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 / bactrim / nsaids attending: chief complaint: dyspnea major surgical or invasive procedure: picc placement history of present illness: 81f with h/o severe bronchiectasis, followed in pulmonary clinic by dr. , admitted with dyspnea. . pt notes increasing dyspnea over past week, along with chronic cough, no frank change in sputum production, but increased cough. she uses 2-3l home o2, but has been using up to 4l recently. she was seen by chest pt, which has been her daily routine, and today was noted to be markedly tachypneic and more hypoxic (90%4l, usually mid 90s%4l by report). she declined referall to the ed, and was therefore direct admitted to the medicine floor. . upon arrival to the medical floor, vs notable for fever 100.8, rr 45-50 (my count). she is tachypneic, speaking in word sentences, and admits to dyspnea, worse than baseline. lung exam is roncherous, with green/yellow sputum. she denies chest pain, orthopnea, lower extremity edema, but beleives her weight has been increasing over the past few days. she has been taking her lasix daily, but does not know her dry weight. cxr showed no focal infiltrate, but was reveiewed with her pulmonary fellow, and felt c/w bronchiectasis. no significant pulmonary edema. ecg is paced, with negative sgarbossa criteria (h/o afib s/p av ablation, s/p pm). jvp was elevated 10-12cm at 90 degrees. . she was treated with albuterol nebulizers x 2, atrovent x1, without improvement. abg was obtained 7.45/44/55 on 4-5l o2. given toxic appearance, she was given iv cefepime, and ordered for vanco/levo after disscussion with pulmonary fellow, though sputum cultures in past have always shown psuedomonas always sensitive to levaquin. she also received 20mg iv lasix, and foley was ordered placed. code status was reviewed with the patient, and her son, and she confirmed dnr/dni status, but would consider bipap. micu consult was obtained, and although she had improved slightly (now speaking in word sentences), given her tenuous pulmonary status, tachypnea, she was brought to the micu. past medical history: #cad - cath () - lmca and lcx, no disease; lad: proximal and mid vessel 30% stenoses; rca - mild luminal irregularities pacemaker/icd ( sigma sdr303 b pacemaker), in #atrial fibrillation, status post avj ablation and ddd pacer #congestive heart failure (ef 30% in ) #mv repair and tvr () #bronchiectasis with presumed pseudomonal colonization ( and treated with ceftazidime and azithromycin): previously suffered exacerbations in and that were treated with meropenem/ciprofloxacin and ceftazidime as outpatient #depression #hyperparathyroidism #pan-sensitive e.coli uti on hospital admission last month #djd; recently tapered off morphine social history: lives in . she worked as a lecturer on egyptology at the mfa in . husband is deceased. she lives with her son and has an aid most days of the week. has three sons, , and . quit smoking 30 years ago, had a 5 pack year history. previously, she drank one drink/day but no etoh now for many years. family history: her father and mother are both deceased. her father had htn. her mother had disease and died as an elderly woman. there is a negative family history of colon cancer, breast cancer, diabetes, and premature coronary artery disease. she has three natural children who are alive and well and one brother who is alive and well. she also has a 17 year old granddaughter recently diagnosed with melanoma physical exam: vs: 100.8 117/66 78 40 (45-50 my count) 91%4l (up from 86%4l on arrival) gen: tachypneic, sitting up, speaking in word sentences, pursed lip breathing, uncomfortable. cachectic. heent: jvp 10-12cm. cv: distant, regular. pul: diffuse, bilteral, roncherous breath sounds. abd: soft, ntnd, +bs. ext: no edema. skin: no rash. psych: pleasant. pertinent results: labs: 06:10pm blood wbc-13.8* rbc-4.81 hgb-13.9 hct-42.5 mcv-88 mch-28.9 mchc-32.7 rdw-13.3 plt ct-230 06:10pm blood pt-18.5* ptt-28.2 inr(pt)-1.7* 06:10pm blood glucose-128* urean-27* creat-0.7 na-136 k-4.4 cl-97 hco3-32 angap-11 06:55pm blood type-art po2-55* pco2-44 ph-7.45 caltco2-32* base xs-5 06:55pm blood o2 sat-89 . . studies: cxr: chest, pa and lateral: the lungs are again hyperexpanded, with diffuse bronchiectasis. globally increased reticulonodular markings likely represent acute exacerbation of disease, with mucoid impaction of small airways. right atrial and ventricular pacemaker courses in expected position. the cardiomediastinal silhouette and hilar contours are normal, with changes of cabg and tricuspid