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: metformin attending: chief complaint: lethargy, hypercapnic respiratory failure major surgical or invasive procedure: intubation history of present illness: ms. is an 82f with pmh asthma, t2dm, htn, osa, dementia who presents with four days of increasing lethargy and not acting like herself. daughters have noticed she's been increasingly somnolent during the day and agitated at night. patient has had multiple nonspecific complaints over the past several days: headache, weakness, heavy arms, stomach ache. daughters noted she's had a runny nose, no sick contacts. fevers, chills, cough, changes in bowel movements, nausea or vomitting. upon leaving church this morning her legs gave out from under her and she was lowered to the ground by her family. patient did not fall or strike her head. no loc but confused, intermittently responsive to family and repeating "i'm on the ground" over and over again. family gave her food incase pt was hypoglycemic. no report of fever, chills, nausea, vomiting, headache, or dysuria. she lives with her daughters. she was hypoxia to 70s in the field. she has been intubated once previously in for a similar presentation. of note, she appears to carry a diagnosis of adult onset asthma for which she uses albuterol and advair only with respiratory illnesses. has not needed these medications recently. nonsmoker. she has been prescribed bipap for many years, but has not used it in the past several months. per recent pcp note in , she has had poor tolerance to bipap. patient with baseline dementia confused, cannot remember daughters' names occasionally, but conversant, and not incontinent of urine and stool. . in the ed inital vitals were 97.6 74 145/63 24 100% 15l non-rebreather. exam was notable for no wheezes, poor air exchange. with the exception of a bicarb of 43, bmp and cbc was reassuring. bnp 218 and troponin neg x1. lactate was 1.0, ua was unremarkable, and cultures were sent. patient had a bicarb of 43 and abg showed 7.19/127/49/51 just prior to initiating bipap. patient was intubated for apnea without complications. ekg showed sr 71, unchanged from prior. cxr showed mild pulmonary edema, with small bilateral pleural effusions. she was given methylprednisolone 125mg and levofloxacin 750mg for copd exacerbation, though diagnosis of copd is unclear. she improved with nebs in the ed. per report, there was concern for previous aspiration given some food particles seen with intubation. she has remained afebrile and hd stable. . recent abg on settings of cmv, fio2 50%, peep 5, tv 400, rr 22 is ph 7.52 pco2 50 po2 182 hco3 42. . on arrival to the icu, patient is intubated, sedated, not opening her eyes or responding to commands. . review of systems: (+) per hpi. daughters note right hand swelling. unable to obtain further ros as patient is intubated and sedated. past medical history: -type 2 diabetes mellitus -hypertension -atypical peripheral neuropathy with cutaneous sensations ("dust on her skin", seen by neurology, on gabapentin + olanzapine) - tactile hallucinosis per pcp : appears to be adult onset asthma. spirometry is restrictive physiology with bronchodilator response. -macular edema s/p surgery -neovascular glaucoma secondary to her proliferative diabetic retinopathy -osa (prescribed bipap, not currently using) -osteoarthritis -dementia -blind in left eye social history: patient is wheelchair bound due to old osteoarthritis and vision loss. in setting of a few recent falls in her apartment, her daughter stays with her at her apartment. born and grew up in the carribean. worked in a chocolate factory in in the . arrived in the us in . denies tobacco, etoh, ivda. she lives with her daughter in . family history: father with diabetes mellitus, died at age 69. mother with heart failure, died at age . oldest daughter with diabetes mellitus and polymyositis. youngest daughter with anoxic brain injury trauma, in rehab. physical exam: admission exam: vitals: t: 97.6 bp: 160/94 p: 81 r: 22 o2: 100% (intubated) general: intubated, sedated, comfortable appearing heent: nonreactive surgical pupils, sclera anicteric, dry mm, intubated neck: supple, jvp not elevated, no lad lungs: coarse breath sounds bilaterally, no wheezes, rales, ronchi appreciated cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses dorsalis pedis, no clubbing or cyanosis. 2+ edema to midthigh on left leg, 1+ edema to knee in right leg. arms without appreciable edema, good pulses. neuro: sedated. . discharge physical exam: vitals: t96.9, hr89, bp 150/59 (130-160s/60-80s), rr18, o2sat 99% on fm weight 120.6kg general: elderly female lying in bed in nad with eyes closed heent: nonreactive surgical pupils bilaterally, sclera red but anicteric, edentulous, moist mucous membranes with clear oropharynx neck: supple, jvp ~8-9cm lungs: no accessory muscle use, speaking in full sentences, clear to auscultation bilaterally anteriorly with good air movement, no wheezes, ronchi or rales cv: regular rate and rhythm with occasional premature beats, normal s1 + s2, grade ii/vi systolic murmur best heard at rusb, no radiation to carotids abdomen: +bs, obese, soft, nontender gu: foley in place draining clear urine ext: wwp, no lower extremity edema, no sacral edema, 1+ dp/pt pulses bilaterally neuro: a+o x3 pertinent results: admission labs: 05:40pm blood wbc-6.9 rbc-4.40 hgb-12.2 hct-40.5 mcv-92# mch-27.6 mchc-30.0* rdw-13.4 plt ct-134* 05:40pm blood neuts-74.9* lymphs-16.9* monos-6.5 eos-1.1 baso-0.5 04:31am blood pt-13.1* ptt-35.7 inr(pt)-1.2* 05:40pm blood glucose-131* urean-10 creat-0.7 na-140 k-4.2 cl-93* hco3-43* angap-8 05:40pm blood probnp-218 05:40pm blood ctropnt-<0.01 05:40pm blood calcium-9.4 phos-3.9 mg-2.0 05:50pm blood type-art po2-49* pco2-127* ph-7.19* caltco2-51* base xs-14 05:50pm blood hgb-13.0 calchct-39 o2 sat-73 cohgb-3 . discharge labs: 02:52am blood wbc-7.3 rbc-4.41 hgb-12.5 hct-38.5 mcv-88 mch-28.3 mchc-32.3 rdw-14.8 plt ct-149* 02:52am blood pt-13.2* ptt-37.2* inr(pt)-1.2* 05:49am blood glucose-243* urean-15 creat-0.8 na-141 k-3.7 cl-101 hco3-35* angap-9 05:49am blood calcium-8.6 phos-4.0 mg-2.0 . microbiology: 6:17 pm urine site: catheter **final report ** urine culture (final ): staphylococcus species. ~/ml. . -blood cx pending, ngtd x2 as of /12pm . imaging: . - echo: the left atrium is normal in size. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular systolic function. no significant valvular disease. . - leni left leg: impression: no evidence of deep vein thrombosis. . - cxr impression: an ap chest performed with the patient rotated severely to the right, excludes lateral right lower chest. it shows moderate left pleural effusion stable or increased since , but improvement in pulmonary vascular engorgement and mild edema. severe right lower lobe atelectasis is presumed and the volume of right pleural effusion cannot be assessed. there is no pneumothorax seen along the imaged pleural surfaces. et tube is in standard placement. right central venous line ends low in the svc and a nasogastric tube passes below the diaphragm and out of view. heart is not appreciably enlarged, but difficult to compare with prior images. brief hospital course: 82 yo female with obstructive sleep apnea admitted with hypercarbic respiratory failure due to not wearing home bipap and acute diastolic heart failure. . active issues: # hypercarbic respiratory failure/obstructive sleep apnea: patient was initially intubated and admitted to the icu. patient is well known to have obstructive sleep apnea and probable obesity hypoventilation syndrome with poor compliance with home night time bipap. she admitted to not wearing her home bipap the week prior to presentation and it was confirmed that part of her bipap machine was not working. during her admission she did not have evidence of pneumonia, lenis were negative, and echocardiogram showed a preserved biventricular systolic function without pulmonary hypertension. therefore, it was felt that her hypercarbia was due to not wearing bipap for successive days leading to slow increase in her pco2. she also may have a component of central apnea. her bipap company was informed of bipap dysfunction and plans were made to have it fixed. post extubation she had no issues with bipap in the hospital although she did complain of it burning her nose. she was discharged to rehab and will have her home bipap serviced before she returns home. #acute diastolic heart failure: patient was diuresed in the icu after intubation and echo showed preserved ef. given that she was volume overloaded on presentation, she was felt to have acute diastolic heart failure and was discharged on lasix instead of hydrochlorothiazide which she was taking prior to admission. . chronic issues: . #type 2 diabetes mellitus: most recent a1c 7.1% in 9/. on nph 80units qam and riss at home. originally ordered for dose nph, however sugars remained low while npo and did not receive nph. nph stopped and patient was managed on a sliding scale during her stay. after transfer to the floor, she was restarted on 60 units of nph in the am and a humalog sliding scale. . #hypertension: sbps were in the 140s-150s while off all home medications. home lisinopril was restarted in the with systolics decreasing to 110s-120s. hctz and diltiazem held during stay in , but were restarted after transfer to the floor, where her pressures remained stable. . # neuropathy/tactile hallucinosis: initially held gabapentin, zyprexa during stay in case this was causing decreased mental status. both were restarted on transfer to the medical floor. . transitional issues: . issues of need to wear bipap were discussed with her daughter as well as the importance of using the bipap despite the tactile neuropathy on her face was stressed. . the following changes were made to her medications: new: -heparin injections to prevent blood clots while she is at rehab -furosemide (lasix), to replace hydrochlorothiazide diuretic. . changed: none . stopped: -hydrochlorothiazide medications on admission: betimol 0.5 % eye drops 1 (one) drop(s) both eyes three times a day (daughters do not believe she takes this, but are unsure) latanoprost 0.005 % eye drops 1 drop(s) both eyes at bedtime brimonidine 0.15 % eye drops 1 drop(s) both eyes three times a day zyprexa 