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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 73 year old woman with hx of esrd on hd, diastolic chf, pvd s/p bilateral lower leg amputations, and atrial fibrillation presenting with shortness of breath. she was recently discharged from on following an admission for hypertensive urgency complicated by hypoxia due to pulmonary edema. during that admission, she was placed on cpap, had blood pressure control with a nitroglycerin gtt initally and had extra hd/uf sessions. there was no clear etiology to the decompensation as she had no clear cardiac ischemic event nor missed hd session. she was discharged to resume her usual mwf dialysis sessions. . on saturday night she first noted shortness of breath when she was trying to sleep. she stated that everytime that she would try to lay flat she would get more short of breath. she denied chest pain, cough, or diaphoresis. she had no fevers/chills/sweats prior to coming to the hosptial. she stated that before coming into the hospital that she noted her heart was racing. . in the ed, her initial vital signs were t not recorded hr 113 bp 230/112 38 100%nrb. she was started on a nitroglycerin gtt. she was started on cpap. she received lasix 100 mg x1 to which she urinated ~80cc. she received 1 dose of ceftriaxone and was prescribed 1 dose of levofloxacin. past medical history: - diastolic chf with lvot obstruction at rest - chronic 2l nc at night - hypertension - diabetes - peripheral vascular disease status post bilateral knee amputations in (l) and (r) - gerd - hypercholesterolemia - esrd on hemodialysis m,w,f. receives dialysis at hemodialysis center in . - paroxysmal atrial flutter, s/p failed ablation with subsequent a. fib - peptic ulcer disease - hypertrophic obstructive cardiomyopathy - mild mitral stenosis (mva 1.5-2.0 cm2) - secondary hyperparathyroidism - diastolic congestive heart failure social history: social history is significant for the presence of current tobacco use (1 pack per week), and ppd x 50 years. there is no history of alcohol abuse. lives in facility and uses a mobile wheelchair or a walker. family history: her father died in his 90s and mother at the age of 102. patient unable to specify cause of death. she has one living sister and 6 sisters and one brother who passed away. her family history is significant for coronary artery disease, cancer, and diabetes. physical exam: vs: 96 78 163/80 23 100% 5l gen: nad heent: at, nc, perrla, arcus senilus, eomi, no conjunctival injection, anicteric, op clear, mmm, neck supple, no lad, no carotid bruits cv: rrr, nl s1, s2, 3/6 systolic murmur at apex pulm: crackles way up from base, dullness at bases abd: soft, nt, nd, + bs, no hsm ext: bilateral bka w/o evidence of skin breakdown. no femoral bruits. biphasic thrill in av graft to left arm neuro: alert & orientedx3, cn ii-xii grossly intact, strength throughout upper extremities. no sensory deficits to light touch appreciated. no asterixis psych: appropriate affect pertinent results: ekg :sinus rhythm. left ventricular hypertrophy with st-t wave changes. left atrial abnormality. compared to the previous tracing of the st-t wave changes are more prominent and may represent superimposed inferolateral ischemic process. followup and clinical correlation are suggested. . renal u/s : impression: no solid renal masses identified. echogenic kidneys consistent with chronic renal disease and multiple bilateral small simple renal cysts. . cxr: cardiac silhouette is difficult to assess as there are dense fluffy bilateral perihilar consolidations, obscuring the heart borders. pulmonary vascularity is increased, with cephalization. there are small bilateral pleural effusions, right greater than left. there is no pneumothorax. . tte - the left atrium is moderately dilated. there is severe symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is severe mitral annular calcification. there is moderate functional mitral stenosis (mean gradient 9 mmhg) due to mitral annular calcification. trivial mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. impression: severe symmetric lvh with a small cavity and hyperdynamic systolic function. minimal resting lvot obstruction. moderate functional mitral stenosis. moderate pulmonary hypertension. . microbiology:sputum 8:46 am sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): budding yeast. 3+ (5-10 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (preliminary): brief hospital course: 73 year old woman with hx of diastolic chf, dm2, esrd on hd presenting with acute hypoxia and hypertensive urgency . # hypoxia: given her hx of severe dchf, difficulty removing fluid at hd due to lvot obstruction, pulmonary edema on presentation cxr, hypoxia appeared most consistent with diastolic chf exacerbation. as she was hypertensive to the 200s systolic and reported palpitations prior to admission, both htn and perhaps a.fib with rvr caused worsening of her pulmonary edema on presentation. although she had leukocytosis, she was without fever, cough, sputum production to suggest underlying pulmonary infection. she does have hyperinflated lungs on cxr and was mildly bronchospastic on admission, so she was started on azithromycin, spireva, and albuterol nebs. cardiac enzymes x3 showed flat troponin at 0.04-0.05 and negative mbi so as not to suggest ischemic event. as she has no pfts in our system, she should follow up for outpatient pfts. additionally, as she is on 2l o2 via nasal cannula at night (prescribed by outside md), she should have outpatient sleep study. . # leukocytosis: