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 / lasix attending: chief complaint: shortness of breath major surgical or invasive procedure: none. history of present illness: hpi: please refer to nightfloat note. in brief, ms. is an 83 year-old patient with a known history of copd, asthma, and hypertension admitted for multiple copd flares this year. she presents now with two days of cough and greatly exacerbated shortness of breath. she reports that her symptoms began roughly two weeks ago, when she developed rhinorrhea. at this time however, she felt that her asthma/copd was at baseline. despite claritin and mucinex, her runny nose continued and she began to develop a progressive worsening of her chronic sob. ms. noted an acute change two days prior to admission, when she could no longer walk to the bathroom without stopping to catch her breath and developed a new cough. note that during the course of her illness, the patient never developed any fevers or chills. patient did report developing white sputum and said that she had trouble sleeping flat, but she has had 3 pillow orthopnea for years. no pnd. otherwise no chest pressure, pain, palpitations, lightheadedness, syncope or pleuritic chest pain. no nausea, vomiting, diarrhea, or constipation. on - the day of admission - the patient reported airway narrowing reminiscent of her previous asthma flares and unresponsive to her nebulizer treatment. at this point in time she called the paramedics and was admitted to the ed. . in ed, patient's vital signs were t=97.9, p=96, bp=209/79, rr=26, and o2 sat of 100% ra. cxr performed and showed no pulmonary edema. patient's sob improved with nebulizers. she improved with nebs. she received combivent, prednisone 60mg, mag, azithro 500mg, asa 325mg, nitro paste x1inch. her repeat bp was 193/60 and 98% on 2.5lnc. at this point she was transfered up to the floor, where she continues to remain comfortable. . ros otherwise negative in detail except for foreign body sensation in right eye. patient attributes this to her trigeminal neuralgia but does grade the pain as . notably no headaches, visual changes, as might be expected with hypertension. past medical history: 1. asthma/copd - recently admitted for a flare on and treated with nebulizers, steroids, and a course of azithromycin. last seen by dr. in pulmonology in , when he thought she was deconditioned from her time in the hospital although adequately medicated. recommended a cardiology consult at this time for what he believed to be significant diastolic dysfunction secondary to long-standing hypertension. 2. paralyzed left hemidiaphragm s/p pericardial window procedure 3. severe hypertension with diastolic dysfunction - per pcp notes typically controlled in the 160's unless patient experiences an asthma flare when it shoots to 170's-180's. notably systolic pressures were in the 130's during her last hospital admission, presumably the reason why her hctz and enalapril doses were halved. patient is poorly compliant and most recently has not been taking her antihypertensives due to her ill son-in-law, unable to pick up her meds from the pharmacy. 4. hyperlipidemia 5. chronic renal insufficiency (creatinine around 1.4). 6. polymyalgia rheumatica. 7. osteoporosis. 8. trigeminal neuralgia - reportedly seen by optometry and referred to dr. of . 9. iron-deficient anemia 10. gastritis social history: ms. is a widow of many years and a mother of three. she lives in the bottom unit of a shared home with her daughter and son-in-law, who provide her with a large amount of care and support. although ms. b is able to complete most of her adl's, she relies on her daughter for shopping and cooking. while she doesn't specifically say it, her increasing dependence on her children has taken a bit of its toll on her. this may be partially responsible for her decreased med compliance - the patient relies on others to go to cvs to pick up her meds. her daughter had the flu prior to ms. ' hospitalization, and because of this, she was unable to pick up her medications on time. additionally, it sounds as if the patient doesn't leave her house very often. she comments on how she doesn't like to walk outside or to sit on her porch. ms. would rather watch television, socializing with friends infrequently. family history: diabetes mellitus in siblings and children. no bleeding or clotting disorders. mom with ?mi physical exam: vs- t:98.7/98.7 p:85(85-107) bp:158/92(158-210)/(72-100) rr:18 o2 sat: 95% on 3l gen- patient sits with three pillows behind her, puffing on her nebulizers. nad. skin- color good. nails without clubbing or cyanosis. heent- ncat. sclera anicteric and conjunctiva clear. eomi intact. pupils equal and reactive to light and accomodation. unable to appreciate optic disk on undilated exam as there did appear to be some posterior cataracts. op clear. mmm. neck- no lymphadenopathy or thyromegaly. pulm- increased ap diameter with some notable kyphosis. diminished