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: phenergan attending: chief complaint: transferred to for bronchoscopy major surgical or invasive procedure: bronchoscopy history of present illness: mrs. is a 70 year old woman with a history of severe copd nsclc s/p lul lobectomy s/p xrt, vent-dependence has s/p tracheostomy since , status post y-stent placement secondary to severe chronic obstructive pulmonary disease and tracheobronchomalacia in . y stent finally removed on due to recurrent migration of y stent. patient has been at rehab where a tracheostomy was noticed to be malfunctioning for the last days. per nurse notes, on patient had a "respiratory arrest" and code blue was called. tracheostomy tube changed to # 7. old trach looked clogged with dry mucous. patient respiratory status improved overnight, however this am, her respiratory status deteriorated with spo2 of 83% on vent. tracheostomy was suctioned ,found to have a "resistance" and copious amount of blood. patient transferred ed where per report there have been no new episodes of bleeding but obvious fresh bloo in suction tube. in ed abgs 7.35/58/111/34 on a/c 450 cc of tv and rr of 14. ros is negative for fever , chills, cough, night sweats, abdominal pain, chest pain , hematemesis or weight loss. past medical history: 1. chf s/p respiratory failure s/p trach 2. copd - o2 dependent 3. nsclc s/p lul lobectomy , s/p chemo (iressa)/xrt, s/p ? pleurodesis 4. dm ii 5. anemia, thrombocytopenia 6. hx recurrent bacteremias 7. hx fungemia 8. s/p l thr 9. s/p cataract surgery . s/p tah 11. paroxysmal afib social history: patient living at rehab, hospital. + hx tobacco (uncertain duration). no etoh, illicits. very involved, supportive family. family history: non-contributory physical exam: vs: t 98.7 hr 71 sinus bp 123/46 rr 16sat 100% vent: ac 450x14 peep 5 fio 0.5 gen: pleasant obese woman +trach +foley +picc heent: op clear, mmm, perrl, sclerae anicteric cv: nl s1/s2 rrr pul: diffuse rhonchi abd: obese, soft, nt, nd +bs ext: 2+ le edema to thighs, 2+ lue edema, 1+ rue edema. picc in r ac. neuro: awake, alert. pertinent results: -ekg : nsr . -cxr : the tip of the internal portion of the tracheostomy tube overlies the left aspect of the tracheal column: no free mediastinal air is seen. appearance of the chest is unchanged from . . echo: patient/test information: indication: left ventricular function. height: (in) 64 weight (lb): 175 bsa (m2): 1.85 m2 bp (mm hg): 78/39 hr (bpm): 60 status: inpatient date/time: at 17:08 test: portable tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2007w029-0:00 test location: west micu technical quality: suboptimal referring doctor: dr. measurements: left atrium - long axis dimension: *4.9 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.9 cm (nl <= 5.2 cm) aorta - valve level: *4.0 cm (nl <= 3.6 cm) aorta - ascending: *3.5 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.2 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.1 m/sec mitral valve - a wave: 0.4 m/sec mitral valve - e/a ratio: 2.75 mitral valve - e wave deceleration time: 186 msec tr gradient (+ ra = pasp): *31 mm hg (nl <= 25 mm hg) interpretation: findings: this study was compared to the prior study of . left atrium: mild la enlargement. right atrium/interatrial septum: aneurysmal interatrial septum. left ventricle: mild symmetric lvh. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. overall normal lvef (>55%). right ventricle: dilated rv cavity. normal rv systolic function. . aorta: moderately dilated aortic sinus. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild (1+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. moderate tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. conclusions: the left atrium is mildly dilated. the interatrial septum is aneurysmal. there is mild symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is dilated. right ventricular systolic function is normal. the aortic root is moderately dilated athe sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the right ventricle is now dilated. electronically signed by , md on 17:32. physician: , . . v/q scan : ventilation images obtained with tc-m aerosol in 6 views demonstrate decreased tracer activity within the right upper lobe, medially, in a non-segmental distribution. small subsegmental ventilation abnormalities are also noted within both lower lobes. tracer activity is noted to pool within the airway, around the patient's tracheostomy tube. perfusion images in the same 6 views show a matched perfusion defect within the right upper lobe medially. small subsegmental perfusion defects in both lower lobes match the ventilation abnormalities. chest x-ray shows an opacity within the right upper lobe medially corresponding to the matched ventilation and perfusion defect in the right upper lobe. the triple matched defect in the right upper lobe is indeterminant for pulmonary embolus. otherwise, there is no evidence for pulmonary embolus elsewhere in the lungs. impression: triple matched defect in the right upper lobe medially which is indeterminant for pulmonary embolus. otherwise, there is no evidence for pulmonary embolus elsewhere in the lungs. brief hospital course: a/p: 70 year old woman with respiratory failure, tracheomalacia, chf, copd on home o2 presenting from rehab with respiratory failure and