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: sulfa (sulfonamides) / morphine / ritalin attending: chief complaint: nausea, vomiting, diarrhea major surgical or invasive procedure: none history of present illness: 88 y/o female with h/o htn, mitral regurgitation, depression, and h/o breast ca who presented with 4 days of nausea/vomiting and dark loose stools. she denied cp, sob, or palpitations. she denies cough. she states that she recently had a fever (?102). she received a course of azithromycin at nh. she was ordered to start ceftriaxone today. . in ed, initial bp in 70s, given ivf, prbc, and started on dopamine gtt. ekg found to have ste in v2, v3, avf, v3-6 with std in v1-2. guaiac positive black stools. unable to pass ngt. gi did not feel egd at this time was appropriate secondary to the patient's cardiac issues. . she was transferred to the ccu for further management of her stemi. past medical history: mitral regurgiation depression anxiety delusional psychosis htn glaucoma s/p r knee replacement s/p r hip fracture - prosthesis removed to infection urinary incontinence chronic abd discomfort - hiatual hernia cancer l breast (s/p lumpectomy ) injury to l sc artery () social history: lives at rehab. denies tobacco, etoh, or ivdu. used to be nurse. worked in north during ww2. family history: no hx of cad physical exam: gen: nad, pleasant heent: dry mmm, marked anisocoria, lt pupil 5 mm and rt pupil 2 mm. neck: 1+ bilateral carotid bruits cvs: irregular, 2/6 systolic murmur along upper sternal border lungs: diffuse wheezing abd: soft, mild tender to palpation at mid lower abdomen, nt, +bs ext: trace pedal edema pertinent results: wbc-9.8 hct-29.8 plt ct-164 glucose-142 urean-76 creat-1.4 na-145 k-4.0 cl-106 hco3-28 ck(cpk)-279-->171-->144-->97-->43-->64 ctropnt-1.54-->1.32-->1.31 . wbc-8.5 rbc-3.84* hgb-11.6* hct-35.4* mcv-92 mch-30.2 mchc-32.8 rdw-14.4 plt ct-173 glucose-169* urean-16 creat-0.9 na-144 k-4.1 cl-106 hco3-35* angap-7* mg-2.0 . ekg: : atrial fibrillation with a rapid ventricular response. compared to the previous tracing of atrial fibrillation with a rapid ventricular response has appeared. ste in v2, v3, avf, v3-6 with std in v1-2. . imaging: cxr () no definite evidence of consolidation. however, examination of the left lower lung fields is limited secondary to overlying hiatal hernia. . cxr (): the right picc line tip is in the inferior portion of superior vena cava. the whole left hemithorax is opacified with a leftward mediastinal shift due to complete or near-complete atelectasis of the left lung. the previously demonstrated hiatal hernia is again noted. . cxr (): left lung has reexpanded, though the base is chronically elevated by a large diaphragmatic hernia containing stomach and intestine. persistent atelectasis of the right lower lobe and small bilateral pleural effusion has increased. cardiac silhouette is largely obscured. mediastinal venous engorgement suggests volume overload or at least elevated right heart pressure. there is no free subdiaphragmatic gas. tip of the right subclavian catheter projects over the superior cavoatrial junction. no pneumothorax. . cxr () new collapse of left upper lung. this may be due to mucus plugging , atelactasis or endobronchial lesion. bronchoscopy would be helpful to evaluate cause of intermittent obstruction of left mainstem bronchus. . cxr () re-expansion of left upper lobe. worsening of mild-to-moderate right lower lobe atelectasis and effusion. stable, chronic elevation, left hemidiaphragm and small, left pleural effusion. . echocardiogram (): the left atrium is dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is small. lv systolic function appears depressed secondary to extensive apical akinesis. however, the basal and midventricular segments are markedly hyperdynamic, resulting in a moderate resting left ventricular outflow tract obstruction. the gradient increased with the valsalva manuever. a mid-cavitary gradient is also identified. right ventricular chamber size is normal. there is focal hypokinesis of the apical free wall of the right ventricle. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present; the increased flow velocity across the aortic valve is due to preacceleration in the left ventricular outflow tract. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is systolic anterior motion of the mitral valve leaflets. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . echocardiogram (): conclusions: focused study. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the distal of the left ventricle, and akinesis of the true apex. no left ventricular thrombus is seen. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , there has been some improvement in the contractility of the distal of the left ventricle,however the rest of the walls are no longer hyperkinetic. pulmonary arterial pressure is similar. . culture data: 1. ucx urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . 2. bcx (total of 4 bottles) no growth. . 3. scx contaminated, culture cancelled brief hospital course: 88 y/o female with h/o htn and no prior h/o cad presents with vomiting/loose stools and found to have stemi and guaiac positive stools. the following issues were addressed during this hospitalization. . 