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: penicillins / bactrim / aspirin / compazine / nifedipine / morphine attending: chief complaint: hemoptysis. major surgical or invasive procedure: 1. endotracheal intubation (x2) 2. thoracentesis (x2 with pigtail catheter placement x1) 3. bronchoscopy history of present illness: 72 yof hx of pulmonary hypertension who presents with massive hemoptysis. per the family had a recent hospitalization for heart failure. has been having small amounts of hemoptysis for weeks (less than a teaspoon). this evening patient became acutely short of breath and hit her lifeline. she is on anticoagulation and has had several falls recently. she fell ~ 2 days ago and has had abdominal pain ever since (mostly llq). no n/v. in the ed, patient was coughing up blood and clots. inr reversed with ffp and vit k. intubated. gastric tube placed also with blood return. was tachycardic and hypertensive, never hemodynamically unstable. given levofloxacin for empiric pneumonia coverage. past medical history: 1. pulmonary hypertension 2. severe tricuspid regurgitation 3. atrial fibrillation on coumadin 4. tia () 5. hypertension 6. sle with joint involvement, malar rash 7. chronic pain syndrome 8. fibromyalgia 9. osa on cpap 10. gerd 11. ibs 12. gout 13. anemia: iron deficency anemia with negative upper and lower endoscopy 14. falls (history of) social history: lives on her own with daughter upstairs and son downstairs. h/o social smoking and drinking. family history: hypertension, cad, cancer. physical exam: vitals: t:99.5 bp:126/72 p:88 r:17 sao2: 100% general: awake, alert, intubated. heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, dried blood on lips. neck: supple, no jvd or carotid bruits appreciated pulmonary: lungs coarse b/l cardiac:irregular, distant, tachy, nl. s1s2 abdomen: soft, diffusely tender, nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no edema, 2+ radial, dp and pt pulses b/l. skin: no rashes or lesions noted. neurologic: awake, alert. moving all 4 extremeties pertinent results: admit labs: wbc-22.7*# rbc-5.16# hgb-13.0# hct-40.2# mcv-78* mch-25.3* mchc-32.4 rdw-20.5* pt-150* ptt-113.8* inr(pt)->22.8* glucose-159* lactate-3.8* na+-138 k+-3.2* cl--84* tco2-37* urea n-47* creat-1.5* discharge labs: wbc-7.9 rbc-3.81* hgb-9.7* hct-31.6* mcv-83 mch-25.5* mchc-30.7* rdw-24.0* plt ct-503* glucose-97 urean-11 creat-1.0 na-138 k-3.3 cl-97 hco3-30 angap-14 ekg: irregular. rate 130 bpm. nl axis. narrow qrs. lvh. st depression in ii, avf, v4-6 cxr (): there has been interval placement of endotracheal tube, which lies 4 cm above the carina. nasogastric tube is seen extending below the diaphragm and out of view. patient is slightly rotated on current radiograph, limiting evaluation. marked global cardiomegaly is probably unchanged. mediastinal widening is difficult to assess given the degree of rotation. no focal consolidations are seen, and there is no pleural effusion or pneumothorax. abd us (): cholelithiasis without son evidence of cholecystitis. echo ():the left atrium is mildly dilated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is dilated. right ventricular systolic function is normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , global biventricular systolic function is similar. the severity of tricuspid regurgitation and the estimated pulmonary artery systolic pressure are now lower (may be related to technical quality rather than a true decline). xray shoulder and hip and wrist (): mild left acromioclavicular joint arthrosis. no fracture. no hip fracture. wrist - diffuse demineralization. mild degenerative change about the articular surfaces of the scapholunate interval. the intercarpal spaces are normal on this non-stress view. ct head (): no intracranial hemorrhage. mild chronic microvascular ischemic changes. ct chest (): 1. new large left pleural effusion, predominantly loculated. 2. bronchomalacia bronchus intermedius. possible air extravasation. 3. marked cardiomegaly, especially right atrial enlargement due to tricuspid insufficiency. pulmonary hypertension. 4. bibasilar atelectasis. right lower lobe pneumonia cannot be excluded. 5. mediastinal lymphadenopathy, slightly increased, most likely reactive, but other causes such as neoplasm can not be excluded. ct chest/abd/pelvis (): 1. decrease in left pleural effusion, status post left pleural catheter. loculated effusion persists in the anterior pleural space with new focal areas of air within the effusion that could be secondary to recent intervention. 