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: penicillins attending: chief complaint: unresponsiveness major surgical or invasive procedure: bronchoscopy a-line placement history of present illness: 47 year-old spanish-speaking female from with restrictive lung disease, avr , h/o endocarditis, severe asthma and proximal tracheal stenosis s/p recurrent episodes of respiratory failure and trach placement (not vent dependent) presents unresponsive with hypercapnia. at 3:30 am pt had unwittnessed fall while getting a glass of water at rehab. pt was found face down and unresponsive. vitals at that time; afebrile, bp 180/90, hr 103, o2 sat 89%. abg revealed ph of 6.89, po2 187. of note, wbc count has been rising at rehab. pt is s/p a 6 week course of vanco (ended ) for endocarditis. pt was placed on vent and sent to ed. . in the ed; initial vitals t 98.8, hr 114, bp 166/100. wbc count found to be 31. initial abg 7.12/120/434, lactate 1.3. she was placed on the ventilator, given 7 liters of fluid with 1 liter uo. her c-spine was cleared. ct head unremarkable. she received one dose of decadron 10 mg, vanco, ctx 2 gms, and flagyl. left femoral line was placed. pt has right picc line (unclear when placed). required levophed briefly when given versed. bld and sputum culture sent. past medical history: 1) severe asthma on home o2, history of 10+ intubations and tracheotomy in . pfts at : fvc 45%, fev1 26%, fev1/fvc 55%, tlc 55% predicted #) tissue avr (no need for anticoag per ct surgeons at ) 2) restrictive lung disease from obesity 3) obstructive sleep apnea on bipap at home (15/5 on 4l oxygen) 4) iddm on glargine and metformin 5) psychotic disorder nos 6) chest pain: normal persantine-mibi on echo : normal lvef >55% 7) vitamin b12 deficiency on monthly injections 8) s/p appendectomy 9) chronic lumbar disc disease . pcp social history: lives at hospital for rehab. uses home o2. history of smoking. no ivdu. family history: nc physical exam: tc 99.8 bp 117/67 hr 75 rr 26 sat 100% vent - ac 450/22/50%/5. abg 7.21/87/139. gen: sedated/intubated, moving extremities to pain hennt: conjunctival edema, anicteric, pupils 2mm symmetric, minimal responsiveness to light neck: obese cv: rrr, nl s1s2, no m/r/g lungs: anteriorly with coarse rhoncherous breath sounds throughout, no wheezes abd: soft, nt/nd, +bs ext: warm, no edema, strong dp/pt pulses bilaterally skin: right picc with erythema, no exudate pertinent results: 07:10am urine amorph-mod 07:10am urine rbc-* wbc-0-2 bacteria-none yeast-none epi- 07:10am urine blood-tr nitrite-neg protein-tr glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 07:10am urine color-yellow appear-clear sp -1.011 07:10am plt smr-normal plt count-348 07:10am hypochrom-3+ anisocyt-normal poikilocy-normal macrocyt-normal microcyt-1+ polychrom-1+ stippled-1+ 07:10am neuts-82* bands-2 lymphs-13* monos-1* eos-0 basos-0 atyps-1* metas-1* myelos-0 07:10am wbc-31.2* rbc-4.27 hgb-11.4* hct-36.5 mcv-85 mch-26.7* mchc-31.2 rdw-16.8* 07:10am urine gr hold-hold 07:10am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 07:10am urine hours-random 07:10am urine hours-random 07:10am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 07:10am amylase-82 07:10am urea n-36* creat-1.8* 07:32am freeca-1.18 07:32am glucose-281* lactate-1.4 na+-141 k+-5.2 cl--96* tco2-42* 07:40am pt-11.4 ptt-26.2 inr(pt)-1.0 07:40am freeca-1.20 07:40am lactate-1.3 k+-4.8 07:40am type-art temp-37.1 tidal vol-400 o2-100 po2-434* pco2-120* ph-7.12* total co2-41* base xs-5 aado2-173 req o2-38 -assist/con intubated-intubated 10:17am o2 sat-97 10:17am k+-5.0 10:17am type-art rates-/22 tidal vol-400 peep-5 o2-50 po2-107* pco2-81* ph-7.21* total co2-34* base xs-1 -assist/con 01:58pm lactate-1.8 01:58pm type-art po2-100 pco2-41 ph-7.44 total co2-29 base xs-3 05:00pm plt count-228 05:00pm wbc-16.6* rbc-3.79* hgb-9.5* hct-30.1* mcv-79* mch-25.0* mchc-31.5 rdw-16.2* 05:00pm calcium-7.7* phosphate-3.2# magnesium-1.5* 05:00pm glucose-239* urea n-30* creat-1.4* sodium-139 potassium-4.4 chloride-102 total co2-29 anion gap-12 05:09pm freeca-1.08* 05:09pm o2 sat-98 05:09pm lactate-2.4* 05:09pm type-art po2-91 pco2-50* ph-7.38 total co2-31* base xs-2 . echo: conclusions: limited views. 