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: patient recorded as having no known allergies to drugs attending: chief complaint: dyspnea major surgical or invasive procedure: cardiac catheterization with 2 bare metal stents to right coronary artery endotracheal intubation foley catheter right femoral triple lumen central venous catheter right radial arterial line history of present illness: 54 yo female with no significant past medical history presented to osh with progressive dyspnea. per report collected from husband, mother and nurse, the patient had symptoms of a uri, ie dry cough, for about one week. on the day of admission the patient reported chest pain and dyspnea while driving home from work. ems was called, and she was unable to speak in full sentences. . initial vitals on arrival to osh 97.5 8 78% ra. the patient had a cta to rule out pe, which showed moderate right and small left pleural effusions, diffuse ground-glass densities, bibasilar consolidations. pe, aortic dissection and aneurysm were ruled out. urinalysis, tox screen and lfts were normal. at the osh, her creatinine .9. bnp 2331 and troponin .11. pt was given 325mg asa, ntg .4mg slx3, lasix 40mg iv x2 and put on bipap. in short order, the pt was then intubated using etomidate, vecc and succ and started on a nitro drip. propofol was used for sedation and a peep of 20 was noted. pt subsequently became hypotensive and was put on both levophed and dobutamine drips. the patient was given ceftriaxone and azithro for antibiotic coverage and a urine legionella was sent. a central line was placed in the right femoral vein. the patient was then transferred to for further management. . in the ed, initial vitals, 98.8 92 105/82 28 100% on fio2 100% peep 20 rr 25set. pressors were discontinued. ekg showed sinus rhythm no signs of ischemia noted. cardiology consulted who initially recommended conservative management with repeat enzymes and felt trop bump likely related to demand. cxr showed bilateral process. pt given vanc in addition to azithro and ceftriaxone, and 4l ivfs. pt was switched from propofol to fentanyl/versed. a limited ultrasound was performed that did not show any free fluid in the abdomen or pericardial effusion. pt also received 40meq kcl iv x1. pt was also noted to be trace guaiac positive. . the patient was admitted to the micu initially. her vitals on arrival were 100 88 148/91 28 100% fio2 80%, peep 16. repeat ekg showed t wave inversion in i and avl. cardiology , ekgs faxed, felt to be unchanged. a tte showed mod lvh, normal cavity size, probable mild regional lv systolic dysfunction with ef 55-60%, and basal inferior hypokinesis. the patient was taken to the cath lab and was found to have 3 vessel disease with diffusely diseased lad, om stenosis and rca stenosis. two baremetal stents were placed in the rca, and the other lesions were unable to be intervened upon. the patient was transferred to the ccu for management of her coronary artery disease. the patient was ruled out for flu. . unable to obtain a review of symptoms secondary to sedation and intubation. past medical history: arthritis social history: married. her husband, is her health care proxy. mother was a former nurse here at the . contacts. pt is a lawyer at the federal reserve bank in . she was fully functional prior to admission. -tobacco history: none -etoh: none -illicit drugs: none family history: mother: hypertension father: deceased "massive coronary." pgf: deceased mi cousin, same age: cad requiring cabg physical exam: general: sedated, intubated, arousable to stimuli. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of to the level of the mandible. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. rales bilaterally anteriorly, expiratory wheezes bilaterally. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 2+ bilateral lower extremity edema. arterial and venous sheaths in place on the left. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 01:40am blood wbc-13.6* rbc-4.00* hgb-10.6* hct-32.4* mcv-81* mch-26.5* mchc-32.7 rdw-19.7* plt ct-387 01:40am blood glucose-132* urean-36* creat-1.2* na-143 k-3.0* cl-108 hco3-21* angap-17 01:40am blood ck(cpk)-156* 01:40am blood ck-mb-15* mb indx-9.6* probnp-3622* 01:40am blood ctropnt-0.56* 05:28am blood ck(cpk)-275* 05:28am blood ck-mb-30* mb indx-10.9* ctropnt-1.70* 12:57pm blood ck(cpk)-314* 12:57pm blood ck-mb-24* mb indx-7.6* ctropnt-2.89* 09:45am blood ck(cpk)-192* 09:45am blood ck-mb-13* mb indx-6.8* ctropnt-2.05* 12:55am blood caltibc-203* ferritn-884* trf-156* 07:10am blood vitb12-1400* folate-9.1 05:28am blood %hba1c-5.3 05:28am blood triglyc-99 hdl-36 chol/hd-4.1 ldlcalc-91 07:10am blood tsh-34* 07:10am blood free t4-0.72* 05:00am blood cortsol-17.6 01:40am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): sparse growth commensal respiratory flora. stenotrophomonas (xanthomonas) maltophilia. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ stenotrophomonas (xanthomonas) maltophilia | trimethoprim/sulfa---- 2 s . cxr - bibasilar consolidations . ekg - nsr, twis i and avl, suggestion of st depression in lateral leads, lvh . telemetry: normal sinus rhythm at a rate of 70bpm . 2d-echocardiogram: suboptimal image quality. the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is probably mild regional left ventricular systolic dysfunction with basal inferior hypokinesis. no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric jet of at least mild (1+) mitral regurgitation is seen. