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: dyspnea major surgical or invasive procedure: intubation. placement of picc line. placement of arterial line. history of present illness: ms. is a 61 year old female with a history of type ii diabetes, hypertension, morbid obesity and chronic dyspnea who presents to the emergency room with a one month history of worsening dyspnea on exertion. her dyspnea has not been associated with chest pain, fevers, chills, cough, or other symptoms. per her family she has been told that she has gained 60 lbs in the past 2 months for unclear reasons. she has been seen in pulmonary clinic in the past for her dyspnea, most recently in . at that time she was requiring home oxygen of unclear amounts. her dyspnea at that time was considered to be multifactorial with a large component of obesity hypoventilation syndrome, mild pulmonary hypertension and diastolic heart failure. bipap was suggested at that time but it is unclear if this was started. she has subsequently been lost to pulmonary followup. . in the ed, initial vs were: t: 96.5 p: 73 bp: 109/86 r: 18 o2 sat 68 % on ra which improved to 96% on 2l nasal canula after a nebulizer treatement. she had a cxr which showed no acute cardiopulmonary process and cardiomegaly. she received two liters of normal saline, solumedrol 125 mg iv x 1, ceftriaxone 1 gram iv x 1, azithromycin 500 mg iv x 1, lasix 20 mg iv x 1, aspirin 325 mg po x 1. her abgs were significant for profound hypercarbia which was unresponsive to a trial of non-invasive ventilation and she was intubated. peak pressures were elevated peri-intubation in the 40s to 50s and this improved with increased sedation and bronchodilators. she was transferred to the micu. . on arrival to the micu she is intubated and sedated. no further history can be obtained. past medical history: - type ii diabetes - hypertension - diverticulosis w/sbo due to intrapelvic abscess s/p small bowel resection then subsequent sigmoid colon resection ' - history of c-section - two large parauterine cysts s/p tah/bso ' - history of c.diff colitis (remote ') - chronic hypoxia and co2 retention attributed to obesity hypoventilation syndrome, diastolic heart failure and possibly pulmonary hypertension. she has required home oxygen in the past. social history: she was born and raised in but moved to 30 years ago. she has six children and lvies alone. she smoked cigarettes as teenager but has not in 40 years. she smoked marijanua heavily until . no known alcohol or drug use. no history of asbestos exposure. no history of tuberculosis exposure. family history: no known history of heart or lung disease. physical exam: vitals: t: 97.1 bp: 124/73 p: 84 r: 20 o2: 97% (ac 450 x 24, peep 5, fio2 50%) general: intubated, sedated, no distress heent: sclera anicteric, mmm, oropharynx clear neck: obese, jvp unable to appreciate, no lad lungs: diffuse wheezing throughout, no clear crackles or ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, mild pitting edema of lower panus gu: foley draining clear yellow urine ext: warm, well perfused, 1 + pulses, 3+ edema to thighs pertinent results: admission labs: wbc 6.9 n71 b0 l18 m11 e0 b0 hct 39.1 mcv 92 plts 150 142 97 43 ----------------gluc 181 k was grossly hemolyzed, repeat was normal 8.0 38 1.3 ca 9.2 mg 2.0 phos 2.4 alt/ast 17/21 ck 167 --> 121 alkp 85 tbili 1.4 bnp 3753 ce negative x2 abg 7.19/106 co2 / o2 66 / hco3 42 lactate 0.6 ua without blood, infxn. prot 75, neg glucose and ketones bcx negative x4, ucx negative x2, sputum cx x2 ekg sinus rhythm with baseline artifact. compared to the previous tracing of artifact is more pronouned. precordial t wave inversions have resolved. cxr as compared to the previous radiograph, an endotracheal tube has been inserted. the tip of the tube projects approximately 1 cm above the carina. normal course of a nasogastric tube. moderate cardiomegaly with signs of mild overhydration. no evidence of pleural effusions. small retrocardiac atelectasis, no evidence of other lung parenchymal abnormalities. no evidence of complications. echo the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). the right ventricular cavity is dilated with borderline normal free wall function. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. no aortic stenosis or regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global systolic function. right ventricular cavity enlargement with low normal free wall motion. mild pulmonary artery systolic hypertension. compared with the prior report (images unavailable for review) of , mild symmetric left ventricular hypertrophy and right ventricular cavity enlargement are now apparent. the other findings are similar. cta 1. no evidence for pulmonary embolus on this is slightly suboptimal study. 2. left thyroid nodule. after outpatient thyroid function test consider thyroid ultrasound. 3. new main pulmonary artery dilatation suggests pulmonary hypertension. prominent chest wall venous collateral veins nd dilated internal mammary vein raise the possibility of systemic shunts. 4. new moderate cardiomegaly with right ventricular enlargement and hypertrophy. 5. new abdominal ascites 6. likley tracheomalacia and bronchomalacia. consider tbm study after treatment. 7. new bilateral small pleural effusions with associated relaxation atelectasis. 8. persistent but increased right hilar adenopathy ,nonspecific. abdominal x-ray : there is a single dilated small bowel loop in the mid abdomen measuring up to 3 cm in diameter. there are multiple small bowel air-fluid levels. there is significant amount of stool in the cecum and transverse colon. surgical clips are projected over the pelvis. impression: findings are consistent with early complete small-bowel obstruction. there is no free air. brief hospital course: 61yof with a history of type ii diabetes, hypertension, morbid obesity and chronic dyspnea who presents to the emergency room with a one month history of worsening dyspnea on exertion. acute on chronic hypercarbic respiratory failure: likely multifactorial from obesity hypoventilation syndrome and possibly pulmonary hypertension and diastolic heart failure. pt was intubated and mechanically ventilated. did not have any signs of pulmonary infection and was not treated with abx. did not have any signs of infection through admission and no cx's were positive. had echo showing good ef and some r ventricle dilatation. physical exam was most significant for fluid overload and gross anasarca to lower abdomen. received short course of prednisone for some wheezes heard on exam, albuterol and ipratropium nebs, and was aggressively diuresed with lasix and by call out from micu was approx. 