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: no known allergies / adverse drug reactions attending: chief complaint: hypoxia, syncope major surgical or invasive procedure: chest tube placement and removal history of present illness: ms. is a 65 year old female, with history of cad s/p nstemi , stemi with proximal lad occlusion treated with bms, systolic heart failure with ef 25%, lv hypertrophy and hypertension, current lle dvt and multiple pulmonary emboli. the patient had a recent admission for multiple syncopal episodes when she was found to be in cardiogenic/septic shock with strep pneumo pneumonia with admission complicated by pe, dvt and right-sided penumothorax, and was discharged to rehab macu yesterday evening with plan to return for icd placement. today, patient became unresponsive and unable to follow commands. per report from ems, she was hypoxic to the 60%s. ed course: 97.6 92 105/73 20 99%ra. ekg showed nsr at 90 bpm with q waves in v1-v3, slight st elevations in v3-v4 and prolonged qt, which were all unchanged from before. labs notable for bnp 2398, k 3.1 and wbc 12.2 with 82% pmns. troponin was 0.01 and lactate 1.7. blood cultures were drawn. given cefepime and vancomycin. ekg in the ed showed nsr at 90 bpm with q waves in v1-v3. ct head did not demonstrate any evidence of intracranial lesions/hemorrhage/masses, but there is sinus opacification. - chest x-ray shows mild-mod pneumothorax at the right base, ?small ptx at apex too. patient had a chest tube in which was discontinued yesterday without any post x-ray. rij terminating in mid-svc - ct w/ & w/o contrast: 1. moderate right basal pneumothorax, increased since the prior study; 2. no interval increase in bilateral pulmonary embolism in the lll, rul. no right heart strain; 3. bibasal consolidations, atelectasis/infection. - central line still in place - bedside cardiac ultrasound shows poor ejection fraction, no pericardial effusion no obvious right-sided heart strain - cta: 1. moderate right basal pneumothorax, increased since the prior study. 2. no interval increase in bilateral pulmonary embolism in the lll, rul. no right heart strain. 3. bibasal consolidations, atelectasis/infection. on admission to the ccu, she is afebrile, 93% on 2l nc, with no specific complaints. she remembers being sob earlier today, and says this has now resolved. she does not remember further details and does not remember syncopizing. she denies any current sob, cough, chest pain, palpitations, lh, dizziness. she has not had a bm in 2 days. no dysuria, urgency, or frequency. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: cad with nstemi , stemi -pci: bms to lad -ischemic cardiomyopathy with lvef of 20-25% on osh tte 3. other past medical history: copd gerd migraine headaches osteroarthritis chronic lower back pain depression social history: patient is married, lives with husband. family stress due to death of her son from heroin overdose. also has daughter w/ current substance abuse problems. a 60 pack year history and currently smokes about one pack per day, but has plans to quit. family history: mother had chf, died from at age 80. father died from lung cancer. physical exam: admission physical exam: vs: t= 96.9; bp 139/91; hr 108; rr 25; o2 sat 93% 2l nc general: cachectic caucasian female in nad. oriented x1. mood, affect appropriate, although she seems distant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. has dentures. neck: supple; unable to assess jvp as ij line in place on right side. cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. holosystolic murmur best heard at lsb. there is a mild lift to her left chest. no thrills. no s3 or s4. lungs: has kyphosis. resp were unlabored, no accessory muscle use, although mildly tachypnic. lung sounds are decreased in the right base. there are crackles in both bases, l>r. no wheezes. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. her skin does appear to hang off her body, consistent with her overall cachectic appearance neuro: a+ox1, cn2-12 intact, 5/5 strength in all extremities pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ discharge physical exam vs: 96.8 102/54 94 20 95% on 2l gen: cachectic, chronically ill appearing, comfortable, appropriate cv: rrr no m/r/g lungs: cta b/l, decreased respiratory effort abd: soft, nt nd. small amount of bleeding from chest tube site ext: no edema skin: warm and dry pertinent results: admission labs 05:43am blood wbc-11.5* rbc-4.05* hgb-13.4 hct-40.5 mcv-100* mch-33.2* mchc-33.2 rdw-15.1 plt ct-481* 03:05pm blood wbc-12.2* rbc-4.33 hgb-13.7 hct-41.9 mcv-97 mch-31.7 mchc-32.7 rdw-15.2 plt ct-536* 03:05pm blood neuts-82.0* lymphs-12.4* monos-4.2 eos-1.1 baso-0.3 05:43am blood pt-13.1 ptt-91.4* inr(pt)-1.1 05:43am blood glucose-131* urean-10 creat-0.4 na-138 k-3.8 cl-98 hco3-30 angap-14 05:43am blood alt-354* ast-232* alkphos-154* totbili-0.7 03:05pm blood probnp-2398* 03:05pm blood ctropnt-0.01 08:00am blood ck-mb-5 ctropnt-<0.01 05:43am blood albumin-3.5 