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: found unresponsive major surgical or invasive procedure: trach placement trach decannulation history of present illness: ms. is a 66 year old female with multiple medical problems, including copd (6l home o2), squamous cell laryngeal cancer (s/p resection, xrt, and trach), large cell lymphoma, tracheobronchomalacia, squamous cell lung ca, and hepatitis c who was in her usual state of health until about a week ago when she developed the onset of progressive dyspnea. she was using her albuterol and mucomyst more frequently and also had been suctioning tannish sputum. she denied fevers or chills, nausea or vomitting. . on day of admission, she was in her bathroom heading out to her chair when she became unconscious, falling to the floor. her roommate heard the crash and called 911. she was found unresponsive, cyanotic, and diaphoretic. she became responsive during nebulizer treatment. she is unable to recall this period until she awoke in the ed. . at the ed, she was cultured and started on methylprednisolone 125 mg, and levaquin 500 mg. combivent was administered x 3. her trachea stoma was accessed with a 6.0 trach and she was started mechanically ventilated. her initial ph was 7.2 with a pco2 of 66. past medical history: 1. severe copd on home o2. 2. squamous cell laryngeal cancer status post resection in , xrt to neck. patient is tracheostomy dependent. 3. large-cell lymphoma status post chop x5 cycles in . 4. tracheobronchomalacia requiring periodic stenting, the last stent to the trachea and bronchus, multiple months ago. 5. history of tracheoesophageal fistula. 6. history of pseudomonal pneumonia. 7. esophageal stricture status post dilation in . 8. squamous cell carcinoma of right lower lobe status post wedge resection . 9. history of endocarditis secondary to iv drug use. 10. hepatitis c positive. 11. chronic renal insufficiency (baseline creatinine 1.4-1.6) social history: history of heavy tobacco use. denies alcohol history of iv drug use. lives in apartment with a roomate. on disability family history: mother with ca father died of prostate ca brother with asthma sister with aids physical exam: physical exam: vs: bp=131/55; hr=85; rr=16; 02=94% (fio2 60%) gen: elderly female, lying in bed, nad heent: eomi, dry mm, edentulous, op clear neck: trach in place cv: rrr, normal s1s2, no m/r/g appreciated resp: no accessory muscle use. not tachypneic. + crackles bilaterally (r>l); diffuse wheezes. abd: normo active bs, non-tender, no rebound, non-distended ext: trace edema in lower ext bilaterally; no cyanosis/clubbing, dp/pt not palpable but dopplerable. left anterior aspect of tibia with 1.5 cm ulcer with clean base. skin: changes of venous stasis on lower extremities bilaterally neuro: cn ii-xii intact bilaterally; strength 5/5 upper and lower extremities bilaterally, decreased sensation bilaterally in hands and feet pertinent results: 09:07pm potassium-4.4 09:07pm magnesium-2.1 11:25am ck(cpk)-183* 11:25am ck-mb-8 ctropnt-0.01 11:25am wbc-4.2 rbc-3.50* hgb-10.5* hct-29.9* mcv-86 mch-30.0 mchc-35.0 rdw-14.9 11:25am plt count-190 05:44am type-art rates-16/ tidal vol-500 peep-5 o2-40 po2-67* pco2-55* ph-7.35 total co2-32* base xs-2 intubated-intubated vent-controlled 05:44am lactate-1.2 05:11am glucose-196* urea n-28* creat-1.3* sodium-138 potassium-4.5 chloride-101 total co2-26 anion gap-16 05:11am ck(cpk)-155* 05:11am ck-mb-7 ctropnt-0.04* 05:11am calcium-8.4 phosphate-3.8 magnesium-2.1 05:11am wbc-5.7 rbc-3.58* hgb-10.2* hct-31.2* mcv-87 mch-28.6 mchc-32.8 rdw-14.8 05:11am plt count-170 12:29am type-art temp-37.2 po2-470* pco2-66* ph-7.20* total co2-27 base xs--3 intubated-intubated 12:29am glucose-288* lactate-4.2* na+-140 k+-5.0 cl--100 12:29am freeca-1.15 12:03am lactate-6.4* 12:02am glucose-311* urea n-29* creat-1.6* sodium-137 potassium-5.0 chloride-98 total co2-22 anion gap-22* 12:02am ck(cpk)-150* 12:02am ck-mb-5 ctropnt-<0.01 12:02am iron-37 12:02am caltibc-321 vit b12-420 folate-7.4 ferritin-83 trf-247 12:02am wbc-9.2# rbc-3.82* hgb-11.1* hct-35.2* mcv-92 mch-29.0 mchc-31.4 rdw-14.8 12:02am neuts-53.0 lymphs-41.8 monos-2.4 eos-2.6 basos-0.2 12:02am hypochrom-3+ 12:02am plt count-260 12:02am plt count-260 12:02am pt-13.4* ptt-26.6 inr(pt)-1.2* tte: the left atrium is normal in size. