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: history of present illness: this is a 62-year-old woman with a history of chronic obstructive pulmonary disease (two intubations, baseline 4 liters of oxygen, steroids), hypertension, who presents with increasing shortness of breath on the morning of admission. no chest pain, no fever or chills. positive nonproductive cough for two to three days. no nausea or vomiting, no abdominal pain, no relief with her inhalers. with ems, the patient was speaking in two to three-word sentences, oxygen saturations 90% on 4 liters, respiratory rate 28 to 30, received two nebulizers en route. in the emergency department, the patient was diaphoretic, with increased work of breathing. temperature 99.3, blood pressure 170/65, heart rate 106, respiratory rate 15, oxygen saturation 90% on 4 liters. arterial blood gas: 7.19/119/85/47. given solu-medrol 125 mg intravenously. placed on cpap with settings of %. peripheral oxygen saturations 96%. repeat arterial blood gas: 7.30/83/56/43. changed to 5 liters nasal cannula. chest x-ray shows questionable right lower lobe infiltrate superimposed upon long-term right lower lobe opacity with question of scarring. one dose of ceftriaxone and levaquin given. upon examination, the patient states breathing better, but still with shortness of breath. denies any chest pain. no abdominal pain. past medical history: 1. chronic obstructive pulmonary disease with last fev-1 15%. intubated x 2, last six months ago after pneumonia. baseline 4 liters of oxygen at home. baseline bicarbonate 39, and pco2 60 to 70. 2. diverticulosis status post colectomy with colostomy bag 3. status post appendectomy and cholecystectomy 4. noninsulin dependent diabetes secondary to steroid use 5. question of mat 6. hypertension allergies: percocet causes gastrointestinal upset. medications: 1. prednisone 20 mg once daily 2. atrovent four puffs four times a day 3. advair one puff twice a day 4. ventolin two puffs four times a day as needed 5. flonase one puff once daily as needed 6. theophylline 400 mg once daily 7. norvasc 10 mg once daily 8. diamox 125 mg once daily 9. enteric-coated aspirin 325 mg once daily 10. digoxin 0.25 alternating with 0.125 each once daily 11. lipitor 10 mg once daily 12. prinivil 15 mg once daily 13. protonix 40 mg once daily 14. paxil 10 mg once daily 15. glipizide 2.5 mg once daily 16. fosamax 70 mg every monday 17. os-cal 500 mg twice a day 18. magnesium 400 once daily 19. potassium chloride 10 mg twice a day 20. ativan 0.25 mg as needed 21. darvocet 100 mg as needed 22. remeron 7.5 daily at bedtime 23. multivitamin 24. vitamin c primary care physician: , .d. social history: 80 pack year history, quit one and a half years ago. denies currently using tobacco. lives with her daughter. physical examination: vital signs: temperature 99.3, heart rate 113, blood pressure 144/57, respiratory rate 16, oxygen saturation 88 to 92% on 5 liters. in general, this is an elderly female, lying in bed, with increased work of breathing, pronounced pursed-lip exhalations, speaking five-plus word sentences. head and neck examination: pupils equal, round and reactive to light, extraocular movements intact, mucous membranes dry with crack in the middle of her lower lip. chest: barrel chest with distant breath sounds, prolonged expiration with wheezes. cardiovascular: distant heart sounds, regular rate and rhythm, no jugular venous distention. abdomen: obese, soft, nontender, with positive bowel sounds. colostomy bag intact, with soft formed stool. extremities: no edema, distal pulses 1+ bilaterally. neurologically alert and oriented. laboratory data: white blood cell count 20.4 (baseline 20.5), hematocrit 38.4, platelets 352, mcv 102, differential 86 neutrophils, 2 bands. inr 1.0. sodium 147, potassium 4.0, chloride 99, bicarbonate 38, bun 19, creatinine 0.7, glucose 192. ck 63, troponin less than 0.3. digoxin level 1.7. electrocardiogram shows mat at 110, normal axis, normal intervals, no segmental q waves, normal r wave progression, no significant st changes, with nonspecific st depression in v5 to v6. chest x-ray was a suboptimal study with stable appearance of right lower lobe opacification, likely secondary to focal scarring, may have slight increase in opacity consistent with atelectasis or scarring or fluid within fissure. lungs otherwise clear. no pleural effusion, no pneumothorax, unremarkable pulmonary vasculature. hospital course: the patient was admitted to the medical intensive care unit service, and her hospital course is as follows: 1. pulmonary: chronic obstructive pulmonary disease exacerbation, questionable precipitant. the patient was started on empiric antibiotic coverage while waiting for sputum culture analysis with levaquin 500 mg once daily. she was also continued on stress dose steroids and nebulizers. she was maintained on noninvasive ventilation through her hospital course in the medical intensive care unit with mask ventilation transitioning to bipap. her pco2 was noted to increase to over 100 and then stabilize in the 90s on her ventilation, without