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 present illness: this is a 57 nursing home resident female, who had been in her usual state of health until about three weeks ago when the daughter noted she was sleeping more. per record, she has had multiple episodes in the last week of changes in mental status. emts called many times. the patient would awake prior to arrival and not need transfer. the patient was seen at the on . no localizing etiology of delta ms. that evening she was unresponsive and the patient was brought to hospital. there her oxygen she was sating 65% on room air, increased to 98% with a nonrebreather mask. there an abg was done which showed an abg of 7.42, 62, and 55. she had a head ct that was negative. chest x-ray that was questionable left lower lobe infiltrate. lumbar puncture was performed and the micro cultures are still pending. she was seen by psychiatry at the outside hospital, but noted there was no psychoses, but delirium. the patient's mental status waxed and waned there. she also had a k of 6.0 and given 30 of kayexalate, 5 of haldol, 2 mg of ativan given for agitation, and 2 mg of ceftriaxone was given for a temperature of 101.3 with a concern for meningitis as a lp was done prior. patient was transferred to the as the patient's primary care provider was here. she is currently being seen by group. on arrival to , she was unresponsive with an oxygen saturation of 72% on 6 liters. she was placed on 50% vent mask, which improved her oxygenation to 97%. patient was placed on bipap. original abg here before bipap was 7.19, 102, and 92. after being placed on bipap, her blood pressure decreased to the 80s. she responded to 1 liter of iv fluids, normal saline and blood pressure remained stable. patient had peripheral iv x1 placed and right femoral line placed in the ed. when laying flat, her sats decreased to 50% on 30% fio2, peep of 10, and pressure support of 5. her abg at the time was 7.24, 91, and 38. once the patient sat up, her sats improved and her airway was no longer obstructed. after a history on bipap about a half an hour, her abg was 7.29, 79, and 106 on 30% pressure support of 5 and peep of 10. patient was intermittently awaking. she denied any pain and was not answering questions at the time. past medical history: 1. obstructive-sleep apnea ? 2. morbid obesity. 3. congestive heart failure, unknown ef. 4. hypertension. 5. diabetes mellitus. 6. depression. 7. nursing home resident. 8. dyspnea on exertion. 9. history of fibroids. 10. hypercholesterolemia. social history: she is a nursing home resident. does not ambulate. denies alcohol or tobacco use. medications on transfer from nursing home: 1. lasix 40 q.d. 2. senna two tablets q.6h. 3. metoprolol 25 mg b.i.d. 4. metformin 1,000 mg b.i.d. 5. colace. 6. niferex one tablet b.i.d. 7. cozaar 25 mg q.d. 8. ranitidine 150 mg p.o. q.d. 9. peroxetine 40 mg p.o. q.d. 10. insulin: nph 70 units q.a.m., 50 units q.p.m., regular insulin-sliding scale. 11. subq heparin 5,000 q.8h. 12. lactulose. 13. multivitamins. 14. albuterol inhalers prn. allergies: penicillin: shortness of breath. physical examination: vital signs: heart rate 108, blood pressure 140/82, oxygen saturation 96%, respiratory rate of 22 on bipap 5/10/30%. in general, sleepy but arousable. arousable intermittently to voice. heent: pupils 3 mm reactive. neck: obese, unable to assess lymphadenopathy or jugular venous distention. lungs: poor effort, no wheezes, rales, or rhonchi. cardiovascular: distant heart sounds, tachycardia, regular rhythm. abdomen is obese, nontender, decreased bowel sounds. extremities: obese, no edema, 2+ pulses. neurologic: responding to commands. moving all extremities well. toes are downgoing. pertinent laboratories: white blood cell count 12.8 (79% polys, 13% lymphocytes, 8 monocytes, nucleated rbcs 1%), hematocrit 31.7. potassium 5.2, creatinine 1.3, bun 35, glucose 152, d dimer 1636, inr 1.3. urinalysis: moderate leukocytes, rbcs, 21-50 lymphocytes, many bacteria, epithelial cells. tox screen negative. urine cultures pending. laboratories at outside hospital: white count 11.8 (90% polys, 4% lymphocytes, 5% monocytes, 1% basophils, 3% nucleated rbcs). potassium 6.6, creatinine 1.4, alkaline phosphatase 302, t bilirubin 0.6, ast 25, alt 84, ck of 15, troponin 0.01. chest x-ray: left lower lobe basal opacity. ekg: sinus tachycardia at 106 beats per minute, left axis deviation, t-wave inversions in leads i and avl that are old. no qrs widening and no peak t waves. this is in comparison to ekg. chest x-ray rotated low lung volumes, hazy opacities at bases. echocardiogram in : mild-to-moderate mr, tr. hospital course: 1. hypercarbic respiratory failure issues: the patient presented with changes in mental status, pco2 of 100, ph of 7.19, decreasing sats on arrival likely element of obstructive-sleep apnea. she was monitored overnight. she had admitted to the micu and had multiple episodes of apnea throughout the night. she was placed on pressure support, which improved her saturations and decreased her hypercarbia. patient improved that her mental status with improvement of her oxygenation and ventilation as well as for correction of her respiratory acidosis. patient was eventually placed on bipap on hospital day three, on the date prior to discharge of bipap settings of /5 liters of oxygen with saturations of 96% with a gas of 7.38, 67, and 91 with an aim of a goal pco2 of 67. she only had one episode of apnea on the day prior to discharge. 