all cell lines were up on presentation however this was pre hd/uf so unlikely due entirely to hemoconcentration. she was, however, without fever and no clear source of infection. cxr showed pulmonary edema and small effusions without clear evidence of infiltrate and she was without cough and fever. ua was negative for infection. she had no gi symptoms to suggest as possible infective source. as she was initially mildly bronchospastic on exam, she was started on azithromycin x 5 day course. . # ? copd: no formal diagnosis, however lungs markedly hyperinflated on cxr and with significant pack year history of tobacco use with continued use (although less so). there was initially some concern for copd contributing to her hypoxia given mild bronchospasm on presentation. she was started on spireva and albuterol nebs as well as azithromycin and her exam improved markedly. she should follow up for outpatient pfts. . # erythrocytosis: previous baseline hct high 20s-low 30s. she presented with hct 51-->43. last hd/uf session was 3 days pta so seemed unlikely all hemoconcentration; she did report poor po however. she has not been receiving epogen at hd session per renal as her hgb has been > goal. renal u/s was negative for mass suggestive of erythropoietin producing mass. an epo level was sent. . # end-stage renal disease: she was continued on her home phos binder and nephrocaps and was continued on hd qmwf as per her normal schedule. . # atrial fibrillation: she remained in nsr while in house and inr was therapeutic on presentation. she was supratherapeutic on day of discharge. thus, she was advised not to take her dose of coumadin on . she was continued on metoprolol and coumadin. . # htn: she was briefly on nitro gtt upon arrival to the icu given sbps in the 200s. she was, however, quickly titrated off and post hd, sbps were stable in the 120-140s range on metoprolol alone. upon transfer to the medical floor pt's home regimen of bb, ccb, , acei were restarted with good effect (bp's 120's-140's). she will go home on this regimen. . # diabetes mellitus type 2 with complication of nephropathy: she was continued on her home dose nph with sliding scale coverage. . # hypercholesterolemia: she was continued on her outpatient dose simvastatin. . # gerd: she was continued on outpatient ranitidine. medications on admission: aspirin 325 mg tablet daily simvastatin 80 mg daily sevelamer hcl 800 mg tid w/meals ranitidine hcl 150 mg metoprolol tartrate 100 mg lisinopril 30 mg daily irbesartan 150 mg daily diltiazem hcl sr 120 mg daily nephro-caps daily warfarin 2 mg po 2x/week (mo,fr) warfarin 3 mg po 5x/week (,tu,we,th,sa). nph 4 units . brimonidine 0.15 % drops - 1 drops(s) in the right eye daily latanoprost 0.005 % drops - 1 drops(s) in the right eye hs discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm: dose on held. disp:*30 tablet(s)* refills:*2* 3. brimonidine 0.15 % drops sig: one (1) drop ophthalmic daily (daily). 4. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*qs cap(s)* refills:*2* 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 7. azithromycin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 8. lisinopril 30 mg tablet sig: one (1) tablet po daily (daily). 9. insulin nph human recomb 100 unit/ml suspension sig: four (4) units subcutaneous twice a day: to be taken qam and qdinner. 10. albuterol 90 mcg/actuation aerosol sig: one (1) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* 11. aspirin 325 mg tablet sig: one (1) tablet po once a day. 12. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 13. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 14. irbesartan 150 mg tablet sig: one (1) tablet po daily (). 15. metoprolol tartrate 100 mg tablet sig: one (1) tablet po bid (2 times a day). 16. sevelamer hcl 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). discharge disposition: home with service facility: discharge diagnosis: major: copd flare htn urgency esrd on hd . minor: dm afib htn hyperlipidemia discharge condition: stable discharge instructions: you were admitted with shortness of breath and high blood pressure. for this you were admitted to the icu and placed on non-invasive ventilation and a nitro drip. you were given a session of dialysis for which your breathing and blood pressure improved. you were restarted on your home regimen of blood pressure meds with good effect. . if you develop fevers, chills, increasing shortness of breath, chest pain, weight gain >3lbs, or any other concerning symptom, please contact your doctor or go to the emergency room. . please take your medications as prescribed and follow up with the appointments below. . you should also continue your already arranged hemodialysis session on m/w/f. you should also resume having your inr checked for proper coumadin dosing as you were at dialysis sessions. followup instructions: provider: , md phone: date/time: 12:40 provider: , md phone: date/time: 11:40 provider: , md phone: date/time: 1:40 procedure: hemodialysis diagnoses: pneumonia, organism unspecified end stage renal disease esophageal reflux pure hypercholesterolemia tobacco use disorder mitral valve disorders congestive heart failure, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure peripheral vascular disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin long-term (current) use of anticoagulants family history of ischemic heart disease secondary hyperparathyroidism (of renal origin) diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status family history of diabetes mellitus 

Answer: The patient is high likely exposed to