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: flagyl / rocephin attending: chief complaint: pea cardiac arrest major surgical or invasive procedure: intubation bronchoscopy laryngoscopy video swallow history of present illness: 50 f w/ htn, hypothyroidism, paroxysmal vocal cord movement admitted following cardiac arrest. this afternoon she was eating lunch, then developed dyspnea and collapsed. she was found to be in pea arrest, received 1 round of epinephrine and atropine and had return of spontaneous circulation. she was intubated in the field and then transferred to the er. . on arrival to ed, she was agitated moving her extremities but no purposeful movements, not following commands and dysynchronous with the ventilator so she was started on a midazolam gtt. she was in atrial fibrillation with rvr at rate 190, a right femoral cvl placed that was emergent, non-sterile and she was then cardioverted to sinus rhythm. oxygen saturation was initially in the 60s-70s; et tube pulled back, and cxr showed complete white out of left lung field. she then underwent a bronchoscopy that was unrevealing, only showing clear secretions. she next underwent recruitment maneuvers, with improvement in her oxygenation. at that time on ac 400 x 24, fi02 100%, peep 15 with oxygen saturation of 100%. a bedside cardiac echocardiogram was done with no right heart strain or pericardial effusion. to further evaluate for a pe a cta of the chest was done that was negative for a pe, but did show bibasilar aspiration, so she was given clindamycin 600mg iv x1. initially the plan was not for cooling, however since she was not responsive or following commands on arrival the decision was then made to undergo cooling with the artic sun protocol. on transfer to micu, afebrile, 95/69, 86, 24, 100% on above ventilator settings; most recent abg 7.2/55/77 with lactate 1.7. she in total received versed, fentanyl, ivf 1l, clindamycin. . on arrival to the micu her initial vs were: 98.6, 84, 109/65, 24, 96% on ac 400x24, peep 15, fio2 of 100%. she is currently paralyzed, the arctic sun machine was initially having difficulty cooling her which was concerning for a likely fever, so she was given acetaminophen 1g. past medical history: -hypertension -hypothyroidism -stridor and paradoxical vocal cord movement -h/o broken ankle -oophorectomy on due to right ovarian cyst, also had tubal ligation at that time. pathology was benign. -seasonal allergies. -history of endometrial polyps with multiple d&cs. -history of plantar fasciitis. -history of bladder incontinence social history: the patient moved from , , to in . she is now employed at the breast imaging center as the manager. she walks three to four days per week with some shortness of breath, does not smoke tobacco. drinks alcohol occasionally, no other drugs. she is currently sexually active with men. she is divorced two years ago. no history of sexual transmitted infections. family history: mother had breast cancer diagnosed at age 72. also has hypertension and hyperlipidemia. father has alzheimer's, hypertension, hyperlipidemia, and diabetes. physical exam: pex on admission: vs: 152/93 67 100% on ac 400x24, peep 15, fio2 of 100% general: intubated, sedated, paralyzed heent: sclera anicteric, pupils reactive/constricted b/l neck: difficult to assess jvd given body habitus lungs: coarse ventilated bs anteriorly cv: rrr nl s1 s2 no murmurs abdomen: obese soft nd +bs gu: foley in place ext: warm, well perfused, 2+ pulses neuro: intubated, sedated, paralyzed . on discharge: vs: tm 98.6, tc 97.7 bp: 128/80 (110-138/72-92), 70 (70-75), 12, 96% ra gen: nad. alert and oriented x3. heent: ncat, eomi, anicteric sclera. mmm, cv: distant sounds body habitus, but rrr. no murmur, rubs, or gallops appreciated. chest: respiration unlabored, no accessory muscle use. ctab, no stridor abd: obese. bs present. soft, nt, nd ext: wwp, no cyanosis or clubbing. trace to 1+ ue and le edema. skin: well-tanned. no rashes, ecchymoses, or other lesions noted. neuro/psych: grossly intact. gait stable. pertinent results: cbc: 01:41pm blood wbc-17.0* rbc-5.26 hgb-14.6 hct-46.4 mcv-88 mch-27.8 mchc-31.5 rdw-13.5 plt ct-428 05:21am blood wbc-12.9* rbc-4.09* hgb-11.8* hct-34.2* mcv-84 mch-28.9 mchc-34.5 rdw-13.8 plt ct-289 10:25am blood wbc-10.0 rbc-3.82* hgb-10.8* hct-32.3* mcv-85 mch-28.3 mchc-33.4 rdw-14.0 plt ct-279 06:30am blood wbc-10.4 rbc-4.31 hgb-12.0 hct-35.9* mcv-84 mch-28.0 mchc-33.5 rdw-14.5 plt ct-355 . coags: 01:41pm blood pt-12.5 ptt-49.2* inr(pt)-1.0 05:59am blood pt-13.2 ptt-25.8 inr(pt)-1.1 . fibrinigen: 01:41pm blood fibrino-448* 05:59am blood fibrino-542* . bmp: 