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. . ett: none . cardiac cath: lmca ostial 20%, distal 20% lad - calcified, diffuse disease, prox 30%, severe disease from mid vessel onwards with calcified 80% disease at s3 after d1, 90% between s3 and s4, aneurysmal lesion after s4, diffuse disease in the distal lad to 80-90%, culminating in a 90% stenosis in the apical lad before it wraps around the apex. lcx - heavily calcified, ostial 20%, proximal 30-40% at om3, small om1, modest caliber om2, subtotal occlusion of small but moderate length om3, diffuse plaquing in mid lcx into large lpl/om4, 90% stenosis in distal av groove cx into modest caliber long om5/lpl rca - heavily calcified, proximal tubular 80% followed by mild diffuse disease throughout the mid rca with worse disease beginning after modest am2 to 85% in a diffusely diseased segment involving a large lower am (perfusing the distal inferior septum) with more diffuse disease in the distal av groove rca supplying a branching rpda and rpl as well as a separate distal av groove rca beyond the rpda, subtotal occlusion of origin of am2 with timi 2 flow in the am2 and timi 2 fast flow into the rpda. . hemodynamics: moderate-severe elevation of pcw with severely elevated lvedp and moderate-severe pulmonary arterial hypertension. . ct head : 1. no evidence of hemorrhage, vascular territorial infarct, or generalized cerebral edema. 2. small hypoattenuation foci in the right caudate nucleus/corona radiata of indeterminate chronicity. while these may represent chronic lacunar infarcts, more acute embolic events cannot be totally excluded in this setting. these findings could be better-characterized with mri with diffusion imaging if clinically indicated. eeg findings: abnormality #1: brief bursts of hz theta frequency slowing were seen involving the both temporal regions independently, left>>right, and synchronously. abnormality #2: occasional bursts of generalized hz theta frequency slowing was seen. background: in the most organized portion of this tracing, a moderately well-organized hz alpha frequency background was seen. hyperventilation: was contraindicated due to the patient's history of cardiac disease. intermittent photic stimulation: could not be performed as the test was requested as a portable study. sleep: there were no normal sleep or wake transitions seen. cardiac monitor: revealed a generally regular rhythm with average rate of 72 bpm. impression: this is a mildly abnormal eeg due to the presence of bursts of independent and synchronous bitemporal slowing, suggesting subcortical dysfunction in these areas. the presence of occasional bursts of generalized slowing suggests a mild encephalopathy or extensive regions of bilateral deep or midline lesions. no evidence of ongoing seizures was seen. mri 1. multifocal regions of restricted diffusion could represent evolving infarcts versus chronic microvascular white matter ischemic disease with no territorial infarct. 2. multifocal regions of nodular enhancement, both superficial and deep within the brain parenchyma, including the left pons. primary differential considerations include evolving enhancing infarcts versus metastatic disease and correlation with the patient's history is needed. short-term followup examination to document stability and/or resolution of these findings is suggested. impression: as seen on the previous mri of diffusion images demonstrate hyperintense areas with equivocal low signal on adc map indicative of acute/subacute infarcts. some of the lesions seen on diffusion images are too small to characterize but the others demonstrate equivocal low signal on adc to indicate acute/subacute infarcts. mra head: the head mra is limited by motion and covers only partially the brain. flow signal is seen in the sylvian branches of both mca and in both anterior cerebral arteries in a2 region. impression: severely limited mra provides no important diagnostic information. if clinically indicated repeat study can be obtained. brief hospital course: # cad: the patient has evidence of coronary artery disease and likely had an nstemi within the last one to two days. the patient had 2 bms placed in her rca and is otherwise being medically managed for her diffuse three vessel cad, as the rest of her cad could not be intervened upon. started on asa, (x at least 1 month), statin, bb. do not miss or stop taking unless dr. agrees with this plan. . # pump: echo with preserved systolic function however cath shows evidence of biventricular diastolic dysfunction. initially had symptoms of fluid overload but has been euvolemic with no signs of chf and stable weight for the last 5 days. currently on no diuretics. will need tte in 3 months. . # respiratory distress: most likely volume overload in the setting of subacute nstemi and diastolic dysfunction. however, the patient has other radiology findings which point towards consolidation. treated the patient for both cap and pulmonary edema with course of ctx + azithro, and aggressive diuresis with lasix. flu negative. patient's respiratory status improved significantly after several days of diuresis and patient was extubated. of note, patient had significant hypertension with sbp > 200 when attempting to wean sedation for extubation. patient had to be placed on nipride gtt to control bp during weaning. after successful extubation, patient was weaned off of nipride and switched to po