct-40.7 mcv-98 mch-30.9 mchc-31.6 rdw-15.0 plt ct-218 06:05am blood glucose-102* urean-20 creat-0.8 na-141 k-3.7 cl-98 hco3-38* angap-9 10:20am blood wbc-7.0 rbc-3.83* hgb-11.9* hct-37.2 mcv-97 mch-31.2 mchc-32.2 rdw-15.3 plt ct-231 10:20am blood pt-15.7* inr(pt)-1.4* 05:21am blood glucose-106* urean-23* creat-0.8 na-143 k-3.9 cl-105 hco3-33* angap-9 . microbiology: 11:40 am rapid respiratory viral screen & culture source: nasopharyngeal swab ()/ (sm,rrt). **final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. . respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. . blood cx x 2 negative . legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. . imaging: cxr : mild pulmonary edema. bilateral pleural effusions, likely small and layering on the right side. retrocardiac opacity may be due to compressive atelectasis, though infection cannot be excluded. . tte : the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. right ventricular chamber size and free wall motion are normal. there is moderate to severe aortic valve stenosis (valve area 1.0 cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate to severe calcific aortic stenosis. mild symmetric lvh with normal global and regional biventricular systolic function. moderate mitral and tricuspid regurgitation. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , aortic transvalvular gradients are higher. estimated pulmonary pressures are also higher. the other findings are similar. . cxr : pa and lateral views of the chest: the diffuse heterogeneous opacification of the right lung with a denser perifissural component at the inferior upper lobe is unchanged from the prior study but considerably improved from . the left lung is clear. moderate cardiomegaly and mediastinal vascular engorgement is stable. there is no pneumothorax. possible small bilateral pleural effusions appear unchanged from two days ago. a right picc terminates in the mid svc and is also unchanged. impression: 1. probable multilobar pneumonia of the right lung, stable from two days ago and much improved from . 2. a focal remaining component of pneumonia versus pleural effusion tracking into the fissures on the right. oblique views may help differentiate the two possibilities. 3. stable congestive heart failure. brief hospital course: pleasant 89 yo woman with history of chf, afib, copd, moderate as, who presented with sob, evidence of volume overload consistent with chf exacerbation. . # acute on chronic diastolic chf: the patient presented with hypoxis, elevated bnp and volume overload on exam and cxr. she was treated with aggressive diuresis and her oxygen level and symptoms improved. echo on showed preserved ef (55%), but moderate/severe as (valve area 1cm2), and mr/tr. current chf exacerbation likely caused by slight progression of as, as well as afib with rvr. acs initially considered, however ruled out given no ekg changes or chest pain. troponins mildly elevated on admission; pt seen by cards who deemed it likely ischemic demand afib with rvr. the patient was diuresed with iv lasix until she had significant elevation of her bicarb, and then changed to oral lasix. cxr on discharge showed improvement in edema, but continued moderate sized right pleural effusion. she should continue lasix 20 mg for the next several days, and then resume her prior dosing of 20 mg daily. chem 7 should be checked on friday . . # resp failure: this was felt to be multifactorial from both volume overload and copd exacerbation. given recent treatment for pna and rll infiltrate while in rehab facility and worsening respiratory status, patient was initially treated with broad antibiotics (levo, vancomycin and meropenem). these were stopped on , as the patient seemed to be significantly improved after diuresis, her hypoxia had resolved, and she did not have any fever or leukocytosis. urine legionella was negative, respiratory viral screen was negative and cultures did not show any growth. additionally, she required bipap while in the micu, but her oxygenation improved significantly with diuresis. she was also treated with nebulizers in case copd was contributing to her respiratory distress. however, she again had a small oxygen requirement on , cxr was obtained and on was suggestive of right sided multifocal pneumonia. consequently, levofloxacin was restarted on and should be continued for a total 7 day course to end on . . # hypotension: the patient had an episode of mild hypotension in the micu, which seemed to occur after lasix diuresis, most concerning for vasodilation in the setting of lasix. another contributing factor was thought to be positive pressure ventilation, which can cause a mild decrease in pressure. this resolved, and the patient remained normotensive after transfer to the medicine floor. . # metabolic alkalosis and respiratory acidosis - after diuresis, the patient had a significantly elevated bicarbonate to 46-49, felt to be most likely contraction alkalosis from lasix diuresis. the patient also had a respiratory acidosis, likely chronic from copd. the alkalosis improved after diuresis was held for several days (it was then resumed with smaller doses of po lasix). # elevated troponins: likely due to demand in setting of afib with rvr. her ck-mb was normal, and the patient had no chest pain or ekg changes to suggest acs. pt received asa in ed. she was continued on telemetry for several days and did not have any arrhythmic or ischemic changes. . # ams: patient was felt to be more confused than her baseline on admission. this was likely due to respiratory failure and infection, as it improved with treatment above. at discharge, patient was felt to be at baseline mental status. . # right arm edema - likely from picc in right upper extremity. ultrasound was checked and patient had no dvt. . # afib: the patient had an episode of rvr in the emergency department. during her hospitalization, metoprolol was titrated up and her hr was better controlled. coumadin was initially held; she was restarted on home dose of 1 mg warfarin but remained subtherapeutic. consequently, warfarin was increased to 2 mg daily. her inr should be checked on , and warfarin adjusted as necessary. . # dementia: continued on haldol. . # gerd: continued on ppi. medications on admission: (per heb reb recs): -levofloxacin 250 mg daily, started -furosemide 20 mg po daily -combivent nebs q6 hr prn -toprol xl 50 mg daily -coumadin 1 mg daily -haldol 1 mg po bid -prilosec 20 mg daily -miconazole topical -tums/vitd -vitamin b12 1000 mcg daily -tylenol prn -robitussin -guafenesin prn discharge medications: 1. furosemide 20 mg tablet sig: one (1) tablet po twice a day for 1 weeks: take 20 mg twice daily for the next several days, then resume 20 mg daily (usual dosing). 2. combivent 18-103 mcg/actuation aerosol sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. 3. toprol xl 25 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. 4. haloperidol 0.5 mg tablet sig: two (2) tablet po bid (2 times a day). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. miconazole nitrate 2 % cream sig: one (1) topical once a day as needed for fungal infection. 7. calcium 500 + d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po once a day. 8. vitamin b-12 1,000 mcg tablet sig: one (1) tablet po once a day. 9. dextromethorphan-guaifenesin 20-400 mg tablet sig: tablets po every eight (8) hours as needed for cough. 10. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 11. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 12. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 13. outpatient lab work chem 7 and inr to be drawn on . 14. levofloxacin 750 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 6 days. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: acute on chronic heart failure aortic stenosis copd exacerbation acute respiratory failure atrial fibrillation discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , you were admitted to the hospital because of difficulty breathing and low oxygen. you were treated with diuretics and breathing treatments and your sumptoms improved. you were also initially treated with antibiotics for a possible pneumonia. however, these medications were stopped when it appeared that your symptoms were improving with diuretics. we made the following changes to your home medications: increase toprol xl to 75 mg daily increase furosemide to 20 mg twice daily for the next week. start levofloxacin - take every other day for 6 more days increase warfarin to 2 mg daily start enoxaparin 100 mg every 12 hours and continue until inr >2 please continue all of your other medications as prescribed. followup instructions: none procedure: central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified esophageal reflux pure hypercholesterolemia mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure aortic valve disorders acute respiratory failure hypotension, unspecified alkalosis other acute and subacute forms of ischemic heart disease, other posttraumatic stress disorder dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to