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 / keflex / clindamycin / lipitor / bacitracin attending: chief complaint: hypotension major surgical or invasive procedure: intubation. arterial line placement. history of present illness: y f hx of atrial fibrillation (?systemic anticoagulation), dchf with chronic lower extremity edema, repaired aaa, and chronic anemia presenting to the ed with shortness of breath, cough, hypoxia admitted to the micu for respiratory failure and hypotension. patient presenting from a nursing home with a history of recurrent cellulitis, uti and bacteremia. patient was alert and interactive on arrival and reports recent history of shortness of breath and cough with po intake. ed course: initial vitals 98.4 52 103/50 28 98% 15l non-rebreather. pt had low grade temp to 100.0 she was intubated after failing trial of niv high volume of secretions. her bp nadir in systolic 80s and she was started on neosynephrine. subclavian r central line was placed. she was given aztreonam, levofloxacin, and cefepime for empiric abx coverage. chest xray concerning for l sided effusion and chronic rll changes. she was bolused approx 1000ml ns but felt to be poorly responsive. she also received calcium gluconate 4g total for hyperkalemia - no ekg changes. initial settings: ac 0.5/350/16/8. vasopressin was added at rate of 2.4 u/hr when pressures persisted in 70s systolic. neosynephrine increased to 5 mcg/kg/min and vitals prior transfer notable for hr 129, sbp 80s. vent settings increased to fio2 0.5/380/20/8. cvp 15 but unclear form per signout. on arrival to the unit, pt was intubated and sedated. sedation was weaned and patient was not responsive to name, sternal rub. granddaughter was updated. she relayed pt complaint of "burning between her legs" for past couple days and that the long-term care facility had restarted her coumadin recently after discussing with her pcp . . review of systems: limited given sedation, intubated status (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: hypercholesterolemia venous insufficiency obesity gerd eczema dermatitis h/o breast ca s/p resection , recurrence in s/p lumpectomy recurrent cellulitis urinary incontinence spinal stenosis atrial fibrillation abdominal aortic aneurysm s/p endovascular repair x3, last in fall . multiple utis s/p tah/bso cervical myelopathy anemia, h/o occult blood positive stool dens fracture social history: she is living at , after stint in rehab. granddaughter is major support. retired factory worker. she never smoked, last drink was over 25 years ago. family history: there is an extensive history of cardiac disease. physical exam: admission exam: vitals: 113/71 144 ventilated general: sedated, nonresponsive, intubated elderly female heent: sclera anicteric, pupils 3mm nonreactive neck: supple, jvp not elevated, no lad cv: irregularly irregular rhythm, tachycardic rate, normal s1 + s2, no murmurs, rubs, gallops lungs: diminished lung sounds over r anterior base, rales noted over l lung fields abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: +foley ext: cool, pulses appreciated in distal extremities, ecchymoses over b/l le, poor skin turgor neuro: no gag or pupillary reflexs elicited discharge exam: deceased pertinent results: admission labs: 04:44am blood wbc-10.7# rbc-3.68* hgb-11.1*# hct-34.9* mcv-95 mch-30.3# mchc-31.9 rdw-21.6* plt ct-302 04:44am blood neuts-88.5* lymphs-6.4* monos-4.9 eos-0 baso-0.2 04:44am blood plt smr-normal plt ct-302 04:44am blood pt-44.8* ptt-40.4* inr(pt)-4.1* 04:44am blood fibrino-493* 04:44am blood glucose-98 urean-65* creat-2.5*# na-134 k-8.3* cl-102 hco3-19* angap-21* 04:44am blood alt-12 ast-27 ld(ldh)-541* alkphos-77 totbili-0.4 04:44am blood probnp-4827* 04:44am blood ctropnt-0.02* 11:14am blood ck-mb-2 ctropnt-0.05* 05:30pm blood ctropnt-0.13* 04:44am blood calcium-8.1* phos-2.9 mg-1.0* 11:14am blood triglyc-32 07:15am blood type-art tidal v-350 fio2-50 po2-132* pco2-50* ph-7.24* caltco2-22 base xs--6 intubat-intubated 04:59am blood lactate-2.7* k-6.9* 08:29am blood o2 sat-74 11:21am blood o2 sat-97 08:00pm blood freeca-1.10* discharge labs: deceased pertinent micro: pertinent imaging: tte: the left atrium is mildly dilated. there is moderate to severe regional left ventricular systolic dysfunction with hypokinesis of the distal 2/3rds of the left ventricle and an lvef of 30-35%. the remaining left ventricular segments contract normally. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets are moderately thickened. moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mitral regurgitation is seen. there is mild to moderate (+) tricuspid regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: no pericardial effusion seen. there is moderate to severe regional left ventricular dysfunction. cxr: moderate cardiomegaly is stable. however, a left lower lobe consolidation is worsened compared to . moderate pleural effusion is likely. new interstitial opacities are seen throughout the left upper lobe. right basilar opacities are chronic and unchanged. there is no pneumothorax. ct head: ct chest: brief hospital course: yo female with hx of afib on warfarin, anemia, dchf presenting with hypoxic respiratory failure and hypotension. active issues: # respiratory failure: concerning for intrinsic pulmonary infectious etiology. no hx of reactive airway or