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: depakote attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 56 year old female with dm, cri, diastolic hf, 2+ar, 2+mr, from nursing home, who presents with 1 day tachypnea, hypoxemia with o2sat initially 88%, then progressed despite lasix/zaroxyln and nebulizer treatment. in ed, rr 30, 92% 3liters with nebulizer, lasix, and prednosine. later patient noted to have acute htn with sbp 200s with acute increased o2 requirement ond respiratory distress. patient given nitro drip, and iv lasix (160mg-->>2.4liters out), hydralazine and morphine for presumed acute chf. patient abg was 7.30/33/471 on 100% nrb. patient put on 3 hour trial cpap then weaned to weaned to nrb. patient currently on nasal cannula. course further complicated by ams, somnolent + transient hypoglycemia. patient given d50, narcan, and negative head ct. she was transfused 1 unit prbc and given hco3 drip for nongap acidosis. patient transferred to micu for management of hypoxia, tachypnea, acute renal failure, altered mental status, with initial presentation most consistent with decompensated chf. in the unit patient was weaned from nrb mask to nasal cannula. chest xray suggests more a pneumonitis than chf. past medical history: dm2 chronic pancreatitis gerd copd s/pccy roux en -y r hip fx cri past etoh abuse social history: she lives alone. she works in a nursing home. she has a daughter who lives in , also named . she smokes cigarettes actively and drinks approximately one to two drinks per week with a prior history of abuse. family history: noncontributory. physical exam: vs: t 98.9 p 110 bp 138/70 o2sat 99% 4l nasal cannula gen: nad, lethargic heent: pupils dialated, poorly reactive. eomi, oral pharynx clear. no teeth. lungs: + crackles bilaterally cardiac: tachycardic, regular rhythm s1/s2 no murmur abd: soft non-tender, nondistended, positive bowel sounds, midline scar ext: no edema, 2+ dp on left, 1+ dp on right pertinent results: 07:40pm glucose-237* urea n-56* creat-3.2* sodium-138 potassium-5.3* chloride-109* total co2-16* anion gap-18 07:40pm ck(cpk)-41 07:40pm ctropnt-0.04* 07:40pm ck-mb-notdone 07:40pm tot prot-7.1 iron-12* 07:40pm caltibc-195* vit b12-617 folate-greater th ferritin-160* trf-150* 07:40pm urine hours-random 07:40pm urine u-pep-multiple p osmolal-314 07:40pm urine uhold-hold 07:23pm urine hours-random 07:23pm urine hours-random 07:23pm urine uhold-hold 07:23pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 06:35pm type-art temp-36.7 rates-/25 o2-100 po2-131* pco2-34* ph-7.28* total co2-17* base xs--9 aado2-561 req o2-91 intubated-not intuba comments-non-rebrea 06:00pm glucose-68* urea n-57* creat-3.3* sodium-145 potassium-5.8* chloride-116* total co2-15* anion gap-20 06:00pm ck(cpk)-44 06:00pm ctropnt-0.04* 06:00pm ck-mb-notdone 06:00pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 05:12pm type-art rates-/25 po2-138* pco2-42 ph-7.22* total co2-18* base xs--10 intubated-not intuba comments-nrb 05:12pm glucose-26* 02:35pm type-art rates-40/37 tidal vol-650 peep-9 o2-100 po2-471* pco2-33* ph-7.30* total co2-17* base xs--8 aado2-222 req o2-44 11:20am urine hours-random 11:20am urine gr hold-hold 11:20am urine color-straw appear-hazy sp -1.015 11:20am urine blood-lg nitrite-pos protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-0.2 ph-5.0 leuk-lg 11:20am urine rbc-* wbc-21-50* bacteria-many yeast-none epi-0-2 10:50am creat-3.3* sodium-143 potassium-5.4* total co2-14* 10:50am glucose-116* urea n-55* creat-3.3* sodium-143 potassium-5.4* chloride-116* total co2-15* anion gap-17 10:50am ld(ldh)-219 dir bili-0.0 10:50am alt(sgpt)-55* ast(sgot)-34 ck(cpk)-51 alk phos-328* amylase-19 tot bili-0.2 10:50am ctropnt-0.03* 10:50am ck-mb-notdone 10:50am calcium-8.4 phosphate-5.0* magnesium-1.6 10:50am albumin-3.3* calcium-8.8 10:50am haptoglob-222* 10:50am osmolal-324* 10:50am acetone-negative 10:50am wbc-9.7 rbc-2.42*# hgb-7.6*# hct-24.3*# mcv-101* mch-31.5 mchc-31.3 rdw-18.8* 10:50am neuts-73* bands-7* lymphs-11* monos-8 eos-0 basos-0 atyps-1* metas-0 myelos-0 10:50am hypochrom-2+ anisocyt-2+ poikilocy-2+ macrocyt-2+ microcyt-1+ polychrom-1+ ovalocyt-1+ teardrop-1+ 10:50am plt count-228 10:50am pt-12.9 ptt-27.0 inr(pt)-1.0 01:47am blood wbc-9.6 rbc-2.65* hgb-8.0* hct-25.9* mcv-98 mch-30.3 mchc-31.0 rdw-20.6* plt ct-190 01:47am blood