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: codeine attending: chief complaint: hypercarbic respiratory failure major surgical or invasive procedure: endotracheal intubation , self-extubated history of present illness: 72 year-old woman with history of copd on home o2, atrial fibrillation, dm, osa and ckd who presents to the hospital with respiratory failure. per the patient's daughter, the patient had been feeling relatively well since her last discharge on until yesterday, when she started having some mild difficulty breathing but per her daughter declined to go see the doctor. of note, during that admission she had hypoxia that was thought to be secondary to flash pulmonary edema. this morning, the patient developed severe respiratory distress and ems was called. by report of them they were called to the house for a female with increasing shortness of breath, who found her with poor air exchange, lethargic, with normal blood pressure in 150's and hr<100, but with poor air exchange, increasingly lethargic, and after a trial with cpap, failed and ems proceeded with intubation with sedative without paralytic, first pass success but reportedly difficult intubation. in the ed, initial vs were: afebrile 60 140/70 100% on vent. she received levofloxacin, solumedrol and was placed on propofol for sedation. her first abg on arrival showed marked respiratory acidosis with hypercarbia, abg was 7.22/107/59/46. her vent settings on transfer were assist control, fio2 40%, 400, 22 and 10. on arrival, these were adjusted to fio2 40%, 350, 20 and 5. her repeat abg showed marked improvement of her hypercarbia, and was 7.44/56/132/39. on arrival to the micu, patient's vs were 97.6 67 138/86 14 100%. review of systems: unable to obtain but per the family the patient had no sick contacts, fever or chills prior to admission. past medical history: - copd on home oxygen-dependent - obstructive sleep apnea with bipap at night - type 2 diabetes mellitus, on insulin - atrial fibrillation on coumadin - diastolic congestive heart failure - diverticulitis s/p colostomy, then s/p reversal - osa, on bipap - obesity - anemia of chronic disease - pedal edema - hypertension - dyslipidemia - chronic kidney insufficiency stage iii in f/u renal - gerd social history: lives with husband. used to be school bus driver. denies alcohol, smoking, or illicit drug use. never smoked, significant second hand smoke exposure, no alcohol or drugs. lives in with husband and usually granddaughter, multiple kids in local area, hha cleans, daughter feels needs more help at home. family history: no history of ckd, lung disease, or malignancies. physical exam: admission exam: vitals: 97.6 67 138/86 14 100% on 40% fio2 general: intubated, sedated, no acute distress. heent: sclera anicteric, mmm, slight anisocoria with pupil 4mm on left, 2mm on right, asymmetric on left c/w recent cataract surgery. neck: supple, jvp could not be assessed. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: significant rhonchi bilaterally, otherwise with good air movement bilaterally. abdomen: soft, mildly distended, midline laparotomy scar. no hepatosplenomegaly detected. gu: foley ext: warm, well perfused, 1+ pulses, minimal edema. neuro: withdraws from pain, babinski downgoing bilaterally. discharge: vs: afebrile 138/70 p71 r20 99% 1l nc gen: comfortable, non-toxic. resp: breathing comfortably, speaking full sentences. no wrr. cv: rrr. pertinent results: admission labs: 05:25am blood wbc-6.7 rbc-3.26* hgb-8.6* hct-30.4* mcv-93 mch-26.4* mchc-28.3* rdw-14.4 plt ct-413 10:13am blood neuts-89.7* lymphs-7.3* monos-2.5 eos-0.5 baso-0.1 05:25am blood pt-19.4* ptt-43.6* inr(pt)-1.8* 05:25am blood fibrino-662* 10:13am blood glucose-76 urean-50* creat-1.8* na-143 k-4.7 cl-99 hco3-39* angap-10 05:25am blood alt-25 ast-26 alkphos-126* totbili-0.3 05:25am blood ctropnt-0.03* 10:13am blood calcium-9.7 phos-3.4 mg-1.7 05:25am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg microbiology: 5:40 am blood culture **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. isolated from only one set in the previous five days. sensitivities performed on request.. corynebacterium species (diphtheroids). isolated from only one set in the previous five days. aerobic bottle gram stain (final ): gram positive cocci in clusters. reported to and read back by 9:00am. anaerobic bottle gram stain (final ): reported to and read back by @ 14:54 on . gram positive rod(s). blood culture: pending urine culture: negative mrsa screen: negative sputum culture: respiratory culture (final ): sparse growth commensal respiratory flora. urine legionella antigen: negative blood culture: pending blood culture: pending blood culture: pending blood culture: pending imaging: ecg: baseline abnormalities. probable sinus rhythm. left atrial abnormality. left anterior fascicular block. lateral t wave abnormalities. since the previous tracing of the rate is now slower. otherwise, there may be no significant change. chest xray (portable): moderate pulmonary edema with small right pleural effusion. chest xray (pa and lateral): in comparison with the study of , there has been improvement in the pulmonary vascular congestion. some elevation of pulmonary venous pressure persists. the area of increased opacification in the left perihilar region has almost completely cleared. mild atelectatic changes