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: ranitidine attending: chief complaint: shortness of breath major surgical or invasive procedure: none. history of present illness: 87 year-old female with history of hiatal hernia/gerd, af, history of recent aspiration pneumonia presents with progressive sob. she was recently admitted to for pneumonia and treated wtih levofloxacin for 14 days. she completed her antibiotics and presented to her pcps office where a cxr was performed. the cxr was unchanged so she had a ct which showed multifocal infiltrates, ? aspiration versus infectious. she was told to eat smaller meals and avoid eating quickly. for the last week, she has had increased shortness of breath. five days prior to admission she was having lots of coughing and shortness of breath. 911 was called but didn't bring her to the ed. on sunday, she was at the because she swallowed a hearing aid. a cxr was performed but no further intervention was performed. over the past week, she notes increasing fatigue and shortness of breath. she endorses a mild non-productive cough, worse at night. no fever/chills. no orthopnea, pnd, or edema. in the ed, a cxr showed new multifocal infiltrates. a chest ct was subsequently obtained, which showed worsening consolidations, especially in rml with rml collapse, with ? rml abscess. she was given ceftriaxone, atithromycin and flagyl. past medical history: 1. hiatal hernia with gastroesophageal reflux disease 2. paroxysmal atrial fibrillation, on coumadin 3. iron deficiency anemia. 4. recurrent utis. 5. hyperthyroidism attributed to amiodarone toxicity 6. history of iatrogenic pneumothorax following line placement in 02/. 7. colonic polyps 8. s/p appendectomy. 9. impaired visual acuity social history: she does not smoke or drink. she walks with a cane at baseline. she lives in with a young woman who helps with her care. family history: non-contributory. physical exam: physical examination on admission: vs: t 98.8, pulse 66, bp 116/76, rr 17, 95% on ra gen: alert, oriented, cooperative female in nad heent: eomi, anicteric, mildly dry mm neck: supple, -lad, jvp not elevated lungs: distant lung sounds (difficult exam as in in noisy ed), no rhales appreciated heart: rrr, nl s1s2, no murmers abd: soft, obese, mild distension, nt +bs ext: 2+ edema bilaterally, ecchymoses at left calf, slight tenderness on anterior palpation of shin bilaterally neuro: a&ox3, responding to all ?'s, moving all ext pertinent results: relevant laboratory data: cbc: wbc-10.3# rbc-4.00* hgb-11.2* hct-33.3* mcv-83 mch-28.0 mchc-33.7 rdw-15.0 neuts-81.9* lymphs-13.4* monos-3.4 eos-0.5 basos-0.7 plt count-508* chemistry: glucose-115* urea n-12 creat-0.8 sodium-138 potassium-4.5 chloride-97 total co2-31 anion gap-15 lactate-1.1 coagulation: pt-34.2* ptt-31.0 inr(pt)-3.7* cardiac enzymes: 01:30pm ck(cpk)-34 01:30pm ctropnt-<0.01 relevant imaging data: cxr: ap chest compared to and . right upper lobe pneumonia is appreciably larger. small region of pneumonia at the right base is stable. heart size top normal. small right pleural effusion, stable. no pneumothorax. ct chest: no evidence of pulmonary embolism. 2. interval increase in the size of right middle lobe consolidation with further progression and increase in size of an area of low attenuation measuring 2.3 x 2.6 cm representing an abscess. there is stable appearance of the right lower lobe consolidation and slight interval decrease in the size of small nodular consolidation in the left apex. 3. large hiatal hernia. barium swallow: large axial hiatal hernia with the gastric fundus above the diaphragm. persistent retention of barium in the herniated fundus at the conclusion of the exam. no evidence of reflux, but poor compliance. echo: . lv wall thicknesses and cavity size normal. overall lvef normal (lvef>55%). rv chamber size and free wall motion are normal. av leaflets are mildly thickened. the aortic valve is not well seen. no as, mild (1+) ar. mv valve leaflets are mildly to moderately thickened. mild (1+) mitral regurgitation is seen. lv inflow pattern suggests impaired relazation. tv valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. ct chest: 1. minimal improvement in extensive necrotizing pneumonia in the right upper lobe. slight improvement in the left upper lobe nodular opacity. no change in the right lower lobe consolidation. 2. increasing right pleural effusion and new left pleural effusion. 3. stable appearance of enlarged thyroid and large hiatal hernia. cxr: 1. resolving multifocal pneumonia and small bilateral pleural effusions. 2. hiatal hernia. brief hospital course: 87 year old female with a large hiatal and probable aspiration events, admitted with worsening shortness of breath, with imaging studies showing progression of her multifocal infiltrates. 1. multifocal pneumonia and ? rml abscess: pulmonary was consulted on admission, and she was placed on ceftriaxone and flagyl for coverage of probable multifocal aspiration pneumonia. blood cultures drawn prior to initiation of antibiotics remained negative. given concern over aspiration events, she was evaluated by speech and swallow, and a barium swallow was obtained on which revealed retention of contrast in the hernia without overt reflux. the study, however, was limited by poor patient compliance. on , she was noted to be more somnolent, with increasing oxygen requirement and a temperature to 101.7. vancomycin was added for broader coverage. a cxr obtained at that time showed some pulmonary edema, and she was treated with lasix diuresis. she, however, remained somnolent, and an abg obtained the following morning showed 7.34/62/65. she was transferred to the micu for further monitoring and