2.5 mg tab tid for strange sensations on the skin and 2 qhs. advair diskus 250 mcg-50 mcg/dose for inhalation 1 inhalation po bid senna 8.6 mg tab as needed for constipation humulin r 100 unit/ml injection iss nph 80 units in am cholecalciferol (vitamin d3) 400 unit chewable tab 2 tablet(s) qday calcium carbonate 200 mg (500 mg) chewable tab tid triamcinolone acetonide 0.1 % cream apply to affected areas enteric coated aspirin 81 mg tab, delayed release qday acetaminophen 500 mg tab 2 tablet(s) by mouth at bedtime dilt-xr 240 mg cap one capsule qday albuterol sulfate 2.5 mg/3 ml (0.083 %) neb solution tid prn asthma flares proair hfa 90 mcg/actuation aerosol inhaler 2 inhalations orally up to qid as needed for flare of asthma (daughters do not believe she takes this) hydrochlorothiazide 12.5 mg tab qday lisinopril 20 mg tab trusopt 2 % eye drops 1 drop(s) both eyes tid ibuprofen 600 mg tab up to tid arthritis pain docusate sodium 100 mg cap prn gabapentin 300 mg cap 1 capsule(s) by mouth up to prednisolone acetate 1 % eye drops, susp 1 drop(s) topical 4x/day left eye discharge medications: 1. betimol 0.5 % drops sig: one (1) ophthalmic three times a day: both eyes. 2. latanoprost 0.005 % drops sig: one (1) ophthalmic at bedtime: both eyes. 3. brimonidine 0.15 % drops sig: one (1) ophthalmic three times a day: both eyes. 4. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po tid (3 times a day) as needed for skin sensations, agitation. 5. olanzapine 5 mg tablet sig: one (1) tablet po at bedtime. 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet, chewable sig: two (2) tablet, chewable po once a day. 9. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po three times a day. 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. acetaminophen 500 mg tablet sig: two (2) tablet po at bedtime. 12. diltiazem hcl 240 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation three times a day as needed for shortness of breath, wheezing. 14. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation four times a day as needed for shortness of breath or wheezing. 15. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 16. lisinopril 20 mg tablet sig: one (1) tablet po bid (2 times a day). 17. trusopt 2 % drops sig: one (1) ophthalmic twice a day: both eyes. 18. ibuprofen 600 mg tablet sig: one (1) tablet po three times a day as needed for arthritis pain. 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 20. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 21. prednisolone acetate 1 % drops, suspension sig: one (1) ophthalmic four times a day: left eye. 22. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 23. insulin nph & regular human 100 unit/ml (70-30) suspension sig: sixty (60) subcutaneous qam. 24. insulin lispro 100 unit/ml cartridge sig: one (1) subcutaneous once a day: per insulin sliding scale. 25. furosemide 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: hypercarbic respiratory failure secondary diagnoses: diabetes hypertension neuropathy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was a privilege to provide care for you here at the hospital. you were admitted because you passed out, and were found to have trouble getting enough oxygen. you were briefly intubated and kept in the intensive care unit, but you were transferred to the regular medical floor after your breathing stabilized. your condition has improved and you can be discharged to home. it is important that you continue to use your breathing machine at night when you sleep, so that you can get enough oxygen. the following changes were made to your medications: new: -heparin injections to prevent blood clots while you are at rehab -furosemide (lasix), replaces hydrochlorothiazide as your diuretic. changed: none stopped: -hydrochlorothiazide please keep your follow-up appointments as scheduled below. followup instructions: department: center when: wednesday at 10:20 am with: eye imaging building: campus: east best parking: garage department: center when: wednesday at 10:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: when: tuesday at 1:30 pm with: , md building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube central venous catheter placement with guidance diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension acute on chronic diastolic heart failure diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes acute respiratory failure diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin osteoarthrosis, unspecified whether generalized or localized, site unspecified personal history of noncompliance with medical treatment, presenting hazards to health chronic obstructive asthma, unspecified adult failure to thrive diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled unspecified psychosis glaucoma associated with vascular disorders proliferative diabetic retinopathy profound impairment, one eye, impairment level not further specified obesity hypoventilation syndrome wheelchair dependence dementia, unspecified, without behavioral disturbance glaucoma stage, unspecified glaucoma associated with systemic syndromes 

Answer: The patient is high likely exposed to