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: adhesive tape / ativan attending: chief complaint: respiratory distress major surgical or invasive procedure: tracheal stent placement history of present illness: this 54 yo woman with a history of obesity, asthma, anxiety, kidney stones is transferred from after diagnosis of mg (+ musk ab) who is being admitted to the medical icu following respiratory decomposition after extubation following placement of tracheal stent via elective rigid bronchoscopy. she has had several recent decompositions from her myasthenia over the past year, and most recently getting ivig while continuing on her cellcept, prednisone, amd pyridostigmine. she has been recalcitrant to steroids in the past. she was last admitted from - during which she had 3 tracheal intubations (*difficult airway/fiberscopic intubation) and underwent plasmapheresis. she underwent trach/peg placement on by dr. . she was decanculated on . this morning, she had noted some increased tiredness and diplopia, she had tracheobronchomalacia on ct from the spring, and underwent initial stent placement on . y stent was removed on and there was moderate granulation tissue seen in the mainstem bronchi at that time. she was electively admitted for y-stent re-placement today, which occurred without complication. she had cryotherapy to local granulation tissue. after the extubation, the patient was noted to be hypoxic in the pacu with o2 sats 70s-80s with mental status change/unresponsiveness. she was on bipap with improvement in mental status and now weaned off to face tent. currently, she is complaining of severe headache mostly, which has followed her general anesthesia the last 3 procedures. mild dyspnea. she has some complaint of pain in her chest following the stent, which she has had previously in same setting. past medical history: asthma bronchitis gerd obesity panic d/o anxiety s/p ccy kidney stones recent pna with possible ards that improved on steroids dmii, diet controlled social history: no smoking, etoh, illicit drug use. lives with son. family history: unknown physical exam: general appearance: well nourished, overweight / obese eyes / conjunctiva: perrl, eom full cardiovascular: (s1: normal), (s2: normal), no(t) s3, no(t) s4, (murmur: no(t) systolic, no(t) diastolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: wheezes : upper airway transmitted wheezing, diminished: at bases) abdominal: soft, non-tender, no(t) distended extremities: right: absent, left: absent skin: warm neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): x3, movement: not assessed, tone: not assessed, ue proxmially, distally, le distally, cn appear intact. no overt ptosis seen pertinent results: 05:05am blood wbc-9.4 rbc-5.05 hgb-13.3 hct-41.4 mcv-82 mch-26.3* mchc-32.1 rdw-14.8 plt ct-319 08:42pm blood neuts-90.2* lymphs-6.1* monos-2.9 eos-0.7 baso-0.2 05:05am blood pt-12.2 ptt-22.7 inr(pt)-1.0 05:05am blood glucose-143* urean-9 creat-0.7 na-145 k-3.5 cl-97 hco3-41* angap-11 05:05am blood calcium-9.6 phos-4.4 mg-2.0 07:14am blood type-art po2-123* pco2-75* ph-7.42 caltco2-50* base xs-20 01:13am blood lactate-1.2 sputum : heavy growth oropharyngeal flora c. diff negative cxr: findings: in comparison with the study of , there is little change. bibasilar atelectasis without evidence of acute pneumonia. ct-head: impression: study limited by motion artifact. however, no evidence of acute intracranial hemorrhage or mass effect. spirometry: spirometry pre drug post drug actual pred %pred actual %pred %chg fvc 1.31 2.76 47 1.33 48 +2 fev1 1.03 2.05 50 1.00 49 -3 mmf 0.97 2.53 39 0.78 31 -20 fev1/fvc 79 75 106 75 101 -5 brief hospital course: assessment and plan 54 yo woman with on cellcept, mestinon, and prednisone, gerd, anxiety, admitted to micu for respiratory distress following extubation for y-stent replacement. ddx for resp failure includes hypercarbia, hypoventilation from mg, or aspiration process # respiratory failure: the patient had an elective stent replacement on . she required admission to the icu s/p procedure, however, for hypoxia (70's-80's) and somnalnace requiring mask ventilation thought secondary either to neuromuscular weakness (in context of mg) causing hypoventialtion vs. obstruciton and collapse in setting of bronch findings above. . in the icu, the patient was started on bipap. she was given a z-pak for possible sinusitis and started on tessalon perles, mucinex, and nebulized saline to aid in secretion clearance. she was placed on an insulin ss for her diabetes. she continued her outpatient mg regimen of prednisone 20mg , mestinone 50mg q4h and cellcept 1000mg po bid. she was followed by ip s/p y-stent placement. she required only 1l o2 by nc. she was tachychardicinto the 150's while in the icu; this was thought 2dary to anxiety. a neurology consult was requested; the neurology team noted that the patient had not taken her pyridostigmine since the day before the procedure. they additionally recommended infectious work-up in case infection was triggering an exacerbation of mg. a trial off bipap was attempted on but she failed, but the team was successful in subsequent weaning such that on