plt ct-190 04:07pm blood glucose-335* urean-60* creat-3.1* na-135 k-4.5 cl-105 hco3-15* angap-20 04:07pm blood calcium-8.4 phos-5.9* mg-1.4* cxr (): impression: 1) more intense patchy bilateral interstitial infiltrate with a changing appearance, more suggestive of patchy pneumonitis than chf. 2) new left lower lobe atelectasis or consolidation with an adjacent small- left sided pleural effusion. ct chest (): impression: 1. smooth interstitial thickening with upper lobe predominance and pleural effusions. findings are consistent with chf/fluid overload. in an immunocompromised patient, diffuse infectious processes such as pcp may also be considered. 2. hypodense appearance of the blood consistent with anemia. 3. air within the biliary system probably relates to prior biliary procedure. correlate clinically. echo (): conclusions: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the proximal descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be quantified. there is a trivial/physiologic pericardial effusion. impression: mild-moderate aortic regurgitation. mild-moderate mitral regurgitation. preserved global and regional biventricular systolic function. compared with the prior report (tape unavailable for review) of , the findings are similar. brief hospital course: a/p: patient 56 year old female with dm2, cri, copd, diastolic hf, and 2+ar/2+mr admitted to micu from nursing home, who presents with 1 day history of tachypnea, hypoxemia with o2sat 88%, and concern for respiratory failure. --respiratory distress most likely multifactorial, but believed to be predominantly chf in the setting of diastolic heart failure and flash edema due to acute htn (sbp in 200s). in the micu treated for chf exacerbation and given iv lasix with good effect. afterload reduction/bp control with hydralazine, isosorbide dinitrate, and labetolol. further review of cxr suggested atypical pnuemonia. the patient was initially started on started on levofloxacin and zosyn, but antibiotics switched to azithromycin and ceftriaxone (which also covered the uti in this patient with h/o levo-resistant uti). the patient was transferred from the micu to the floor on hd2. chest ct on hd3 suggestive of chf. retrocardiac infiltrate and evidence of emphysema also noted on chest ct. echo on hd3 indicated intact systolic function (ef 60%) in the setting of stable mild-mod ar and mr. diuretics held due elevated creatinine. she had good urine output w/out diuretic and since arriving on the floor. copd exacerbation also considered. the patient was started on iv steroids in micu and wsa then put on a po prednisone taper. she was also treated with nebulizers and inhalers. she completed a 5-day course of azithromycin and ceftriaxone. she was weaned off of o2 to room air by hd5. repeat cxr on hd5 showed overall improvement of chf, but noted a new opacity in the left lingula. on hd6 azithromycin and ceftriaxone stopped and the patient was started on a 7-day course of levofloxacin. --acute on chronic renal failure cri (baseline approx cr 2.0?), most likely due to diabetic nephropathy. in addition, the patient thought to have atn during hospitalization. her creatinine was cr 3-3.4 during most of this hospitalization and decreased to 2.7 on hd6. bun (baseline 40?) increased from 55 to 70 during hospitalization. arf during this hospitalization might have been pre-renal in the setting of aggressive diuretic use. intrinsic etiologies investigated. the patient was hyperphosphatemic (secondary to renal disease) and treated with tums. in addition, pth was 277 so she was started on calcitriol. dr. followed the patient in the hospital and will follow her as an outpatient (appt scheduled for . --metabolic acidosis pt had elements of ag and non-ag metabolic acidosis. ag metabolic acidosis most likely due to uremia of arf. decreased renal hc03 production in the setting of cri +/- type iv rta the likely cause of non-ag metabolic acidosis. patient was taking hc03 as an outpatient. her dose was doubled in the hospital. during the hospitalization her hco3 increased from 15 to 18. --diabetes mellitus type 2 this patient had had dm2 for approximately 25 years and had been insulin-dependent for approx 12 years. during this hospitalization her blood sugars have been very labile (10s-400s). prior records show blood sugars labile in the past. recent