any evidence of somnolence secondary to hypercarbia. she was able to maintain peripheral oxygen saturations and pco2 in the 90s, with periods of rest off of her bipap on venturi mask and nasal cannula combined, and also just nasal cannula on its own. given the patient's baseline high co2, it is thought that she will likely benefit from chronic bipap. the patient remained tenuous during her medical intensive care unit course, and had an acute decompensation which was requiring increasing oxygen requirement in order to maintain her peripheral oxygen saturation greater than 88%. she developed thick copious sputum with a temperature spike. it was thought that, at this time, she would likely need intubation. the issue of intubation and difficulty weaning once this was to be instituted was discussed with the patient and her daughter, possible long-term chronic ventilation support would be required. both the patient and her daughter were in agreement if intubation was required. the patient, however, was able to be stabilized with noninvasive ventilation. she continued to improve, requiring mostly nasal cannula only, with periods of rest on the venturi mask and nasal cannula ventilation. 2. infectious disease: the patient completed a ten day course of levaquin. there was no identified organism in her sputum secondary to nonproductive cough. when the patient developed a temperature spike and increased secretion production, repeat sputum culture was obtained, which was pending at the time of this dictation. she was given a dose of vancomycin and three days of ceftazidime during this increase in her sputum production for coverage of nosocomial infection, however, given her rapid clinical improvement, it was thought that this was unlikely, and the ceftazidime was discontinued. the patient also developed change in her stools to green liquid diarrhea with an increase in her white blood cell count from the baseline of 20 through her hospital course to 30, with evidence of increased bands. she was then started empirically on flagyl for likely c. difficile with cultures pending. 3. cardiovascular: the patient continued to have mat. her theophylline level was checked as the possible precipitant, which revealed low levels. she was discontinued off of her digoxin, and started on diltiazem, which was titrated up to 60 mg four times a day for her heart rate control. her blood pressure was elevated, and the patient was continued on zestril, started at 10 and increased to 30 mg once daily at the time of this dictation, which obtained better blood pressure control without any evidence of increase in her creatinine. she received one time dosage of lasix secondary to desaturation and crackles on examination, presumed fluid overload with pulmonary congestion. at that point, she diuresed on very low-dose lasix and then maintained negative i&o status for the remaining following days. the patient was maintained on enteric-coated aspirin as well as her lipitor. her norvasc and diamox were discontinued. 4. endocrine: the patient normally is on glipizide secondary to her diabetes from steroids. she was maintained on regular insulin sliding scale only, and transitioned over to nph, given the need to titrate while her steroids were being adjusted. 5. gastrointestinal: the patient was on protonix given her steroids. she developed likely c. difficile colitis. 6. renal: her creatinine remained stable. her bun and creatinine were borderline high upon admission, and she was given some intravenous fluid hydration, given the mask impeded full oral intake. she had hypernatremia with a sodium of 149, for which she was given free-water repletion via intravenous and then encouraged to take in oral intake. 7. neuropsych: the patient was continued on her standing remeron and paxil. she was on ativan as needed in order to maintain compliance with her mask ventilation. this was eventually not required. she was given tylenol for pain as needed. 8. fluids, electrolytes and nutrition: the patient is on full oral intake. receives standing potassium, magnesium and calcium. 9. prophylaxis: maintained on protonix and subcutaneous heparin. 10. lines: she had an arterial line while she was in the medical intensive care unit, as well as peripheral intravenous lines and a foley. 11. communication: communication is with her daughter. daughter, , is also her health care proxy in the case that the patient is unable to make decisions. 12. code status: at the time of this dictation, is full code. the patient was transferred on , to the medicine floor. the remainder of her hospital course from until the day of discharge will be dictated as an addendum. , m.d. dictated by: medquist36 procedure: non-invasive mechanical ventilation arterial catheterization diagnoses: pneumonia, organism unspecified acidosis anemia of other chronic disease obstructive chronic bronchitis with (acute) exacerbation candidiasis of mouth acute respiratory failure other specified cardiac dysrhythmias intestinal infection due to clostridium difficile hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to