management. she spontaneously improved, and did not require bipap. her decompensation was ultimately attributed to anxiolytic administration. she was transferred back to the floor after 1 day in the icu. while in the icu, an echo was obtained, which showed preserved systolic function, evidence of diastolic dysfunction, and non-significant valvular disease. note was made of thickened mv valve leaflets, non-specific, no obvious vegetation. on the floor, she was changed to clindamycin. a repeat ct on showed "minimal improvement in extensive necrotizing pneumonia in the rul, slight improvement in the lul opacity, no change in the rll consolidation. note was also made of increasing right pleural effusion and new left pleural effusion.". given these findings, a thoracentesis was entertained, and coumadin was held in anticipation for this. a repeat cxr on , however, showed decreased effusions, and a bedside ultrasound performed by ip on showed insufficient fluid to tap. she continued to improve, eventually without oxygen requirement. she will complete a prolonged course of clindamycin (5 additional weeks), and will follow-up in the pulmonary clinic with dr. . they will contact her with the appointment date and time. she is also scheduled for a repeat ct chest on at 1130. lenght of antibiotic therapy will ultimately be dictated by clinical/radiographic resolution. emphasis was placed on aspiration precautions, and eating small meals. 2. paroxysmal atrial fibrillation: as noted above, her coumadin was held in anticipation for a possible thoracentesis. she was given 2 doses of vitamin k to expedite reversal of warfarin therapy. she was started on heparin iv when inr<2. coumadin was eventually resumed at 5 mg daily (her out-patient dose) on , and she was placed on lovenox (1mg/kg ) to brige until therapeutic inr (goal inr ). she remains on amiodarone. please discontinue lovenox when inr . 3. copd: she was continued on fluticasone and combivent, with bronchodilator therapy via nebulizers as needed. 4. hypertension: she was continued on lisinopril 5 mg daily. hydralazine was held in the hospital given good blood pressure control on the latter. if her blood pressure remains elevated, please consider addition of hydralazine 25 mg po qid (pre-hospital regimen). 5. hyperthryoidism: she was continued on methimazole 5 mg daily. 6. code: dnr/dni. on this admission, there was a conversation with the patient and family regarding code status. it was determined that she wanted to be dnr/dni. medications on admission: senna 8.6 mg pantoprazole 40 mg daily amiodarone 100 mg daily hydralazine 25 mg qid methimazole 5 mg daily psyllium 1.7 g daily fluticasone 110 mcg/actuation aerosol 2 puffs warfarin 5 mg daily lisinopril 5 mg daily combivent 103-18 mcg/actuation aerosol 1 inh qid discharge medications: 1. amiodarone 200 mg tablet sig: 0.5 tablet po daily (daily). 2. methimazole 5 mg tablet sig: one (1) tablet po daily (daily). 3. psyllium 1.7 g wafer sig: one (1) wafer po daily (daily). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po hs (at bedtime). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. warfarin 5 mg tablet sig: one (1) tablet po once a day: please give 5 mg daily 6x/week, and 7.5 mg daily 1x/week. please monitor inr, and discontinue lovenox when inr between . . 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 8. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 10. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 11. combivent 103-18 mcg/actuation aerosol sig: one (1) inhalation inhalation four times a day. 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily): hold for sbp<100. 13. enoxaparin 100 mg/ml syringe sig: 90 mg sc subcutaneous (2 times a day): please monitor inr, and discontinue lovenox when inr between . 14. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 4 weeks: please continue until patient follows-up in pulmonary clinic. . 15. albuterol sulfate 0.083 % solution sig: one (1) nebulizer inhalation every six (6) hours as needed for shortness of breath or wheezing. discharge disposition: extended care facility: of discharge diagnosis: multifocal pneumonia probable right middle lobe lung abscess secondary diagnoses: paroxysmal atrial fibrillation hyperthyroidism discharge condition: patient discharged to a rehab facility in stable condition. oxygen saturation stable on room air. discharge instructions: please note that we have started an antibiotic for your lung infection called clindamycin. please take 300 mg four times daily. please continue to take it until you follow-up in the pulmonary clinic. you need to sleep with the head of the bed elevated to prevent further aspiration events. please call your doctor or return to the ed if you develop worsening shortness of breath, chest pain, worsening cough, or new fever, or any symptoms of concern to you. followup instructions: 1. you need to follow-up with dr. in the pulmonary clnic. they are looking for an appointment for you in 4 weeks. please contact his office this week, and schedule an appointment to be seen in 1 month. his office number is . you will need a repeat ct scan prior to your appointment. ask them to schedule that as well. 2. please also schedule a follow-up appointment with your primary care doctor to be seen in the next 2-3 weeks to discuss your hospital admission. procedure: insertion of endotracheal tube diagnoses: unspecified pleural effusion unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm diaphragmatic hernia without mention of obstruction or gangrene constipation, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus abscess of lung iron deficiency anemia, unspecified 

Answer: The patient is high likely exposed to