1. cardiac - ischemia the patient presented with a stemi with ste in inferior and septal leads. she was found to have positive cardiac enzymes. due to gi bleed and patient's functional status, conservative management of her stemi ensued with aspirin 81 mg daily and clopidogrel 75 mg po daily. . - pump the patient was found to have an ef of 50% by echocardiography. the patient's initial echo on dopamine gtt revealed extensive apical akinesis; the basal and midventricular segments were markedly hyperdynamic, resulting in a moderate resting left ventricular outflow tract obstruction. dopamine gtt was discontinued within the first few hours in the ccu with subsequent decrease in hr and increased in bp due to improved diastolic filling. patient had chf secondary to diastolic dysfunction and was successfully diuresed with iv lasix. repeat echo revealed some improvement in the contractility of the distal of the left ventricle and the rest of the walls were no longer hyperkinetic. . - rhythm the patient went into afib and aflutter with rvr intermittently (as high as hr 150-160s), with associated hypotension. the patient was loaded and maintained on amiodarone. her episodes of rvr responded to iv diltiazem, so she was started on an oral regimen of diltiazem. she intermittently required iv diltiagem gtt. on discharge, the patient continued to alternate between nsr in 50s to af with rvr to 100-120 range and remained hemodynamically stable. she needs to continue amiodarone load 400 mg daily for 2 days followed by a maintenance dose of 200 mg daily. . 2. gib there was an initial concern for ugib given patient's h/o of melena. hematocrit remained stable in mid-30s. no blood transfusions required. gi was consulted early in presentation and did not proceed with egd due to patient's cardiac issues. . 3. aspiration pna the patient was empirically treated with levofloxacin and metronidazole for aspiration pneumonia. metronidazole was later discontinued and the patient 7 days of levofloxacin and has 3 more days remaining upon discharge to complete a 10 day course. . 4. mucous plugging the patient was noted to have intermittent mucous plugging contributing to sob and wheezing. she had cxrs on and which showed collapse of the entire left lobe mucous plugging and atelectasis. pt responded to chest pt, suctioning, and exsufflation. aggressive chest pt will be recommended upon discharge. . 5. wheezing the patient was noted to have intermittent wheezing which is multifactorial secondary to aspiration pneumonia, mucous plugging, chf (successfully diuresed), and possible underlying copd in setting of smoking history. pt was given standing atrovent nebs and flovent. she required frequent prn albuterol treatments. pt was given solumedrol for 1 day. . 6. hypernatremia the etiology of the patient's hypernatremia was thought to be secondary to poor po intake and a free water deficit. she was given free water via ivf and her sodium level corrected. this will need to be monitored upon discharge. . 7. uti the patient was found to have a uti and was treated with 3 days of levofloxacin. . 8. depression the patient was continued on outpatient regimen of remeron. . 9. insomnia the patient was given trazodone 25mg qhs prn for to aid in sleep. . code: dnr/dni . access upon discharge: porta-cath medications on admission: bisacodyl combivent nebs lisinopril 2.5 mg daily aluminum hydroxide docusate 200 mg protonix 40 mg qhs reglan 5 mg qid mvi magnesium citrate 240 mg qd mirtazapine 15mg qhs depakote ed 250 mg alubuterol inh tigan 200 mg prn calcium carbonate ceftriaxone 1gm q24 (start - ) azithromycin discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q2h prn (). 4. albuterol sulfate 0.083 % solution sig: one (1) inhalation q2h (every 2 hours) as needed. 5. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain, sob. 11. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 12. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 13. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 14. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 15. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 16. levofloxacin in d5w 250 mg/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 3 days. 17. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily) for 2 days. disp:*4 tablet(s)* refills:*0* 18. amiodarone 200 mg tablet sig: one (1) tablet po once a day: please start after 400mg dose x 2 days. 19. multivitamin capsule sig: one (1) cap po daily (daily). 20. depakote er 250 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po twice a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: stemi chf af/aflutter with rvr mucous plugging aspiration pna uti gib lvot obstruction . secondary diagnoses: depression hx breast cancer discharge condition: normal o2 sats on 5l supplemental o2 (stable) the patient was discharged hemodynamically stable, afebrile with appropriate follow up. discharge instructions: 1. please take all medications as prescribed. . 2. please return to the ed or call your pcp if you develop chest pain, difficulty breathing, palpitations/rapid heart rate, fevers, or any other concerning symptoms. . 3. please keep all follow up appointments. followup instructions: follow up with the doctor rehab. md, procedure: transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of breast unspecified glaucoma depressive disorder, not elsewhere classified atrial flutter anxiety state, unspecified pneumonitis due to inhalation of food or vomitus blood in stool acute myocardial infarction of other inferior wall, initial episode of care hematemesis hyperosmolality and/or hypernatremia knee joint replacement insomnia, unspecified wheezing foreign body in other specified parts bronchus and lung 

Answer: The patient is high likely exposed to