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: enalapril / amlodipine attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: this is a 89 year-old female with a history of mds, hip fracuture , living at rehab who presents with shortness of breath. per nursing home staff, patient has been coughing with chest congestion, fatigue, and poor po intake for 1 week. additionally, staff states that she is the 4th patient hospitalized for pnemonia and th 10th with chest cold symptoms and fevers. . cxr on was without cardiopulmonary process and labs were significant for hct of 60, wbc 26.3 (90%neut, 1%lymph), cr of 1.5, and probnp of 6000 (3000 1 month earlier). patient was started on lasix 40mg for presumed chf exacerbation, but continued to have cough, fatigue, poor po intake and on , desated to the 70's. . in the ed, patient's initial vitals were t 96.6, bp 111/58, hr 64, rr 30, sating 90% on nrb. while in ed she spiked to 101.8, with continued low sat on nrb and was placed on bipap as patient is dnr/dni. bp dropped to 83/41 but responded to 1l ns back to 102/41. cx sent and patient was given vanc and cefipime. . on ros, patient was oriented x 2 (did not know which hospital). ros likley inaccurate as patient denied fevers/chills and sob which were documented in ed. . past medical history: myeloproliferative syndrome hypothyroidism gi bleeds, diverticular, last r bell's palsy hypertension osteoporosis s/p hip fracture with surgical treatment () one previous episode of atrial fibrillation . social history: has lived in rehab at in since hip surgery , ambulates with cane or walker. no smoking, quit 35 years ago, about 20-30 pack year history, no alcohol, no drug use. family history: the patient's mother died of peritonitis. the patient's father had an unknown cancer. no history of gastrointestinal bleeding in the family physical exam: vitals: t: 98.5 bp: 102/42 hr: 97 rr: 17 o2sat: 95% bipap 10/5 40% gen: no acute distress, elderly woman, mildly somnolent with bipap mask on heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mm dry neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: tachy but regular, no m/g/r, normal s1 s2, radial pulses +2 pulm: decreased breath sounds throughout with fine crackles at bases abd: soft, nt, mild distention, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. no gait disturbance. no cerebellar dysfunction. skin: decreased turgor, no jaundice, cyanosis, or gross dermatitis. no ecchymoses pertinent results: 03:10pm wbc-50.7*# rbc-6.30* hgb-18.6*# hct-56.0*# mcv-89 mch-29.5# mchc-33.2 rdw-14.8 03:10pm neuts-96.1* lymphs-1.1* monos-2.5 eos-0.1 basos-0.2 03:10pm plt smr-very low plt count-627* . 03:10pm glucose-115* urea n-53* creat-1.6* sodium-139 potassium-4.9 chloride-90* total co2-34* anion gap-20 03:10pm alt(sgpt)-9 ast(sgot)-26 ck(cpk)-33 alk phos-145* tot bili-1.0 . 03:10pm ctropnt-0.28* 03:10pm ck-mb-6 probnp-* 09:30pm ck-mb-6 ctropnt-0.28* 09:30pm ck(cpk)-24* . admit cxr: impression: limited examination. a left lower lobe infiltrate cannot be excluded. a dedicated lateral view may be helpful. tiny bilateral pleural effusions. . cxr findings: in comparison with the study of , there is little change except for somewhat better degree of inspiration. bilateral pulmonary opacifications continue at the bases, consistent with some combination of atelectasis or/and effusion. enlargement of the cardiac silhouette with pulmonary vascular congestion persists. brief hospital course: this is an 89 year-old female with a history of mds, hip fracuture , living at rehab who presented with shortness of breath, hypoxia, leukocytosis and ? r pleura effusion/infiltrate. pt made comfortable with morphine/ativan per family/pt wishes. upon discharge to , we were notified she expired shortly upon arrival there. the following is her course by problem. . # hypoxia/health care associated pna - patient c/o sob and sating only 90 on nrb so transitioned to bipap. most likely pneumonia. influenza negative. hyperviscousity syndrome possible with polycythemia, but resolved with ivf. patient appeared hemoconcentrated on labs and was given ivf. she was started on vanc, cefipime from ed and levoquin was added for increased psuedomonal and atypical coverage. patient wean off bipap breifly, but was again found to be lethargic with pco2 in 70s. she is noted to be quite delerious in the pm. by day 4 in the icu, patient refused suctioning and many po meds. per her daughter and hcp, the patient was changed to comfort-oriented care. continue abx, but can give morphine for pain/respiratory discomfort. hcp is aware that this may lead to her demise, but feel that she should be comfortable at this point. the pt will complete a 10 day course of levofloxacin, as the family refused midline to continue cefepime treatment. the pt was seen by gerontology, who made recommendations on her medications from a palliative care perspective. for discomfort the pt will