copd. could be chf exacerbation vs ards with possible urosepsis. cv o2 sat 74. started on empiric abx for hcap (pcn, likely spurious vanco allergy): levofloxacin, vancomycin, flagyl, aztreonam, daptomycin x1, amikacin x1. patient's oxygen saturation improved to 100% on ventilation. sbt was attempted on hospital day 2 but the patient failed. she was lucid and clearly uncomfortable. a family meeting was held which re-affirmed the patient's pre-existing wish to not be extubated for a protracted period. she was extubated and died several hours later. # hypotension: appeared septic given lactate elevation, tachycardia, wbc with left shift, fever. she was started on 3 pressors in the ed, which was weaned down to 2 pressures on day of admission. concern that poor response to pressors could be related to acidemia. possible sources of infection include lung (cxr with lll infiltrate compared to and new lul opacities), skin (pt with recurrent cellulitis and venous insufficiency in bles) and urine (ua positive). in addition, tte shows of the distal lv hypokinetic with lvef of 30-35% compared to normal ef and wall motion in , concerning for regional cardiac event. troponins 0.02 -> 0.05 -> 0.13, however pt with and flat mb, likely be due to demand ischemia. blood cultures came back positive for gram positive cocci in chains and clusters. this speciated to group b strep. unfortunately the patient's hypotension was severe enough in extent and temporal duration that her cardiac, hepatic, renal, and (perhaps transiently) neurologic function were all severely affected. # afib with rvr: concern that ongoing tachycardia may worsen underlying diastolic chf. has been anticoagulated in the past (stopped for fall risk, continued on asa 325mg) and restarted recently for unknown reason. inr supratherapeutic currently and concerning for overmedication. she was given 5mg vitamin k. cardioversion not indicated given likely chronicity of afib. # arf: baseline creatinine 1.3 presenting with acute increase to 2.5 concerning for ischemic injury due to hypotension vs infection/urosepsis. ua concerning for genitourinary bleed given large rbcs and supratherapuetic inr. urine eos positive also. given overall hypotensive picture, however, severe hypoperfusion was thought the most likely cause. renal replacement therapy was not pursued as this would have been futile. # transaminitis: the patient's lfts were mildly elevated on presentation. by the time of her death, her alt had increased to over 2,000, consistent with shock liver. # ams: no acute process on head ct. mental status improved over the course of her first day, with ability to respond to questions and follow commands. # uti: treated with empiric abx as above. # acute on chronic diastolic chf: presentation concerning for concurrent exacerbation with possible pneumonia vs urosepsis. currently on lasix and metolazone therapy. has been admitted for chf exacerbations in the past. dry weight noted to be 125lb (previous discharge). she was given several liters of ivf to stabilize pressure. a tte was done which showed a decreased ejection fraction consistent with either takutsubo cmp or multi-vessel disease. it was thought that her hypotension was the cause of her cardiac dysfunction rather than vice versa. her ekg was not grossly changed on admission, nor her enzymes floridly elevated to an extent that would be compatible with an mi large enough to cause hypotension. inactive issues: #. gerd: continue ppi ppx, start pantoprazole #. hx of gout: home allopurinol 200 mg po daily # bone health: home vit d/ca # brca hx: home exemestane # vitamins: home vit c and b12 transitional issues: patient deceased medications on admission: 1. acetaminophen 325-650 mg po q6h:prn pain/fever <4 g per day please tell ho for t>100.5 2. docusate sodium 100 mg po bid:prn constipation 3. aspirin 325 mg po daily 4. metoprolol tartrate 25 mg po daily hold for sbp < 90 hr < 55 5. metolazone 2.5 mg po qmowefr 6. omeprazole 40 mg po daily 7. allopurinol 200 mg po daily 8. exemestane *nf* 25 mg oral qday 9. ascorbic acid 500 mg po bid 10. cyanocobalamin 1000 mcg po daily 11. caltrate-600 plus vitamin d3 *nf* (calcium carbonate-vitamin d3) 600 mg(1,500mg) -400 unit oral tid 13. hydrocerin 1 appl tp qid pply to legs 14. imodium a-d *nf* (loperamide) 2 mg oral qid diarrhea 15. ocuvite *nf* (vit a,c & e-lutein-minerals;<br>vit c-vit e-lutein-min-om-3) 1,000-60-2 unit-unit-mg oral daily 16. collagenase ointment 1 appl tp daily 17. senna 1 tab po bid:prn constipation 18. vitamin d 400 unit po daily 19. potassium 30 daily 20. aldactone 25 daily 21. lisinopril 2.5 daily 22. lasix 20mg qod 23. warfarin 1.0 - 1.5mg daily discharge medications: deceased discharge disposition: expired discharge diagnosis: deceased discharge condition: deceased discharge instructions: deceased followup instructions: deceased md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization central venous catheter placement with guidance diagnoses: hyperpotassemia abnormal coagulation profile anemia, unspecified esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis gout, unspecified atrial fibrillation acute on chronic diastolic heart failure personal history of malignant neoplasm of breast acute respiratory failure septic shock obesity, unspecified urinary incontinence, unspecified 

Answer: The patient is high likely exposed to