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: dyazide / prozac / nsaids / inderal / cefazolin attending: chief complaint: dyspnea major surgical or invasive procedure: hemodialysis (; ) history of present illness: history obtained from family, patient, and chart. 64 yo female with h/o esrd on hd, dm and chf who presented to the ed on with one day history of sob. the patient states that she began feeling ill two days prior to admission. she began to develop a non-productive cough. she was staying with her daughter and had soup (broth-like) for dinner on saturday. her daughter reports that she woke up at 2 am on sunday morning c/o of being hot, but did not take her temperature. she woke up again at 4 am c/o of being hot, and was confused and had difficulty finding her way to the bathroom. when she woke up on sunday morning (day pta), she continued to cough and was having "trouble breathing." her daughter reports that she had doe on adls. she also states that the patient looked puffy and had lower extremity edema. she awoke on monday morning at approximately 1 am with increased dyspnea and was brought to the hospital by ems. on arrival in the ed she was somnolent, but arousable and able to follow commands. she was hypertensive to 204/92 with a heart rate of 54. she was afebrile at that time and had a cough productive of yellow sputum. her exam in the ed showed jvd, bibasilar crackles, but no lower extremity edema. she was given nitroglycerin in the ed along with 60 mg iv lasix and was placed on cpap. she was eventually transitioned to 100% nrb. she was also started on levaquin (750 mg iv). she was admitted to the micu for dyspnea. past medical history: # esrd (on hemodialysis) - s/p cadaveric renal tx in - renal transplant complicated by cdiff, polyoma virus infection - returned to hd # dm c/b retinopathy, neuropathy # chf (diastolic dysfunction) -- ef>55% on # hyperlipidemia # h/o multiple cvas # cad s/p cath -- lad 50% stenosed # s/p hysterectomy # s/p cataract surgery # htn # s/p thrombectomy lue graft # hyperparathyroidism # l2 compression fracture # ostium secundom atrial defect seen on tte # mild aortic stenosis/aortic regurg social history: originally from , formerly worked as a nurse's aide. lives with her daughter. denies etoh, tobacco, ivdu. family history: father -- dm mother -- hypertension physical exam: vs: 98.1, 57, 128/45 (on nitro gtt 0.44), 100% 4l, rr 28 somnolent but arousable and able to speak full sentences jvp elevated rrr, 2/6 sem rhoncherous thorughout, ? rml egophany soft, obese, nt/d +bs l arm fistual with thrill/non tender trace-1+ edema bilaterally pertinent results: labs on admission: wbc-10.3 hct-36.8 mcv-98 plt ct-275 neuts-68.2 lymphs-21.2 monos-6.2 eos-4.2* baso-0.3 pt-11.4 ptt-24.7 inr(pt)-1.0 glucose-117* urean-49* creat-4.6* na-139 k-5.0 cl-104 hco3-26 angap-14 12:40pm blood type-art po2-69* pco2-61* ph-7.31* caltco2-32* base xs-1 intubat-not intuba comment-nasal 04:34am blood calcium-8.7 phos-3.8 mg-2.2 . urine: color-straw appear-clear sp -1.008 blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg rbc-0-2 wbc-0-2 bacteri-few yeast-none epi- . cardiac enzymes: 04:34am ck(cpk)-175* ck-mb-4 ctropnt-0.09* probnp-4026* 12:04pm ck(cpk)-151* ck-mb-5 ctropnt-0.12* 10:41pm ck(cpk)-131 ck-mb-4 ctropnt-0.18* . labs on discharge: wbc-8.4 hct-39.1 mcv-96 plt ct-237 glucose-62* urean-30* creat-4.3* na-137 k-4.1 cl-95* hco3-30 angap-16 calcium-9.4 phos-4.6* mg-2.1 . micro: blood cx x2 no growth urine cx urine culture (final ): presumptive gardnerella vaginalis. >100,000 organisms/ml.. sputum cx source: expectorated. **final report ** gram stain (final ): <10 pmns and <10 epithelial cells/100x field. no microorganisms seen. quality of specimen cannot be assessed. smear reviewed; results confirmed. respiratory culture (final ): moderate growth oropharyngeal flora. . imaging: cxr: 1. obscuration of the left hemidiaphragm which was not identified on previous study from . this may represent effusion, atelectasis or infiltrative process. 