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: hypoxia major surgical or invasive procedure: none history of present illness: this is a 70 year-old female with a history of diastolic heart failure, ckd, and dm2 who presents with shortness of breath, hypoxia and acute on chronic renal failure. she was placed on a nrb in the ambulance, satting 92, and was transitioned to bipap in the ed, started on nitro gtt, and received a dose of furosemide 40mg iv. of note, the patient was recently admitted with acute on chronic renal failure and her furosemide was held on discharge. she put out 600cc urine to the 40 of lasix iv, and per ed report, the patient felt symptomatically improved after the dose. abg on arrival was 7.36/36/47 after being initiated on bipap. . past medical history: ckd, stage iv (baseline creat 4.3-4.), s/p r ras stent and pta (renal md: ) diastolic hf dm ii hypertension s/p cva () pvd, s/p revascularization rle hypercholesterolemia valvular disease: mild mr & tr (echo ) mild symmetric lvh, mod pa syst htn, lvef >75%, diastolic dysfunction cad, coronary artery calcifications per ct diverticulosis pulmonary subpleural rul nodule degenerative changes in the spine h/o calcified gallstones severe small vessel ischemic changes (head ct ) . pshx: s/p revascularization rle s/p hysterectomy, fibroids () s/p r ras stent and pta/ renal: social history: notable that she had a 15-pack-year smoking history, quitting in . she formerly consumed alcohol heavily but not since her early 20s. she has no history of intravenous drug use. she is retired. . adls - hha assists with bathing, independent in all other; iadls - independent with phone, has mow, sister/hm assists or does all other iadls. . she lives alone, apt in bldg, elevator. sister lives on & helps alot. services from ethos (case manager: , ): hha 2 x's/wk, mows; homecare for sn & pt. . assistive devices - has lifeline, shower chair, grab bars in br, , & wc; has glasses but they are home, sister will bring to . dentures: full uppers only, lost bottoms some time ago - states she eats "ok" with only uppers. no hearing aids. family history: family history: notable for a sister who has hypertension and a cva, mother who died from an mi and had diabetes mellitus. there is no specific history of kidney disease, no history of kidney stones. physical exam: discharge pe: ============ vs: tmax 99.2 hr - 80-81, bp - 127-148/56-70 o2 sat - 96%ra general: obese elder black female in nad, ncat eyes: eomi, perrl, conjuntiva clear, non-icteric ent: mmm, some tenderness left lateral neck with rotation, no lad cardiovascular: rrr, s1 s2 s4, 2/6 systolic murmur best @ apex resp: bs @ bilat bases/posterior, no wheezes gastrointestinal: soft, , obese, +bs, nontender musculoskeletal-ext: no edema, + venous stasis changes neurological: alert, oriented, engaging right-sided def s/p cva integument: healed scarred decubiti on right heel (old); no rash, no ulceration genitourinary: foley removed today () pertinent results: admission labs: ============== 08:23pm urine hours-random urea n-262 creat-25 sodium-75 08:23pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 07:30am urine type-random color-yellow appear-clear sp -1.008 07:30am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 07:30am urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi-0-2 07:30am urine amorph-few 08:19pm urea n-85* creat-4.7* potassium-3.7 08:19pm wbc-8.0 rbc-3.42* hgb-10.2* hct-30.4* mcv-89 mch-29.8 mchc-33.6 rdw-15.1 08:19pm plt count-185 01:54pm type-art po2-82* pco2-27* ph-7.44 total co2-19* base xs--3 01:54pm freeca-1.17 01:08pm glucose-158* urea n-85* creat-4.7* sodium-139 potassium-4.1 chloride-109* total co2-19* anion gap-15 01:08pm ck(cpk)-73 01:08pm ck-mb-3 ctropnt-0.03* 01:08pm calcium-8.7 phosphate-4.3 magnesium-2.4 01:08pm wbc-8.2 rbc-3.21* hgb-9.6* hct-28.3* mcv-88 mch-30.0 mchc-34.0 rdw-15.0 07:10am type-art peep-5 o2-40 po2-47* pco2-36 ph-7.34* total co2-20* base xs--5 intubated-not intuba 05:25am glucose-145* urea n-82* creat-4.5* sodium-138 potassium-4.0 chloride-106 total co2-19* anion gap-17 05:25am ck(cpk)-78 05:25am ctropnt-0.03* 05:25am lactate-1.2 05:25am wbc-11.8* rbc-4.08* hgb-11.6* hct-36.0 mcv-88 mch-28.5 mchc-32.3 rdw-14.8 05:25am neuts-83.4* lymphs-11.2* monos-3.9 eos-1.2 basos-0.3 