annuloplasty. there are no pleural effusions or pneumothorax. impression: acute on chronic bronchitis. . . ecg: my , v-paced, underlying afib, lad, negative sgarbosa criteria, with new loss of rbbb pattern since office ecgs. formal report: . cardiology report ecg study date of 7:29:54 pm atrial fibrillation with ventricular pacing. since the previous tracing of no significant change. read by: , w. . cxr: findings: radiodense guidewire of right picc terminates just below the expected cavoatrial junction. widespread areas of bronchiectasis and bronchiolitis are again demonstrated as well as developing areas of superimposed consolidation, particularly in the right upper and both lower lobes. this could reflect an acute bacterial pneumonia superimposed upon the patient's reported history of chronic mac infection. asymmetrical hilar enlargement, right greater than left, is in keeping with known lymphadenopathy detected on prior chest cta which also demonstrated evidence of mediastinal lymphadenopathy. . sputum: 3:30 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): moderate growth commensal respiratory flora. gram negative rod(s). sparse growth. . labs: 04:20am blood wbc-10.6 rbc-4.35 hgb-12.7 hct-39.0 mcv-90 mch-29.2 mchc-32.6 rdw-13.3 plt ct-211 02:39am blood pt-30.6* ptt-30.1 inr(pt)-3.0* 04:20am blood glucose-88 urean-16 creat-0.6 na-139 k-3.8 cl-99 hco3-34* angap-10 brief hospital course: 81f with h/o systolic chf, severe bronchiectasis, on 2l o2 at baseline, admitted from chest pt with tachypnea, hypoxia, and fever. . # dyspnea / tachypnea / hypoxemia / bronchiectasis flare - initial concerning was for infection given fever, roncherous breath sounds, and underlying severe pulmonary disease. ddx also included systolic congestive heart failure, given initially elevated jvp, and patient's report of increased weight over past few days (last recorded weight 98 lb in cardiology note, pt reports baseline weight 90s, currently 105.7lbs on admission), and less likely pe given above exam. . upon arrival to the medical floor, pt was febrile to 101, tahypneic to 40s-50s, speaking in 1 word sentences, using accessory muscles, and in distress. abg notable for hypoxemia in setting of 4-5l o2 (po2 55), but more cocerning for pco2 44 in setting of rr=40-50. she was not a significant chronic retainer based on prior abgs. cxr consistent with bronchiectasis, but without frank significant infiltrate. . she was started on albuterol, atrovent nebs, lasix 20mg iv x1 given, cefepime/vanco/levaquin given underlying pulmonary disease, and frequent health care encounters, though reveiw of prior sputum cultures revealed bacteria largely levaquin sensitive. repeat sputum culture ordered. she improved only modestly, thus icu evaluation obtained. she confirmed dnr/dni status, with her son present. given tenuous respiratory status, ongoing rr 30s, sats 86% on 6l, fever 101, she was transferred to icu for closer monitoring, where she slowly improved overnight without additional intervention, and was returned to the medical floor on pm, with rr 30s, sats 90% on 3l (close to baseline), and speaking more comfortably. . on , vancomycin was discontinued based on sputum with gnrs only. after discussion with her pulmonologist, plan was made for home on a course of cefepime/levaquin x14 days through . picc line was placed. she was continued on aggressive chest pt, albuterol, atrovent nebs, spiriva. the severity of her underlying lung disease was discussed with patient, son, and confirmed with her pulmonologist. . ultimately, she was discharged with plan for 14 days of levofloxacin/cefepime, and close follow-u with her pcp and pulmonologist. . # cad, native - reported allergy to aspirin. not on bb pulmonary disease. initial ecg noted ?loss of rbbb morpholgy in precordium, however formal felt unchanged from . she denied chest pain. acs was felt unlikely given above. . # acute on chronic systolic congestive heart failure - as above, pt initially given 20mg iv lasix x1 given concern for contribution from mild pulmonary edema, though not marked on cxr, and now le edema. she was then resumed on her home regimen of lasix, spirinolactone. . # atrial fibrillation - s/p avn ablation, pm placement. pt continued on coumadin. she is not on a bb as above. - given her antibiotics and increasing inr, her coumadin was decreased to 1mg daily until her antibiotics were finished, with instructions to resume her normal dose thereafter. her inr was 3. we recommended repeat inr in 2 days. . # axiety/depression - continued on home regimen of citalopram, ativan. . # code - dnr/dni