anti-hypertensives. sputum cx grew out scant stenotrophomonas, of unclear significance, not treated. . # hypertension: following extubation, patient's bp was well controlled on po labetalol + lisinopril. as patient has had no primary care for 15 years, unclear if this is long standing but diastolic dysfunction suggests it is. . # hypothyroidism: tsh inc and t4 low. no known hx of hypothyroidism. started po replacement. cortisol level wnl. f/u tsh in months. . # confusion: noted since extubation, initially thought meds however failed to resolve with time and space. ct head showed old lacunar infarct, diffusion weighted mri was suspicious for acute/subactue stroke. eeg showed mild encephalopathy with bitemporal subcortical dysfunction, no seizure activity. our suspicion is that her labile and volatile bp changes at the osh with documented sbps of 220 follow by 60 possibly lead to these infarcts. her profound hypothyroidism may contribute. per speech therapy, pt unable to follow more than simple commands, has very poor short term memory and likely will be unable to care for herself. neuro consult felt that her mental status is slowly improving and she will f/u in the stroke clinic in 4 weeks. pt will need extensive ot support to help in her cognitive recovery. please see ot referral note. medications on admission: aleve prn discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. labetalol 200 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. multivitamins with minerals tablet sig: one (1) tablet po daily (daily). 8. lisinopril 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily): please take in am, on an empty stomach and 1 hour prior to any food or other pills. disp:*30 tablet(s)* refills:*2* 10. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day): continue until one week after rash resolves. disp:*1 tube* refills:*2* 11. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalations inhalation every six (6) hours as needed for shortness of breath or wheezing. 12. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) inhalation inhalation every six (6) hours as needed for shortness of breath or wheezing. discharge disposition: extended care facility: - discharge diagnosis: non st elevation myocardial infarction acute diastoic congestive heart failure aspiration pneumonia non-embolic cerebral vascular accident hypothyroidism tinea corporis discharge condition: activity status:ambulatory - requires assistance or aid (walker or cane) mental status:confused - always level of consciousness:alert and interactive discharge instructions: you had a heart attack and some fluid accumulation in your lungs. you received 2 bare metal stents in your right coronary artery. it is crucial that you take all of your medicines every day and don't miss of your aspirin and . you will be on the following new medicines: 1. , a platelet medicine to keep the stent open. 2. aspirin: to keep your stent open 3. labetolol: a medicine to keep your blood pressure and heart rate low 4. lisinopril: a medicine to lower your blood pressure 5. atorvastatin: a medicine to lower your cholesterol 6. thiamine: a vitamin 7. folic acid: a vitamin . during your stay, you were also noted to be more confused than your baseline and having difficulty walking. mri of the brain revealed changes consistent with a stroke, possibly related to episodes of severe hypertension that occurred at the beginning of your hospitalization. maintaining tight blood pressure control is essential to prevent further damage to the brain. it is essential that you continue the labetolol and lisinopril to maintain control of your blood pressure. you will also need rehabilitation from your stroke which will occur at rehab. . additionally, you were found to have hypothyroidism during your stay. you were started on levothyroxine (synthroid) once daily and will need to have your thyroid function monitored by your primary care physician 6 weeks. it is important that you continue to take this medication, first thing in the morning, on an empty stomach and 60 mins prior to any food or any of your other medications. . you completed a seven day course of antibiotics for your aspiration pneumonia and do not require further antiobiotics. . weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. follow a low sodium diet followup instructions: primary care: dr. with dr. phone: friday, at 2:10pm. their office is located in the building, on the of . . cardiology: , md phone: date/time: 4:00. dr. office is located on the of the building, on the , . . neurology: dr. and dr. ( date/time: at 2:30pm. clinical center, , . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization injection or infusion of platelet inhibitor other and unspecified coronary arteriography insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified acquired hypothyroidism other chronic pulmonary heart diseases other opiates and related narcotics causing adverse effects in therapeutic use pneumonitis due to inhalation of food or vomitus family history of ischemic heart disease hypoxemia malignant essential hypertension nonspecific abnormal findings in stool contents acute diastolic heart failure encephalopathy, unspecified cerebral artery occlusion, unspecified with cerebral infarction arthropathy, unspecified, site unspecified unspecified persistent mental disorders due to conditions classified elsewhere dermatophytosis of the body 

Answer: The patient is high likely exposed to