20l negative. pt improved with this diuresis and pt was able to be successfully weaned from vent, abg's by time of d/c significant for chronic hypercarbia with metabolic compensation which pt tolerated well. pt transitioned to po lasix on day of call out which will need to be titrated, goals while in icu were 1-2l negative daily. pulmonary/sleep medicine was consulted and recommended bi-pap with ipap 12 and epap 6. on starting bi-pap she had a desaturation to 78%. on reestablishing bi-pap her o2sat returned to 93%. her pulmonary exam was clear, and she satted >92% on 2l nc during the day, and on bi-pap at night. she was treated with albuterol and ipratropium nebulizers every six hours. she was continued on her home dose of lasix 20mg po daily. elevated hco3: most likely in response to elevated co2 chronically as compensation for respiratory acidosis. as she was diuresed 20l, she likely had an element of contraction alkalosis as well. she received 5 doses of acetazolamide in the micu with some improvement in her hco3. on discharge, her serum bicarbonate was 34. type ii diabetes: pt was started on regular insulin sliding scale and her actos was stopped. on arrival to the floor, she was given a diabetic diet and her insulin was switched to a humalog sliding scale. her blood sugars ranged from 100-200. she was started on metformin 500mg po daily. hypertension: blood pressures in the 100s on sedation, and home antihypertensives were held. she was restarted on her lisinopril 10mg po daily before discharge. small bowel obstruction: on , patient developed severe abdominal pain, and vomiting. she was made npo, and an abdominal x-ray was consistent with small bowel obstruction. a nasogastric tube was placed, and placed to continuous wall suction. once output decreased, ng tube was clamped. no minimal residuals were present after 4 hours, and the ng tube was removed. her diet was advanced with no return of her abdominal pain. medications on admission: per daughters, pt was minimally compliant with home meds. zestril 20 mg albuterol 2 puffs q4h:prn simvastatin 20 mg daily lasix 20 mg daily lisinopril 40 mg daily actos 45 mg daily discharge medications: 1. oxygen/bi-pap oxygen by nasal cannula, 2l per minute continuous, for portability pulse dose system. diagnosis: chf. room air sat 88% at rest. bi-pap: , with heated humidification, diagnosis: obstructive sleep apnea 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 5. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours): please provide enough treatments for q6hrs x 30 days. disp:*qs box* refills:*2* 7. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours): please provide enough treatments for q6hrs x 30 days. disp:*qs box* refills:*2* 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. nebulizer please provide nebulizer machine for nebulized breathing treatments. all accessories. mass health # diagnosis: bronchospasm 11. metformin 500 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: respiratory failure hypoventilation small bowel obstruction secondary diagnosis: diabetes, type ii discharge condition: stable, alert and oriented to person, place and time. ambulating with assistance. oxygenating ~93% with oxygen 2l by nasal cannula while awake, and ~93% on bi-pap 6/12 2l at night. discharge instructions: you were admitted for shortness of breath. your blood levels of oxygen were low and a breathing tube was inserted. you were placed on a ventilator for 9 days. diuretic medications were given that removed excess fluid from your body. once the breathing tube was removed, you were given nebulizer breathing treatments. your oxygen level improved. on you developed acute belly pain and vomiting. an x-ray demonstrated a blockage of your intestine (small bowel obstruction). we held food, and placed a tube through your nose into your stomach (nasogastric tube). once the pain resolved, we removed the tube and you tolerated food again. the following changes were made in your medications: please stop taking actos please start taking metformin 500mg po daily please change your dose of lisinopril to 10mg by mouth daily. please review all changes in your medications with your primary doctor. you have been provided prescriptions for all of your medications, but you only need to fill those that are new. please go to your follow-up appointments. they are important for managing your long-term health. . please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, or any other symptoms that you are concerned about. followup instructions: please follow up with the following appointments: dr. greater community health center . , ma at 9:00 am the sleep center at hospital will contact you for a sleep study and to follow up on your bi-pap breathing machine. if you have not heard from them by the end of the week, please call to arrange an appointment (. the center where the sleep study will be performed is: sleep healthcenters . , ( procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization insertion of other (naso-)gastric tube diagnoses: thrombocytopenia, unspecified anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension other chronic pulmonary heart diseases acute and chronic respiratory failure morbid obesity other ascites diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled diastolic heart failure, unspecified unspecified intestinal obstruction mixed acid-base balance disorder 

Answer: The patient is high likely exposed to