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: natural tears / tetracyclines attending: chief complaint: mental status change, fever major surgical or invasive procedure: none history of present illness: 79 year-old woman with a history hx of copd, cad, dm2 who lives at , was in her usuall state of health until yesterday, when she was found to be more lethargic and weak appearing with vs being stable. through the course of the day her ms improved. today, however her ms deteriorated and she was found to be barely arousable. her o2 sat was 82 on ra (87 on 4l - baseline 96%-97%) and she was found to have a temp of 101.2. patient has a histrory of coagh however unbclear since how long. no sick contacts. discussion with rn her was uncomlicated until yeasterday without focal signs ans symptoms. ed: blood pressure noted to be as low as 78/49. code sepsis was initiated with a rij placed. two liters of ns were given, along with vanco/levofloxacin/zosyn. norepinephrine was also started. past medical history: 1. cad - s/p mid-lcx to om1 in , known 90% rca occlusion. admitted with unstable angina , with reversible lateral defect on mibi, decision to medically manage. 2. dm type ii - last hgba1c in was 6.2 3. paf 4. seizure disorder 5. copd 6. obesity 7. venous stasis, h/o overlying cellulitis 8. depression 9. mycosis fungoides in (treated with phototherapy and put into remission. has not been a problem since that time, according to the patient) 10. hypothyroidism 11. hypercholesterolemia 12. s/p bilateral tkr in - walks w/ walker at baseline 13. s/p right shoulder repair social history: currently lives at . previously lived by herself in in public housing. continuing to smoke >1ppd+ x 50+ years. not on o2 at home. no etoh. used to work as a banker for bank of , with power of attorney forms. married and divorced, no children. family history: non-contributory physical exam: vitals - bp 92/51, hr 84, 98% on facemask gen - cyanotic, but in nad and no accessory muscle use, appropriate affect. heent - dry mm, thick secretions in mouth cv - rrr pulm - bibasilar crackles. abd - soft and non-tender. ext - warm. no edema. neuro - alert. oriented to "". unsure of date. pertinent results: 11:05am wbc-5.7 rbc-4.52 hgb-12.6 hct-37.7 mcv-84 mch-27.9 mchc-33.5 rdw-14.2 11:05am neuts-60 bands-25* lymphs-7* monos-5 eos-0 basos-0 atyps-0 metas-2* myelos-1* 11:05am glucose-133* urea n-27* creat-1.5* sodium-140 potassium-4.0 chloride-103 total co2-23 anion gap-18 11:10am lactate-2.2* 11:05am alt(sgpt)-48* ast(sgot)-81* ck(cpk)-71 alk phos-108 amylase-35 tot bili-0.4 09:54pm type-art po2-88 pco2-36 ph-7.36 total co2-21 base xs--4 . cxr () markedly limited examination. the study is degraded by respiratory motion and body habitus. no gross consolidation is noted; however, there is a subtle increased density within both lung bases, particularly in the retrocardiac left lower lobe. the mediastinum is grossly stable. lung volumes are markedly diminished likely accentuating the cardiac silhouette size, although there is a left ventricular predominance noted. there is slightly asymmetrical left apical pleural thickening noted. no pneumothorax is seen. the bones are diffusely osteopenic with degenerative changes throughout the thoracic spine. impression: markedly limited study. suggestion of bibasilar opacities, likely atelectasis; however, early developing pneumonias cannot be excluded. . 11:05 am blood culture blood culture, routine (preliminary): staphylococcus, coagulase negative. isolated from one set only sensitivities performed on request.. anaerobic bottle gram stain (final ): gram positive cocci. in pairs and clusters. . 11:41 pm sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): oropharyngeal flora absent. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. streptococcus pneumoniae. sparse growth. possible penicillin resistance by oxacillin screen. resistance to be confirmed by mic testing. staph aureus coag +. rare growth. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. yeast. brief hospital course: 79 y/o female admitted with sepsis, believed from pulmonary source, initially admitted to micu and called out after rapid improvement. . #. septic shock: this was thought most likely to be due to pneumonia. the pt never had clear infiltrate on cxr, however she did have an impressive bandemia at the time of admission and subsequently had an elevated wbc count. the pt grew s. pneumo and staph non-aureus from her sputum and staph non-aureus from one blood culture bottle. she was briefly on levophed in the micu although blood pressures quickly improved with treatment. . #. pneumonia: the pt was initiated on broad spectrum emperic coverage (levofloxacin, vanocymicin and zosyn) for presumed pna. when her culture results returned, she was continued on levofloxacin and vancomycin only. . #. acute renal failure: the pt's cr was 1.5 at the time of admission. this was thought to be due to a prerenal state in the setting of poor po intake and sepsis. her cr improved with iv hydration and with the normalization of her overall clinical status. it was 0.9 at the time of discharge. . #. af: during her hospital course, the pt was noted to be in af much of the time with poor rate control. based on a review of old records, it appeared that she was not anticoagulated because her af burden was thought to be very low. as this did not appear to be the case during her stay, anticoagulation was initiated and the pt's beta blocker was titrated up to achieve better rate control. prior to discharge, the pt's inr was elevated to as high as 7; she was given vitamin k and her inr was 1.4 on the day of discharge. she had been receieving 5 mg daily; a dose of 2 mg a day, with frequent inr checks, is advised, particularly as antibiotics are discontinued. . #. cad: the pt's home asa was continued. plavix was stopped as the pt is more than one year post-stent and she was started on anticoagulation. . #. dm type ii: the pt was maintained on an insulin sliding scale. her sugars were well-controlled. . #. seizure disorder: home dilantin was continued. . # copd: the pt's home albuterol and ipratropium were continued. . #: hypothyroidism: levothyroxine was continued. . #: hypercholesterolemia: home statin was continued. medications on admission: advair 250/50 furosemide 20 daily gabapentin 200 tid phenytoin 100 tid ropinirole 3 mg qhs isosorbid 45mg qhs bisacodyl 10 mg supp milk of magnesia atrovent inhaler q6h guiafenesin proair 90mcg inhaler q6h tylenol 2x325 q4h discharge medications: 1. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po qam (once a day (in the morning)). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po hs (at bedtime). 4. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. gabapentin 100 mg tablet sig: two (2) tablet po every eight (8) hours. 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days: day 1 = . continue through . 9. vancomycin in dextrose 1 gram/200 ml piggyback sig: 1000 (1000) mg intravenous q 24h (every 24 hours) for 7 days: day 1 = . continue through . 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. metoprolol tartrate 25 mg tablet sig: 2.5 tablets po tid (3 times a day). 12. ropinirole 1 mg tablet sig: three (3) tablet po qpm (once a day (in the evening)). 13. biscolax 10 mg suppository sig: one (1) rectal once a day. 14. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. 15. atrovent hfa 17 mcg/actuation aerosol sig: one (1) inhalation every six (6) hours. 16. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for 7 days. 17. avandia oral 18. coumadin 2 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: pneumosepsis renal failure congestive heart failure . secondary: coronary artery disease type two diabetes seizure disorder copd hypothyroidism discharge condition: clinically improved, vitals stable. discharge instructions: -you were admitted with pneumonia and low pressure. we have treated you with antibiotics, iv fluids and medicines to raise your blood pressure. you are now doing much better and are being transferred back to your nursing home for further care. -it is important that you continue to take your medications as directed. we made the following changes to your medications during this admission: --> your metoprolol dose was increased and will continue to be adjusted at . --> you were started on coumadin; the exact dose is currently being adjusted. 5 mg daily was found to be too much; you will now be at 2 mg daily. you will need to have the effect of the coumadin on your blood checked with a test (inr) in the next 1 to 2 days. -contact your doctor or come to the emergency room should your symptoms return. also seek medical attention if you develop any new fever, chills, trouble breathing, chest pain, nausea, vomiting or unusual stools. followup instructions: please call and schedule an appointment with your primary care doctor after you are discharged. procedure: venous catheterization, not elsewhere classified diagnoses: coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation percutaneous transluminal coronary angioplasty status septic shock epilepsy, unspecified, without mention of intractable epilepsy pneumococcal pneumonia [streptococcus pneumoniae pneumonia] venous (peripheral) insufficiency, unspecified 

Answer: The patient is high likely exposed to