calcium-8.8 phos-2.9 mg-2.4 03:19pm blood lactate-1.7 discharge labs 05:18am blood wbc-8.9 rbc-3.41* hgb-11.0* hct-34.8* mcv-102* mch-32.1* mchc-31.4 rdw-14.9 plt ct-359 05:18am blood glucose-94 urean-6 creat-0.4 na-137 k-3.8 cl-105 hco3-24 angap-12 06:19am blood alt-94* ast-34 alkphos-154* totbili-0.4 imaging tte: overall left ventricular systolic function is severely depressed (lvef= 20%). right ventricular chamber size is normal. trivial mitral regurgitation is seen. tricuspid regurgitation is present but cannot be quantified. the pulmonary artery systolic pressure could not be determined. microbubles are seen in the left atrium. this could represent a right to left shunt through the inter atrial septum. a complete transthoracic echo looking for right-to-left shunt is recommended. impression: severe global left ventricular systolic dysfunction. tricuspid regurgitation. cta chest w&w/o c&recons, non-coronary: 1. no significant interval change in the bilateral pulmonary emboli involving the lobar and segmental branches of the right upper lobe and left lower lobe. no evidence of right heart strain. 2. possible developing infarction in the left lower lobe (superior segment). bibasilar consolidations, due to aspiration are similar. 3. interval increase in the moderate right pneumothorax. ct head w/o contrast: re is no evidence of acute intracranial hemorrhage, edema, masses or mass effect. -white matter differentiation is preserved. the ventricles and sulci are mildly dilated, consistent with involutional changes. the basal cisterns are normal. calcifications are seen in bilateral vertebral arteries and cavernous internal carotid arteries. there is near-complete opacification of the left maxillary sinus, and partial opacification of bilateral ethmoid and sphenoid sinuses. the mastoid air cells are clear. impression: no acute intracranial abnormality. extensive pansinus disease. cxr: as compared to the previous radiograph, the right-sided chest tube has been removed. there is no evidence of pneumothorax or other complication. a minimal right pleural effusion with a small right basal atelectasis persists. unchanged mild to moderate left pleural effusion with subsequent atelectasis and minimal enlargement of the left pulmonary artery. unchanged size of the cardiac silhouette. unchanged evidence of the left lung parenchyma. the right picc line is also unchanged. brief hospital course: ms is a 65yof with h/o cad s/p nstemi , stemi with proximal lad occlusion treated with bms, systolic chf w/ ef 20%, and lle dvt and multiple pulmonary embolisms. she had a recent admission for multiple syncopal episodes, complicated by cardiogenic/septic shock with strep pneumo pneumonia, pe, dvt, and right-sided penumothorax. she returned from rehab with recurrent pneumothorax. # recurrant pneumothorax - an ij placed for her original micu stay was the cause of her initial pneumothorax. a chest tube was placed and her lung reexpanded. she was discharged to rehab for a short stay but returned with hypoxia and was found to have a recurrent pneumo. a chest tube was placed and her lung reinflated on suction. her chest tube was then placed to water seal, and then clamped. followup cxrs showed lung reexpansion and the tube was removed on . cxr on prior to d/c showed an expanded right lung. she continued to have slight bleeding from the chest tube site due to her anti-coagulation. # air embolism - on , her right ij was removed. she was in trendelenburg and humming at the time. about 1 minute after tube removal, she became acutely hypoxic and tachypneic, with o2 saturation down to 45%. she was placed on a non-rebreather and code blue was called. her o2 sat increased to 88% on nrb and she was transferred to the micu. she was stable in the micu, breathing at 94% on nrb. her o2 sat continued to improved and she was transferred back to the floor. presumptive diagnosis of air embolism. # pulmonary embolisms - diagnosed on prior admission. switched to heparin drip acutely for management of pneumothorax chest tube while admitted. transitioned to lovenox on . warfarin started at 4mg on . inr 1.0 on discharge. # delirium - she was intermittently delirious throughout her hospital stay, often a+ox1. many of her medications had been stopped or tapered, including fluconazole (no evidence for fungal uti), fluoxetine, wellbutrin and fexofenadine. her gabapentin was also decreased to 200 mg . psychiatry was called for concerns of delirium vs. psych disorder. if symptoms of depression return, can consider restarting anti-depressants. she was and oriented to person, place and time on day of discharge. # cardiogenic shock - from her previous admission, likely in the setting of pes and poor lvef. recommendation from cardiology was placement of an icd for secondary prevention of sudden cardiac death, but due to her acute illness, this was deferred. ep saw the patient prior to discharge and will followup for icd placement soon. she should remain on tele monitoring until icd is