be discharged on both standing ativan and ativan as needed (which often helped her) as well as concentrated morphine solution (both standing and as needed) which can be titrated up as needed. she was satting 90% on 5l nc at discharge, mildly dyspneic. she was given a 1 time dose of levsin and started on scopolamine patch. humidified shovel mask plus extra morphine can be considered (if pt tolerates) if she becomes more dyspneic. pt is refusing suctioning. . mental status: mild delirium present with dementia at this time. is to avoid triggers. however some triggers below are to be used with pt's wishes. - avoid foley catheters -try to avoid anticholinergics, and sleeping medications. - avoid physical restraints. they do not prevent falls or pulling out lines. they increase aggitation. if needed, can obtain a sitter. if pharmacologic intervention is needed, would use low dose haldol 0.25 mg iv up to tid prn or zyprexa 2.5 mg x1. - please provide frequent reoorientation - minizmize disruptions to sleep wake cycle <br> # arf - cr to 1.6 with baseline of 1.0. unable to place foley as met obstruction both in ed and on floor. cr back to 0.8 on last lab draw. <br> # ? aspiration - patient apparently aspirates while delerious at night, but passed a swallow study. she can take regular diet with thin liquids under aspiration precautions. . # a-fib rvr - patient went into a-fib with rvr when po metoprolol was stopped for risk of aspiration. she was rate controlled and flipped in and out of a-fib with iv doses of metoprolol. eventually agreed to standing iv metoprolol. changed iv lopressor to po lopressor. po lopressor can be discontinued given goals of care/comfort measures if pt has difficulty swallowing pills. . # elevated ce - trop elevated to 0.28, but ck normal and trend was flat. likely demand ischemia in setting of pneumonia. . # myeloproliferative syndrome - with baseline leukocytosis and thrombocytosis. followed by dr. . per heme/onc, no more phlebotomy in the setting of comfort measures . # goals of care: comfort measures, no lab draws, vital signs check daily ok per family; morphine/ativan standing and as needed for comfort. . # code: dnr/dni . # comm: daughter and hcp, (c) , (h) medications on admission: milk of mag prn tylenol 325-650 prn lorazepam 0.5mg hs prn caco3 500mg tid mvi qday docusate 100mg qday feso4 325mg qday kcl 20 meq qday lasix 40mg (presumably started with elevated bnp) levothyroxine 150 mcg qday metoprolol 12.5mg omeprazole 40mg qday alendronate 70mg qwed . discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for wheeze. 5. tylenol 325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 6. ativan 0.5 mg tablet sig: one (1) tablet po twice a day: can substitute 5 mg/ml solution if needed. 7. ativan 0.5 mg tablet sig: one (1) tablet po every four (4) hours as needed for agitation, discomfort: can substitue 5 mg/ml solution if needed. 8. levofloxacin 750 mg tablet sig: one (1) tablet po q48 hr for 2 doses. 9. morphine concentrate 20 mg/ml solution sig: two (2) mg po every six (6) hours. 10. morphine concentrate 20 mg/ml solution sig: 2-4 mg po q2h as needed for breakthrough. 11. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po twice a day. 12. scopolamine base 1.5 mg patch 72 hr sig: one (1) patch transdermal every seventy-two (72) hours. discharge disposition: extended care facility: nursing home - discharge diagnosis: primary diagnosis: pneumonia with hypoxia acute mental status change <br> secondary diagnosis: acute renal failure a-fib with rvr myelodysplastic syndrome discharge condition: stable discharge instructions: you were diagnosed with pneumonia. you were treated with antibiotics while you were here. in discussion with your family, it was decided we should treat you with comfort measures . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet <br> continue antibiotic regime as prescribed for complete course. please discuss hospice care at the nursing facility you are going to. <br> pt is noted for comfort care measures, also with h/o delirium please institute the following precaustions as best as possible: - avoid foley catheters -avoid benzos, anticholinergics, and sleeping medications. - avoid physical restraints. they do not prevent falls or pulling out lines. they increase aggitation. if needed, can obtain a sitter. if pharmacologic intervention is needed, would use low dose haldol 0.25 mg iv up to tid prn or zyprexa 2.5 mg x1. - please provide frequent reoorientation - minimize disruptions to sleep wake cycle followup instructions: follow up with dr. as needed. procedure: non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation other persistent mental disorders due to conditions classified elsewhere myelodysplastic syndrome, unspecified acute respiratory failure hypotension, unspecified osteoporosis, unspecified delirium due to conditions classified elsewhere 

Answer: The patient is high likely exposed to