05:25am pt-12.9 ptt-25.9 inr(pt)-1.1 . imaging: ======= chest (pa & lat) - comparison: . findings: there is marked improvement in degree of pulmonary edema, with only mild pulmonary vascular congestion remaining. bilateral small effusions remain present, but significantly decreased. the cardiac silhouette is mildly enlarged. there is no focal consolidation or pneumothorax. impression: significant improvement in degree of now only mild interstitial edema with residual small bilateral effusions. . chest (portable ap) - impression: ap chest compared to & 12. severe bilateral consolidation worsened appreciably. perihilar distribution suggests this is edema, although mild cardiomegaly has not worsened. moderate right pleural effusion has increased. . renal u.s. - impression: 1. normal right kidney; 2. atrophic hyperechoic left kidney with abnormal doppler waveforms. if clinically indicated, cross- sectional imaging could be performed for further characterization. . ct chest w/o contrast - impression: 1. multifocal perihilar areas of consolidation and ground-glass opacity associated with smooth septal thickening, bilateral pleural effusion, most prominent on the right, interstitial fluid, bronchial wall thickening and mild cardiomegaly as well as small pericardial effusion suggesting pulmonary edema; 2. ongravitational asymmetric ill-defined peribronchial vascular, partly nodular and partly ground-glass, opacity with air bronchogram suggesting multifocal pneumonia, most prominent on the right; 3. subpleural right upper lobe nodule. in the absence of risk factor, no further followup is warranted. if risk factor is present for lung cancer, chest ct is recommended in 12 months; 4. coronary artery calcifications, aortic and aortic annulus calcifications are scattered; 5. calcified gallstone. right renal artery stent. left renal atrophy. diverticulosis. . bilat lower ext veins port - impression: no evidence of lower extremity dvt of either leg. . cardiac echo (tte) - la is markedly increased (>32ml/m2). the left atrium is dilated. the interatrial septum is aneurysmal, no asd. mild symmetric lvh with normal cavity size. lv systolic function is hyperdynamic (ef>75%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg), no vsd. rv chamber size and free wall motion are normal. no as or ar. mild (1+) mr. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. diastolic dysfunction. moderate pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the estimated pulmonary artery systolic pressure is higher. . ekg: === sinus rhythm. non-specific inferolateral st-t wave changes. compared to the previous tracing of the qrs voltage is decreased. ventricular rate is slower. qt/qtc 374/407. . discharge labs: ============== complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:20am 6.7 3.26* 9.9* 28.8* 88 30.2 34.3 15.3 254 glu urean creat na k cl hco3 angap 07:20am 123* 91* 5.9* 140 4.3 103 23 18 brief hospital course: 70 year old female with esrd admitted with hypoxia in setting of lasix being held. she was admitted to the icu where she was aggressively diuresed with iv lasix. #1. pneumonia, multifocal pneumonia, most prominent on the right per ct. initially treated with vancomycin and levofloxacin but narrowed to levo. completed a seven day course of levofloxacin #2. pulmonary edema, acute on chronic decompensated diastolic heart failure aggressively treated with lasix iv, respiratory status much improved. after diuresis, symptoms, clinical exam & repeat cxr appear to indicate that the patient's dry weight to be ~173.5 lbs. was treated with 100mg po lasix on with good diuresis, but with weight to 171.5 on and creatinine to 5.9. lasix dose decreased to 100mg once daily on discharge. note that it can be changed to if weight increases as she responds to it. - recommend sleep study as outpatient to eval for obstructive sleep apnea, as it may contribute to clinical picture. #3. acute on chronic renal failure, stage iv ckd renal consultation supported need for aggressive diuresis, given pulmonary edema, despite rising creatinine. renal aware creatinine in 5's. renal will continue to follow at /macu. out-patient appointment per renal consult set-up with clinic (next available - ). please avoid all medications that contain aluminum, magnesium. patient on renal