confirmed with patient, and son, at bedside. # comm - (son) . . to do: 1. complete 14 day course antibiotics (cefepime/levofloxacin) 2. chest pt, nebs, pulmonology follow up 3. coumadin dose decreased to 1mg daily until finishes antibiotics. frequent inr checks should be performed. most recent inr was 3 medications on admission: medications - prescription albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 (two) puffs by mouth every four (4) to six (6) hours as needed for cough/wheezing alendronate - 70 mg tablet - 1 tablet(s) by mouth q week citalopram - 20 mg tablet - 2 tablet(s) by mouth once a day fluticasone-salmeterol - 250 mcg-50 mcg/dose disk with device - 1 puff inhaled twice a day rinse after use furosemide - 20 mg tablet - 0.5 (one half) tablet(s) by mouth once a day and increase as directed by dr lisinopril - 5 mg tablet - tablet(s) by mouth once a day lorazepam - 0.5 mg tablet - tablet(s) by mouth qhs as needed for sleep potassium chloride - (not taking as prescribed: not taking) - 10 meq tablet sustained release - 1 tablet(s) by mouth qd as directed by dr simvastatin - 20 mg tablet - 1 tablet(s) by mouth once a day spironolactone - 25 mg tablet - tablet(s) by mouth once a day tiotropium bromide - 18 mcg capsule, w/inhalation device - 1 capsule inhaled once a day warfarin - 1 mg tablet - take up to 3 tablets by mouth once a day or as directed by anti-coag medications - otc calcium citrate-vitamin d3 - (otc) - 315 mg-200 unit tablet - 3 tablet(s) by mouth once a day guaifenesin - (otc) - 600 mg tablet sustained release - 2 tablet(s) by mouth twice a day prn multivitamin - (prescribed by other provider; otc) - tablet - 1 tablet(s) by mouth once a day medications: 1. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 5. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 9 days: through . disp:*9 tablet(s)* refills:*0* 6. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 7. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). 10. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 11. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). 12. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm: until antibiotics completed, then resume normal dose. 13. cefepime 2 gram recon soln sig: one (1) recon soln injection q24h (every 24 hours) for 9 days: through . disp:*9 recon soln(s)* refills:*0* 14. guaifenesin 600 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 15. zofran 4 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. 16. outpatient work pt/inr check: send to pcp . fax: disposition: home with service facility: critical care systems diagnosis: primary: bronchiectasis flare with community acquired pneumonia atrial fibrillation condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). instructions: you were admitted to the hospital with worsening shortness of breath, likely due to bronchitis/infection in the setting of your chronic bronchiectasis. . you were treated with iv antibiotics, and lasix, with some improvement, but were transferred to the icu for closer monitoring. upon return to the medical floor, your symptoms slowly imroved with antibiotics. . you received daily aggressive chest physical therapy. . you were ultimately discharged to home with instructions to complete a regimen of levofloxacin and cefepime for 14 days, through , in addition to your usual medications. . the following changes were made to your medication regimen: 1. you were started on antibiotics levofloxacin and cefepime, to complete a 14 day course. 2. please decrease your coumadin to 1mg daily until you finish your antibiotics, then resume to normal dose. please have your inr checked in days. . inr at : 3 . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: you will need to follow-up with chest pt as per your usual routine. department: rehabilitation services when: tuesday at 2:50 pm with: ding, pt, dpt building: sc clinical ctr campus: east best parking: garage you will need to follow-up closely with your primary care physician, appointment has already existed for you: department: when: wednesday at 10:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: rehabilitation services when: wednesday at 3:00 pm with: , pt, ccs building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation aortocoronary bypass status dysthymic disorder heart valve replaced by other means long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified hypoxemia acute on chronic systolic heart failure primary hyperparathyroidism bronchiectasis with acute exacerbation 

Answer: The patient is high likely exposed to