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: the patient is a 44 year-old woman who was brought to the emergency department by emergency medical services complaining of shortness of breath. the patient states that her shortness of breath has been constant, lasting all day and unrelieved by frequent use of mdis. the emts noted diffuse wheezing, accessory muscle use, and oxygen saturation in the 50s. her oxygen saturation improved to 80% on 100% face mask. on arrival to the emergency department the patient noted having shortness of breath progressing over several days with cough productive of yellow sputum. in the emergency department she was given solu-medrol and nebulizers. arterial blood gases obtained in the emergency department demonstrated respiratory acidosis. subsequently the patient was markedly tachypneic, and she was therefore subsequently intubated. she was also given 500 mg of levofloxacin for empiric treatment of pneumonia. suctioning of her airway while in the emergency department demonstrated yellow sputum. past medical history: 1. asthma. the patient has been hospitalized twice previously in the intensive care unit for asthma exacerbations, but she has never previously been intubated. 2. legionella pneumonia in . past surgical history: none. allergies: the patient has no known drug allergies. medications: 1. albuterol inhalers. 2. serevent inhalers. social history: the patient was not to believed to be actively smoking on admission to the hospital, but she does have at least a 20 pack year smoking history. she had no known history of alcohol abuse. she had no known history of prior recreational drug use, it is of note that the patient's initial urine tox screen was positive for cocaine. the patient lives alone and works in the area. she has a very supportive family network. her sisters were often at the bedside throughout her hospitalization. family history: not known to be contributory. review of systems: was not initially obtained secondary to the patient's respiratory distress on presentation to the emergency department. initial physical examination: temperature 97.2 degrees fahrenheit, blood pressure of 146/80. heart rate 100s. oxygen saturation of 82% on 100% face mask, followed by 97% on the ventilator with 100% fio2 and a peep of 10. in general, the patient was intubated and sedated. on heent examination her pupils were 2 mm in diameter and reactive. her oropharynx was clear, there was no palpable lymphadenopathy and there was no jugulovenous distention. on examination of her lungs rhonchi were heard diffusely, there were no crackles. on cardiovascular examination the patient's heart was a regular rate and rhythm. there were normal s1 and s2 heart sounds and there were no murmurs, rubs or gallops. her abdomen was soft, nonrigid and there was no guarding on examination. she had no edema of her extremities. neurological examination was not assessed secondary to the patient's sedation. initial laboratory examination: remarkable for a white blood cell count of 24.1, hematocrit 47.1, platelet count of 472. the differential on her white count included 96 neutrophils, 1 band and 3 lymphocytes. initial coagulation studies indicated a pt of 12.4, ptt 25.9, inr of 1.1. initial serum chemistries demonstrated a sodium of 136, potassium 5.1, chloride 97, bicarbonate 25, bun 11, creatinine 0.6, serum glucose of 211. initial urinalysis was contaminated. initial arterial blood gas on 100% face mask demonstrated a ph of 7.23, paco2 of 60 and pao2 of 53. after intubation an initial arterial blood gas demonstrated ph of 7.09, paco2 of 79 and pao2 of 136. the settings were assist control with a tidal volume of 500, rate of 12 and a peep of 5. a second arterial blood gas obtained on assist control with a tidal volume of 500, rate of 20, and peep of 10 demonstrated arterial blood gas with a ph of 7.17, paco2 of 65 and pao2 of 85. initial chest x-ray demonstrated an endotracheal tube 3 cm above the carinae. there was lingular and retrocardiac opacity. there was also right perihilar and upper lobe opacity. there was no evidence of pneumothorax. hospital course: the patient was admitted to the medical intensive care unit. she was started on round the clock nebulizer treatments, intravenous steroids, intravenous antibiotics (levofloxacin) and she was sedated and paralyzed given the fact that she was intubated. her mechanical ventilation was adjusted to normalize her acid based status as well as to optimize her ventilation. on the second day of admission the patient had a brief episode of hypotension. she was briefly placed on a dopamine drip, which was quickly weaned off as the patient's blood pressure increased appropriately. also on the second day of admission the patient was started on clindamycin for expanded antimicrobial coverage. in addition, her urine tox screen came back positive for cocaine on the second day of admission. this positive result raised the possibility of an aspiration pneumonia leading to an exacerbation of severe reactive airway disease as the etiology of the patient's presentation with status asthmaticus to the emergency department. several days after admission the patient underwent a