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: vancomycin / iodine; iodine containing / tape / ibuprofen / levofloxacin attending: chief complaint: cc: dyspnea pcp: outpatient cardiologist: none major surgical or invasive procedure: right sided pa catheter placement history of present illness: 54 yo f with pmh sarcoidosis, tracheostomy upper airway obstruction, dchf, dm1, pulmonary htn, cad, morbid obesity p/w abdominal pain radiating to the back and shortness of breath. given nebs/lasix 80 iv/ and 2 nitro sl. has history of cad, chf and sarcoidosis. bibems 95% on nrb. bp 210/100 with ems. she has had 3 admissions within the last 2 months for dyspnea (thought related to chf/copd) and nausea/abdominal pain likely from gastroparesis ms. was sitting at home this afternoon when she began experiencing gradual onset sob. she says she first noticed dyspnea with exertion (wheeling around apartment) about a day ago; no orthopnea/pnd. sleeps on 3 pillows for comfort. she has noticed progressive le edema since last discharge. she took a few nebs at home without relief so she called 911. ems found her ot have sao2 in mid 80's on room air; put her on blow-by. 80 iv lasix, 2 sl ntg. she also complains of nausea/vomiting and sharp epigastric intermittent pain, similar to what last brought her to the ed. she denies any chest pain or tightness, no syncope or palpitations. . initial vs in ed: t 97.3 hr 72 bp 164/74 rr 16 sao2 89% on ra; respiratory distress. she was given 80mg iv lasix & 2 ntg by ems and is negative 1.8l. she was placed on nitro drip in ed with improvement in her symptoms. cxr showed chf. past medical history: morbid obesity asthma diastolic heart failure diabetes mellitus type 1 (since age 16): neuropathy, gastroparesis, nephropathy, & retinopathy sarcodosis () tracheostomy - upper airway obstruction, sarcoid. trach changed from #6 cuffed portex to a #6 uncuffed, nonfenestrated portex arthritis - wheel chair bound neurogenic bladder with chronic foley asthma hypertension pulmonary hypertension hyperlipidemia cad s/p cabg (svg to om1 and om2, and lima to lad) last c. cath : widely patent vein grafts to the om1 and om2, widely patent lima to lad (distal 40% anastomosis lesion). chronic low back pain-disc disease s/p cholecystectomy s/p appendectomy history of sternotomy, status post osteomyelitis in . leukocytoclastic vasculitis vancomycin in . history of pneumothorax in . colon resection, status post perforation. j-tube placement in . social history: the patient formerly lived alone and has a female partner for 25 years that visits frequently and is her hcp. she had been living in rehab recently, but most recently discharged home w/o services. the patient is mobile with scooter or wheelchair and can walk short distances. remote smoking history <1 pack per day >30 years ago, denies etoh or drug use. family history: father: , diabetes & mi in 60s mother's side: family history of various cancers & heart disease physical exam: on admission - t af hr 80 bp 158/72 rr 18 sao2 97% on 50% general: obese, tachypnic, not speaking in full sentences heent: normocephalic, atraumatic. left pupil 3mm, right pupil 2mm both reactive to light, eomi, dry mucous membranes neck: obese, supple, no lad, unable to appreciate jvp cardiac: regular rhythm, no appreciable murmur; heart sounds distant lungs: decreased breath sounds at the bases, few basilar crackles; difficult to tell given body habitus abdomen: obese, slightly distended but soft, umbilical hernia with, positive bowel sounds, no rebound or gurding. extremities: 2+ pitting edema to the knees bilaterally, trace dp's bilaterally, cool extremities. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant . pertinent results: admission labs: 09:24pm blood wbc-12.6* rbc-4.04* hgb-11.9* hct-35.5* mcv-88 mch-29.6 mchc-33.6 rdw-14.9 plt ct-114* 09:24pm blood neuts-88.8* lymphs-6.4* monos-2.1 eos-2.5 baso-0.2 08:40pm blood glucose-109* urean-34* creat-1.0 na-129* k-4.8 cl-93* hco3-24 angap-17 09:45pm blood calcium-9.3 phos-3.3 mg-1.6 05:57am blood alt-81* ast-58* ld(ldh)-257* ck(cpk)-63 alkphos-200* totbili-0.5 . cardiac enzymes: 08:40pm blood ck-mb-notdone ctropnt-<0.01 probnp-* 09:45pm blood ctropnt-<0.01 09:45pm blood ck-mb-notdone probnp-2185* 08:40pm blood ck(cpk)-87 01:26am blood ck(cpk)-42 . upright ap view of the chest: the patient is status post tracheostomy, with the tube tip in satisfactory position approximately 4.5 cm from the carina. bilateral hazy opacities are seen with increased vascular markings and vascular indistinctness, compatible with pulmonary edema. cardiac silhouette is difficult to assess, but appears at least mildly enlarged. the right costophrenic angle is excluded from view. there is likely at least small bilateral pleural effusions. no pneumothorax. clips are seen projecting over the left superior mediastinum. elevation of the right hemidiaphragm is seen. impression: findings compatible with moderate pulmonary edema and probable small bilateral pleural effusions. the right costophrenic angle is excluded from the study. ct torso 1. mild dilation of ileal small bowel loops with transition point near an umbilical hernia represents at least partial small-bowel obstruction. early complete obstruction is a less likely possibility. 2. stable extensive coronary artery atherosclerotic calcification and post cabg changes. 3. pulmonary artery enlargement suggestive of pulmonary artery hypertension is unchanged since . 4. no evidence of pneumonia. echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. there is no aortic valve stenosis. no aortic regurgitation is seen. trivial mitral regurgitation is seen. there is no pericardial effusion. . ekg: nsr at 88. borderline left axis. normal intervals. q in iii. poor rwp and low voltages. . cardiac cath comments: 1. resting hemodynamics demonstrated marked biventricular diastolic dysfunciton, with a mean pcwp of 45 mmhg and an rvedp of 32 mmhg. there was severe elevation of the pa pressures, with a mean pap of 80 mmhg. final diagnosis: 1. severe biventricular diastolic dysfunction. 2. severe pulmonary hypertension. brief hospital course: ms. is a 54 yo woman with morbid obesity, dm1 with numerous complications, diastolic chf, pulmonary hypertension, sarcoid s/p trach for upper airway obstruction who presents from home with dyspnea # dyspnea/diastolic heart failure: ms. had complicated respiratory issues with many admissions for dyspnea felt to be from multifactory causes: diastolic chf, reactive airways, pulmonary hypertension. her current presentation and cxr seem consistent with chf exacerbation likely related to hypertension and underdiuresis given progressive le edema. she was referred for right heart cath with mean pcwp of 45, pa systolic of 110 with pa diastolic 50. a pa catheter was placed and aggressive diuresis was initiated. diuresis was limited by several episodes of hypotension requiring pressors, she appeared to be very sensitive to quick volume shifts without time for intravascular/extravascular equilibration. it was felt that she needed slow gentle diuresis over prolonged period of time to prevent hyptensive insults and she was set up wit heart failure vna for outpatient lasix titration and referred to see dr. in heart failure clinic. . # coronary artery disease: s/p cabg (svg to om1 and om2, and lima to lad)in : all grafts widely patent. she was continued on aspirin, beta blocker & statin . # abdominal pain, nausea/vominting: patient had these symptosm for one day prior to admission that were thought c/w gastroparesis. she was continued on reglan with reoslution of her symptoms on hospital day #1. . # hypertension: hypertensive on admission although it was unclear if this was a response to respiratory distress or the inciting event. her losartan & metoprolol were uptitrated as tolerated. patient then had several episodes of hypotension erquiring pressor support that was temporally related to diuresis. her blood pressure seemed to be very sensitive to volume shifts liekly due to diastolic dysfunction for long-standing hypertension. . # asthma: unclear dx. fev1/fvc ratio's preserved in pfts. she was continued on home regimen of advair + nebs. not thought that bronchospasm was contributing significantly to this presentation . # type i diabetes: long-standing history with numerous complications including neurogenic bladder, cad, neuropathy, nephropathy, retinopathy. she was continued on basal lantus insulin with sliding scale with good overall control medications