1. the left atrium is normal in size. 2. right ventricular chamber size is normal. right ventricular systolic function is normal. 3. a mechanical aortic valve prosthesis is present. the transaortic gradient is higher than expected for this type of prosthesis. the aortic prosthesis cannot be adequately assessed. no aortic regurgitation is seen. 4.the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. 5.there is mild pulmonary artery systolic hypertension. 6.there is no pericardial effusion. impression: no echocardiographic evidence of endocarditis. would recommend a tee if clinically indicated. -------------------- portable ap chest. heart size is normal. mediastinal and hilar contours are normal. lung fields are clear. no pneumonia, chf, pleural effusions, or pneumothorax. the tracheostomy tube is in good position. . impression: no change compared to the prior radiograph obtained one day earlier. --------------- ekg: baseline artifact sinus tachycardia possible biatrial abnormality although is nondiagnostic otherwise may be normal ecg but baseline artifact makes assessment difficult since previous tracing of , sinus tachycardia rate faster ----------- ct head : findings: there is no acute intracranial hemorrhage, shift of normally midline structures, or hydrocephalus. -white matter differentiation appears preserved. a few small areas of focal punctate calcification are seen within the right lobe of the cerebellum, left occipital lobe, and along the falx. these are unchanged compared to the prior examination. osseous structures and soft tissues are normal. minimal mucosal thickening is seen in the ethmoid air cells. --------------- ct c-spine : findings: in the sagittal projection the c1 through upper portion of t2 vertebral bodies are visualized. normal vertebral body height and alignment with preservation of disc space height. mild degenerative changes are seen with anterior osteophytes at the c5 and c6 levels. no fractures are seen. prevertebral soft tissues are normal. the spinal canal is essentially normal in caliber. . a tracheostomy tube is present. the visualized portion of the upper lung fields is clear. soft tissues demonstrate small bilateral lymph nodes in the cervical region. . impression: mild degenerative changes in the mid cervical spine. no fracture identified. ------------ cxr :single portable chest radiograph demonstrates the patient to be status post sternotomy, new when compared to . tracheostomy is in place. cardiomediastinal contours are unchanged. increased, bilateral, airspace opacities represent mild-to-moderate pulmonary edema. the left costophrenic angle is excluded from the image. osseous structures are unremarkable. impression: congestive heart failure. brief hospital course: 47 year-old spanish-speaking female with restrictive lung disease, severe asthma and proximal tracheal stenosis s/p recurrent episodes of respiratory failure and trach placement, avr, h/o endocarditis tx'd from after being found down, unresponsive, with hypercapnia. . # hypercapnic respiratory distress - lwas ikely the etiology of initial unresponsiveness, most likely secondary to mucous plug vs trach malfunction given rapid improvement, though no further obstruction (from basline) noted on bronch. pt was weaned from vent on hd1, to ps on hd2, to 2l nc late on hd2 into day 3. note: pt should have red cap on trach when on nc oxygen. . # initial unresponsiveness likely secondary to hypercapnia. ct head and c-spine were unremarkable. tox screen was negative. neuro exam was normal post weaning of sedation. . # leukocytosis: source unclear. cx, in picc cath tip were ngtd x 2d. no veg on tte. ua negative. cxr w/o clear infiltrate. empiric tx with vanco and levoflox were discontinued after two days of neg cx and clean repeat cxr. however, late on hd#3, sputum