hb-a1c 6.4, which is down from previous hb-a1c of 9.2 in . her outpatient dose was nph . consult changed her insulin regimen several times during the hospitalization to better control blood glucose levels. on discharge her insulin regimen was lantus 17 units qam and riss. c-peptide level and is pending. dr. , her pcp, follow her dm as an outpatient. --blood pressure the patient had a sbp in the 200s on admission, which is thought to have contributed to her pulmonary edema. during hospitalization she had bp ranging from 100-160/50-90. afterload reduction/bp control with hydralazine, isosorbide dinitrate, and labetolol. on hd6, after her creatinine decreased to 2.7, lisinopril was re-started (she is on this as an outpatient). --anemia the patient's hct was 24.3 on admission. she was transfused 1 unit prbc in the micu on hd1 and hct increased to 25.9 on hd2. on hd3 the hct was 23.9 so she received 2 units prbc on hd4 and hct increased to 31.1 on hd5. on hd6 her hct was 33.6. the patient had low iron level (12) on admission and was given supplemental iron and vitamin c. chronic renal disease and anemia of chronic disease probably contributing etiologies. pt has been treated with epo in the past and will re-institute epo (10,000 units per week) as an outpatient. --uti ua on admission suggestive of uti. the patient has a h/o levo-resistant uti. she was treated with ceftriaxone for 5 days. she has had no urinary sx. medications on admission: insulin, lisinopril labetolol lasix advair flovent folate discharge medications: 1. fluticasone propionate 110 mcg/actuation aerosol sig: four (4) puff inhalation (2 times a day). 2. labetalol hcl 200 mg tablet sig: two (2) tablet po bid (2 times a day). 3. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 4. hydralazine hcl 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 5. multivitamin capsule sig: one (1) cap po daily (daily). 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po tid (3 times a day). 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours). 11. isosorbide dinitrate 20 mg tablet sig: one (1) tablet po tid (3 times a day). 12. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po with meals (). 13. montelukast sodium 10 mg tablet sig: one (1) tablet po daily (daily). 14. albuterol sulfate 0.083 % solution sig: inhalation q6h (every 6 hours) as needed. 15. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 16. citalopram hydrobromide 20 mg tablet sig: 0.5 tablet po daily (daily). 17. ascorbic acid 500 mg tablet sig: one (1) tablet po tid (3 times a day). 18. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for fever. 19. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. 20. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 7 days. 21. insulin glargine 100 unit/ml solution sig: seventeen (17) units subcutaneous qam. 22. calcitriol 0.25 mcg capsule sig: one (1) capsule po 3x/week (mo,we,fr). 23. sodium bicarbonate 650 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 24. sodium bicarbonate 650 mg tablet sig: three (3) tablet po qam (once a day (in the morning)). 25. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). discharge disposition: extended care facility: roscommon discharge diagnosis: congestive heart failure pnuemonia uti chronic renal failure discharge condition: stable - patient respiratory status stable. patient with chronic renal failure needs to follow up with renal doctor for further managment, currently stable. discharge instructions: please continue to take medications as prescribed please make sure you follow up with dr. (kidney doctor); appointment scheduled below. please make sure you follow up with your primary care doctor next week; dr @ on chest xray it was found that you have a small pnuemonia. please continue to finish course of antibiotics as prescribes followup instructions: provider: , m.d. where: medical specialties phone: date/time: 4:30 (renal doctor) schedule appointment to see your primary care doctor next week procedure: arterial catheterization transfusion of packed cells diagnoses: pneumonia, organism unspecified nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere anemia, unspecified esophageal reflux tobacco use disorder urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin chronic pancreatitis diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to