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: aspirin attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: ms. is an 81 yo female with pmh of trached since stomach mass, trouble weaning. much of the history is provided by her husband, who is her hcp, given her ventilatory status. she was initially intubated for resection of a gastric cardiac tumor, but had difficulty weaning from the vent with complications including pna. she spent 72 days at for this. she was discharged to rehab on , where she was slowly weaned. she underwent bronchoscopy and endoscopy at roughly one week ago which showed healed resection sites. she was at rehab today when she noticed sudden onset dyspnea and tachycardia. . in the ed, initial vs were: t 100.6 p 117 in afib bp 128/52 (decreased to 91/41 upon signout) r 36 o2 sat 95% on 100% fio2. she had no leukocytosis, hct was 34, trop was 0.03 but ck was 36. lactate was 2.9. cxr showed mild chf, small bilateral effusions, and a retrocardiac opacity. cta showed pe in his lul pulm artery, right lung pna, and lll collapse. ua was positive for > 50 wbcs. patient was given diltiazem, levofloxacin 750mg, vancomycin 1g, ceftriaxone 1g, and started on heparin. 2 18 gage pivs were placed. ucx and bcx were sent. . on arrival to the icu, she is intubated. she is resting and comfortable. denies abd pain, chest pain. she reports continued sob, though it is better than upon presentation to the ed. past medical history: - stomach/esophageal ca of cardia s/p resection - herpes zoster in - mi treated at in , s/p heart - catheterization in , unknown details - hepatitis in , ? medication induced - obesity - hypercholesterolemia - htn . social history: nonsmoker. no etoh family history: nc physical exam: vitals: t: 99.7 bp: 147/68 p:112 r:22 99% on 100% fio2 vent: psv 10/5 40% fio2 general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple. bounding carotid pulses. jvp not elevated, no lad. ttp right neck. fullness of right neck and supraclavicular area. lungs: bronchial bs in left base. rales in right base. cv: regular rate and rhythm, normal s1 + s2, 2/6 sem murmur at base. no rubs, gallops abdomen: soft, non-distended, bowel sounds present. diffuse ttp. no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: answers questions appropriately by nodding. cns intact grossly. pertinent results: admit labs: 07:40pm blood wbc-9.7 rbc-3.53* hgb-11.2* hct-34.0* mcv-97 mch-31.7 mchc-32.8 rdw-16.3* plt ct-333 07:40pm blood neuts-63.7 lymphs-28.9 monos-5.5 eos-1.4 baso-0.4 07:40pm blood pt-12.6 ptt-20.4* inr(pt)-1.1 07:40pm blood glucose-128* urean-12 creat-0.5 na-134 k-4.1 cl-93* hco3-33* angap-12 03:40am blood alt-13 ast-29 ld(ldh)-320* ck(cpk)-40 alkphos-68 amylase-5 totbili-0.3 07:40pm blood ck(cpk)-36 11:28am blood ck(cpk)-30 07:40pm blood ctropnt-0.03* 03:40am blood ck-mb-notdone ctropnt-0.05* 11:28am blood ck-mb-notdone ctropnt-0.03* 03:40am blood lipase-16 07:40pm blood calcium-9.0 phos-1.9* mg-1.5* 07:51pm blood lactate-2.9* 04:40am blood lactate-0.9 . discharge labs: 05:15am blood wbc-7.0 rbc-2.93* hgb-9.6* hct-28.4* mcv-97 mch-32.9* mchc-33.9 rdw-16.0* plt ct-267 03:40am blood neuts-72.0* lymphs-20.5 monos-5.6 eos-1.3 baso-0.5 05:15am blood pt-15.6* ptt-62.5* inr(pt)-1.4* 05:15am blood glucose-142* urean-9 creat-0.4 na-138 k-3.8 cl-98 hco3-35* angap-9 05:15am blood calcium-8.3* phos-3.5 mg-1.8 04:40am blood lactate-0.9 . studies: cxr ap : mild chf with small bilateral pleural effusions and retrocardiac opacity which may represent atelectasis and/or pneumonia. would recommend followup post-diuresis. . cta chest : pulmonary artery filling defects, consistent with acute thrombus, begin at the origin of the right upper lobe pulmonary artery extending into segmental and subsegmental right upper lobe branches. focal acute pulmonary embolism is noted in the right interlobar pulmonary aretery as well. other pulmonary artery filling defects appear peripherally located within the vessel, perhaps representing recannulated arteries in the setting of chronic embolism (i.e. branches to the superior segment of the left lower lobe). . breathing artifact obscures evaluation of subsegmental levels, particularly to the right lower lobe. no left sided pulmonary emboli are identified. there is no overt evidence of right- sided heart strain. atherosclerotic calcifications involve the thoracic aorta and its branches including the coronary arteries. there is no evidence of pericardial effusion. small scattered mediastinal lymph nodes are identified though they do not appear to meet ct criteria for pathologic enlargement. an tracheostomy tube appears appropriately positioned. heterogeneous appearance of the thyroid with rim- calcified left thyroid nodules are partially imaged. lung windows reveal extensive right lung peribronchovascular opacity throughout the upper, middle, and lower lobes. more consolidative changes at the right base are also noted. there is a small left pleural effusion with consolidation of the left lower lobe consistent with collapse. secretions are noted in the left main stem bronchus extending into left lower lobe bronchi. although this exam is not tailored to evaluate abdominal organs, limited evaluation of the upper abdomen is unremarkable. there are no bone findings of malignancy. fracture deformity of the left seventh rib is old. multilevel thoracolumbar bridging anterior osteophytosis is noted. impression: 1. pulmonary emboli including those beginning at the origin of the right upper lobe pulmonary artery extending into segmental and subsegmental vessels and another in the right interlobar artery. 2. focal right basilar consolidation and diffuse right lung peribronchovascular opacity is most concerning for infection or aspiration, though the sequela of chronic emboli is in the differential. 3. left lower lobe collapse with opacification of lower lobe bronchi, perhaps reflecting mucus impaction. associated small left pleural effusion. . tte : the left atrium is normal in size. 