the day of transfer, she required only 3 hours bipap and was breathing 97% on 2l nc. she did have new complaints suggestive for possible hospital aquired pna, and was started on vancomycin but not ceft/zosyn. although her pco2 was elevated, she was clinically stable and thought to be stable for transfer from the icu. she was briefly transferred to the floor and then returned to the icu with hypertension and respiratory distress likely secondary to flash pulmonary edema. she was stablized overnight and returned to the floor. the patient was continued on nebs, but still continued to have difficulty breathing and was not at her baseline status. the patient continued to be increasingly anxious to go home and decided the leave ama. the patient understood the risks, but felt that she stable enough to return home. the patient was setup with follow-up appointments and will return for an outpatient bronch in approx one week. . #) myasthenia - neurology consulted for possibility of mg component to respiratory status, however given nifs were -80 it was thought that her mg was under control. she was continued on her prednisone, mestinone, and cell cept. she had one episode of diplopia that self-resolved. #) tracheomalacia s/p y stent # anxiety/panic d/o: the patient had continued anxiety during her admission. she was continued on paxil 15 mg daily. additionally, the patient was treated with xanax 0.125mg prn. # dm: stable, followed fsg and covered with riss . #tachycardia: pt had sinus tachycardia and was started on 30mg diltiazem. the patient was stable and her sinus tachycardia was likely secondary to anxiety. she was not continued on diltiazam upon discharge. . #diarrhea: the patient had compliants of loose stools. the patient states that these symptoms had occured for awhile prior to admission. she stated it was well controlled by immodium prior to admission. it was felt that her loose stools were likely secondary to her mestinon and she was restarted on immodium. . #fen: - regular diet - replete lytes prn. . #access: piv . #ppx: heparin sub-q for dvt prophylaxis, bowel regimen, ppi, . #code: full. . #communication: patient, sons: , hcp (, (other son) ? . medications on admission: alendronate 70 mg tablet - qsun flonase - 50 mcg spray 2 sprays daily omeprazole - 40 mg paroxetine hcl - 15 mg daily potassium chloride - 20 meq tab sust.rel. calcium carbonate - 1 tab tid dextromethorphan-guaifenesin - 1,200 mg-60 mg tab, multiphasic release 12 hr - 1 tab(s) by mouth twice a day compazine 5mg po prn riss discharge medications: 1. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 2. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 3. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 4. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 5. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 6. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 7. paroxetine hcl 30 mg tablet sig: one (1) tablet po daily (daily). 8. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po q6h (every 6 hours). 9. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: ten (10) ml po q6h (every 6 hours) as needed. 10. fosamax 70 mg tablet sig: one (1) tablet po once a week: sunday. 11. flonase 50 mcg/actuation spray, suspension sig: two (2) spary nasal once a day. discharge disposition: home with service facility: homecare discharge diagnosis: primary: hypercapneic respiratory failure secondary: bronchitis gerd obesity panic d/o anxiety s/p ccy kidney stones dmii, diet controlled tracheobronchomalacia s/p y stent placement discharge condition: against medical advice discharge instructions: you are leaving against medical advice. the risks of leaving were explained to you and you stated that you understood. you were admitted to for elective y-stent replacement, but had respiratory decompensation after the procedure. your stay in the icu was complicated by continued respiratory distress, hypertension and increased heart rate. you were stablized and sent to the general medical floor for further management. please continue to take your medications as prescribed below. please follow-up with the appointments made below. please call your pcp or go to the ed if you experience worsening shortness of breath, respiratory distress, cough, fevers, chills, nausea, vomiting, diarrhea, chest pain or other concerning symptoms. followup instructions: interventional pulm will call you regarding setting up an outpatient bronchoscopy in 1 week. if you do not hear from them in days please call provider: , .d. phone: date/time: 11:15 provider: . & phone: date/time: 10:30 provider: , md phone: date/time: 1:00 procedure: non-invasive mechanical ventilation other intubation of respiratory tract endoscopic excision or destruction of lesion or tissue of bronchus diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled asthma, unspecified type, unspecified anxiety state, unspecified acute respiratory failure other specified cardiac dysrhythmias diarrhea headache obesity, unspecified other diseases of trachea and bronchus acute edema of lung, unspecified myasthenia gravis without (acute) exacerbation 

Answer: The patient is high likely exposed to