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 attending: chief complaint: cough major surgical or invasive procedure: none history of present illness: this is an 80 year-old woman with a history of copd/?intersitial lung disease who presents as a transfer from . the patient initially presented to on with complaints of shortness of breath and cough. at the time of her arrival, the patient was noted to be afebrile, hypotensive (sbps in the 80's) with an abg of 7.42, 35, 65 and sating 93% on 3l. cxr was notable for right/lower and left upper lobe consolidations. lab studies showed leukocytosis of 12.5, hct 34.3, creat 1.6, bnp 542. she was admitted for a community acquired pneumonia and hypotension a 10 day course of levaquin was initiated. over the first 72 hours of admission, the patient continued to have increased work of breathing and a productive cough. she was transition to bipap, but on hd 3, she was intubated. she required mechanical ventilation for 7 days after which point she was extubated. she was stable for a brief 36 hour period, but continued to have supplemental oxygen requirements and subsequently desated into the 70's requiring re-intubation on hd 12. while intubated, the patient was noted to become hypotensive when treated with sedatives. she was started on low dose neosynephrine for bp control. during the her course, a tte was obatined and was notable for pulmonary hypertention (pa pressure of 75). while ct scan was not obtained, it was felt that the patient's respiratory failure was due to and underlying non-reversable intersitial lung disease. the patient's family was not comfortable with this assessment and so transfer to was requested. the patient arrived here intubated, but awake and oriented. she reports some throat pain and feelings of anxiety regarding her et tube. she denies feeling short of breath or any other discomfort. family notes progressive decline in physical abilities and physical activities over 6 months prior to admission, noting exertional dyspnea. pt became less active than prior. past medical history: - copd w/ preserved fev1 of 1.5; pfts consistant with restrictive disease - peripheral vascular disease - hypothyroidism - hyperlipidemia - chronic kidney disease (cr 1.4) - osteoporosis; hx of compression fractures - gerd - intersitial lung disease - pulmonary hypertension surgical hx: s/p cardiac ablation for unknown arrythmia s/p vertebroplasty s/p carotid endarterectomy social history: patient is married and lives with her husband. she is very active at baseline, does yoga 3x per week. she has a remote smoking history of ~1ppd until for nearly 20 years. she quit in . family history: nc physical exam: respiration: assist control rr25, peep 8, 400, fio2 80% gen: elderly woman, no acute distress heent: eomi, perrl, sclera anicteric, mmm, no cervical lymphadenopathy cor: rrr, no m/g/r, normal s1 s2, pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: 2+ distal pulses +2, no c/c/e, no palpable cords neuro: alert, appropriate responses to qestioning. cn ii ?????? xii grossly intact. moves all 4 extremities. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: =========== labs =========== admission 09:47pm blood wbc-15.0* rbc-2.70* hgb-8.5* hct-26.0* mcv-96 mch-31.6 mchc-32.8 rdw-15.1 plt ct-520* 09:47pm blood neuts-89.2* lymphs-4.9* monos-5.5 eos-0.3 baso-0 09:47pm blood pt-12.5 ptt-32.3 inr(pt)-1.1 09:47pm blood glucose-128* urean-26* creat-0.7 na-142 k-4.4 cl-106 hco3-29 angap-11 09:47pm blood calcium-8.0* phos-2.9 mg-2.2 1:04 pm bronchoalveolar lavage gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. legionella culture (preliminary): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 7:57 pm sputum source: endotracheal. **final report ** gram stain (final ): pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci in pairs. ======= radiology ======= cta chest impression: 1. no pulmonary embolus. 2. diffuse, severe interstitial lung disease. no evidence of pneumonia or pulmonary edema. 3. multiple compression deformities in the mid thoracic spine, chronicity unknown ========= cardiology ========= tte the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. rv with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is mild functional mitral stenosis (mean gradient 4 mmhg) due to mitral annular calcification. mild (1+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: # respiratory failure/pneumonia: according to the transfer records, the patient's initial respiratory failure was felt to be due to community acquired pneumonia. her pneumonia had initally responded to antibiotic therapy; as was evidenced by her extubation and per report, resolution by cxr (although no radiology reports were included in transfer documents). her reintubation was felt to be due to worsening of a possible chronic lung disease, however the patient has never had a ct scan. no evidence of cardiac cause; outside culture data negative to date. pt has elevated wbc. possible causes for continued respiratory failure include persistant bacterial pneumonia, viral pneumonia, vap. bronchoscopy was unremarkable and bal results were negative. given some concern for pulmonary edema, patient was cautiously diuresed daily with lasix. ct chest consistent with ild and copd. given findings consistent with ild and nsip on ct scan, patient was started on solumedorol and transitioned to prednisone on . unfortuantely, high dose steroids did not improve the patient's respiratory compromise, and she continued to require ventilatory support. sputum gram stain with gpc, and so patient was covered transiently with vancomycin but nothing grew in sputum culutre so this was d/cd. patient did not wean from ventilator, and a tracheostomy was performed. steroids were tapered, and the patient remained unable to wean from the ventilator. on , she developed evidence of ventilator associated pneumonia with increased ventilatory support requirement, infiltrate and sputum which ultimately grew pseudomonas. # atrial fibrillation: on she developed atrial fibrillation with rapid ventricular response. as this was in the setting of worsening clinical status, the family did not want treatment at the time, as the focus of care was shifted to comfort. # hypotension: pressor requirement related to sedation at admission. these were able to be discontinued. # hypothyroidism: continue synthroid # hyperlipidemia: lipitor currently held due to og tube. # chronic kidney disease (cr 1.4): improved from baseline. # osteoporosis; hx of compression fractures: no acute issues # gerd: ppi # fen: on tube feeds at osh. # access: right arm picc, a-line # disposition: close daily contact about the patient's status was maintained with the patient's husband and daughters. they desired the patient to be dnr/dni. as she clinically deteriorated, goals were changed to comfort. the patient expired quietly on at 1:40. a limited autopsy will be performed of the heart and lungs to better characterize her interstitial lung disease. medications on admission: medications on transfer: neosynephrine gtt levothyroxine 25mcg qd asa 81mg qd protonix 40mg iv heparin 5000u tid insulin drip per protocol colace 100mg senna 2 tabs qhs fentanyl prn versed prn chlorhexadine mouth combivent 4 puffs q4 prednisone taper 50mg tylenol 605 q4 prn ativan 0.5-1mg iv q4 prn discharge medications: expired discharge disposition: expired discharge diagnosis: interstitial lung disease chronic respiratory failure with ventilator-dependence s/p tracheostomy chronic obstructive pulmonary disease pseudomonas aeruginosa ventilator associated pneumonia atrial fibrillation with rapid ventricular response hypotension hypothyroidism osteoporosis anasarca hyperlipidemia chronic kidney disease gastroesophageal reflux disease discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: pneumonia, organism unspecified anemia of other chronic disease esophageal reflux unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia acute and chronic respiratory failure hypotension, unspecified osteoporosis, unspecified postinflammatory pulmonary fibrosis other postprocedural status encounter for palliative care ventilator associated pneumonia foreign body accidentally entering other orifice pseudomonas infection in conditions classified elsewhere and of unspecified site foreign body in larynx edema 

Answer: The patient is high likely exposed to