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. ecg: sinus tachycardia. since the previous tracing of the rate is more rapid. the electrocardiogram is otherwise, normal and unchanged. intervals axes rate pr qrs qt/qtc p qrs t 116 168 86 338/407 71 48 36 leni: -scale and doppler son of the bilateral common femoral, superficial femoral, and popliteal veins were performed. these show normal compressibility, augmentation, and doppler flow and waveforms. no intraluminal thrombus is identified. impression: no evidence of deep vein thrombosis. ap portable upright view of the chest: there is a metallic tracheostomy tube. left and right main stem bronchus stents are seen. there are bilateral lower lobe opacities there are bilateral interstitial opacities with perihilar fullness. no evidence of pneumothorax. mediastinal contour is stable. impression: perihilar fullness and interstitial opacities consistent with volume overload/chf pattern. bilateral lower lobe opacities are also present and superimposed infectious process cannot be excluded. brief hospital course: ms. is a 68 y.o. woman with unwitnessed loss of consciousness and evidence of ?pna vs. chf on cxr. * syncopal event: the patient's loss of consciousness was attributed to a hypoxic event from a mucus plug. her cardiac enzymes were negative x 3. leni's were negative making pe less likely. no v/q was done because her cxr was poor quality because of the finding of consolidation vs atelectasis. cta was not obtained because the patient has renal failure and pe was not high on the differential. echo showed preserved ef and no wall abnormalities, making a cardiac process unlikely as etiology for the event. her telemetry showed no events that might have indicated a rhythm abnormality. when the patient was transferred to the medicine service, her course was complicated by a 38 beat run of nsvt. ep was consulted and they felt that this was artifact. * respiratory failure: at home, the patient is on 6l of 02 at baseline. her failure was thought to be secondary to aspiration vs. mucus plug in setting of increased secretions likely pna. her trach was changed to an 8 . she has no teeth so less likely to have anaerobes. she also is at risk of post obstructive pna as she's had lung ca and had bronchial stents placed. leni's were negative for dvt making pe less likely. she was treated with levofloxacin. her mucomyst was continued although the patient needs to be educated about reducing the amount of mucomyst she uses given that it can cause bronchospasm. she was gently diuresed as some of her cxr findings and exam were consistent with chf. her respiratory status improved with all these measures and she was feeling markedly better on hospital day 2. * copd: the patient had wheezes on exam and evidence of infection. albuterol and ipratropium nebs were administered. she was also started on methylprednisolone 125 q6, which was transitioned to prednisone taper. * h/o tracheobronchomalacia: pt was scheduled to have an outpt bronchoscopy with dr. today (mon ) for routine followup of stents. instead, the patient was bronched while in house with samples sent for culture. * hypothyroidism: the levothyroxine was continued * hyperglycemia: as the patient was on steroids, her high sugars were attributed to the excess glucocorticoids. she was covered with humalog sliding scale. * pain control: continued on ms contin and percocet for home pain control. * depression: continued on zoloft. * uti: the patient was discharged on levaquin for uti. on the day of discharge the patient's urine culture came back positive e.coli resistant to levaquin. the patient's pcp was and the final micro senstivities report was faxed to her office. after speaking to the pcp she said that she would call in another precription. the patient was also at home about the change in antibiotics. * renal insufficiency: now at baseline cr around 1.5. - renally dose meds. * anemia: pt has low hct at baseline likely due to anemia of chronic disease. her normal range is 27-30. she have been hemoconcentrated. iron studies did not show iron, b12, or folate deficiency * dispo: the patient was discharged home with close follow up. medications on admission: .tolterodine