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: penicillins / codeine attending: chief complaint: respiratory failure . major surgical or invasive procedure: picc line placement endotracheal intubation . history of present illness: 70 yo woman with h/o cad, cabg, last des , iddm, ckd, chf on lasix here from with r sided pna, nstemi. she reports chest pain, typical for her angina but resistent to slng (5-6 tabs) over the last 5 days (longer duration than normal). she also c/o dizziness/lightheadedness, nausea/vomitting (bilious, nb) for the past 2 days, with diarrhea yesterday (watery, non-bloody, no mucous, but black at baseline given iron), with no abdominal pain. she notes fever to 102 at home yesterday. she denies ill contacts, travel, exotic foods. she does not normally have diarrhea but sometimes can get n/v with her chest pain. she describes the chest pain as sharp, rated yesterday, currently very dull. she notes being seen at and hosp over the past 5 days and told she had musculoskeletal chest pain. she denied cough to me but did endorse a feeling of wheezing. she has home oxygen only for anginal relief and o2 sat monitoring (baseline 95-96% on ra) but noted decreased o2 sat yesterday to 70's on ra. she was seen at , t 101.2 hr 96 rr 18 bp 124/96 sat 95% nrb, ck 171, trop 1.67, wbc 16.3, (n 88, l 5). she was found on cxr with 'right lung white out' and nstemi. she was given levofloxacin 500mg iv, compazine iv, 0.5mg ativan, zofran, 1 gm tylenol, aspirin 325mg, 1" nitro paste. . she was then transferred here. vs on arrival t 101, hr 92 bp 158/85, rr 18 sat 85% on ra. she was given 2.5mg iv metoprolol, 1l ns, 4 gm mag. her ecg was similar to , but trop continued to rise. she was started on heparin gtt. stool guaiac negative here. . ros: wt stable, no increased swelling, no ha, chronic (unchanged) photphobia, no neck stiffness, no congestion, denies cough to me, no orhtopnea, denies palpitation, sore throat, dysuria, hematuria, rash, + myalgias and chronic joint pain. past medical history: -cad: s/p cabg, last des 12/05 per her, with unstable angina (comes and goes at rest), dr. called, cardiologist at , s/p cabg with lima, svg x2, cath x2, one complicated by lad disection, no further anatomical intervtion for improvement, she does go for outpatient counterpulasion treatments for treatment of her cad/chf -iddm: insulin x22 years, a1c 9 last, s/p b toe nail removal dm -ckd (baseline crt 1.9) -chf -low back surgery -arthiritis: osteo ? hands, knees -le edema -vertigo -pvd social history: widowed, many children live near by, lives with one son (he's moving), no tobacco, etoh, illicit drug use now or in past. family history: mother rheumatic heart dx, father cva. physical exam: vs: t 97.9 hr 85 bp 163/80 rr 26 sat 99% on nrb gen: nad, comfortable, able to speak in full sentences heent: at, nc, perrla, eomi, no conjuctival injection, anicteric, op clear, mmm neck: supple, no lad, jvp to 8 cm cv: rrr, nl s1, s2, iii/vi hsm at rusb with radiation to b carotids, no rubs/gallops pulm: diffuse expiratory wheezes, scattered rales, no accessory muscle use but abdominal paradox in breathing abd: soft, nt, nd, + bs, no hsm ext: warm, dry, +2 distal pulses bl radial and dp; soft tissue swelling of mcp's b without erythema, warmth, tenderness, b tenderness to mcp squeeze, bony deformity of dip's/pip's. neuro: alert & oriented, cn ii-xii grossly intact, 5/5 strength throughout. no sensory deficits to light touch appreciated. skin: no rash pertinent results: pertinent labs: studies: cxr : 1. focal opacity at right lung base concerning for pneumonia. 2. likely mild pulmonary edema. 