cx grew pseudomonas and another gram neg rod. sensitivities were pending at discharge, but levaquin was restarted to finish a 10 day course. . # avr: initially, the type of st. valve was unclear, so pt received a short course of heparin gtt. once it was confirmed with ct at that this type of tissue "" valve did not require anticoag, hep gtt was d/c'd. . # dm. sugars poorly controlled until ssi tightened. likely role of steroids and demargination. . # htn. sbps ranging 140-180s. pt initially on nitro gtt, then changed to metoprolol 12.5mg po tid. no change in respiratory status was noted (given asthma history). . # arf. cr was as high as 1.8 (baseline 0.7), now down to 1.4. etiology likely prerenal azotemia. these should be followed. . # fen. pt passed speech and swallow on hd #2. tolerating pos well at time of discharge. . overall, pt was transferred to on baseline o2 requirement, tolerating pos, mentating well. new meds she was started on here are metoprolol and levaquin. sputum sensitivities should be followed up in 24 hours. medications on admission: - risperdal 1 mg qhs and q 12 prn anxiety - tylenol 650 mg q 6 hr prn - mg oxide 400 tid - heparin sc tid - duonebs q 6 hrs - paxil 40 daily - zocor 20 daily - epogen 40,000 q sunday - phoslo 2 tabs tid - prednisone 10 mg qod (last dose 1/28) - riss - nph 35 units q pm, 40 qam - accolate 20 - asa 81 daily - vitamin d 400 daily discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 3. epoetin alfa 10,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). 4. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 5. risperidone 1 mg tablet sig: one (1) tablet po hs (at bedtime). 6. risperidone 1 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 7. prednisone 10 mg tablet sig: one (1) tablet po qod (). 8. accolate 20 mg tablet sig: one (1) tablet po twice a day. 9. magnesium oxide 400 mg tablet sig: one (1) tablet po tid (3 times a day). 10. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). 11. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 12. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 13. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 14. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours). 15. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q2 hrs prn (). 16. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 17. insulin nph human recomb 100 unit/ml cartridge sig: thirty eight (38) units subcutaneous qpm. 18. insulin nph human recomb 100 unit/ml cartridge sig: forty two (42) units subcutaneous qam. 19. humalog 100 unit/ml solution sig: per sliding scale units subcutaneous qac: please administer via sliding scale as follows: 0-150, give none; if 151-200, give 4 units; if 201-250, give 6 units; if 251-300, give 8 units; if 301-350, give 10 units; if >350 please notify md. 20. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. discharge disposition: extended care facility: - discharge diagnosis: 1. hypercapnic respiratory distress with unresponsiveness 2. dm 3. htn 4. arf discharge condition: 1. fair, with patent well-placed trach, on usual o2 requirement, mentatin well and tolerating pos. discharge instructions: please take medications as prescribed. notable changes are: metoprolol 12.5mg po tid. discuss options of dowsizing trach vs decanulation with primary md / pulmonologist. . please schedule and attend all followup appointments. . please seek medical attention for chest pain, shortness of breath, changes in your mental state, or with other concerns. followup instructions: please followup with your pulmonologist, cardiothoracic surgeon, and primary care physician 3 days to let them know about your hospitalization here and to arrange for a followup visit with them as they deem appropriate. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube other bronchoscopy arterial catheterization diagnoses: 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 acute respiratory failure heart valve replaced by transplant 

Answer: The patient is high likely exposed to