05:24pm blood glucose-161* urean-14 creat-0.8 na-135 k-4.2 cl-103 hco3-25 angap-11 10:13am blood glucose-155* urean-10 creat-0.4 na-135 k-4.4 cl-104 hco3-21* angap-14 11:39pm blood glucose-138* urean-6 creat-0.4 na-139 k-3.2* cl-104 hco3-26 angap-12 10:25am blood glucose-100 urean-8 creat-0.5 na-142 k-4.1 cl-108 hco3-28 angap-10 07:15am blood glucose-92 urean-9 creat-0.6 na-139 k-4.1 cl-105 hco3-27 angap-11 . liver function tests: 05:24pm blood alt-38 ast-35 ld(ldh)-268* alkphos-81 totbili-0.2 05:59am blood alt-25 ast-19 ld(ldh)-203 totbili-0.7 dirbili-0.2 indbili-0.5 . cardiac enzymes: 01:41pm blood ctropnt-<0.01 03:49am blood ck-mb-5 ctropnt-0.04* . minerals: 05:24pm blood albumin-3.7 calcium-7.9* phos-5.2* mg-2.0 10:13am blood calcium-7.8* phos-2.2*# mg-1.8 05:59am blood calcium-8.4 phos-2.1* mg-2.4 07:15am blood calcium-8.7 phos-4.0 mg-2.2 . arterial blood gas: 01:58pm blood type-art po2-58* pco2-49* ph-7.16* caltco2-18* base xs--11 08:18pm blood type-art temp-35.6 rates-24/ tidal v-400 peep-15 fio2-100 po2-240* pco2-47* ph-7.25* caltco2-22 base xs--6 aado2-448 req o2-75 intubat-intubated vent-controlled 03:55am blood type-art temp-33.5 rates-26/ tidal v-400 peep-15 fio2-40 po2-101 pco2-40 ph-7.38 caltco2-25 base xs-0 intubat-intubated 10:41am blood type-art temp-38.3 rates-26/ fio2-40 po2-80* pco2-39 ph-7.42 caltco2-26 base xs-0 intubat-intubated . thyroid function tests: 05:59am blood tsh-11* 05:59am blood t4-8.3 # # # # ################################################################ imaging: cxr (): findings: single supine portable view of the chest was obtained. endotracheal tube is seen, terminating just above the level of the carina, recommend withdrawing approximately 3 cm. emergency physician . there is complete opacification of the left hemithorax. the right lung demonstrates low volume. there is also patchy opacification of the right upper to mid lung. no evidence of pneumothorax is seen. large air distended gastric bubble is partially imaged. . findings: single supine ap portable view of the chest was obtained. the endotracheal tube has been withdrawn some, now terminating approximately 2.9 cm above the level of the carina. there has been interval improvement in aeration of the left lung, although areas of diffuse ground-glass opacity persist. there is also diffuse ground-glass opacity projecting over the right lung, to a lesser extent. the left costophrenic angle is blunted and underlying effusion cannot be excluded. the cardiac silhouette is top normal, given low lung volumes and ap supine technique. slight prominence of the mediastinum may relate to mediastinal lipomatosis and vascular structures, although ct may relate to mediastinal lipomatosis, as seen on concurrent chest ct. impression: 1. interval withdrawal of the endotracheal tube, now terminating 2.9 cm above the level of the carina. 2. interval improvement in aeration of the left lung, although there remains diffuse ground-glass opacity projecting over the left lung. diffuse ground-glass opacity also projects over the right lung, to a lesser extent. findings consistent with massive aspiration as seen on concurrent chest ct. . frontal and lateral chest radiographs: right internal jugular central venous line tip terminates at the cavoatrial junction. cardiomediastinal silhouette is stable. pulmonary vasculature is normal. there is no focal consolidation, pneumothorax or effusion. impression: no acute cardiopulmonary abnormality. . cta chest w/&w/o reconstruction: impression: 1. no evidence of pulmonary embolism to the segmental level bilaterally. 2. extensive bilateral pulmonary consolidation, most consistent with massive aspiration. 3. slightly low lying endotracheal tube as above, recommend withdrawal approximately 1.5 to 2 cm. . eeg findings: continuous eeg: began at 11:00 on the morning of . it showed a widespread rapid, 14-16 hz rhythm in all areas. there were very infrequent bursts of generalized theta slowing. for the most part, the background was unchanged. much of the record after 16:00 on the 24th was obscured by muscle and other artifact, but intermittently, the same background was visible. by 19:00 that evening the background was of somewhat lower voltage and was slower, at about 12 hz, but still with the same frequencies in all areas rather than with any particular gradient. toward the end of the recording, up to 6 the next morning, the low voltage rhythmic patterns were at about hz again and resembled sleep spindles. spike detection programs: showed some minimally sharp features but no epileptiform discharges. seizure detection programs: there were five entries in these