breath sounds in left lower lung field. crackles heard diffusely through upper and lower lung fields, r>l however. no wheezes or rhonchi. cv- displaced pmi not appreciated. rrr. normal s1 and s2 without rubs or murmurs. abd- positive bowel sounds. non-obese or distended. soft. non-tender to light or deep palpation. no abnormal masses or organomegaly. ext- bilateral non-pitting edema, left leg greater than right leg. dp pulses palpable bilaterally. neuro- cn ii-xii intact. notably deltoids 4+ strength bilaterally but otherwise strength was . no signs of impairment to cold or light touch. biceps/triceps/br/petellar/achilles reflexes all bilaterally pertinent results: admission labs: |100|25 ----------<137 4.6|35|1.6 estgfr: 31/37 (click for details) ck: 88 mb: notdone 10.2 7.3><300 30.0 n:56.5 l:27.1 m:5.4 e:10.2 bas:0.9 ck: 88 mb: notdone trop-t: 0.07 -> ck: 88 mb: notdone trop-t: 0.06 cxr : stable radiograph with multiple priors with no acute pulmonary process noted. again seen is a stably elevated left hemidiaphragm, atheromatous disease of the aorta, and an enlarged cardiac silhouette. ecg : sinus rhythm. left ventricular hypertrophy with associated st-t wave changes. compared to the previous tracing there is no significant change. brief hospital course: assessment/plan: 83 year-old woman with a known history of copd, asthma, and hypertension admitted for multiple copd flares this year. she presents after two days of cough and greatly exacerbated sob/sensations of airway narrowing in the setting of hypertensive urgency. 1) dyspnea: multi-factorial likley with component of asthma exacerbation probably with recent viral uri given sputum change and wheezing, but also given elevated blood pressure and diastolic heart failure that contributes. she was treated with home inhalers and nebs(albuterol .083% q4h, ipratropium .02% q4h, cromolyn 800mcg 2 puffs q6h, budesonide .25mg/2ml q4h, guaifenesin 600mg ), prednisone taper (40mg daily for 3 days then taper to 30mg), azithromycin for 5 day course. also we attempted to improve her diastolic dysfunction and blood pressure as outlined below. on discharge she was breathing comfortably, satting 96% on ra at rest. 2) diastolic heart failure: initially decompensated with hypertensive urgency. she would benefit from improved bp and hr control as her blood pressure is labile (sbp 120-220 in house) and hr 80-100, sinus. she was given 2 doses over 2 days of ehtacrynic acid for mild diuresis to improve her respiratory status. to improve afterload reduction her enalapril was increased to 20mg daily. her thiazide was stopped to off-set any decrease in blood pressure this change might cause. she has never had nodal for rate control and after discussion with her pcp and review of cost of medications (as she has difficulty paying for her meds) she was started on diltiazem 30mg qid. she initially tolerated this well but the second day of it felt dizzy, lightheaded, weak and unwell. her blood pressure at this time was systolic 140's but just prior to getting the medications it had been 200. she was not orthostatic by bp or hr with this. despite this her enalapril dose was decreased back to 10mg daily and she was discharged with follow-up with who works with dr. . transportation was also arranged for this appointment. 3) hypertension: patient's bp's according to pcp typically are running at 150-160's systolic when well-controlled. these numbers can peak to the 190's or higher during an acute asthma exacerbation, and attempts to lower pressures below 160 have resulted in lightheadedness, fatigue, and dizziness. she had missed one of her clonidine patches and probably her enalpril prior to admit to explain her elevated bp on arrival, but her blood pressure was quite labile in house as well (120-220). her clonidine and nifedipine were continued with no dose adjustment. the enalapril with increased then decreased as above. she was started on diltiazem and was discharged on 30mg tid. her hydrochlorothiazide was discontinued. 4) trigeminal neuralgia: she complained of right eye pain the same as it was when evaluated by optometry, dr. , , who felt this was trigeminal neuralgia as previously diagnosed. he has been recommending a pain clinic evaluation for this since but ms. has never had this. she has been taking her carbamazepine 1-2 tabs daily prn with no relief. she was increased to 300mg with some improvement. a follow-up appointment was made in pain clinic and transportation was arranged. 5) hyperlipidemia: normally controlled at home on statin (atorvastatin 10 mg po daily), but we held this given risk of rhabdo in the setting of azithromycin. 