2. increasing atelectasis with consolidation of the right lower lung with opacification of the right lower lobe bronchus with endobronchial secretions. 3. persistent cardio megaly and small pericardial effusion. 4. right renal cysts brief hospital course: 1. hemoptysis/anemia: in setting of supratherapeutic inr (22) and pulmonary hypertension. bleeding stopped once inr reversed. bronchoscopy initially showed large clot across the carina but no active bleeding. repeat bronchoscopy showed slight ooze from lll. again no active bleeding but a large clot. ip subsequently came and removed the clot. after inr reversal and clot removal, patient no longer had hemoptysis and hematocrit remained stable. 2. respiratory failure (pneumonia and pleural effusions): patient intubated in ed for hemoptysis. extubated the following morning but had increasing respiratory difficulty through out the day and was re-intubated in early evening. in addition to hemoptysis and heart failure, patient developed aspiration pneumonia. sputum showed gpc on gram stain but cultures negative (taken while on levofloxacin). vancomycin was added. ct scan of the chest showed left loculated pleural effusion that was tapped on by ir showed 4+ pmns but no organism. ip further drained the l posterior loculated fluid (~900cc) and a pigtail catheter was placed on . the pigtail catheter can be removed when drainage stops. pt developed fever on despite being on vanc/levofloxacin and aztreonam was added after panculture was obtained. repeat ct chest subsequently showed improved l posterior pleural effusion, unchanged l loculated pleural effusion (too small to tap) and increased opacities in the rll. because all her sputum, pleural fluid cultures were negative, vancomycin and aztreonam were discontinued on and , respectively. a 10 day course of levaquin was completed. patient was extubated successfully on , and at the time of transfer was satting well on room air. 3. coagulopathy: on coumadin for a fib. her coumadin dose was increased a week prior to admission. unclear why inr so dramatically elevated. reversed with ffp and po vitk. and had no longer hemoptysis. 4. congestive heart failure, diastolic: initially bb/diuretics were held due to hypotension. they were reintroduced once hemodynamically stable. 5. atrial fibrillation: initially held bb given hypotension. metoprolol was readded to control her rate (and titrated up). her elevated inr was reversed as above. given her recurrent falls per family and hemoptysis, patient was not felt to be a good candidate for anticoagulation; given her aspirin allergy, plavix was started. 6. renal failure: likely in the setting of blood loss and hypertension. scr 1.0 at the time of discharge after peaking to 1.5 on admission. 7. mental status change: after arriving to the floor, the patient would become mildy agitated at night and would also become disoriented. this was felt to be secondary to narcotics provided earlier in her stay. her pain regimen was changed with the hope to minimize narcotics use. tylenol rtc was given and a lidocaine patch was applied to her left flank. low doses of oxycodone ir and ultram were used. geriatrics was consulted and recommended low dose of haldol and re-institution of klonopin, given that the patient presented on chronic benzoes. this worked well and the patient improved greatly with no issues over the final 3-4 days of her stay. 8. pain: the patient presented with a history of chronic pain. based on prior pcp notes, multiple regimens have been tried with no only moderate success. at the time of discharge, her pain regimen was as outlined in #7. consideration could be given to eliminating oxycodone in favor of the ultram if the latter is working well. 9. hypertension: presented on nifedipine sr 60mg daily, hctz 25mg daily and metoprolol 100mg . the first two medications were not restarted before discharge, but likely could be as the patient's blood pressure was no optimized. the metoprolol was initially held, then restrated and titrated to 100mg tid. 10. obstructive sleep apnea: cpap settings are -- mask ventilation: nasal cpap w/ psv (bipap) inspiratory pressure: 8 cm/h2o expiratory pressure: 5 cm/h2o backup rate: 10 bth/min supp o2: 2 l/min. 11. hyperglycemia: blood glucose 223 on admission finger sticks as high as 160s thereafter. sliding scale inslulin was used during stay. require oral hypoglycemics. medications on admission: 1. tramadol 50 mg tablet sig: 1-2 tablets po tid (3 times a day) as needed for pain. 2. fluvoxamine 50 mg tablet sig: one (1) tablet po hs (at bedtime). 