files. they showed the same rhythmic background described earlier and also some artifact. there were no electrographic seizures. pushbutton activations: there were none. sleep: no normal waking or sleeping patterns were evident. cardiac monitor: showed a generally regular rhythm. impression: this telemetry captured no pushbutton activations. it showed a very regular low voltage background throughout, mostly in the hz range and with a widespread distribution of these frequencies, with a bit of frontal emphasis. these rhythms indicate a strong likelihood of medication effect. there was no area of prominent focal slowing, and there were no epileptiform features. . continuous eeg: showed a low voltage faster pattern in all areas including an hz alpha frequency in all areas with some suppression of the background for a few seconds at a time in between these alpha or faster beta patterns. within the first hour background frequencies were more in a faster, beta range. they were still distributed widely. there was no posterior alpha. the record did not change appreciably through its end at 15:03 that afternoon. toward the end there were some posterior patterns suggestive of rudimentary alpha frequencies. spike detection programs: there were no entries in these files. seizure detection programs: there were no entries in these files. pushbutton activations: there were none. sleep: there was no clear posterior alpha activity, and the record was dominated by a faster beta rhythm. by video, the patient appeared to be awake for much of the morning. there were frequent episodes of muscle artifact and additional eye movement artifacts from blinking. cardiac monitor: showed a generally regular rhythm. impression: this telemetry captured no pushbutton activations. the eeg was dominated by a faster beta frequency throughout, usually reflective of medication effect. there was no clear waking background, but obscuration of the background by the medication effect can explain this. there were eye blinking artifacts. there were no epileptiform features, and there were no electrographic seizures. . echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. no valvular pathology or pathologic flow identified. . video swallow findings: barium passes freely through the oropharynx and esophagus without evidence of obstruction. there is no gross aspiration or penetration. for full details, please refer to speech and swallow division note in the online medical record. impression: normal oropharyngeal swallowing video fluoroscopy. brief hospital course: 50 f w/ htn, hypothyroidism, paroxysmal vocal cord movement admitted s/p pea arrest. . # pea arrest: etiology unclear. was intubated and admitted to the icu, where she underwent artic cooling protocol. initially the plan was not for cooling, however since she was not responsive or following commands on arrival the decision was then made to undergo cooling. on , the patient was noted to be more responsive, so re-warming started early. she spiked temperature to 101.5 after rewarmed. she was successfully extubated at 11am and transferred to the floor for further monitoring. regarding etiology, potential massive aspiration event may have resulted in hypoxia leading to pea arrest. signs of aspiration were evident on imaging (cxr and cta), however, imaging cleared once patient was extubated. pe was excluded per cta and event did not seem primary cardiac. trop to 0.04. she had tte while hospitalized, evaluation by speech and swallow, was monitored on tele, seen by social work and ent to better cope with anxiety regarding her vocal cord dysfunction. as she was a participant in a drug study, she was started on placebo versus coenzyme q10, and continued through . pt had video swallow to rule out aspiration risk and echo to rule out mi or other cardiac etiology. ent also came and evaluated the patient and she had no evidence of paradoxical motion of the vocal cords at that time. she will follow up with her pcp as well as with ent and speech therapy in the outpatient setting. there was still no clear underlying cause of her pea arrest. . # fevers/leukocytosis: likely inflammation and stress response from arrest as well as unclear aspiration. findings on imaging may simply represent pneumonitis, but our patient also had s. pneumoniae and gnrs on sputum samples. she was started on levaquin in icu, which was discontinued on given quick resolution on imaging suggesting a pnuemonitis over pneumonia. the patient was also found to have a uti growing e. coli and was started on ciprofloxacin for a total 7 day course. the patient's wbc trended down and she remained