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: atorvastatin / zestril / cephalosporins / penicillins attending: chief complaint: unresponsive, hypoxia major surgical or invasive procedure: endotracheal intubation history of present illness: 77 yo female who lives at (baseline, oriented to person and place) had a fall at . 4 hrs later found unresponsive. intubated at scene. cxr with rll collapse/infiltrate; bronch/endotracheal specmen grew mssa. also with copd exacerbation, on prednisone and vancomycin (given unknown pcn/ceph allergy). extubated last week, failed (believed copd) and re-intubated. extubated again on and now stable on 2l. post-second extubation, made dnr/dni. _______________ micu summary by dr. : hpi: 78f, h/o dm, htn, found unresponsive 4 hrs after she was put into bed after a fall, intubated on scene, now more responsive - intubated/sedated. according to notes, she fell out of bed around 2am (denied trauma to head); assessment revealed normal vitals and patient was apparently mentating appropriately. she was put back in bed. about 3 hours later, she was found by staff to be unresponsive (she had been complaining of sob--85% ra, improved with o2). vs were otherwise stable, bg was 97. ems was called, and she was intubated on the seen and brought to the ed. in the ed, she was hypertensive (220/palp), afebrile, was responsive to commands when off sedation. initial gas showed severe acidosis (7.11/111/141), potassium was increased to 6 with a creatinine of 1.8. one set of ces that were negative. ekg showed sinus brady with no obvious st/t changes. she was given 3 l ivf (was transiently hypotensive to 90s while on propofol -- this resolved off propofol and with ivf). she was found to have a positive ua and was given a dose of levofloxacin. she was given kayexalate for hyperkalemia (improvement of k to 5.3). fast scan was negative, and she had ct neck/head. ct neck was significant for ?right rp soft tissue prominence (no fracture or dislocation), and ct head was negative for acute event. she was transferred to the for further management. __________________________________________ micu course -- per notes: : bronch without mucous plug. bal with 1+gpc pairs. vanc and prednisone started. echo with preserved ef, sm-mod pericard effusion. : failed ps trial due to tachypnea/tachycardia. restarted lasix and increased lopressor. added back home clonidine. changed tfs started. proteus returned to cephalosporins/zosyn, so switched cipro to ceftriaxone : cleared c-spine clinically. on ps for several hours. uop very low, gave repeated fluid boluses. lasix d/c'd for rising creatinine. : extubated, but retained c02/somnolent and required re-intubation. lantus restarted at 1/2 home dose. : rue us - for dvt. spoke with brother re: trach, he's thinking about it but likely will pursue. increased bp meds (clonidine). diuresed with lasix x 2. : brother re: trach: no. prednisone tapered to 40. lantus increased to 30. : dnr/dni per family. plan thoracentesis tomorrow, extubation fri. : further discussion with family. no plan for trach. planned but not a large enough effusion. d/c'd antibiotics. : extubated. tolerating at time of writing. officially dnr/dni: no re-intubation planned if she worsens. past medical history: 1. status post right total knee replacement 2. dm ii, c/b neuropathy and nephropathy. 3. osteoarthritis. 4. hypertension. 5. asthma. 6. hypercholesterolemia. 7. parkinson's. 8. obesity. 9. gerd. 10. bipolar/paranoia. 11. history of falls. social history: shx: lives in an facility. no known h/o tobacco or alcohol use. family history: nc physical exam: temp 96.5 bp 171/74 hr 58 rr 18 sats 99% on 2 liter oxygen nasal canula gen: very awake, very alert, pleasant, no acute distress, cooperative patient examined sitting up in a chair heent: anicteric sclera chest: good inspiratory air movement; a bit ronchorous on expiration throughtout heart: rrr; i could not notice a murmur abd: has peg. very soft. bs+. not tender at all. is mildly distended tympanitic - notably upper of abdomen (she is sitting in chair) ext: trace pitting edema le bilaterally pulses: 2+ dp pulse bilaterally neuro: knows her full name. knows president is "." identifies all 4 family members in the room correctly. eyebrows up symmetrically tongue is midline biceps is 4+/5 bilaterally handgrip is bilaterally quads is bilaterally plantarflexion feet is bilaterally dorsiflexion feet is bilaterally sensation to light touch is intact on her face/arms/legs (she correctly identifies the body part i touched) pertinent results: 07:29pm type-art temp-38.0 rates-20/ tidal vol-400 peep-10 o2-60 po2-88 pco2-51* ph-7.37 total co2-31* base xs-2 -assist/con intubated-intubated 04:53pm type-art temp-36.6 po2-241* pco2-48* ph-7.35 total co2-28 base xs-0 intubated-intubated 04:53pm lactate-0.7 02:59pm glucose-88 urea n-36* creat-1.4* sodium-147* potassium-4.1 chloride-111* total co2-25 anion gap-15 02:59pm ck(cpk)-44 02:59pm ck-mb-4 ctropnt-0.03* 02:59pm calcium-9.3 phosphate-3.0# magnesium-2.6 02:59pm tsh-1.2 02:59pm wbc-9.4 rbc-3.76* hgb-11.2* hct-34.4* mcv-92 mch-29.9 mchc-32.7 rdw-16.7* 02:59pm pt-12.6 ptt-20.3* inr(pt)-1.1 02:59pm plt count-305 01:00pm po2-205* pco2-33* ph-7.46* total co2-24 base xs-1 comments-green top, 01:00pm k+-5.3 08:15am urine color-yellow appear-slhazy sp -1.025 08:15am urine blood-neg nitrite-pos protein->300 glucose-neg ketone-neg bilirubin-neg urobilngn-0.2 ph-8.0 leuk-mod 08:15am urine rbc-0-2 wbc->50 bacteria-many yeast-none epi-0 08:15am urine hyaline-0-2 08:15am urine 3phosphat-few 07:56am type-art tidal vol-280 po2-231* pco2-87* ph-7.16* total co2-33* base xs-0 intubated-intubated vent-controlled 06:49am rates-/16 peep-5 po2-141* pco2-111* ph-7.10* total co2-36* base xs-1 intubated-intubated comments-green top 06:49am k+-5.8* 06:45am glucose-125* urea n-42* creat-1.8* sodium-143 potassium-6.0* chloride-107 total co2-28 anion gap-14 06:45am estgfr-using this 06:45am alt(sgpt)-15 ast(sgot)-17 ld(ldh)-251* ck(cpk)-60 alk phos-106 amylase-25 tot bili-0.2 06:45am lipase-26 06:45am ck-mb-notdone ctropnt-0.02* 06:45am albumin-4.2 calcium-10.0 phosphate-5.8* magnesium-2.9* 06:45am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 06:45am wbc-9.3 rbc-3.87* hgb-11.8* hct-37.5 mcv-97 mch-30.5 mchc-31.5 rdw-16.6* 06:45am pt-12.5 ptt-22.6 inr(pt)-1.1 06:45am plt count-334 . cta chest: 1. no pulmonary embolism or acute aortic pathology. 2. right lower lobe collapse, left lower lobe partial collapse and patchy atelectasis of the aerated portions of lung. 3. small bilateral pleural effusions. 4. endotracheal tube terminates in low position 1-2 cm above the carina. 4. multiple enlarged mediastinal lymph nodes up to 12 mm are nonspecific. 5. moderate pericardial effusion. 6. emphysema. 7. 3 cm predominantly low attenuation lesion of the left hepatic lobe is incompletely characterized, but has features suggestive of a hemangioma. this could be confirmed with ultrasound. . ct c spine: 1. no evidence of acute fracture or dislocation. 2. soft tissue prominence mostly within the right retropharyngeal space and extending anterior and medial to the right carotid space. this likely represents a hematoma, possibly related to patient's traumatic injury or traumatic intubation. 3. prominent interseptal thickening within the apices, may be related to underlying failure/volume overload as suggested on chest radiograph done on same day. 4. multilevel spondylytic changes. . head ct: no intracranial hemorrhage or mass identified. . abd u/s: 2.9-cm lesion of the left hepatic lobe could represent an atypical hemangioma but is not definitively characterized by ultrasound. it does not have particularly worrisome features. if clinically indicated, it could be further characterized with mr after the patient's acute medical problems have resolved. . tte: the left atrium is normal in size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. 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. physiologic mitral regurgitation is seen (within normal limits). the left ventricular inflow pattern suggests impaired relaxation. there is a small to moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. brief hospital course: ## pulm - respiratory failure that was thought to be multifactorial (pna, copd, rll collapse, tracheomalacia, diastolic heart failure) has resolved and pt now on 2 liters of oxygen by nasal canula with sats of 99%. she is completing a 2 weeks course of vancomcycin for mssa pna. ## cards - hx of htn and is on many medications for control and still has elevated bp. has diastolic chf. initially bp meds held given instability, but then restarted. on she triggered on the floor for flash pulmonary edema with elevated bp. after giving iv lasix and better bp control her chf improved. she may need continued diuresis at nh. will need daily weights, 1500 cc fluid restriction. ## gi - has hx of peg and i am not sure why. tolerates po, apparently. of note, imaging studies