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: amoxicillin / nortriptyline attending: chief complaint: "respiratory distress / chf exacerbation." major surgical or invasive procedure: intubation and mechanical ventilation placement of right internal jugular cvl history of present illness: ms is a 64yof with h/o chf, dm2, cad, history of morbid obesity, obstructive sleep apnea on cpap, diastolic heart failure, copd, obesity hyperventilation syndrome, and smoking, who presents with respiratory distress after stopping her lasix 2 weeks ago. she is hypoxic at baseline (noted to be 80% on room air at recent pulmonology clinic), and is supposed to be on home o2, but continues to smoke so not getting it. . in the ed with gross fluid overload and cardiomegaly, no large pericardial effusion seen on bedside ultrasound. lle superinfected chronic ulcer. she was intermittently obtunded and then progressively become more obtunded, did not tolerate cpap, per hcp full code and was intubated. 40mg lasix iv x 1, with not much out. ekg with pvc's and pac's. now has rij in place, ? air trapping as well with agitation, higher pip pressures. et pulled back. was on levophed 0.06 with bp's 129/33, 59, etco2 51 to 52, ac fio2 14x500, peep 5, satting 100%. vanc/flagyl for lle cellulitis, on fent/midaz for sedation. . on the floor, pt is intubated and sedated. she is on fio2 100%, with o2 sat 100%. levophed is at 0.06 and map is 105. she is unresponsive to voice and pain stimuli. past medical history: morbid obesity cad osa on cpap ohs chf diastolic (ef 55% in ). bnp during last chf exacerbation 23,000 afib copd - last fev1 31% predicted dm type 2 htn h/o intubations for respiratory failure -- last polysubstance abuse - currently smoking alcoholism ugib depression migraines gallstones s/p hysterectomy macrocytosis social history: history of smoking, etoh, marijuana and cocaine. denies currently. lives at . still smoking per omr notes family history: dm, htn. physical exam: admission vitals: t: 98.9f bp: 145/98 p:59 r:15 o2: 100% on fio2 100% general: intubated, sedated, obese female heent: sclera anicteric, mmm, pupils 2mm, equal, round, reactive neck: supple, jvp hard to assess cvl, no lad. right cvl in place. lungs: crackles in lateral fields, mild expiratory wheeze on left lateral side cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, prominent umbilical hernia gu: foley in place ext: warm, well perfused, weak pulses, 3+ edema in lle, 2+ in rle, chronic venous ulcers in b/i les discharge weigth 280 i/o in last 24 hours-1380/4200 bp-120/65 (had some lows-sbp 100's) hr-50-70 was 92% on ra gen-aaox3 in nad heent- cn 2-12 grossly intact, no jvp detected cv-rrr, no rmg lungs-mid to end expiratory wheeze, distant bs, no significant crackles abdomen-obese, not ttp, active bs extremities-mild ble edema-1+, lle has chronic venous stasis changes 1x1 cm ulcer that has clean borders, rle has multiple 2x2 cm areas of denuded skin, pulses 1+ and equal, extremities are warm neuro-able to ambulate with walker, cn, strength, sensation equal and intact pertinent results: admission 01:30pm blood wbc-6.3 rbc-4.93 hgb-12.2 hct-42.5 mcv-86# mch-24.8*# mchc-28.7*# rdw-19.0* plt ct-200 01:30pm blood pt-13.5* ptt-33.1 inr(pt)-1.2* 01:30pm blood glucose-108* urean-32* creat-1.2* na-134 k-9.2* cl-100 hco3-29 angap-14 02:59am blood alt-10 ast-16 alkphos-97 totbili-0.6 02:59am blood albumin-3.5 calcium-8.9 phos-3.0 mg-1.6 01:42pm blood type- po2-44* pco2-67* ph-7.29* caltco2-34* base xs-2 01:42pm blood glucose-99 lactate-1.3 k-4.6 discharge cbc within normal limits bg 221, bicarb 34 and electrolytes were wnl imaging: cxr : single ap upright portable view of the chest was obtained. there are relatively low lung volumes. mild elevation of the right hemidiaphragm is unchanged. there has been interval removal of endotracheal and nasogastric tubes. there is pulmonary vascular congestion. no large pleural effusions are seen, although a trace effusion on the left would be difficult to exclude. no pneumothorax is seen. the cardiac silhouette remains enlarged. impression: pulmonary vascular congestion with persistent enlargement of the cardiac silhouette. no large pleural effusion is seen, although a small left pleural effusion would be difficult to exclude. 