6)osteoporosis: she was restarted fosamax as she had not refilled her prescription. also she was continued on vitamin d 400 and calcium carbonate 500mg po tid. 7)iron deficiency anemia: hemoglobin usually running and hematocrit running 29-31. current hemoglobin and hematocrit at baseline. continued on ferrous sulfate 325mg po daily. medications on admission: hydrochlorothiazide 12.5 mg daily - not taking immediately prior to admission as ran out of medication. on 25mg according to omr but 12.5mg after last hospital discharge for unspecified reason. clonidine 0.1 mg/24 hr patch weekly transdermal qwed clonidine 0.3 mg/24 hr patch weekly transdermal qwed nifedipine 180 mg tablet sustained release daily enalapril maleate 10 mg po daily - not taking immediately prior to admission as ran out of medication. on 20mg according to omr but decreased to 10mg after last hospital discharge for unspecified reason. prednisone 5 mg daily - patient reports not taking at home. appears to be some confusion over this. dr. note indicates that she should have been continuing with 5mg daily until her next appointment, but patient reports that she already completed her required course. cromolyn 800 mcg/actuation two (2) puff inhalation q6h albuterol sulfate 2.5mg/3ml (.083%) neb q6h ipratropium 0.5 mg/2.5 ml (.02%) neb q6h budesonide .25 mg/2 ml neb q6h - patient reports not taking this with regularity. combivent mdi and flovent when out of house guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day) oxygen 3l at night aspirin 325 mg daily. atorvastatin 10 mg po daily cholecalciferol 400u two (2) tablet po daily omeprazole otc 20 mg po daily. docusate sodium one hundred (100) mg po bid (2 times a day). senna 8.6 mg po bid ferrous sulfate 325 mg daily carbamazepine 100 mg fosamax 70mg qwk tolterodine 2 mg qhs discharge medications: 1. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) neb inhalation every six (6) hours. 2. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 3. cromolyn 800 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 4. quinine sulfate 324 mg capsule sig: one (1) capsule po hs (at bedtime). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. nifedipine 90 mg tablet sustained release sig: two (2) tablet sustained release po daily (daily). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*5* 9. detrol la 2 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po at bedtime. 10. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 11. guaifenesin 600 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 12. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). 13. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). 14. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 15. alendronate 70 mg tablet sig: one (1) tablet po qwed (every wednesday). disp:*4 tablet(s)* refills:*2* 16. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing. 17. budesonide 0.25 mg/2 ml suspension for nebulization sig: one (1) neb inhalation every six (6) hours. 18. prednisone 10 mg tablet sig: as directed tablet po once a day for 30 doses: please take 3 tablets daily for 2 days then reduce to 2 tablets daily for 3 days, then 1 tablet daily through when you see dr. . . disp:*30 tablet(s)* refills:*0* 19. carbamazepine 100 mg tablet, chewable sig: three (3) tablet, chewable po bid (2 times a day). disp:*180 tablet, chewable(s)* refills:*2* 20. atorvastatin 10 mg tablet sig: one (1) tablet po once a day. 21. oxygen 3l nc oxygen when sleeping and 2l nc oxygen with ambulation only. 22. enalapril maleate 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*5* 23. diltiazem hcl 30 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: home health care discharge diagnosis: primary: asthma exacerbation, hypertensive urgency, diastolic heart failure with mild exacerbation, trigeminal neuralgia. secondary: chronic kidney disease, osteoporosis, gastritis, anxiety. discharge condition: stable on her home dose of oxygen, stable blood pressure. discharge instructions: please take all medications as prescribed. please keep all follow-up appointments. please notify your primary care doctor, dr. , or return to the emergency department if you experience fevers, chills, cough, shortness of breath, chest pain or pressure, dizziness, lightheadedness, or any symptoms that concern you. followup instructions: please follow-up with nurse on wednesday at 10:00 am. please call if questions or you need to move this appointment. please follow-up with dr. , md on monday at 10:40pm. please call if questions. please follow-up with dr. on monday at 8:20am. please call if questions regarding this appointment. please follow-up with dr. of pulmonology, on at 9:45am. please call if questions regarding this appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube non-invasive mechanical ventilation other intubation of respiratory tract diagnoses: polymyalgia rheumatica congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia osteoporosis, unspecified iron deficiency anemia, unspecified personal history of noncompliance with medical treatment, presenting hazards to health chronic obstructive asthma with (acute) exacerbation acute diastolic heart failure trigeminal neuralgia acute upper respiratory infections of unspecified site 

Answer: The patient is high likely exposed to