found a possible hemangioma on liver. will need f/u abdominal mri per pcp as an outpatient. ## gu - cr back to normal, follow up with pcp after diuresis. ## id s/p treatment for proteus uti and also proteus pna (sputum + currently finishing abx for mssa pna. pt on vanco bc of concerns of allergies to pcn. last day will be of vanco. # endo. pt has dm with hgaic in of 10. pt with multiple cardiac risk factors so would hope to get better glucose control. currently on ss insulin. restarted pt's home lantus dose. code status: dnr/dni decision maker is her brother medications on admission: 1. novolin r sliding scale 2. toprol xl 100mg po bid 3. tylenol 500mg, one tab qid po 4. alprazolam 0.5 mg tablet po qhs 5. fleets enema 1 rectally daily prn constipation (2 hr after docolax supp if no bm) 6. bisocodyl 10 mg supp rectally daily prn constipation (give 24 hrs after mom of no bm) 7. mom 30 ml via g-tube daily prn constipation (give on 3rd day without bm) 8. alprazolam 1 mg tablet po bid prn anxiety/agitation 9. combivent inhaler 2 puffs by mouth qid prn wheezing 10. tylenol 650 mg via g-tube q 4 hr prn pain/temp >100 11. duonieb neb 0.02% qid prn congestion/sob 12. lantus 35 units sc q evening 13. neurontin 50 mg po qhs 14. isosorbide 60 mg po daily 15. norvasc 10 mg po daily 16. prilosec 20 mg po daily 17. seroquel 100 mg po daily at 4pm 18. quinine sulfate 260 mg po daily at 8pm 19. clonidine hcl 0.1 mg po q 12 hr 20. depakote 250 mg po bid 21. furosemide 40 mg po daily 22. senna 2 tablets po bid discharge medications: 1. prilosec 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 4. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 5. zinc sulfate 220 (50) mg capsule sig: one (1) capsule po daily (daily). 6. divalproex 125 mg capsule, sprinkle sig: two (2) capsule, sprinkle po bid (2 times a day). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 9. guaifenesin 600 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 10. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 11. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 12. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po bid (2 times a day). 13. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 14. insulin glargine 100 unit/ml solution sig: thirty five (35) units subcutaneous at bedtime. 15. insulin regular human 300 unit/3 ml insulin pen sig: sliding scale sliding scale subcutaneous four times a day. 16. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 17. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 18. prednisone 10 mg tablet sig: taper as directed tablet po once a day: take 3 tabs daily for 3 days, then 2 tabs daily for 3 days, then 1 tab daily for 3 days, then stop. disp:*18 tablet(s)* refills:*0* 19. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours). 20. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q2h (every 2 hours) as needed. 21. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 22. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed. 23. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) g intravenous q 24h (every 24 hours) for 3 days. disp:*3 g* refills:*0* 24. lasix 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: diastolic congestive heart failure staph pneumonia respiratory failure copd discharge condition: stable discharge instructions: continue your medications as listed. please continue a 1500 cc fluid restiction, and a low salt diet. please make sure to weigh yourself daily and call your doctor if you gain more than 3lbs. please make sure you follow up with your pcp weeks. followup instructions: 1. please follow up with dr. in weeks. please discuss having a follow up abdominal mri with him to evalaute the liver mass seen on ultrasound. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: acidosis hyperpotassemia nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere esophageal reflux urinary tract infection, site not specified acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes paralysis agitans acute respiratory failure long-term (current) use of insulin pressure ulcer, other site morbid obesity methicillin susceptible pneumonia due to staphylococcus aureus acute diastolic heart failure bipolar disorder, unspecified knee joint replacement diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled gastrostomy status other diseases of trachea and bronchus unspecified hypertensive heart disease with heart failure history of fall 

Answer: The patient is high likely exposed to