07:30am blood wbc-5.7 rbc-5.07 hgb-13.2 hct-42.4 mcv-84 mch-26.0* mchc-31.0 rdw-21.1* plt ct-402 07:30am blood wbc-5.7 rbc-5.07 hgb-13.2 hct-42.4 mcv-84 mch-26.0* mchc-31.0 rdw-21.1* plt ct-402 brief hospital course: 64 year old female with h/o diastolic left-sided chf, right heart failure, pulmonary hypertension, dm2, cad, morbid obesity, obstructive sleep apnea on cpap, copd, obesity hypoventilation syndrome, and active smoking, who presented with respiratory failure secondary to acute on chronic diastolic heart failure in the setting of stopping lasix. she was initially intubated in the medical icu and subsequently diuresed aggressively on the medical floor. her course was c/b providencii pna for which she completed a course of ceftriaxone while in the hospital. her hospital course is further summarized by major issues below. . # acute on chronic diastolic chf (ef 55% in ) complicated by right heart failure: home regimen includes on acei, furosemide, spironolactone, metoprolol. all home meds held in acute setting while sedated and with borderline pressures. they were all restarted on the medical floor and titrated back to her home doses. we estimate that during this admission, she was diuresed approximately 20 liters net. weight at the time of discharge was 280. the patient was re-started on 40 po qd of lasix which was her prior dose # providenci stuartii pna: -associated gram-negative rod. completed course while in the hospital of ceftriaxone, started , ended . # chronic venous stasis ulcer with possible surrounding cellulitis: improved with wound routine wound care and diuresis. received antibiotics for this in the ed, but these skin changes seem to be chronic. . chronic problems: -osa/ohs: supposed to be on cpap at home but non-compliant. modafinil and triazolom held in micu and not restarted on the medical floor. -dm: on metformin at home. received ssi while here. need to be on glipizide which she was reportedly on in the past -cad: unclear why she is on plavix monotherapy, but this was continued. should address potential need for a statin with her pcp. changed omeprazole to protonix due to interaction with plavix -afib: not anticoagulated as an outpatient despite chads score of 3. in sinus during most of this admission. -depression: fluoxeteine and abilify. -copd: started patient on fluticazone and continued spiriva as well as nebulizers and breakthrough inhalers. confirmed this regimen with outpatient pharmacy and discontinued symbicort and trospium. -patient is a danger to herself and others smoking while on oxygen. her facility has deemed her not a candidate for oxygen due to this. she was desaturating to the mid to low 80's while here. in the short term, i encouraged her to quit smoking and only do mild to moderate activity. long term, she should ideally quit smoking and be on oxygen but is scheduled to follow up with pulmonary -due to this limit in ambulation, continued her on sc heparin for now . goals of care: has a hcp. full code. seen by palliative care while here with no major changes in her stated goals. medications on admission: albuterol sulfate - 2.5 mg/3 ml (0.083 %) solution for nebulization - 1 neb inhaled every six (6) hours as needed for shortness of breath or wheezing albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs every six (6) hours as needed for shortness of breath or wheezing ammonium lactate - 12 % cream - apply to affected area once a day aripiprazole - 10 mg tablet - tablet(s) by mouth once a day clopidogrel - 75 mg tablet - 1 tablet(s) by mouth once a day commode over toilet - - use as directed as needed estradiol - 0.01 % cream - 1 gram per vagina at bedtime twice weekly ( 2 times a week) - no substitution fluoxetine - 20 mg capsule - 1 capsule(s) by mouth once a day furosemide - 20 mg tablet - 2 tablet(s) by mouth once a day take 40mg (2 tablets) in morning ibuprofen - 400 mg tablet - 1 tablet(s) by mouth three times a day as needed for pain isosorbide mononitrate - 120 mg tablet extended release 24 hr - 1 tablet(s) by mouth once a day lisinopril - 30 mg tablet - 1 tablet(s) by mouth once a day metformin - 500 mg tablet - 1 tablet(s) by mouth twice a day metoprolol tartrate - 25 mg tablet - 1 tablet(s) by mouth twice a day modafinil - 200 mg tablet - one tablet(s) by mouth daily every morning omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day spironolactone - 25 mg tablet - 1 tablet(s) by mouth once a day triazolam - 0.25 mg tablet - 1 tablet(s) by mouth at the hour of sleep as needed for insomnia use only with cpap machine trospium - 60 mg capsule, ext release 24 hr - 1 capsule(s) by mouth once a day take on an empty stomach, hour before breakfast tub chair - - use as directed as needed medications - otc diaper,brief, adult,disposable - misc - use as needed once a day multivitamin - tablet - 1 tablet(s) by mouth once a day nicotine (polacrilex) - 4 mg gum - use as directed every hour as needed for smoking cessation chew for 20 seconds, then park in mouth. use as directed. sennosides - 8.6 mg capsule - 1 capsule(s) by mouth twice a day as needed for constipation thiamine hcl - 100 mg tablet - 1 tablet(s) by mouth once a day weigh scale - misc - use once a day once a day discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): to be continued until pt is sufficiently mobile. 