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 / triamterene / percocet attending: chief complaint: shortness of breath, respiratory distress. major surgical or invasive procedure: endotracheal intubation. history of present illness: a yo woman with history of diastolic chf (ef 40-45%), mild to moderate aortic stenosis, cad s/p mi, asthma, presents from home with sob and cough. per omr and discussion with family, she was recently hospitalized at from for acute chf/hypotension/ards requiring intubation, treated for ? mi + pneumonia, w/ acute wt loss (nadir 117) related to dysphagia (rx esophagus stretched, has hiatal hernia). course also complicated by c diff diarrhea (rx flagyl then vancomycin) and thrush, prolonged rehab stay. she was recently back to her baseline status, living independently and active (plays cards regularly), but reports that for the past few days she has not been feeling well, too weak to get out of bed yesterday when family came to visit, worsening cough, sob. she was visited by someone at her senior living on the day of admission and ems was called. per ems, her lungs sounded tight with poor air movement, no wheeze. she was placed on oxygen, given 2 mg iv magnesium, and brought to . in the ed, initial vitals were: t 101.8, p 139-->99, bp 132/73, r 22, o2 sat 69% on ??? improved to 96% with bag mask ventilation. patient appeared tachypneic with poor mental status, moving all extremities but not following commands. on lung exam, she had poor air movement throughout but no wheezes. she was intubated with etomidate and succinylcholine. tube was initially noted to be at the carina and was pulled back to good position. cxr showed r-sided infiltrate with possible pulmonary edema. ua negative. lactate nl. ekg with old lbbb, trop neg. she was started on levofloxacin, then developed streaking rash up r arm tracking along vein where iv was placed. levo was stopped and iv re-positioned. given vancomycin. she became transiently hypotensive to 80s, but improved with ivf. also received fentanyl, versed, and tylenol. in the micu, she was treated initially with vanco/meropenem for concern of hap. she was noted to have af with ventricular response to the 120s and was given metoprolol with good response. on the 11th, she was unresponsive during a spontaneous breathing trial with cxr concerning for aspiration event vs flash pulmonary edema, so she remained intubated. she was given 40 mg iv lasix x3 on the 11th and restarted on her home bp meds, which include metoprolol and lisinopril. cardiac enzymes were negative. echo showed preserved lvef, with moderate as, mild ar, mild mr, and mild pulmonary hypertension (increased from prior). she was extubated on the 12th, again diuresed with 40 mg iv lasix boluses for net negative of 2l and now is transferred to the floors in stable condition. past medical history: chf with preserved lvef (50% per tte ) as/ai ( 1.2-1.9cm2 in ) cad, s/p mi ', angina at rest hypertension glaucoma hyperlipidemia asthma osteoarthritis social history: she lives alone in senior living in . she is independent of all adls at baseline with high level of functioning. she walks with a walker. there is no history of smoking, etoh, or illicit drug use. family history: positive for premature cad (50s-60s) in sisters and brother. physical exam: vitals: tm 97.8, tc 97.8 (afebrile throughout admission), hr 80 and regular, bp 119/63, o2 sat 96% on 6l oxygen by nasal cannula i/os: 2.4l net negative since admission; 1l negative in last 24 hours general: awake, alert and oriented. pleasant elderly woman in no acute distress, sitting comfortably in chair and speaking in complete sentences. calm and cooperative. heent: normocephalic, eomi, perrla, moist mucous membranes neck: supple lungs: diffuse wheezes in upper lung fields with crackles at bases; inspiratory efforts are poor limiting full assessment, although air movement in general seems decreased cardiovascular: rrr, normal s1/s2, 3/6 systolic murmur loudest at the lusb, non-radiating to the coratids abdomen: soft and non-tender ext: trace pitting edema to ankles bilaterally; dp pulses intact; no le erythema, rashes, or tenderness; no assymetric swelling pertinent results: labs at admission: 10:00am blood wbc-7.9# rbc-4.21 hgb-13.1 hct-41.0 mcv-97 mch-31.2 mchc-32.1 rdw-14.2 plt ct-285 10:00am blood neuts-36.4* bands-0 lymphs-60.5* monos-2.4 eos-0.2 baso-0.5 10:00am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-1+ microcy-normal polychr-normal 10:00am blood pt-12.7 ptt-29.3 inr(pt)-1.1 06:58am blood ret aut-1.2 10:00am blood glucose-259* urean-19 creat-0.9 na-132* k-3.9 cl-95* hco3-28 angap-13 07:38pm blood calcium-8.1* phos-3.4 mg-2.4 cardiac enzymes: 10:00am blood ck-mb-notdone probnp-2143* 