bronchoscopy in the intensive care unit. this procedure demonstrated all airways and the endotracheal tube to be patent. scant mucous was aspirated during the procedure. for the first several days of her hospitalization the patient required aggressive mechanical ventilatory support to maintain adequate oxygenation. she remained heavily sedated and paralyzed during the initial several days of her admission in order to minimize the stress of the mechanical ventilation. in addition, she was continued on intravenous steroids throughout the initial period of her hospitalization. on the the patient developed mild anasarcas, she was administered intravenous lasix and had an appropriate diuretic response. in addition, on the , the patient was taken off of clindamycin. on the a chest x-ray demonstrated a new left lower lobe/lingular infiltrate. given the possibility of a new nosocomial pneumonia the patient was started on ceftazidime as well as vancomycin for treatment of this possible nosocomial pneumonia. on , the patient was started on oxacillin for treatment of this possible nosocomial pneumonia and the vancomycin was discontinued. also on the 29th the patient had a thoracic ct scan for evaluation of the possibility of pulmonary embolism, no evidence of pulmonary emobolus were found on this scan. on the , a neurology consult was obtained for evaluation of the patient's gross motor weakness. this consulting service felt that high dose steroid myopathy was the possible etiology of the patient's diffuse weakness. they did not feel that a critical polyneuropathy was likely given the patient's preserved reflexes. in addition, they felt that a critical illness myopathy or neuropathy was also unlikely. for the next several days the patient remained difficult to wean off of the ventilator. she continued to require mechanical ventilation to maintain adequate oxygenation. on the , however, the patient was successfully extubated. she was then transferred to the general internal medicine service on . on transfer to the general internal medicine service, the patient was in good medical condition. she no longer had any symptoms of asthma and her asthma was being well controlled with appropriate asthma medications. she was also begun on an oral prednisone steroid taper upon transfer to the general internal medicine service. the patient remained in stable medical condition while on the internal medicine service. the only significant physical finding while on this service was gross clinical evidence of a vaginal yeast infection. given this gross clinical evidence the patient was treated empirically with fluconazole 150 mg orally on the . given that the malodorous discharge did not resolve with one dose of fluconazole the patient was again treated with 150 mg of oral fluconazole on the . of note, upon extubation the patient remarks that she had been sexually assaulted prior to her admission to the hospital. a social work consult was obtained and the patient discussed this sexual assault with the social worker. the social work service offered the patient social work follow up upon discharge from the hospital. in addition, laboratory tests for syphilis, hiv, and chlamydia and gonorrhea were sent. an rpr test for syphilis was negative. at the time of discharge serum hiv test was pending. in addition, urine, chlamydia tests as well as a cervical chlamydia and gonorrhea probe were also pending. the patient continued to exhibit diffuse muscular weakness on the general internal medicine service. the etiology of this weakness was believed to be secondary to prolonged administration of steroids while in the hospital. the patient was deemed by physical therapy and occupational therapy to be in excellent rehabilitation candidate. arrangements were therefore made for the patient to be transferred to an acute rehabilitation facility upon discharge from the hospital in order for her to increase her physical and muscular strength. the patient was in good medical condition on discharge from the hospital. discharge diagnoses: 1. status asthmaticus. 2. cocaine abuse. discharge medications: salmeterol inhaler four puffs twice a day. albuterol inhaler two to four puffs every four hours as needed. atrovent inhaler two to four puffs every four to six hours as needed. flovent 110 micrograms four puffs twice a day. nystatin ointment applied topically as needed four times a day. diphenhydramine 25 mg in the evenings as needed for sleep. the patient was sent home on a prednisone taper. she was to take 30 mg of prednisone once on the day following discharge followed by 20 mg once a day for three days followed by 10 mg once a day for three days followed by 5 mg once a day for seven days. that would be the end of the prednisone taper. note an addendum will follow this dictation to note where the patient was discharged to as well as any additional information required. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube other bronchoscopy arterial catheterization diagnoses: acidosis cocaine abuse, unspecified pneumonitis due to inhalation of food or vomitus toxic myopathy asthma, unspecified type, with (acute) exacerbation 

Answer: The patient is high likely exposed to