afebrile on no antibiotics. . # anemia: hematocrit decreased from 46.4 on day of admission to 32.9 on day of transfer. unclear etiology, but hemolysis labs negative, no signs of active bleeding or dic. stools were guaiaced and negative. there was no clear evidence for her anemia, but can continue to be followed in the outpatient setting. . # hypothyroidism: this was not an active issue during this admission. continued home synthroid . # htn: continued lisinopril-hydrochlorothiazide once clinical status stable. . # depression: continued duloxetine and cnsulted social work. # stridorous breathing: from paradoxical movement of her vocal cords. continued fluticason and montelukast as well as anxiety control. pt is followed by a speech therapist and will follow up with her in the future. . # gerd: started patient on lansoprazole in icu, but transitioned to home omeprazole before discharge. this was not an active issue during this admission. . # code status: full code . transitional issues: - patient has no outstanding culture data. pt was diagnosed with uti and should follow up on pt symptoms. - assess pt mood as she is still unclear about what happened and slightly shocked by it. she has a history of depression and want to ensure she is coping with this traumatic experience. medications on admission: duloxetine - 20 mg daily fexofenadine - 180 mg daily fluticasone - 50 mcg - 2 spray(s) intranasally twice daily levothyroxine - 175 mcg daily lisinopril-hydrochlorothiazide- 10 mg-12.5 mg daily montelukast - 10 mg daily omeprazole - 40 mg twice a day zolpidem - 5 mg at bedtime as needed for for sleep melatonin - 1 mg tablet - 6 tablet(s) by mouth at bedtime as needed for sleep discharge medications: 1. duloxetine 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 2. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 3. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*10 tablet(s)* refills:*0* 4. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 5. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal (2 times a day) as needed for congestion. 6. fexofenadine 180 mg tablet sig: one (1) tablet po once a day. 7. lisinopril-hydrochlorothiazide 10-12.5 mg tablet sig: one (1) tablet po once a day. 8. ambien 5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 9. melatonin 1 mg tablet sig: six (6) tablet po at bedtime as needed for insomnia. discharge disposition: home discharge diagnosis: primary: -pea cardiac arrest . secondary: -hypertension -hypothyroidism -stridor and paradoxical vocal cord movement -seasonal allergies discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , you were admitted to the hospital after suffering from a form of cardiac arrest. after you were revived, you were admitted to the icu, where your body temperature was lowered in order to conserve energy. gradually, you were warmed, and regained consciousness. although we don't have a good explanation for why you, the ent doctors not that it's not related to your vocal cord difficulties. at first we thought you might have aspirated and had a pneumonia causing fevers, but a repeat chest xr looked quite good, so we stopped your antibiotics and monitored you. we know that this is very anxiety-inducing, and that's why the social workers came to speak with you. the speech and swallow professionals also came and found that your swallowing was normal and there was no aspiration. echo showed normal heart function. during your admission we did find that you had a urinary tract infection and we will treat you for a total of 7 days. . the following medication was added to your regiment: ciprofloxacin 500mg by mouth two times a day for 5 days . please take your other medications as prescribed. followup instructions: department: when: monday at 8:30 am with: , md. post clinic building: sc clinical ctr campus: east best parking: garage *this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: medical specialties/sleep medicine when: wednesday at 11:00 am with: , md building: campus: east best parking: garage please call dr. at to make an appointment and see him and also please continue to follow up with your speech therapist for continued treatment of your paradoxical movement of your vocal cords. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other bronchoscopy arterial catheterization diagnoses: acidosis anemia, unspecified esophageal reflux urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation depressive disorder, not elsewhere classified pneumonitis due to inhalation of food or vomitus cardiac arrest stridor other diseases of vocal cords 

Answer: The patient is high likely exposed to