on admission: 1. losartan 25 mg po saily 2. citalopram 20 mg po daily 3. furosemide 40 mg po daily 4. multivitamin po daily 5. calcium carbonate 500 mg po tid 6. simvastatin 10 mg po daily 7. metoprolol tartrate 50 mg po bid 8. gabapentin 300 mg po bid 9. ipratropium bromide qid 10. fluticasone 110 mcg/actuation 11. miconazole nitrate 2 % tid 12. docusate sodium 50 mg/5 ml 13. lansoprazole 30 mg po daily 14. metoclopramide 20 mg po bid 15. metoclopramide 10 mg po bid 16. aspirin 81 mg po daily 17. hydrocodone-acetaminophen 5-500 mg q 8 hrs prn 18. clopidogrel 75 mg po daily 19. slow-mag 64 mg po twice a day. 20. benztropine 1 mg po tid 21. psyllium tid prn 22. lorazepam 1 mg po qhs 23. heparin tid. 24. albuterol q 6 hrs 25. acetylcysteine 20 % (200 mg/ml) solution : five (5) ml miscellaneous every six (6) hours as needed for secretions. 26. insulin 27. nystatin powder discharge medications: 1. losartan 50 mg tablet : one (1) tablet po daily (daily). 2. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 3. citalopram 20 mg tablet : one (1) tablet po daily (daily). 4. multivitamin tablet : one (1) tablet po daily (daily). 5. furosemide 40 mg tablet : one (1) tablet po daily (daily). 6. calcium citrate 200 mg (950 mg) tablet : two (2) tablet po three times a day. 7. vitamin d 1,000 unit tablet : one (1) tablet po once a day. 8. simvastatin 10 mg tablet : one (1) tablet po daily (daily). 9. gabapentin 300 mg capsule : one (1) capsule po bid (2 times a day). 10. ipratropium bromide 0.02 % solution : one (1) vial vial inhalation q6h (every 6 hours). 11. reglan 10 mg tablet : three (3) tablet po twice a day. 12. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 13. benztropine 1 mg tablet : one (1) tablet po tid (3 times a day). 14. heparin (porcine) 5,000 unit/ml solution : one (1) cc injection tid (3 times a day). 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) vial inhalation q6h (every 6 hours) as needed for dyspnea. 16. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 17. magnesium chloride 64 mg tablet sustained release : one (1) tablet sustained release po twice a day. 18. docusate sodium 100 mg capsule : two (2) capsule po bid (2 times a day). 19. lactulose 10 gram/15 ml syrup : thirty (30) ml po twice a day as needed for constipation. 20. miconazole nitrate 2 % powder : one (1) appl topical (2 times a day). 21. hydrocodone-acetaminophen 5-500 mg tablet : 1-2 tablets po every eight (8) hours as needed for headache. 22. psyllium packet : one (1) packet po tid (3 times a day) as needed for constipation. 23. sodium chloride 0.9 % 0.9 % syringe : three (3) ml injection once a day as needed for line flush. 24. fluticasone-salmeterol 250-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 25. lorazepam 1 mg tablet : 1-2 tablets po three times a day as needed for anxiety. 26. insulin glargine 100 unit/ml solution : fifty eight (58) units subcutaneous at bedtime. 27. humalog 100 unit/ml solution : per sliding scale attached units subcutaneous four times a day: before meals and hs. discharge disposition: extended care facility: radius specialty- discharge diagnosis: acute on chronic diastolic heart failure discharge condition: good. hemodynamically stable and afebrile discharge instructions: you had trouble breathing at home and required intravenous furosemide to weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: an appointment was made for you with dr. in the heart failure clinic on at 9am. his office is located on the of the clinical center, at . . primary care: , md phone: please make an appt to see when you are out of healthcare. rheumatology: provider: , md phone: date/time: 1:30 cardiology: provider: , md phone: date/time: 1:40 . provider: , rn, cs phone: date/time: 12:00 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified right heart cardiac catheterization diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute on chronic diastolic heart failure asthma, unspecified type, unspecified polyneuropathy in diabetes sarcoidosis hypotension, unspecified long-term (current) use of insulin primary pulmonary hypertension morbid obesity diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled neurogenic bladder nos 

Answer: The patient is high likely exposed to