blood in trachesotomy for rigid bronchoscopy. . # respiratory failure: patient has underlying severe copd, lung resection, diastolic dysfunction. most likely exacerbation of respiratory failure secondary to upper airway obstruction due to tracheostomy malfunctioning ?granulation tissue. bronch showed patent airways. no signs on imaging or clinical exam to suspect pna or chf exacerbation, however sputum growing pseudomonas and gpc - unclear if these are contaminants or true pathogens. patient treated initially treated with zosyn, cipro, and vanc. sensitivities showed pan-sensitive pseudomonas but zosyn was continued since it will cover both psuedomonas in sputum as well as proteus and klebsiella in urine. plan is to treat for 7 days (day one ). she was continued on bronchodilators. she was restarted on her regular dose of diuretics. she had an echo cradiogram which showed a dilated right ventricle, so we obtained a vq scan to assess patient for possible pe. the scan was indeterminate for evidence of chronic pulmonary embolism so she was not started on anticoagulation. . # hypotension: patient has history of intermittent hypotension of unclear etiology. her first 2 nights in the unit she dropped her pressures with concurrent decrease in uop, leading to her being supported on pressors overnight. her pressures improved during the day. she was admitted on midodrine tid. she had two stim tests, one with 250 mcg and one with 1 mcg of cosyntopin which were both normal and an echo with no elucidating reason. her midodrine was increased to 10 mg po qid with stabilization of her pressures. . # uti: intial ua showed 21-50 wbc. while patient has chronic foley, given hypotension and ill appearance decided to treat as infection. she was treated with cipro. added zosyn for pseudomonas in sputum but will cover urine as well. foley catheter was changed during this admission. . # diastolic dysfunction : patient has chf, preserved ef with diastolic dysfunction, which was essentially unchanged on repeat echo except for new finding of dilated right ventricle. she is not significantly fluid overloaded on exam. lasix was initially held for hypotension and then restarted once her pressures had stabilized. her digoxin was continued at outpatient dose. . #elevated troponins : patient had elevated tropinins on admission, which as attributed to diastolic dysfunction . cks were flat and there were no concerning dynamic changes on ekg. echo did not show any new wall motion abnormalities, although it did show a new dilated right ventricle. . #hypothyroidism: continue levothyroxine. tsh was normal. . #anemia: stable. . # diabetes: patient was covered with insulin sliding scale. plan to restart her standing nph on discharge. . # ppx: patient received pneumoboots for dvt prophylaxis, ppi, and her head of bed was kept at > 30degrees. . # code: full medications on admission: fluticasone 220mcg mdi twice daily combivent inh 4puffs q6h atorvastatin 10mg daily spironoalactone 50mg lasix 40mg po q12hr digoxin 0.125mg daily aranesp 0.06mg qfri digoxin 0.125mg daily esomeprazole 40mg daily iron sulfate 300mg daily seroquel 50 mg qhs seroquel 15 mg tid nph 6u sc qam midodrine 10mg po q8h paroxetine 20mg daily trazadone 50mg prn insomnia levothyroxine 50 mcg qd discharge medications: 1. levothyroxine 25 mcg tablet sig: two (2) tablet po daily (daily). 2. quetiapine 25 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 3. quetiapine 25 mg tablet sig: one (1) tablet po tid (3 times a day). 4. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 7. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day) as needed for constipation. 8. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 9. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 10. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours). 11. midodrine 5 mg tablet sig: two (2) tablet po q6h (every 6 hours). 12. pantoprazole 40 mg iv q24h 13. heparin flush port (10units/ml) 5 ml iv daily:prn 10 ml ns followed by 5 ml of 10 units/ml heparin (50 units heparin) each lumen daily and prn. inspect site every shift. 14. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 15. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 16. fluticasone 110 mcg/actuation aerosol sig: eight (8) puff inhalation (2 times a day). 17. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 6 days. 18. insulin lispro (human) 100 unit/ml solution sig: as directed subcutaneous asdir (as directed). 19. piperacillin-tazobactam 4.5 g recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 6 days. 20. iron (ferrous sulfate) 325 (65) mg tablet sig: one (1) tablet po once a day. 21. nph sig: six (6) units q am. 22. paroxetine hcl 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: chronic intermittent hypotension pseudomonas in sputum gram positive cocci in sputum discharge condition: stable discharge instructions: care facility if weight > 3 lbs. adhere to 2 gm sodium diet. followup instructions: follow up with the doctor at the extended care facility as necessary. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy diagnoses: anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of bronchus and lung acute respiratory failure hypotension, unspecified tracheostomy status dependence on respirator, status other tracheostomy complications 

Answer: The patient is high likely exposed to