10:00am blood ctropnt-<0.01 07:38pm blood ck-mb-3 ctropnt-<0.01 12:28pm blood ck-mb-notdone ctropnt-<0.01 08:49pm blood ctropnt-0.01 10:00am blood ck(cpk)-35 12:28pm blood ck(cpk)-48 08:49pm blood ck(cpk)-49 anemia labs: 06:58am blood ret aut-1.2 06:58am blood iron-48 06:58am blood caltibc-239* ferritn-223* trf-184* micro studies: blood cultures: negative urine cultures: negative urine legionella: negative mrsa screen: negative imaging studies: transthoracic echocardiogram (): the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the estimated pulmonary artery systolic pressure is higher. the rhythm is now atrial fibrillation. the transaortic valve gradient and the severity of aortic regurgitation and mitral regurgitation are similar. cxr (): probable asymmetric pulmonary edema and left lower lobe atelectasis, with small right pleural effusion. infection within the left lung base and right perihilar region cannot be excluded and recommend follow up radiographs after diuresis for further evaluation. cxr (): the et tube tip is 3.5 cm above the carina. og tube tip passes below the diaphragm with its tip being below the inferior margin of the image. compared to the prior study there is no change in cardiomediastinal silhouette. bibasal opacities are present although there is interval improvement of vascular engorgement that might be attributed to better lung volumes. bilateral pleural effusions are unchanged. cxr (): interval removal of the et and ng tubes. interval improvement of pulmonary edema with cardiomegaly. small bilateral pleural effusion. no pneumothorax. cxr (): there is significant interval improvement in pulmonary edema, which is completely resolved on the current study. the lungs are hyperinflated but currently essentially clear except for minimal left basal atelectasis. cardiomediastinal silhouette is stable. the significant kyphosis with multiple wedge thoracic spine fractures is grossly unchanged dating back to . there is no pneumothorax. brief hospital course: in summary, a yo woman with dchf, cad, mild to moderate as/ai, and asthma, who presents with dyspnea and fever requiring intubation. # dyspnea: this was felt to be multifactorial. there was concern for pneumonia given fever and cough, could be bacterial vs viral. based on cxr and elevated bnp, also likely element of chf. additionally, patient was wheezy with poor air movement throughout, which supported the diagnosis of asthma exacerbation or cardiogenic pulmonary edema. she was started on albuterol and atrovent, iv steroids, and diuresed with boluses of 40 mg iv lasix. initially she was covered empirically with vancomycin and meropenem for presumptive hap. however, as she remained afebrile with normal white count, antibiotics were stopped after the first hospital day. a tte was done to work-up cardiogenic pulmonary edema. this showed preserved lvef (50%) with mild to moderate as, mild ar, mild mr, and slight worsening of pulmonary hypertension. she was extubated on with no complications. she was then monitored in the intensive care for 24 hours, intermittently given lasix boluses of 40 mg as above for net 2l negative, and transferred to the medicine floor on . steroids were switched over to prednisone, and bronchodilator nebs were continued. with this treatment, her oxygenation and respiratory status improved. most recent cxr shows clear lung fields with decreased pulmonary edema. she continues to have desaturation to mid 70s with exertion (walking), usually in the setting of coughing. we feel that she needs several days of rehab prior to returning home. she should complete a 10-day taper of prednisone and can continue on her home asthma inhaler regimen. # fever: this was felt to be due to pulmonary source (possibly viral) given her cough and no other localizing signs or symptoms of infection. blood and urine cultures were negative, and urine legionella was negative. once in the unit, she remained afebrile with no white count. as above, antibiotics were stopped after the first dose because bacterial pneumonia was felt to be less likely. # atrial fibrillation with rapid ventricular response: in the intensive care unit, she was noted to have atrial fibrillation with rapid ventricular response to the 140-150s. this responded to iv metoprolol, and she spontaneously converted to sinus rhythm prior to transfer to the floors. she remained in nsr for two days, but again developed af after working with pt (in the setting of not receiving her morning metoprolol). we again pushed iv metoprolol, and initially increased her oral metoprolol dose. we did not pursue anticoagulation due to her advanced age and risk of bleeding. she can continue metoprolol and aspirin for paroxysmal atrial fibrillation. # sinus