3. cortisone 1 % cream sig: one (1) appl topical (2 times a day) as needed for rash. 4. clindamycin phosphate 1 % solution sig: one (1) appl topical (2 times a day). 5. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for itching. 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 7. lactulose 10 g/15 ml syrup sig: fifteen (15) ml po q8h (every 8 hours) as needed for constipation. 8. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 9. prilosec otc 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 10. coumadin 5 mg tablet sig: one (1) tablet po at bedtime. 11. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 12. furosemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). 13. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 14. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 15. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 16. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day. 17. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). discharge medications: 1. metoprolol tartrate 100 mg tablet sig: one (1) tablet po three times a day. 2. furosemide 40 mg tablet sig: 1.5 tablets po bid (2 times a day). 3. tramadol 50 mg tablet sig: one (1) tablet po three times a day as needed for pain. 4. prilosec otc 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 5. fluvoxamine 50 mg tablet sig: one (1) tablet po hs (at bedtime). 6. vitamin d-3 400 unit tablet sig: one (1) tablet po twice a day. 7. lactulose 10 g/15 ml solution sig: fifteen (15) ml po q8h (every 8 hours) as needed for constipation. 8. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 9. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po once a day. 10. clonazepam 0.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 11. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 15. insulin regular human 100 unit/ml solution sig: as directed. injection asdir (as directed): see sliding scale. 16. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for bloating. 17. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 18. haloperidol 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 19. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 20. oxycodone 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 21. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 22. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 23. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. hemoptysis 2. pulmonary hypertension 3. pneumonia 4. pleural effusion 5. acute renal failure 6. mental status change 7. chronic pain syndrome / fibromyalgia secondary: 1. congestive heart failure, diastolic 2. atrial fibrillation 3. hypertension 4. anemia, iron deficient 5. tricuspid regurgitation 6. prior tia 7. systemic lupus 8. obstructive sleep apnea 9. gastroesophageal reflux disease 10. gout discharge condition: hemodynamically stable. discharge instructions: you were admitted after having hemoptysis (bloody coughing). this was likely related to your pulmonary hypertension and an elevated inr (coumadin level). given the deconditioning you experienced while hospitalized, you will require rehab to get stronger. please note that there have been a number of changes to your medication regimen. please weigh yourself every morning and call your doctor if your weight increases by 3 lbs or more. followup instructions: please follow-up with your primary care doctor 1-2 weeks after discharge from rehab. md, procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube fiber-optic bronchoscopy other lavage of bronchus and trachea diagnoses: systemic lupus erythematosus obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified pleural effusion acute posthemorrhagic anemia acute kidney failure, unspecified gout, unspecified atrial fibrillation acute respiratory failure pneumonitis due to inhalation of food or vomitus primary pulmonary hypertension long-term (current) use of anticoagulants calculus of gallbladder without mention of cholecystitis, without mention of obstruction acute diastolic heart failure myalgia and myositis, unspecified other abnormal glucose chronic pain syndrome tricuspid valve disorders, specified as nonrheumatic 

Answer: The patient is high likely exposed to