2. aripiprazole 5 mg tablet sig: one (1) tablet po once a day. 3. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours). 5. estrace 0.01 % (0.1 mg/g) cream sig: one (1) vaginal twice a day. 6. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours). 7. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. 8. isosorbide mononitrate 60 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 9. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 10. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 11. metformin 500 mg tablet sig: one (1) tablet po twice a day. 12. albuterol sulfate 2.5 mg/0.5 ml solution for nebulization sig: one (1) inhalation every six (6) hours. 13. plavix 75 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*90 tablet(s)* refills:*2* 15. ibuprofen 400 mg tablet sig: one (1) tablet po three times a day as needed for pain. 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 17. pantoprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 18. multivitamin capsule sig: one (1) capsule po once a day. 19. nicotine (polacrilex) 4 mg gum sig: one (1) piece buccal every four (4) hours as needed for smoking cessation: please use for smoking cessation. 20. thiamine mononitrate 100 mg tablet sig: one (1) tablet po once a day. 21. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for rash: please apply to intertiginous areas with rash if needed. 22. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*30 30* refills:*2* 23. outpatient lab work please draw a complete metabolic panel in days and fax to pcp: , (t) 24. senna 8.6 mg tablet sig: one (1) tablet po twice a day. 25. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. discharge disposition: home with service facility: vna discharge diagnosis: acute on chronic diastolic and systolic congestive heart failure -ventricular congestive heart failure pulmonary hypertension pneumonia, providenci stuartii (gram negative rod) copd obstructive sleep apnea medication non-compliance discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted to the medical icu through the emergency department for respiratory failure which required intubation. we suspect that this was mostly due to an exacerbation of congestive heart failure caused by your discontinuation of lasix two weeks ago. you also had a pneumonia for which you completed a course of antibiotics while you were in the hospital. to prevent this from happening again, you absolutely must take lasix regularly. if for some reason you are unable to do so, you should discuss it promptly with your physicians. when you do not take lasix, fluid accumulates in your legs and lungs. during this admission we removed approximately 20 liter ( gallons) of fluid from your body. it is very important that you not smoke while using oxygen at home--this could lead to a lethal explosion and is dangerous not only for you, but also the people around you. medication changes::: -continue on lasix 40 po qd-please take everyday -discontinue provigil and triazolam -start fluticasone 110 inh -stop sybicort -cont spiriva, stop trospium -pantoprazole 20 po qd and discontinue omeprazole 20 po qd -take half of your normal dose of imdur-please take 60 mg po qd (old dose was 120 po qd) -metoprolol 25 po bid followup instructions: name: , location: address: 545a centre st, , phone: *your primary care physician or nurse will follow up with you at home within 72 hours. department: medical specialties-sleep medicine when: thursday at 3:30 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage *you have been placed on a cancellation list. the office will contact you at home with the appointment information if one becomes available. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases depressive disorder, not elsewhere classified acute respiratory failure cellulitis and abscess of leg, except foot morbid obesity calculus of gallbladder without mention of cholecystitis, without mention of obstruction personal history of noncompliance with medical treatment, presenting hazards to health do not resuscitate status hyperosmolality and/or hypernatremia migraine, unspecified, without mention of intractable migraine without mention of status migrainosus personal history of alcoholism ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified unspecified sinusitis (chronic) acute on chronic combined systolic and diastolic heart failure other dependence on machines, supplemental oxygen obesity hypoventilation syndrome body mass index 45.0-49.9, adult 

Answer: The patient is high likely exposed to