bradycardia: after the increase in metoprolol for af with rvr (see above), she developed bradycardia to 40s, primarily at night. there was concern of second degree heart block (concern of non-conducted p-waves on telemetry), and cardiology was consulted. they reviewed the telemetry strips and felt that the changes were likely due to poor baseline, and felt that she was having sinus bradycardia. they recommended decreasing the dose of metoprolol to 12.5 mg twice daily. she has been well rate-controlled on this dose at time of discharge. # hypotension: in the ed she became hypotensive in the setting of intubation and sedation meds. this quickly resolved with ivf. upon admission to the unit she was normotensive. her blood pressure meds (lisinopril and metoprolol) were re-started post-extubation. imdur has also been added back prior to discharge, and blood pressures have ranged from 110-140s/50s. # coronary artery disease: she has a history of mi in . cardiac enzymes were cycled and negative x3. we continued her home statin, added back her bb, acei, and nitrate as blood pressure would tolerate, and continued her aspirin. # hyperlipidemia: we continued her home statin. # glaucoma: we continued her home eye drops. # fen: she was cleared by speech and swallow for ground solids and thin liquids. # prophylaxis: subcutaneous heparin, pneumoboots, ppi. # code: her code status is full code, although patient has made it clear in discussion with family that she would not want to be on a life-supporting machine for a prolonged period of time. medications on admission: imdur 90mg po daily lisinopril 20mg po daily alendronate 35mg po q fri metoprolol 50mg po tid mvi po daily priolosec 20mg po daily simvastatin 20mg po hs vitamin d 400 units po daily xalatan eye gtt advair 250/50 1 puff aspirin 81mg po daily ferrous sulfate 325mg po daily oscal discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever/pain. 2. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 4. os-cal 500 + d oral 5. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 6. xalatan ophthalmic 7. simvastatin 10 mg tablet sig: two (2) tablet po hs (at bedtime). 8. alendronate 35 mg tablet sig: one (1) tablet po once a week. 9. prednisone 5 mg tablet sig: 1-2 tablets po once a day: please take 10 mg each day on through , then take 5 mg on through . disp:*9 tablet(s)* refills:*0* 10. aspirin 81 mg tablet sig: one (1) tablet po once a day. 11. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 12. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 13. centrum oral 14. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation every six (6) hours as needed for shortness of breath or wheezing. 15. nitroglycerin 0.3 mg tablet, sublingual sublingual discharge disposition: extended care facility: nursing home - discharge diagnosis: primary diagnoses asthma exacerbation requiring intubation acute on chronic diastolic congestive heart failure atrial fibrillation with rapid ventricular response . seconary diagnoses mild to moderate aortic stenosis coronary artery disease hypertension glaucoma hyperlipidemia osteoarthritis discharge condition: vital signs stable. afebrile. discharge instructions: you were admitted to the hospital for treatment of asthma exacerbation, requiring placement of a breathing tube (intubation) and a brief stay in the intensive care unit. we treated the symptoms with steroids to help reduce inflammation in the airways. you were also given medicine to help reduce fluid accumulation in the lungs. . the hospital course was complicated by an irregular heart beat (dysrrhythmia) called atrial fibrillation. this causes the heart to beat rapidly and erratically and can lead to symptoms of fatigue, shortness of breath, lightheadedness, and chest pain. . we have made the following changes to your medicines: -we added prednisone; please take 10 mg each day on through , then take 5 mg on through -we decreased metoprolol to 12.5 mg twice daily -we stopped the lasix; please talk to your primary care physician before restarted this medicine -we did not make other changes to your medicines . please note your follow-up appointments below. . please call the doctor or return to the emergency room if you develop worsening shortness of breath, fever, weakness, or any new concerning symptoms to you. followup instructions: previously scheduled appointments: , - adult medicine (sb) phone: date/time: 10:30 , - adult medicine (sb) phone: date/time: 9:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases unspecified glaucoma pulmonary collapse acute respiratory failure other specified cardiac dysrhythmias asthma, unspecified type, with (acute) exacerbation acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to