are seen at the left base. 08:00am blood wbc-9.3 rbc-3.09* hgb-8.2* hct-27.4* mcv-89 mch-26.6* mchc-30.1* rdw-14.9 plt ct-401 07:18am blood pt-20.5* inr(pt)-1.9* 08:00am blood pt-19.9* inr(pt)-1.9* 06:46am blood pt-21.3* inr(pt)-2.0* 07:17am blood pt-21.5* ptt-37.6* inr(pt)-2.0* 05:10pm blood glucose-375* urean-74* creat-2.3* na-138 k-4.7 cl-93* hco3-38* angap-12 08:00am blood glucose-115* urean-77* creat-2.1* na-142 k-4.0 cl-97 hco3-40* angap-9 06:46am blood glucose-131* urean-77* creat-2.2* na-140 k-4.1 cl-97 hco3-36* angap-11 07:17am blood glucose-129* urean-78* creat-2.1* na-142 k-4.4 cl-98 hco3-38* angap-10 06:46am blood calcium-9.3 phos-3.5 mg-2.0 micro: blood culture blood culture, routine-final inpatient urine legionella urinary antigen -final inpatient sputum gram stain-final; respiratory culture-final inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final {staphylococcus, coagulase negative, corynebacterium species (diphtheroids)}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final emergency urine urine culture-final emergency blood culture blood culture, routine-final emergency pending: blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient brief hospital course: 72 year-old woman with copd, diastolic heart failure who presented with hypercarbic respiratory failure which required intubation . she self-extubated on . she was initially on levaquin, but antibiotic coverage was broadened when blood cultures returned positive. she rapidly improved with regard to her respiratory status. sputum culture ultimately showed respiratory commensal flora and blood culture showed typical skin contaminants (corynebacterium and coagulase negative staph aureus), so antibiotics were discontinued on because actual infection was very questionable given her well appearance. she was monitored off antibiotics and surveillance cultures drawn. she demonstrated no signs of worsening or infection. of note, last admission , her hctz and furosemide were discontinued. on this admission, she had evidence of volume overload and received intermittent doses of iv furosemide for volume overload. problem list: # hypercarbic respiratory failure due to mild copd exacerbation and pulmonary edema. a diagnosis of pneumonia was initially considered, but was later felt unlikely. sputum cx showed respiratory flora. legionella negative. pt received 3 days of antibiotics and 5 days of prednisone 60 mg. she continued albuterol and ipratropium nebulizers, and she was resumed on her home advair at the time of discharge. it may be that she had a more significant component of volume overload given that her regular diuretics (hctz and furosemide) were discontinued at discharge . her respiratory status is now back to baseline and she is having good oxygen saturation. she was noted to have persistently elevated bicarbonate, which remained near her baseline. due to the concern of hypercarbia, her home oxygen flow (2l o2/min) was decreased to 1l o2/min). at the time of discharge, her oxygen saturation was 99% on 1 l nc. she continued her regular cpap at night. she was provided a prescription and referrals for outpatient pulmonary rehab after discharge. # blood culture positive, 1 set, on showing corynebacterium and coagulase negative staph aureus (common skin contaminants). she was briefly treated with antibiotics, but infection was subsequently felt unlikely, so they were discontinued on . she was monitored off of antibiotics, and surveillance blood cultures while off antibiotics have been no growth to date. # acute kidney injury on stage 3 ckd, baseline cr 1.8. intermittent doses of iv furosemide were given for acute on chronic dchf. she was subsequently resumed on her home lasix dose of 20 mg po q day. her cr remained above her previous baseline at the time of discharge. # acute on chronic diastolic chf pt has a known history of chronic diastolic heart failure, with history of flash pulmonary edema. it was felt that acute on chronic dchf likely contributed to her presentation of hypercarbic respiratory failure. she received intermittent doses of iv furosemide, and she was transitioned to her home dose of furosemide 20mg po daily prior to discharge. she will require close follow-up with pcp for volume status assessments and she should monitor daily weights at home. it is noted that there is concern about possible medication and dietary non-compliance contributing to her decompensation. # hypertension, stable. blood pressure is poorly controlled at home and often reports that she runs very high with systolics in the 180s. the patient had an episode of flash pulmonary edema during her last admission. as such, it will be extremely important to keep her blood pressure under good control as this could cause worsening of her chf. she received lisinopril 40mg during the hospitalization considering benazepril is non-formulary. she was resumed on home benazepril at the time of discharge. she was started on oral hydralazine tid during the hospitalization, with improvement in blood pressure. she will continue this after discharge. she continued amlodipine. # anemia, normocytic, chronic. likely related to ckd and diabetes. hct stable in mid-high 20's. # diabetes mellitus, type ii, uncontrolled, with possible diabetic nephropathy. continue home lantus, sliding scale insulin. lantus was decreased while she was intubated