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: clindamycin / vancomycin attending: chief complaint: dyspnea major surgical or invasive procedure: intubation history of present illness: the patient is a 83 yo female w/ h/o bilateral pe's, pneumonia, pulmonary hypertension and emphysema who presents with dyspnea. the patient has chronic dyspnea that has steadily worsened such that she has been breathing very heavy in the last 3 days. she has no cp, cough, pleuritic pain, or fevers with dyspnea and dyspnea is worse with activity. she only notes she may have had chills lately. with this she has felt very weak and tired lately, and the night prior to admission she felt as if she was going to collapse. patient did not lose consciousness, and may have had some palpitations prior to this episode. in addition to the above, the patient has had decreased po intake, nausea x 1 week (and 2 episodes of non-bloody vomitius), associated with po intake. she denies abd pain, dysuria, hematuria, diarrhea (although chronically she stools ~ 3x/day). she has had no sick contacts to her knowledge either. per the family, it seems as if the patient has many issues, that have recently escalated and they are most concerned with her recent fatigue and inablility to do activities given her sob. . in ed pt. was hypoxic and placed on nrb. she was given 40 iv lasix and 60 prednisone x 1. in ed she underwent cta chest, which ruled out pe. ct abdomen showed gallbladder wall thickening, confirmed by ruq us. surgery was consulted to consider hida scan. past medical history: 1. s/p thr 22 years ago complicated by clot in leg 2. s/p cataract surgery 3. back pain s/p corticosteroid injections 4. pfts - fev1- 52; fvc- 54%, fev1/fvc 104: restrictive ventilatory defect 5. chf: diastolic dysfunction ef 50% 6. emphysema (2 l home oxygen) 7. bilateral pe's () 8. multiple pna's recent in 9. pulmonary hypertension 10. recent right arm fx social history: pt. is from and lives in an independent senior facility with vna 2 x/week. son in area very involved in her care. no smoking (now or history), etoh or drugs family history: no heart or lung disease in family. physical exam: vs: t: 96.5; bp: 120/80; hr: 114; rr: 22; o2: 93-94% on 10 l fm mask. gen: fatigued pale female, appears frail heent: right surgical pupil. left pupil errla, sclera anicteric, pale conjunctiva, mm dry, no oral lesions neck: jvd 8-10 cm. no lad cv: tachy no m/r/g lungs: wheezes throughout but no crackles noted. no accessory muscle use. moving air well. abd: nabs. soft, nt, nd ext: 1+ pitting edema b/l to knees neuro: non-focal, cn intact pertinent results: admission labs: 08:45pm pt-32.8* ptt-31.8 inr(pt)-3.5* 08:45pm plt count-193 08:45pm wbc-7.8 rbc-3.57* hgb-10.8* hct-31.7* mcv-89 mch-30.2 mchc-33.9 rdw-17.1* 08:45pm ck-mb-notdone ctropnt-<0.01 08:45pm ck(cpk)-66 08:45pm glucose-126* urea n-30* creat-1.2* sodium-134 potassium-4.3 chloride-101 total co2-20* anion gap-17 08:56pm po2-27* pco2-34* ph-7.40 total co2-22 base xs--3 09:49pm type-art o2 flow-5 po2-52* pco2-23* ph-7.44 total co2-16* base xs--5 intubated-not intuba 05:50am ck-mb-notdone 05:50am ctropnt-<0.01 05:50am lipase-56 05:50am alt(sgpt)-18 ast(sgot)-31 ck(cpk)-55 alk phos-87 amylase-71 tot bili-0.7 . results: cta: impression: 1) no evidence of pe. 2) persistent multifocal ground glass opacities with interval resolution of peribronchiolar patchy opacities and multifocal nodular opacities seen on the prior ct of , suggesting a resolving infectious process. 3) significant atherosclerotic burden of the aorta and its major tributaries, 4) thickened gallbladder wall, with hyperenhancing gallbladder mucosa. . cxr: : .interval improvement of multifocal patchy opacities, likely consistent with resolving pneumonia . us ruq: conclusion: edematous gallbladder wall without significant luminal distention and without gallstones. there was no focal tenderness directly over the gallbladder. the lack of a more distended gallbladder lumen plus the prominent hepatic veins, and the appearance of the lungs on today's cta study suggests the gallbladder edema may be due to third spacing of fluid secondary to congestive heart failure. clinical correlation is recommended, but in nearly all cases of acute cholecystitis, the lumen is much more distended than we see in this patient. if necessary, this could be further evaluated with a radionuclide biliary scan. . ct head : impression: no evidence of acute intracranial hemorrhage or significant change from prior study. mri with diffusion-weighted images is more sensitive in the evaluation for acute ischemia/infarct and for vascular detail. . echo : conclusions: the left atrium is normal in size. there is asymmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. the right ventricular cavity is dilated with borderline depressed right ventricular function (not full visualized). there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no brief hospital course: 1. dyspnea: the patient presented with acute on chronic dyspnea and given her history of multiple pneumonias, chills and per patient's family low temperatures the concern was for a recurrent pneumonia. another concern originally was for copd exacerbation. the patient was treated with azithromycin and ceftriaxone for presumed pneumonia and prednisone and nebulizers for copd exacerbation. the pulmonary team was consulted and felt most of this was due to fluid overload so th patient was diuresed. the patient improved, but on she was noted to be cyanotic off oxygen so placed on 4l and became unresponsive, with junctional rhythm (av dissociation ?). a code blue was called for unresponsiveness and hypoxia (80%). she was intubated and placed on dopamine drip due to hypotension and sent to ccu. her course in the ccu involved being weaned off pressors and her hypotension resolved. she was extubated on without any issues. she was treated with high dose steroids for her pulmonary status and also treated for presumed aspiration pneumonia with ceftriaxone and flagyl. she had a cta that was negative for pe. she was transferred back to the floor, and at that time she was weaned off steroids and completed a 7 day course of ceftriaxone and flagyl for aspiration pneumonia. the patient improved on the floor and pulmonary felt most of her symptoms were related to her pulmonary hypertension and some fluid overload. she was started on sildenafil and diuresed. she was doing well at discharge and will continue her inhalers, sildenafil and will have close follow-up as an outpatient with pulmonary. . 