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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: hemodialysis (cvvh) history of present illness: mrs. is a 68 year old female with a history of systolic congestive heart failure (ef 15%), esrd on hd, cad and dmii who presents with two days of worsening shortness of breath. the patient has had multiple admissions to this hospital between and present for shortness of breath and was most recently discharged on . the patient reports that she was in her usual state of health until two days prior to admission. she received dialysis as on . she began to feel short of breath on with associated dyspnea on exertion and worsening orthopnea. she reports that she has had a cough productive of clear sputum for the past month but this has not worsened acutely over the past two days. she reports that she does have pressure in her chest and that this has been present essentially constantly over the past 48 hours. the chest pressure is associated with her shortness of breath. it is not clearly associated with exertion. the patient reports three pillow orthopnea which has not clearly worsened. she does report a worsening of her dyspnea on exertion. she says that her daughter helps her taker her medications and that she has been compliant to her knowledge. she does not report any dietary indiscretion. the patient uses 3 l oxygen by nasal cannula at home and has not needed to increase her o2. she also has been compliant with her home cpap. the patient reports that she presented to the emergency room on . at that time she had a chest xray which showed improved but persistent pulmonary edema and small pleural effusions. she had one set of cardiac enzymes which were notable for a troponin of 0.21 which is within her baseline. she was discharged with plans to follow up with her pcp. reports that her shortness of breath acutely worsened the following morning and she represented to the emergency room. . in the emergency room her initial vital signs were t: 95. hr: 100 bp: 131/68 rr: 24 o2: 95% on 100% nrb (88% on ra). initially she was hemodynamically stable but while in the emergency room her blood pressure decreased to the 70s systolic transiently and she required fluid bolus. she received 0.5 mg iv ativan and was subsequently noted to be more somnolent. abg performed revealed a ph of 7.31, pco2 of 70 and po2 of 73. she was placed on bipap with improvement in her mental status. she had a cxr which showed a new right basilar opacity and increasing pulmonary congestion. she received 20 mg iv lasix with minimal urine output. she received ceftriaxone 1 gram, azithromycin 500 mg po, aspirin 325 mg po, tylenol 500 mg po and levofloxacin 750 mg iv. her ekg showed a ventricularly paced rhythm with no significant changes from prior tracings. a left ij central line was attempted with misplacement in the carotid. pressure was held. while in the emergency room her blood pressure improved to the 100s systolic. her mental status improved and at the time of transfer she was satting well on 3 l nc. she was transferred to the for further management. . on review of systems she reports that her shortness of breath is slightly improved from this morning. she continues to have constant chest pressure. she denies fevers, chills, lightheadedness, dizziness, nausea, vomiting, abdominal pain, dysuria, hemturia, diarrhea, constipation, melena, hematochezia, leg swelling. she does have persistent left stump pain which is unchanged from baseline. past medical history: 1. chf with ef of 15% s/p biv pacer on coumadin 2. esrd - on hd since , *edw 60 kg* at last admit, t,th, sat dialysis 3. cad s/p mi & cabg x 2 ( and revised in ) 4. dmii x 4yrs on insulin 5. s/p l aka 6. hypothyroidism 7. atrial fibrillation on coumadin 8. no formal diagnosis of reactive airway disease although on albuterol and fluticasone at home 9. no formal diagnosis of osa although uses cpap machine at home social history: lives at home with daughter who helps her with her medications. she has vna services. she has a remote smoking history of less than 1 year total but her daughter does . she does not currently drink alcohol. she does not have a history of ivdu. she is wheelchair bound and does not have a prosthetic. family history: no family history of coronary artery disease. otherwise non-contributory. physical exam: vitals: t 97.3 hr: 74 bp: 110/68 rr: 24 o2: 100% on 3l general: alert, oriented, no acute distress, speaking in full sentences heent: sclera anicteric, mmm, oropharynx clear neck: right sided tunnelled catheter site intact, left neck with bandage, jvp 12 cm chest: expiratory wheezing diffusely, decreased breath sounds on the right, no egophony cv: rrr, s1 + s2, no murmurs, ii/vi sem at lusb gi: soft, non-tender, non-distended, +bs ext: left aka, right foot with 1 cm ulcer with clean base, middle toe with small ulcer neurologic: alert and oriented, moving all extremities pertinent results: 10:56pm pt-93.5* ptt->150* inr(pt)-12.2* 09:56pm glucose-145* urea n-28* creat-2.6* sodium-137 potassium-4.4 chloride-97 total co2-32 anion gap-12 09:56pm calcium-8.9 phosphate-4.8*# magnesium-2.0 07:09pm