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: history of the present illness: the patient is a 62-year-old female with a past medical history significant for congestive heart failure, chronic obstructive pulmonary disease, type 2 diabetes mellitus, coronary artery disease, and obesity who was transferred here from home after she complained of chronic midscapular back pain for approximately one month and several days of a nonproductive cough, shortness of breath, slight fevers and chills and increased urination. she states that percocet help her back pain. she denied any abdominal pain, dysuria, bowel changes, or palpitations. she states that she feels tired and cold. also, in the nursing home, she was found to have a klebsiella uti sensitive to ciprofloxacin, to be tachycardiac and hypovolemic. in the emergency room, her initial vital signs revealed a temperature of 98.4, pulse 106, blood pressure 119/66, respiratory rate 18, saturating 96% on 3 liters. an ekg found her to be in atrial fibrillation/atrial flutter. she received 20 mg of diltiazem with an appropriate heart rate down to the 80s temporarily. she was then given another 5 mg of diltiazem without effect. her systolic blood pressure at this time was in the 80s to 90s with a heart rate still in the 120s to 150s. the patient was maintaining well at this point with good urine output. she was given a 250 cc bolus of normal saline and a right internal jugular triple lumen catheter was placed. she had continued fluctuating systolic blood pressures in the 80s to 110s. she was given another 5 mg of diltiazem for heart rate in the 120s. at this point, her systolic blood pressure fell to the 70s and the repeat ekg showed questionable fib versus flutter pattern. carotid massage was initiated which led to five second pauses with flutter waves. past medical history: 1. obesity. 2. type 2 diabetes. 3. asthma. 4. copd. 5. manic depression. 6. bipolar. 7. history of atypical chest pain. 8. history of congestive heart failure. 9. history of coronary artery disease, status post rca stent in . 10. history of small bowel resection. 11. history of nephrolithiasis. 12. history of lithium-induced renal failure. social history: she denied alcohol. she denied tobacco. she currently resides at home. she has no family in the united states. admission medications: 1. lasix 40 mg p.o. q.a.m., 20 mg p.o. q.p.m. 2. lipitor 20 p.o. q.d. 3. trazodone 50 p.o. q.d. 4. lactulose 15 cc p.o. b.i.d. 5. standing senna and colace regimen. 6. risperdal 1 mg p.o. b.i.d. 7. depakote 250 mg p.o. q.a.m., 125 mg p.o. q.p.m. 8. protonix. 9. albuterol and flovent inhalers. 10. tums. 11. vitamin d. 12. aspirin 81 p.o. q.d. 13. lisinopril 40 p.o. q.d. 14. luvox 100 mg p.o. q.d. 15. synthroid 25 micrograms p.o. q.d. 16. zyrtec 10 mg p.o. q.d. allergies: the patient has allergies to penicillin, iodine, naprosyn, ibuprofen, phenobarbital, oxacillin, doxycycline, benadryl, amoxicillin, ampicillin. laboratory/radiologic data: on admission, she had a white blood cell count of 9.7, hematocrit 29.0, platelets 206,000. sodium 140, potassium 4.8, chloride 105, bicarbonate 18, bun 41, creatinine 1.3, glucose 115. she had 61 neutrophils, 32 lymphocytes, 8 monocytes, 7 eosinophils, 2 basophils. pt 13.2, inr 1.2. alt 20, ast 41, amylase 15, alkaline phosphatase 62, total bilirubin 0.2. cardiac enzymes were drawn which showed a ck of 32, one troponin of 0.08, and another troponin of 1.0. she had an ekg which showed narrow tachycardia of 120 with normal axis. she had a chest x-ray which showed a left upper lobe pneumonia with a right ij without pneumothorax. physical examination on admission: vital signs: temperature 98.4, blood pressure 116/56, pulse 117, saturating 100% on 2 liters. general: she is a morbidly obese woman. she was alert and oriented times three. neck: supple with a right ij in place. heent: pupils were equal, round, and reactive to light. her extraocular movements were intact. her mucous membranes were dry. chest: distant breath sounds and no wheezing. cardiac: tachycardia which was regular. abdomen: an obese abdomen which was nontender and nondistended with very active bowel sounds. extremities: cold without edema. hospital course: 1. pulmonary: the patient was shown to have a pneumonia for which she was started on levofloxacin and clindamycin for possible aspiration pneumonia. it was believed that the back pain that she was experiencing was related to her left upper lobe pneumonia. a ct scan was done on which showed left upper lobe lingula consolidation and collapse without a patent airway. this necessitated a bronchoscopy by the pulmonary service here and multiple biopsies were taken at this time which the results currently on the date of discharge are still pending. otherwise, the patient from a pulmonary standpoint has remained at her baseline. she has been saturating well with 02 sats in the upper 90 percentile on room air. the patient was continued on her levofloxacin and clindamycin which were started on for a full 14 day course for a possible community-acquired versus aspiration