2. nausea: the patient's nausea and abdominal discomfort was attributed to her enlarged gallbladder. with diruesis this improved. surgery saw the patient and did not see the need for a hida scan. her urine was negative for infection, and with diuresis she no longer complained of nausea or pain. . 3. svt: on tele the patient had several episodes of svt and remained asymptomatic. the abnormal rhythm always broke without intervetion, and she was treated with a beta-blocker that helped to keep her in a normal rate. she will continue the beta-blocker as an outpatient, and should have it titrated up if her pressure can tolerate this. . 4. presyncope: the patient described presyncope, and this could have been due to a number of factors. her vitals revealed orthostasis and with fluids she improved. she was ruled out for mi, and the only other possible cause was her svt, which resolved with a beta-blocker. the patient felt better at discharge and will continue her beta-blocker and will work with physical therapy at rehab. . 5. diastolic dysfunction: the patient presented with volume overload and improved with diuresis, a low sodium diet and with a beta-blocker. she should have her weight followed at discharge and if she appears overloaded may need more lasix. she will be discharged with a low dose of lasix and a beta-blocker. . 6. bilateral pe's: the patient has a history of pe, but 2 cta's were performed and were negative for pe. she was maintained on her coumadin and this was held for several days due to supratherapeutic inr. as an outpatient she should continue to have her inr checked and have her between . she should have her coumadin adjusted accordingly. . 7. anemia: the patient's baseline hematocrit is around 30-33. while in the ccu she had a hct drop of 4 points, but the recheck was back at her baseline. she had iron studies consistent with iron deficiency anemia but iron was held and may need to be started as an outpatient. her hematocrit remained fairly stable during her course and should be followed as an outpatient. she never required transfusions during her course. . 8. acute on chronic renal insufficiency: the patient was never formally diagnosed with renal insufficiency though her baseline was noted to be around~ 1.2-1.5. in the unit her creatinine increased to 1.8 and this was attributed her hypotension, as once her hypotension improved so did her creatinine. her renal function normalized at discharge and should continue to be followed as an outpatient. . 9. leukocytosis: the patient had leukocytosis for most of her course and this was attributed to steroids. she remained on antibiotics for a possible pulmonary source and blood and urine cultures were sent. all cultures are negative to date, though some are still pending and should be followed at rehab. . 10. steroid induced hyperglycemia: the patient required insulin while on steroids and may have some underlying diabetes. the patient will have ssi written for at rehab, but a formal diagnosis of diabetes may be immenent and should be addressed as an outpatient. medications on admission: 1. toprol xl 25 qd 2. albuterol 2 puffs q 6 hr prn 3. ipratroprium 2 puffs qid prn 4. timolol 0.5 % one drop right eye qd 5. coumadin 3 mg qhs 6. lisinopril 5 mg qd discharge medications: 1. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) inhalation four times a day. 2. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. warfarin 3 mg tablet sig: one (1) tablet po hs (at bedtime): coumadin. 5. outpatient lab work please have your inr checked in 2 days. your is 6. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q1-2h () as needed for wheezing. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for fever. 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 12. sildenafil 25 mg tablet sig: 0.5 tablet po tid (3 times a day): hold for sbp < 100. 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp <100 and hr < 55. 14. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). 15. humalog 100 unit/ml cartridge sig: follow ss subcutaneous per ss. discharge disposition: extended care facility: for the aged - discharge diagnosis: 1. hypoxia 2. pneumonia 3. chf 4. acute on chronic renal insufficiency 5. copd exacerbation 6. steroid induced hyperglycemia 7. anemia 8. pulmonary hypertension 9. svt discharge condition: stable, tolerating medications discharge instructions: you were admitted for hypoxia, which was related to your fluid status and possibly an infection with a copd exacerbation. the most likely cause though is your pulmonary hypertension. you were diuresed, treated with antibiotics, and treated with steroids. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet, to maintain fluid balance. . you also will need your inr checked 2 days after discharge to verify you are on the appropriate dose of coumadin. . you will continue all home medications, except the toprol xl. new medications include metoprolol, pantoprazole, aspirin, colace, senna, lasix and sildenafil. you will no longer take lisinopril. . call your doctor or go to the emergency room for vomiting, worsened dizziness, fainting, new headache, chest pain or worsened shortness of breath. followup instructions: 1. you have a pulmonary appointment as follows: provider: breathing tests phone: date/time: 4:10 provider: , intepretation billing date/time: 4:30 provider: . /dr. phone: date/time: 4:30 2. you have an appointment with your primary doctor as follows: thursday at 10:45 am with dr. #. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube cardiopulmonary resuscitation, not otherwise specified infusion of vasopressor agent diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure other chronic pulmonary heart diseases chronic kidney disease, unspecified acute respiratory failure long-term (current) use of anticoagulants iron deficiency anemia, unspecified diseases of tricuspid valve 

Answer: The patient is high likely exposed to