tartrate 2 mg qd 2. sertraline hcl 200 mg po qd 3. pantoprazole sodium 40 mg tablet po q24h 4. morphine sulfate 100 mg tablet sr po q12h 5. oxycodone-acetaminophen 1-2 tablets po q4-6h prn 6. acetylcysteine 20 % 1-2 mls q4-6h prn 7. docusate sodium 100 mg po bid 8. senna 8.6 mg prn 9. fluticasone propionate 110 mcg 10. albuterol 90 mcg2 qid 11. ipratropium bromide 2 puffs qid 12. levothyroxine sodium 200 mcg qd * allergies: nkda discharge medications: 1. acetylcysteine 20 % (200 mg/ml) solution sig: 6-10 mls miscell. q4-6h (every 4 to 6 hours) as needed. disp:*500 ml(s)* refills:*1* 2. albuterol sulfate 0.083 % solution sig: vials inhalation four times a day as needed for shortness of breath or wheezing. disp:*qs vials* refills:*3* 3. famotidine 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 4. capsaicin 0.025 % cream sig: one (1) appl topical tid (3 times a day). disp:*qs tubes* refills:*2* 5. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. morphine 100 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours). disp:*60 tablet sustained release(s)* refills:*0* 7. alprazolam 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed. disp:*30 tablet(s)* refills:*0* 8. prednisone 10 mg tablet sig: one (1) tablet po once () for 1 days. disp:*1 tablet(s)* refills:*0* 9. prednisone 20 mg tablet sig: one (1) tablet po once () for 1 days. disp:*1 tablet(s)* refills:*0* 10. prednisone 10 mg tablet sig: one (1) tablet po once () for 1 days. disp:*1 tablet(s)* refills:*0* 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 12. detrol la 2 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. disp:*30 capsule, sust. release 24hr(s)* refills:*2* 13. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*qs device* refills:*2* 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 15. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 16. sertraline 100 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 17. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*30 tablet(s)* refills:*2* 18. duoneb 2.5-0.5 mg/3 ml solution sig: three (3) ml inhalation q6: prn. disp:*qs ampules/ solution* refills:*2* 19. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 6 days. disp:*6 tablet(s)* refills:*0* 20. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. disp:*qs inhaler* refills:*0* 21. portable nebulizer please provide patient with portable nebulizer machine 22. humidifed oxygen please provide patient with humidified oxygen. discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis hypoxic respiratory failure secondary to mucus plug . secondary diagnosis 1. severe copd on home o2. 2. squamous cell laryngeal cancer status post resection in , xrt to neck. patient is tracheostomy dependent. 3. large-cell lymphoma status post chop x5 cycles in . 4. tracheobronchomalacia requiring periodic stenting, the last stent to the trachea and bronchus, multiple months ago. 5. history of tracheoesophageal fistula. 6. history of pseudomonal pneumonia. 7. esophageal stricture status post dilation in . 8. squamous cell carcinoma of right lower lobe status post wedge resection . 9. history of endocarditis secondary to iv drug use. 10. hepatitis c positive. 11. chronic renal insufficiency (baseline creatinine 1.4-1.6) discharge condition: good, vitals stable discharge instructions: please seek medical services immediately if you should have any chest pain, shortness of breath, fevers, chills or any other worrisome symptom. . please take your medications as prescribed. . please keep all follow up appointments. . your are being discharged on a prednisone taper. 30mg 20mg 10mg then stop followup instructions: dr. at 3pm please follow up with your primary care physician 1 week of discharge md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours bronchoscopy through artificial stoma diagnoses: unspecified viral hepatitis c without hepatic coma personal history of malignant neoplasm of bronchus and lung obstructive chronic bronchitis with (acute) exacerbation chronic kidney disease, unspecified acute respiratory failure reticulosarcoma, unspecified site, extranodal and solid organ sites other tracheostomy complications personal history of malignant neoplasm of larynx 

Answer: The patient is high likely exposed to