3. probable small bilateral pleural effusions. . tte : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with hypokinesis of the mid- and distal segments of the anterior wall, and severe hypokinesis/akinesis of the distal of the left ventricle, c/w lad disease. the remaining segments contract normally (lvef = 30-35%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. there are three moderately thickened aortic valve leaflets. there is mild aortic valve stenosis (area 1.2-1.9cm2). the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. impression: moderate regional left ventricular systolic dysfunction, c/w cad. mild calcific aortic stenosis. moderate pulmonary hypertension. . bilateral lenis : no deep vein thrombosis identified in either leg. . cxr : significant interval improvement in bilateral perihilar opacities is consistent with resolution of pulmonary edema. still present bibasilar consolidations might represent atelectasis and/or infectious process as well as there is no significant change in bilateral pleural effusions. . ct torso : 1. cardiomegaly with small bilateral pleural effusions and mild pulmonary edema. mild bibasilar atelectasis vs aspiration. 2. extensive coronary artery calcification. 3. normal positioning of lines and tubes. 4. nonobstructing renal calculus measuring 3 mm in the lower pole of the right kidney. 5. extensive mesenteric vascular calcifications and renal arterial calcifications. 6. scoliosis with degenerative changes. 7. two small pulmonary nodules measuring less than 4mm. one year follow-up chest ct or comparison with prior outside studies is recommended. . tte with bubble study : no obvious intracardiac shunt detected. . cxr : combination of bibasilar atelectasis and small right pleural effusion are unchanged over the past two days. moderate cardiomegaly is stable though larger today than yesterday accompanied by increase in caliber of the central pulmonary arteries and azygos vein, all of which may be due to interval extubation rather than cardiac decompensation. left pic line ends in the mid-svc. no pneumothorax. . wbc-16.8 hgb-13.6 hct-39.5 mcv-95 plt ct-259 neuts-91.6 lymphs-5.3 monos-2.8 eos-0.2 baso-0.1 wbc-17.7 hgb-13.3 hct-38.4 mcv-95 plt ct-282 wbc-11.1 hgb-11.5 hct-33.3 mcv-93 plt ct-349 glucose-281 urean-28 creat-1.8 na-138 k-3.6 cl-101 hco3-19 glucose-202 urean-78 creat-2.7 na-137 k-3.6 cl-93 hco3-33 ck(cpk)-201 ck-mb-17 mb indx-8.5 ctropnt-0.85 probnp- >70,000 alt-17 ast-44 ck-234 alkphos-103 amylase-17 tbili-0.4 lipase-11 alt-29 ast-35 ldh-248 alkphos-100 amylase-24 totbili-0.4 lipase-23 %hba1c-8.4 tsh-2.1 . urinalysis color-yellow appear-hazy sp -1.015 blood-sm nitrite-neg protein-100 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.5 leuks-neg rbc-8* wbc-8* bacteri-none yeast-none epi-<1 casthy-6* urine osmolal-309 urean-153 creat-23 na-97 . micro: 5/5 blood cx- no growth blood cx- pending at time of discharge urine cx- no growth urine cx- no growth bal- gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~1000/ml oropharyngeal flora. sputum cx- gram stain (final ): pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): no growth. stool c diff- negative, fecal cx- negative brief hospital course: ms. is a 70 year-old female with history of cad, chf with ef 30%, htn, dm2 who presented from an osh with hypoxic respiratory failure and nstemi. she was initially admitted to the micu. she was treated with levofloxacin and vancomycin to cover for hap. cardiology consult was obtained and recommended medical management as she is not a candidate for revascularization. bnp was noted to be >70,000. she was diuresed with iv lasix and is 4l. overnight on she developed afib with rvr to 120-130s and transient desat to 70s on cpap, felt to be hypoxia and pneumonia. rate controlled with metoprolol and diltiazem. on she was electively intubated for failing cpap. trop peaked at 0.82 and heparin gtt was discontinued on . converted back to nsr on . started lasix gtt on for diuresis. she was successfully extubated on . on , she was transferred to the medical floor. . # respiratory failure: this was felt to be due to a mixed picture of chf +/- pna on cxr; both improved clinically and on imaging with antibiotics and diuresis with lasix. she was elective intubated the day after admission (after a 24h trial of cpap failed to improve her respiratory status) and successfully extubated on hospital day 3. pao2/fio2 initially 200-300 - . low probability pe with well's criteria. us to assess pleural effusions - no appreciable effusions. ct chest without contrast - small bilateral pleural effusions and mild pulmonary edema, mild bibasilar atelectasis vs aspiration. sputum culture, mini-bal - no organisms on gram stain, cultures pending - potential viral/atypical infection. vanco was discontinued given