diet & fluid restriction. had vein mapping while inpatient. #4. urinary retention foley placed () after patient did not void, despite oob to commode, after lasix 60 mg ivp & bladder scan showed ~ 400 cc retention. foley removed on . #5. diabetes: continued with home nph and humalog sliding scale. fsbs running 126-215 in the 24 hrs prior to discharge. #6. change in mental status seen by psych while in icu for auditory hallucinations. felt to be brief episodes of delirium. patient now a&o x's 3. psych recommended considering starting dementia medication such as namenda in near future. . #7. pain intermittent lower left lateral neck pain with movement. needs f/u by pcp. acetaminophen. . #8 skin, s/p revascularization rle well-healed old decubitus on right heel. needs close attention to skin. # code status: full medications on admission: (per d/c summary) 1. ecasa 325 mg po qd 2. calcitriol 0.25 mcg po qd 3. nifedipine sr 60 mg 2t po qd 4. toprol xl 200 mg po qd 5. gabapentin 300 mg po qod 6. atorvastatin 40 mg po qd 7. insulin: 15 units humalin n qam & 6 units humalin n qpm 8. tylenol 650 mg po (otc) discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 5. gabapentin 300 mg capsule sig: one (1) capsule po q48h (every 48 hours). 6. metoprolol succinate 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 7. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 10. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 12. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 13. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 14. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 15. hydralazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours). 16. furosemide 20 mg tablet sig: five (5) tablet po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: ================= multifocal pneumonia acute on chronic decompensated diastolic heart failure pulmonary edema, with right pleural effusion acute on chronic renal failure . secondary diagnosis: =================== chronic kidney disease, stage iv (baseline creat 4.3-4.), s/p r ras stent and pta, (renal: , md) diastolic hf diabetes, type ii hypertension s/p cva () peripheral vascular disease, s/p revascularization rle hypercholesterolemia valvular disease: mild mr & tr (echo ) mild symmetric lvh, mod pa syst htn, lvef >75%, diastolic dysfunction cad, coronary artery calcifications per ct diverticulosis pulmonary subpleural rul nodule degenerative changes in the spine h/o calcified gallstones severe small vessel ischemic changes (head ct ) . pshx: s/p revascularization rle s/p hysterectomy, fibroids () s/p r renal aretery stent and pta discharge condition: stable. dry weight is 173 lbs. weight on discharge is 171.5. lasix dose decreased to once daily. discharge creatinine 5.9. discharge instructions: you were admitted to the hospital after becoming very short of breath. you were found to have a pneumonia, pulmonary edema from heart failure and acute (on chronic) renal failure and were admitted to the icu. your treatment has included antibiotics, medications to control your bp & to help your heart and also strong medicines to assist your kidneys to get rid of the extra fluid in your body (lasix iv). your breathing has become much better and you are now ready to go to a rehabilitation setting where your kidney doctors in your care. . please let your health care providers know if you have any of the following: chest pain or pressure, trouble breathing, fever > 100.6 and/or shaking chills, pain that is not controled by medicines, dizzyness when standing, blood in your stool or urine or any other health-related concerns. . please follow the instructions of the physical therapists. please also take all your medications as prescribed. . it is important to make and keep all of your follow-up appointments. followup instructions: provider: , dpm phone: date/time: 9:00 . provider: , md, renal clinic, phone: date/time: 8:50 . provider: , transplant social work date/time: 1:00 procedure: non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure peripheral vascular disease, unspecified retention of urine, unspecified other diseases of lung, not elsewhere classified other alteration of consciousness mixed acid-base balance disorder cervicalgia 

Answer: The patient is high likely exposed to