2. delta ms/mental status issues: most likely her waxing and mental status and hypercarbia/hypoxia compounded by infection of pneumonia and uti. with improvements of her ventilation and oxygenation and treatment with levofloxacin of her uti and pneumonia, her mental status greatly improved on hospital day two without further waxing and . her daughters came by and visited her, and reported that she was at her baseline mental status on the day prior to discharge. b12, folate, rpr were all sent that were unremarkable as causes for delta ms. we are awaiting results of the lumbar puncture from the outside hospital, but on hospital day two. those cultures are still pending at the time. patient was also given multivites. 3. fever issues: the patient initially presented with t max of 101.3 at outside hospital with increasing white blood cell counts and a positive urinalysis. a chest x-ray with bilateral patchy infiltrates likely pneumonia and uti. upon calling the outside hospital, the urine was growing out klebsiella, and patient was given a 10 day course of levofloxacin to cover both the pneumonia and uti. blood cultures and urine cultures are still pending at this hospital visit and the csf fluid from needs to be further evaluated. patient on the day of discharge was afebrile with a decreasing white count x48 hours. 4. acute renal failure issues: creatinine initially presented at 1.3. patient is known to have a baseline of 1.0, most likely hypovolemia and prerenal. a fena was sent, was 0.3%. patient was gently hydrated and iv fluids started up on a p.o. diet regimen. on hospital day two, her creatinine returned to 0.8, and she remained with a creatinine of 0.8 for the remainder of her hospital stay. patient's k was followed, and trended back down to normal on the day of discharge at 3.9. 5. elevated transaminases: patient had no right upper quadrant pain. sign was negative. a right upper quadrant ultrasound was performed that showed no hepatic or biliary pathology likely due to acute phase stress changes given the fact that she had no clinical symptoms. there is no need to followup these transaminases. 6. congestive heart failure history: patient was stable without evidence of chf on chest x-ray. followed her sats likely due to obstructive-sleep apnea and hypoventilation. patient was restarted on her beta blocker and .......-receptor blocker on hospital day two given that her creatinine had stabilized. patient had no further cardiac issues at this time. she was on telemetry without any episodes of any rhythm abnormalities. 7. gyn: the patient had some vaginal bleeding x2 days. patient had a history of fibroids during this hospitalization. followed her examination. her hematocrit remained stable throughout this course. patient is strongly encouraged to followup with her outside primary care provider to followup for the vaginal bleeding given her history of fibroids and question metaplasia of the endometrium. 8. heme: her hematocrit remained stable. she had a history of nucleated rbcs likely secondary to stress and hypoxia during this admission. hemolysis laboratories were negative. patient was restarted on her iron supplementation. reticulocyte count was performed that was negative. 9. fen: she was npo with a decrease in her mental status. we slowly advanced her diet as her mental status improved and repleted her electrolytes, and started on her p.o. medications on hospital day two. 10. diabetes: patient had q.i.d. fingersticks with a humalog sliding scale and nph doses were cut in half while she was npo, and they were brought back to her normal doses on the day of discharge with a full diet. 11. code status: full. two daughters came by and requested to be health care proxies as patient approved. documentation is in her medical chart. 12. prophylaxis: the patient was on subq heparin for dvt and ranitidine for gi prophylaxis. disposition: the patient is to be discharged today to hospital for long-term pulmonary ........ therapy and further evaluation of her obstructive-sleep apnea. discharge condition: patient was stable with complete clearance of her mental status, advancement of her diet, blood pressure, and heart rate remained stable, and her oxygen saturations were well above 90% during the daytime on 2 liters nasal cannula and at night on the bipap settings described above. physical therapy consult is pending today. discharge medications: 1. nph 70 units q.a.m., 50 units q.p.m. 2. humalog sliding scale. 3. subq heparin 5,000 units t.i.d. 4. ranitidine 150 mg p.o. b.i.d. 5. multivitamin x1. 6. losartan 25 mg p.o. q.d. 7. iron supplementation 150 mg p.o. q.d. 8. levofloxacin day four of 10 to be completed for a full 10-day course, 500 mg p.o. q.d. 9. metoprolol 25 mg p.o. b.i.d. 10. colace 100 mg p.o. b.i.d. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified acute respiratory failure unspecified sleep apnea morbid obesity 

Answer: The patient is high likely exposed to