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 right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: mild right ventricular systolic dysfunction. preserved global left ventricular systolic function. no significant valvular disease seen. no pericardial effusion. . bilateral leni: no evidence of deep vein thrombosis in either leg. . cxr ap : in comparison with the study of , there are persistent low lung volumes in this patient with a tracheostomy tube in place. opacification at the left base is consistent with pleural fluid and atelectasis, though superimposed pneumonia cannot be excluded in the absence of a lateral view. the pulmonary vasculature is essentially within normal limits. the cardiac silhouette is somewhat prominent, though much of this may reflect the poor inspiration. opacification at the right base medially could reflect crowding of vessels or a possible consolidation in this area as well. . brief hospital course: 81 year old lady was admitted with acute respiratory distress. patient was found to have pulmonary emboli as mentioned above. she also had pneumonia. she was found to be in atrial fibrillation with rapid ventricular response on admission. . # pulmonary emboli: she was started on heparin drip on admission. this was switched to lovenox bridge to coumadin on . her respiratory status continued to improve and she was being weaned off the ventilator as tolerated. her tte showed rv free wall hypokinesis. patient needs to be in therapeutic inr prior to discontinuing her lovenox shots. she had negative lower extremities for dvt. . # pneumonia: patient has trach. she was found to have pnuemonia on both cxr and ct. final sputum culture is still pending but she was growing 4+ gram positive cocci. patient will be treated with vancomycin, levofloxacin and zosyn for a 8 day course to be completed on . her sputum culture and sensitivities needs to be followed up. patient initially had elevated lactate to 2.9 on admission which quickly trended down. . # afib/aflutter: patient was found to be in intermittent afib/aflutter, mostly in sinus with good rate control in icu. she received iv diltiazem in ed. she was continued on home digoxin in icu. anticoagulation course as above. . # abdominal pain: found to have diffuse tenderness on admission which quickly resolved. her lfts and pancreatic labs were within normal limits. . # urinary tract infection: positive ua in ed. cultures are pending at the time of discharge. she is already pancovered for pneumonia as above. . # htn: patient has a history of htn on multiple antihypertensives at home. sbp ranging 100s to 140s in icu. her home medications were held due to active infection. could gradually restart as she improves. . # dm: her metformin was held in house and she was placed on sliding scale insulin. could restart her metformin as out patient. . # contacts: husband: . cell . . medications on admission: zofran 9mg kcl 20meq spironolactone 25mg qday ambine 5mg qhs percocet 5/325 0.5 tab q 6 hrs prn pain tramadol 50mg q 6 hrs prn pain ativan 0.25mg po prn anxiety reg insulin ssi lactobacillus lidocaine patch 5% td qday losartan 75 qday metformin 500mg metoprolol tartrate 50mg tid mritazapine 7.5 mg qhs omeprazole 20mg albuterol/ipratropium 4 puffs qid amlodipine 5mg qday digoxine 0.25mg qday duloxetine 20mg lovenox 40mg qday (starting ) fentanyl patch 50mcg q3 day ferrous sulfate 325mg lasix 40mg qday hydralazine 25mg qid discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 4. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 5. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 6. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. 7. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 8. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 9. levofloxacin 750 mg tablet sig: one (1) tablet po q48h (every 48 hours): 8 day course to be completed on . 10. duloxetine 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 11. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 12. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 13. enoxaparin 100 mg/ml syringe sig: ninety (90) mg subcutaneous q12h (every 12 hours) for as directed below days: patient should have therapeutic inr for atleast 3 days prior to discontinuing this medication. 14. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 15. zosyn 4.5 gram recon soln sig: one (1) intravenous every eight (8) hours for as directed below days: 8 day course to be completed on . . 16. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed. 17. vancomycin 500 mg recon soln sig: 1250 (1250) mg intravenous q 12h (every 12 hours): 8 day course to be completed on . vancomycin trough levels should be checked after 3 doses and the dose should be adjusted accordingly (target level 15 to 20). 18. insulin lispro 100 unit/ml solution sig: as directed subcutaneous asdir (as directed). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: pulmonary embolism pnuemonia . sendary: chronic vent dependence s/p trach discharge condition: afebrile and hemodynamically stable. discharge instructions: you were admitted to with acute respiratory distress. you were found to have pulmonary embolims (clot in lung arteries). you also have a pneumonia. you are being treated with anticoagulation for pulmonary embolism. you will have lovenox shots in the next five days. you are started on coumadin. you need to be lovenox till you have appropriate blood thinning with coumadin. your comadin levels (inr) need to be monitored daily and adjusted accordingly, with the target inr being 2 to 3. you will also need to be on antibiotics, vancomycin, levofloxacin and zosyn for atleast 8 days ending on . . you need to be weaned off of the ventilator at facility. please follow up the culture results at . . please take the medications as written. . please keep all of the follow up appointments. . if you develop worsening breathing, chest pain or any other concerning symptoms, please call your primary care provider or come to the emergency department. followup instructions: please follow up with your primary care provider early next week. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation atrial flutter pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute and chronic respiratory failure alkalosis old myocardial infarction long-term (current) use of anticoagulants ventilator associated pneumonia other pulmonary embolism and infarction tracheostomy status dependence on respirator, status 

Answer: The patient is high likely exposed to