negative cultures. she was quickly weaned off of oxygen once she reached the medical floor. she completed an eight-day course of levofloxacin to empirically treat for health-care associated pneumonia. cxr 2 days prior to discharge showed resolution of pulmonary edema and infiltrates. . # acute on chronic systolic congestive heart failure: she has an ef 30-35%, and as above, was felt to be in florid heart failure on initial presentation. bnp was >70,000 with pulmonary edema on cxr and hypoxic respiratory failure requiring intubation. fluid overload improved with diuresis. diuresis was complicated by acute renal failure (cr 1.8-->2.7) so lasix were held on the medical floor. she remained euvolemic and creatinine returned to her baseline. she was continued on optimal medical management with metoprolol, imdur, and hydralazine. she has a reported allergy to acei and . could consider ep evaluation as outpatient for aicd placement for primary prevention. . # nstemi/cad: suspected to be due to demand in the setting of hypoxic respiratory failure. also likely related to her inability to take her cardiac meds the 2 days prior to her initial admission to osh n/v/d. patient has been deemed not a candidate for further revascularization based on cardiac catheterization reports from . heparin gtt was discontinued on (48 hours since event). she was continued on asa, plavix, bb, statin, imdur, ranexa. medications were titrated to optimal medical management, with cardiology consult assistance. . # fever/leukocytosis: either due to pna or a presumed viral gastrointestinal process. bacterial cultures were negative. ua negative; urine culture negative; blood cultures no growth. lfts unremarkable. no diarrhea since admission. she completed an 8 day course levofloxacin for empiric treatment of pna or gi source of infection. . # afib with rvr: occurred in the setting of pna/hypoxic respiratory failure and fluid overload. tsh wnl. chads2 score 3. she was effectively treated with antibiotics and diuresis and converted to sinus rhythm. metoprolol was continued for rate control. no further episodes. . # arf on crf: her baseline creatinine is 1.9. on admission her creatinine was 1.8. as she was diuresed her creatinine rose to 2.7 by the day of transfer to the floor, likely pre-renal arf. lasix was held initially after transfer. her medications were renally dosed. . # hypertension: she is on an extensive blood pressure regimen at home, including imdur, toprol, clonidine, and norvasc. her regimen was slowly up-titrated toward her home regimen. hydralazine was also added. clonidine was held. . # dm2: her diabetes is poorly controlled as an outpatient, evidenced by her hba1c of 8.4. she was continued on lantus and a humalog insulin sliding scale. her lantus dose was increased to achieve better control. . # nausea/vomitting/diarrhea: she had 2 days of nausea, vomiting, and diarrhea associated with fever prior to admission to the osh. this was felt likely to represent an infectious (viral) gastroenteritis. less likely diabetic gastroparesis. lfts, amylase/lipase unremarkable. c diff and stool cultures were negative. stool cx negative. these symptoms quickly resolved after admission, until she had a recurrent episode 1 week into her admission (see below). . # nausea/vomiting/lightheadedness (second episode)-- coffee grounds emesis: on the day following being called out out of the micu, the patient complained of lightheadedness and nausea, exacerbated by movement. the following day she was unable to tolerate po liquids or solids. no diarrhea. later that day she developed one episode of small coffee grounds emesis. this cleared quickly with ng lavage with no evidence of bright red blood. felt most likely related to mucosal irritation or small tear from excessive vomiting. ekg was obtained without ischemic changes. she was orthostatic with sbp 140s-->120s from lying to sitting. po lasix was held out of concern that her symptoms were due to being over-diuresed. lfts, amylase, and lipase were within normal limits. she was afebrile. kub was unremarkable. the patient had been constipated for >1 week. after an aggressive bowel regimen was instituted she eventually had a large bowel regimen. her