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: patient is an 83-year-old woman who was previously admitted to the medical intensive care unit in for bilateral pneumonia that was complicated by adult respiratory distress syndrome. patient was discharged to pulmonary rehabilitation on home 02 and did well. she was discharged from rehabilitation and went home. she continued to do well at home and followed up by dr. , her pulmonologist. at that time, she seemed to be doing well. the week prior to admission the patient noted that she was developing a cough and chest discomfort. she then developed fevers to 101 and a cough productive of sputum. she developed shortness of breath on minimal exertion. patient had previously taken gammaglobulin monthly, but stopped taking this when her igg levels remained in the normal range off therapy. patient is status post splenectomy and has received appropriate prophylaxis. patient noted decreased po intake in the two days prior to admission. she presented to her primary care physician on the day of admission complaining of shortness of breath with a respiratory rate in the 40s and an oxygen saturation of 90% on room air. the patient proceeded to the emergency department where she received a dose of ceftriaxone, azithromycin, as well as albuterol and atrovent nebulizers. at that time, her blood pressure was in the high 80s to low 90s. she was given one liter of normal saline and her blood pressure increased to 110. patient notes that her grandson was approximately one week prior to her admission with a cough and upper respiratory tract infection symptoms. past medical history: 1. brain meningioma. 2. cll in , transformed to nhl, status post chop. 3. hypogammaglobulinemia. 4. colon cancer status post hemicolectomy (stage 3, t3n1m0). 5. motor vehicle accident, status post splenectomy. 6. svc clot in in setting of indwelling central line. 7. pneumonia complicated by adult respiratory distress syndrome in . 8. ejection fraction greater than 60%, mild mitral regurgitation and mild pulmonary hypertension on an echocardiogram from . medications on admission: advair, aspirin, vioxx, fosamax. last pneumovax two to three years ago. allergies: morphine causes vomiting. social history: the patient is a nonsmoker, nondrinker. she lives with her daughter. physical exam on admission: the temperature is 101.7. blood pressure 103/44. heart rate 103. respiratory rate 26-35, saturating 93% on two liters by nasal cannula. patient is in mild respiratory distress. she is using her accessory muscles. her skin is warm and dry. she has a surgical left pupils. the mucous membranes are moist. there is no scleral icterus. the jugular venous distention is 8-9 cm below the angle. there is no lymphadenopathy in the head or neck. the neck is supple. the heart is regular. s1, s2 are normal. there is no murmurs, rubs or gallops. the lungs have crackles at the bases, of the way up the back. the abdomen is soft, nontender, nondistended. bowel sounds are present. there is 1+ pitting edema of the extremities bilaterally. there is no calf tenderness. she is alert. laboratories: the white blood cell count is 20.7, hematocrit 40.6, platelet count 460,000. sodium 128, potassium 3.9, chloride 98, bicarbonate 20, bun 13, creatinine 0.5, glucose 92, ebv of 7.42/40/117 on four liters nasal cannula. an electrocardiogram showed normal sinus rhythm at a rate of 95. there is left axis deviation. there are normal intervals. there is a left atrial enlargement. there are no st-t wave changes. chest x-ray shows bilateral infiltrates in the lingula, left lower lobe, right lower lobe with baseline in interstitial pattern. there are no pleural effusions. blood cultures were drawn. course in the hospital: the patient was initially admitted to the medical intensive care unit for treatment of her pneumonia. her course in the hospital will be discussed by system: 1. pulmonary: the patient was admitted for treatment of pneumonia. blood cultures as well as sputum cultures were taken. these remained negative. patient was treated with a seven day course of levofloxacin as she defervesced and her white cell count decreased. a pulmonary consult was obtained as the patient's chest x-ray was suggestive of an interstitial pulmonary process and possibly interstitial lung disease. the patient had improved when she was started on antibiotic, however, at the same time, she was also given a few days of steroids to treat her adrenal insufficiency. it was unclear which the patient had responded too. the pulmonary service felt that the patient's ct scan of the chest demonstrated a flocal infiltrate, esp. in the rml area, superimposed on changes consistent with resolving ards. it was decided not continue the patient on steroid treatments at this time. the patient's outpatient pulmonologist, , conferred on the plan and will consider cxr in one month with ct chest follow up in months. 2. adrenal insufficiency: the patient was noted to be adrenally insufficient. stem test was performed. the patient's cortisol went from 15 to 19. she was therefore treated with 4 days of hydrocortisone. the patient will require a follow-up stem test in approximately four weeks after discharge. 3. hyponatremia: the patient was noted to be hyponatremic on admission. this was felt to be secondary to decreased po intake. her fena was 0.1% suggestive of prerenal condition. the patient was hydrated with resolution. 4. cardiovascular: the patient was ruled out for myocardial infarction with serial enzymes. she had no electrocardiogram changes. her chest pain was thought to be secondary to her pulmonary process. 5. left back pain: the patient complained of left back pain while in the hospital. during a ct of her chest to assess for lung disease, it was noted that she had nine rib fractures on the left, as well as two rib fractures on the right. upon further questioning, the patient's family noted that she fell at home one month prior to admission w/o dizziness, cp, or head trauma. the patient was treated with oxycodone but tolerated this poorly, then ultram, tylenol and ibuprofen prn for her pain. 6. hyperglycemia: the patient was put on a regular insulin sliding scale while she was on steroids as her blood sugars increased. the hyperglycemia resolved after steroids were discontinued. 7. hematology/oncology: the patient has a history of cll and hypogammaglobulinemia. this was not an issue during her stay in house. 8. gastrointestinal: the patient was kept on a proton pump inhibitor while in the hospital. 9. osteoporosis: the patient was maintained on fosamax while in the hospital. discharge diagnoses: 1. pneumonia. 2. adrenal insufficiency. 3. hypotension. 4. steroid induced diabetes. 5. rib fractures. 6. history of pneumonia complicated by adult respiratory distress syndrome in . 7. history of brain meningioma. 8. history of cll. 9. history of hypogammaglobulinemia. 10. history of colon carcinoma, status post hemicolectomy. 11. history of motor vehicle accident, status post splenectomy. 12. history of svc clot in . 13. ejection fraction greater than 60%, mild mitral regurgitation, mild pulmonary hypertension in an echocardiogram from . discharge medications: 1. tylenol 325-650 mg po q. 4h prn. 2. protonix 40 mg po q.d. 3. aspirin 325 mg po q.d. 4. ibuprofen 400 mg po q. 8h prn. 5. oxycodone 5 mg po q. 3h prn. 6. fosamax 70 mg po q. tuesday. 7. advair 2 puffs b.i.d. discharge follow-up: it was felt that the patient would benefit from pulmonary rehabilitation prior to being discharged home. however the patient's family wished her to go direclty home. the patient was cleared by physiotherapy. she will follow-up with her primary care physician . . she will also continue to be followed by her outpatient pulmonologist dr. . , m.d. dictated by: medquist36 procedure: other oxygen enrichment diagnoses: pneumonia, organism unspecified acidosis other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use other pulmonary insufficiency, not elsewhere classified atrial fibrillation postinflammatory pulmonary fibrosis closed fracture of multiple ribs, unspecified 

Answer: The patient is high likely exposed to