pneumonia. in terms of her bronchoscopy, she had transbronchial needle aspiration of subcarinal node from the right side. a needle aspiration biopsy also of the left main lung mass. they also took brushings from the left main and washings from the left main. 2. atrial fibrillation/atrial flutter: the patient was maintained on diltiazem 60 mg p.o. q.i.d. and metoprolol 50 mg p.o. t.i.d. with stable systolic blood pressures in the low 100s with diastolics in the upper 60s. the patient did have one episode during the course of her hospital admission where she became tachycardiac to the 140s with systolic blood pressures in the 80s and diastolic pressures in the 50s. she responded well to a 500 cc then 250 cc bolus of normal saline. she was given diltiazem 10 mg iv which improved her heart rate back down into the 90s. the patient has continued to be in an atrial fibrillation/atrial flutter during her hospitalization. she was maintained on a heparin drip which was temporarily discontinued for her procedures such as her bronchoscopy. she did have an echocardiogram done while here which showed an ejection fraction of 55% and a small highly mobile 2 mm mass on the mitral valve which was fibrinous and calcified that was questionable for either thrombus or tumor. the echocardiogram also showed an intra-atrial septal aneurysm. the patient was started on lovenox on the day before discharge and she will be sent out on coumadin 2 mg p.o. q.d. for her new atrial fibrillation/atrial flutter. it was decided during the course of her hospital admission due to her continuing pulmonary disease that we would not attempt cardioversion or electrophysiology studies at this time. 3. anemia: on , the patient did have a hematocrit drop from 28.4 to 21.7. this drop in hematocrit occurred on the same evening where the patient had runs of tachycardia in the 140s and was given her two 500 and 250 normal saline boluses. it was believe that part of this drop in hematocrit is secondary to a dilutional effect with these normal saline boluses. however, her anemia was worked up. she was shown to be guaiac negative the next morning. the patient did have some bruising on her abdomen which was suggestive of a possible retroperitoneal bleed. a ct of the abdomen and pelvis demonstrated no bleeding in the retroperitoneal space or in the femoral areas. she was transfused with 4 units of packed red blood cells. she did not show evidence of congestive heart failure during or after these transfusions. her hematocrit remained stable in the low 30s. on the date of discharge, her hematocrit was 30.4. 4. hypercalcemia: the patient did have calcium levels in the low 10 range. it is possible that this is secondary to a perineoplastic syndrome in the setting of a patient with a 100 pack year smoking history and a new lung mass. the patient was given lasix 40 mg p.o. q.d. which was elevated to 40 mg p.o. b.i.d. her calcium levels remained stable in the 10.0 range and the patient did not have any symptoms of hypercalcemia and did not show ..................... 5. diabetes: the patient was maintained on her sliding scale insulin in the hospital only. her fingersticks were in the 140s to 150s fasting in the morning. she should be restarted on her home insulin dose on discharge from the hospital. condition on discharge: fair. discharge diagnosis: 1. airway obstruction. 2. atrial fibrillation/atrial flutter. 3. pneumonia. 4. diabetes mellitus. discharge medications: 1. pantoprazole 40 mg p.o. q.d. 2. trazodone 50 mg p.o. q.h.s. 3. lactulose 30 milliliters q. eight p.r.n. 4. atorvostatin 20 mg p.o. q.d. 5. risperidone 1 mg p.o. b.i.d. 6. ipratropium 80 micrograms two puffs q.i.d. 7. levofloxacin 500 mg p.o. q. 24 hours for a total of a 14 day course. 8. prochlorperazine malate 10 mg p.o. q. six hours p.r.n. nausea. 9. aspirin 81 mg p.o. q.d. 10. multivitamin one capsule p.o. q.d. 11. levothyroxine sodium 25 micrograms p.o. q.d. 12. fluoxetine malleate 100 mg p.o. q.d. 13. fluticasone propionate 110 micrograms two puffs b.i.d. 14. clindamycin 300 mg p.o. q. six hours for a total of 14 days. 15. docusate sodium 100 mg p.o. b.i.d. 16. albuterol 90 micrograms two puffs q. six hours p.r.n. 17. guaifenesin 10 milliliters p.o. q. six hours. 18. metoprolol 50 mg p.o. t.i.d. 19. furosemide 40 mg p.o. b.i.d. 20. nystatin topical ointment q.i.d. as needed. 21. miconazole powder t.i.d. as needed. 22. warfarin 2 mg p.o. q.h.s. 23. diltiazem 90 mg p.o. q.i.d. 24. lovenox 100 mg subcutaneously q. 12 hours to be continued until inr reaches 2.0. follow-up plans: the patient will follow-up with dr. for results of pulmonary biopsies. the patient will be discharged to nursing home. , m.d. dictated by: medquist36 procedure: closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung biopsy of lymphatic structure diagnoses: anemia of other chronic disease urinary tract infection, site not specified atrial fibrillation pneumonitis due to inhalation of food or vomitus malignant neoplasm of other parts of bronchus or lung hypercalcemia 

Answer: The patient is high likely exposed to