type-art temp-36.7 po2-120* pco2-54* ph-7.40 total co2-35* base xs-7 07:09pm lactate-0.9 07:09pm o2 sat-97 07:09pm freeca-1.23 02:20pm pt-15.3* ptt-95.9* inr(pt)-1.4* 12:54pm type-art po2-73* pco2-70* ph-7.31* total co2-37* base xs-5 11:06am urine hours-random 11:06am urine gr hold-hold 11:06am urine color-yellow appear-clear sp -1.026 11:06am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-mod urobilngn-neg ph-5.0 leuk-sm 11:06am urine rbc-0-2 wbc-* bacteria-mod yeast-mod epi- 10:30am glucose-191* urea n-25* creat-2.4* sodium-140 potassium-4.5 chloride-97 total co2-31 anion gap-17 10:30am ck(cpk)-35 alk phos-231* tot bili-0.3 10:30am ctropnt-0.20* 10:30am ck-mb-notdone probnp-* 10:30am ck-mb-notdone probnp-* 10:30am albumin-3.5 10:30am wbc-7.7 rbc-4.14* hgb-12.4 hct-41.4 mcv-100* mch-29.9 mchc-29.8* rdw-19.4* 10:30am plt count-263 12:25pm urine color-amber appear-clear sp -1.026 12:25pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-mod urobilngn-1 ph-5.0 leuk-tr 12:25pm urine rbc-0-2 wbc- bacteria-mod yeast-none epi- 10:15am glucose-190* lactate-1.0 k+-4.1 09:50am urea n-17 creat-2.1*# sodium-139 chloride-96 total co2-35* 09:50am estgfr-using this 09:50am ck(cpk)-25* 09:50am ctropnt-0.21* 09:50am ck-mb-notdone probnp-9430* 09:50am calcium-9.3 phosphate-2.7 magnesium-1.8 09:50am wbc-5.9 rbc-4.12* hgb-12.1 hct-41.0 mcv-100* mch-29.3 mchc-29.5* rdw-19.2* 09:50am neuts-75.5* lymphs-13.6* monos-6.6 eos-3.9 basos-0.6 09:50am plt count-261 09:50am pt-15.4* ptt-33.0 inr(pt)-1.4* brief hospital course: 1. acute on chronic systolic heart failure: continued management with hemodialysis. due to mild hypotension, lisinopril was held and carvedilol was continued. 2. ckd stage v on hd: stable. 3. hypotension: resolved 4. acute respiratory failure: appears to be secondary to sedation after receiving benzodiazepines - resolved. during her icu admission she was treated empirically for pna, but the antibiotics were discontinued when it was determined that she did not have pna. 5. coronary artery disease: stable 6. atrial fibrillation: stable. 7. diabetes mellitus yype ii: stable. 8. ischemic ankle ulcer: followed by podiatry, no role for revascularization, and they recommended continuing local wound care. 9. peripheral vascular disease: the patient will be continued on aspirin, ace if she can tolerate by bp, warfarin, per report did not tolerate statin therapy. 10. end of life care: i had an extensive conversation with the patients daughter, the details of which can be found in the omr note dated . in brief, she is not ready for hospice yet, but is open to the concept, she did agree that the patient's code status would be dnr/dni. a palliative care consult was obtained so that the daughter will have an established relationship when the time comes to transition to comfort measures.note, the patient defers all medical decision making to her daughter, and was not part of these conversations. medications on admission: on admission: oxycontin 10mg oxycodone 5mg prn . meds on transfer: ciprofloxacin 400mg iv q12h albuterol nebs q6h prn chlorhexidine oral rinse colace 100mg heparin sc tid hydrocortisone 100mg iv q8h ipratropium neb q6h prn magnesium sliding scale oxycontin 10mg oxycodone 5mg q4h prn pantoprazole 40mg po q24h zosyn 4.5mg iv q8h day#1 potassium sliding scale prochlorperazine 10mg q6h prn senna 1 tab po bid vancomycin 1000 mg iv q 12h d#1 discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 6. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 7. sevelamer hcl 400 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 8. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 11. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 13. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: to be titrated at hemodialysis - last dose 5 mg on . 14. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 15. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 17. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 18. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 19. insulin glargine 10 units each evening discharge disposition: home with service facility: vna discharge diagnosis: acute on chronic systolic heart failure hypotension hypercarbic repiratory failure discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: you will not be on your lisinopril because your blood pressure is too low. this medication can be restarted by your doctor at the time of follow-up. you coumadin dose will be changed as needed until your inr is in the correct range. followup instructions: hemodialysis t/th/sat provider: . phone: date/time: 1:00 i spent > 30 minutes on discharge related activities for this patient. , md procedure: hemodialysis non-invasive mechanical ventilation diagnoses: end stage renal disease congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure hypotension, unspecified long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants cardiac pacemaker in situ acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with ulceration above knee amputation status chronic total occlusion of artery of the extremities ulcer of ankle 

Answer: The patient is high likely exposed to