symptoms of nausea and vomiting quickly resolved and she was able to tolerate pos again. . # pvd: no active issues. continued her outpatient cilostazol. . # depression: no active issues. she was continued on her outpatient celexa. . # hypothyroid: no active issues. tsh 2.1. she was continued on her outpatient levothyroxine dose. . # vertigo/history of meniere's disease: takes meclizine at home. occasionally this acts up when she is hospitalized. meclizine had been held for most of her hospitalization but was re-started in the setting of her nausea and dizziness, thinking that her meniere's disease could be contributing. . # pulmonary nodules: two small pulmonary nodules measuring less than 4mm were seen on ct scan. one year follow-up chest ct or comparison with prior outside studies is recommended. . medications on admission: imdur 240mg daily toprol xl 200 plavix 75mg daily aspirin 325mg daily slng prn ranexa 500mg norvasc 10 po daily clonidine 0.3mg po bid levoxyl 75mcg daily protonix 40 daily lasix 120mg qam 80mg qpm mvi lipitor 80 daily zetia 10 daily cilostazol 100mg qam 50 qpm lantus: 22u qhs iron 325mg daily celexa 20 daily ativan 0.5mg q4 prn meclizine 25mg daily colace 100mg ambien 5mg qhs nystatin to skin novolog 4u ac meals . discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. cilostazol 100 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 8. cilostazol 50 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 9. ranolazine 500 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po bid (2 times a day). 10. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 11. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: four (4) tablet sustained release 24 hr po daily (daily). 12. toprol xl 200 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po twice a day. 13. meclizine 12.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 14. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 15. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 16. hydralazine 25 mg tablet sig: two (2) tablet po q8h (every 8 hours). 17. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 18. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed. 19. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 20. insulin lispro 100 unit/ml solution sig: as per sliding scale subcutaneous four times a day. 21. lantus 100 unit/ml solution sig: twenty four (24) units subcutaneous at bedtime. 22. ambien 5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 23. celexa 20 mg tablet sig: one (1) tablet po once a day. 24. novolog 100 unit/ml solution sig: four (4) units subcutaneous three times a day: with meals. 25. ativan 0.5 mg tablet sig: one (1) tablet po every six (6) hours as needed. 26. lasix 40 mg tablet sig: three (3) tablet po qam. 27. lasix 40 mg tablet sig: two (2) tablet po qpm. 28. multivitamin tablet sig: one (1) tablet po once a day. 29. zetia 10 mg tablet sig: one (1) tablet po once a day. . discharge disposition: extended care facility: hospital - discharge diagnosis: primary: nstemi, chf exacerbation, pneumonia secondary: -cad -iddm -ckd (baseline crt 1.9) -chf -low back surgery -arthiritis -le edema -vertigo -pvd . discharge condition: vitals stable. satting well on ra. tolerating a regular diet. . discharge instructions: you were admitted to the hospital with a heart attack and worsening of your heart failure, as well as possible pneumonia. these were treated with antibiotics, heart medications, and lasix. you also had nausea and vomiting, likely from constipation. . take all medications as prescribed. . if you develop shortness of breath, chest pain, fevers>101, persistent nausea and vomiting, or other concerning symptoms, you should return to the nearest ed. . followup instructions: you should follow up with your pcp within the next 2 weeks. , a . . md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified chronic kidney disease, unspecified constipation, unspecified acute respiratory failure long-term (current) use of insulin other diseases of lung, not elsewhere classified hematemesis acute on chronic systolic heart failure intestinal infection due to other organism, not elsewhere classified 

Answer: The patient is high likely exposed to