placed. # copd - chronic from many years of smoking, with no indication of worsening status at this time. continues on oxygen which may be her home requirement. ipratropium used in house. discharged on tiotroprium, advair and albuterol prn. # cad: nstemi , stemi with bms to lad, stents patent on cath from . continued aspirin. no need for plavix anymore. statin was held due to elevated lfts. this can be restarted as an outpatient if lfts continue to trend down. # schf: lvef = 25% on tte from . no evidence for acute exacerbation at this time. repeat tte around # depression - stopped fluoxetine and wellbutrin to minimize polypharmacy and reduce delirium. can restart as outpatient if necessary. # chronic back pain: decreased gabapentin to 200mg . also on topamax. occasional oxycodone as needed. # gerd: stopped pantoprazole. restarted ranitidine as she was previously on it. transitional --- pulmonary embolisms - trend inr and discontinue lovenox when therapeutic --- icd placement - ep will contact rehab to arrange transfer on wednesday for icd. patient should be remain on tele until icd placement. --- depression - can consider restarting anti-depressants as needed medications on admission: 1. bupropion hcl 100 mg po daily 2. folic acid 1 mg po daily 3. thiamine hcl 100 mg po daily 4. multivitamin po daily 5. topiramate 100 mg po bid 6. fluoxetine 60 mg po daily 7. clopidogrel 75 mg po daily 8. gabapentin 400 mg po bid 9. aspirin 325 mg po daily 10. pantoprazole 40 mg , delayed release (e.c.) po daily 11. fexofenadine 60 mg po bid 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6 prn pain 13. albuterol sulfate 90 mcg/actuation hfa 1 puff q6 prn sob/cough 14. ipratropium bromide 17 mcg/actuation hfa 1 puff q6 prn sob/wheeze 15. enoxaparin 75 mg sc daily 16. fluconazole 100 mg po daily for three days (first day ) 17. furosemide 10 mg/ml, continuous infusion 18. lisinopril 5 mg po daily meds on transfer from micu: acetaminophen aspirin 81 colace 100mg folate gabapentin 400mg heparin drip ipratropium lisinopril 5mg mvi pantoprazole 40mg senna thiamine topamax 100mg discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. topiramate 100 mg tablet sig: one (1) tablet po bid (2 times a day). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 8. gabapentin 100 mg capsule sig: two (2) capsule po twice a day. 9. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 10. enoxaparin 60 mg/0.6 ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours). 11. ranitidine hcl 150 mg capsule sig: one (1) capsule po twice a day. 12. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. 13. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation four times a day as needed for shortness of breath or wheezing. 14. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) inh inhalation twice a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis pneumothorax air embolism secondary diagnosis cardiogenic shock 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: ms. , you were admitted to the hospital with a recurrence of your pneumothorax that had been caused by the insertion of an iv in your neck. your stay was also complicated by an air embolism caused by the removal of that line that caused difficulty with your breathing. weigh yourself every morning, md if weight goes up more than 3 lbs. medication changes: stop buproprion, fluoxetine, fexofenadine and fluconazole, since these may have contributed to some confusion decrease gabapentin to 200mg twice a day for pain stop pantoprazole start ranitidine 150mg twice a day for heartburn start albuterol four times a day as needed for shortness of breath start tiotropium daily for copd start advair inhalation twice a day for copd followup instructions: please contact your primary care physician to schedule after you leave rehab. cardiology icd placement: the ep lab will contact to arrange transfer for icd placement on wednesday . if you do not hear from them monday, please contact them at . department: pulmonary function lab when: thursday at 12:30 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: thursday at 1 pm with: rn/dr. building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified diagnoses: other chronic pain coronary atherosclerosis of native coronary artery esophageal reflux tobacco use disorder mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified depressive disorder, not elsewhere classified other specified forms of chronic ischemic heart disease 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 iatrogenic pneumothorax old myocardial infarction chronic systolic heart failure lumbago other pulmonary embolism and infarction delirium due to conditions classified elsewhere nutritional marasmus acute myocardial infarction of unspecified site, subsequent episode of care body mass index less than 19, adult acute venous embolism and thrombosis of internal jugular veins venous embolism and thrombosis of superficial vessels of lower extremity 

Answer: The patient is high likely exposed to