and returned to 60 units after extubation. while on prednisone she received 62 units daily. # atrial fibrillation, rate controlled, in sinus rhythm. continued anticoagulation with warfarin. her warfarin dose remained 6 mg po q 1600 for several days prior to discharge. # glaucoma: continued latanoprost, apraclonidine # s/p cataract surgery: continued prednisolone # dvt prophylaxis: warfarin with therapeutic inr # communication: family - hcp is daughter # status: full code transitional issues: 1. copd with hypercarbia: she remains hypercarbic with high bicarbonate, which may predispose her to future episodes of failure. she was provided a prescription for pulmonary rehab. wean oxygen as tolerated during the day, for goal spo2 >90-92%. encourage compliance with cpap, and consider interrogation of her home cpap device to assess compliance. consider referral to pulmonary medicine. 2. dchf: recommend close volume status monitoring, and titration of lasix as needed to maintain euvolemia. good blood pressure control, medication compliance, and low-salt diet were stressed to patient to minimize exacerbations. she may benefit from social work involvement to further assess barriers to compliance. 3. atrial fibrillation: inr currently therapeutic at inr for past 2 days. recommend close inr follow up. 4. chronic renal failure: her creatinine is currently above her previous baseline, but i am uncertain whether her current cr (2.1) may represent a new baseline. recommend close follow up of renal function. 5. pending results: there are several blood cultures remaining pending, although my suspicion for blood stream infection is currently very low. medications on admission: - albuterol 90mcg 1-2puffs inhaled q4h prn sob/wheeze - amlodipine 10mg po daily - benazepril 40mg po daily - famotidine 20mg po bid - fluticasone-salmeterol (discontinued by pcp ) - furosemide 20 mg po daily (discontinued last hospitalization ) - gemfibrozil 600mg po bid - hctz 50 mg po daily (discontinued last hospitalization ) - prednisolone 1% 1gtt left eye daily - latanoprost 0.005% 1gtt right eye qhs - apraclonidine 0.5% 1gtt left eye daily - lantus 60units sc daily - ipratropium-albuterol 0.5mg-3mg(2.5mg base)/3ml nebs inhaled q4h prn sob/wheeze - metoprolol 50mg po daily - tiotropium 18mcg inhaled daily - warfarin 6mg po daily - home o2 continuous 2l/min by nasal canula discharge medications: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 2. benazepril 40 mg tablet sig: one (1) tablet po once a day. 3. famotidine 20 mg tablet sig: one (1) tablet po twice a day. 4. gemfibrozil 600 mg tablet sig: one (1) tablet po twice a day. 5. prednisolone acetate 1 % drops, suspension sig: one (1) drop left eye ophthalmic daily (daily). 6. lantus 100 unit/ml solution sig: sixty (60) units subcutaneous once a day. 7. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) unit inhalation every four (4) hours as needed for shortness of breath or wheezing. 8. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. 10. apraclonidine 0.5 % drops sig: one (1) drop left eye ophthalmic daily (daily). 11. latanoprost 0.005 % drops sig: one (1) drop right eye ophthalmic hs (at bedtime). 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inh inhalation every 4-6 hours as needed for shortness of breath or wheezing. 13. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) inh inhalation twice a day. 14. warfarin 6 mg tablet sig: one (1) tablet po q 4 pm. 15. hydralazine 25 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*0* 16. home oxygen 1 liter/min 17. outpatient pulmonary rehab 18. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: - respiratory failure - copd, mild exacerbation - acute on chronic diastolic heart failure - obstructive sleep apnea secondary diagnoses: - chronic kidney disease, stage iii/iv - diabetes mellitus, type ii - atrial fibrillation 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: you were admitted to the icu with respiratory failure and required the support of a ventilator. there was initially a question of whether or not you had an infection in your lungs or in your blood stream. it was determined that you were not likely to be infected, so antibiotics were stopped. after a few days in the icu, your condition improved and you were transferred to the medical floor. your breathing issues were probably from a combination of having a copd flare and perhaps excess fluid in your lungs. you improved with prednisone and with some diuresis with lasix. it is important that you weigh yourself each day. if you find that you have gained pounds above your baseline weight, you should call your doctor to advise. you should also wear elastic compression stockings on your legs to mobilize fluid from your skin back into your blood vessels. keeping your legs elevated when you are not standing is also helpful to decrease leg swelling. followup instructions: department: bidhc when: thursday at 10:00 am with: , md building: 545a centre st. (, ma) none campus: off campus best parking: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) abnormal coagulation profile anemia, unspecified esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure unspecified glaucoma chronic kidney disease, stage iii (moderate) acute respiratory failure long-term (current) use of insulin other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to