2. cephalization and prominence of the pulmonary arterial vasculature consistent with pulmonary edema. . cxr: there is a marked thoracic scoliosis convex to the right. there is cardiomegaly but no evidence for chf. the ill-defined opacities present in the left mid and lower zones and at the right base on the previous film of , have resolved suggesting that they represented atelectasis. no new lung lesions. no pneumothorax. the relative lucency of the left lung compared to the right is likely related to technical reasons (rotated chest). brief hospital course: ms. is a 64 yo female with esrd s/p cadaveric transplant with return to hd, chf, cad, htn, hyperlipidemia, and dm who presented to the ed with increasing sob and evidence of chf exacerbation on cxr and physical exam. . 1). cv: # cad: patient denied any chest pain, but cardiac enzymes were checked to evaluate for ischemic cause of her chf. her enzymes were cycled in the micu and her troponin was elevated, it was felt that her elevated troponin was likely to troponin leak from htn and that it did not clear due to her renal insufficiency. she was maintained on aspirin, atorvastatin. ecg was unchanged from priors. . # pump: chf likely to diastolic dysfunction and fluid overload associated with esrd and increased salt intake. sob resolved throughout admission with hemodialysis. patient continued to cough with production of white frothy sputum, likely chf. she was maintained on lisinopril. she was kept on a low salt diet and a nutrition consult was placed for patient education regarding a low salt diet. . # rhythm: sinus rhythm throughout admission. continued on home meds (metoprolol). . # htn: the patient arrived in hypertensive urgency with bp to 204/92. she was originally on a nitroglycerin gtt and received 60 iv lasix in the ed. she did not respond well to the lasix, so the nitroglycerin gtt was initially continued in the micu. once her bp stabilized, the nitroglycerin gtt was discontinued and she was taken for hemodialysis on the day of admission. 3.2l of ultrafiltrate were removed. her bp remained stable and was well controlled during the remainder of her micu stay and on the floor. she was continued on her home meds (lisinopril and metoprolol). . 2). pulm: her sob improved with volume management which was mostly achieved through hemodialysis. she had required cpap for a short period in the er, but prior to transfer to the micu, she was able to titrate down to 4l o2 by nc. her initial cxr showed a question of a lll opacity obscuring the hemidiaphragam and evidence for pulmonary edema. she was started on levaquin in the er, but this was not continued given that she was afebrile and did not have a leukocytosis. repeat cxr on showed improvement in the lll opacity, suggesting that it was secondary to atelectasis or pulmonary edema. she had no oxygen requirement on the floor. sputum culture was sent but only grew oropharyngeal flora. pt was consulted for help with deconditioning and preparing the patient for discharge. initially, there was discussion of aspiration or osa contributing to her symptoms but the patient improved quickly and the decision was made to defer any further workup to her pcp. . 3). renal: ms. hemodialysis on and . she had 3.2l of uf removed on and 2.3l of uf removed on . her bp was closely monitored during hd and it was stopped when it seemed like her bp became low or if she became symptomatic. electrolytes were followed in the micu and on the floor and were stable. she was continued on her home meds, including prednisone, sevelamer, and bactrim. . 4). id: originally, there was question of a lll opacity seen on cxr, but its resolution on follow-up cxr suggested that it was not due to an infectious cause. the patient was initially started on levaquin in the ed, but that was not continued. a sputum culture was sent, but only grew op flora. she remained on bactrim for prophylaxis. . 5). endocrine: her bg were well controlled throughout her admission. she was continued on her home insulin regimen, but had a few episodes of symptomatic hypoglycemia in the mornings (fs 62 in am on ). based on her trend, her evening dose of nph was decreased from 5u to 3u and the patient was advised to follow up with her pcp weeks from discharge to review her fingersticks. . 6). neuro, msk: no issues. . 7). code: full (confirmed with patient and family). medications on admission: 1. aspirin 81 mg qd 2. metoprolol tartrate 25 mg po bid 3. atorvastatin 40 mg po qd 4. trimethoprim-sulfamethoxazole 80-400 mg tablet po qmwf 5. paroxetine hcl 10 mg po qd 6. lisinopril 5 mg po qd 7. gabapentin 100 mg po q-hemodialysis 8. prednisone 5 mg po qd 10. sevelamer 800 mg po tid 13. insulin nph-regular 38 units qam, 5 units qpm discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. paroxetine hcl 10 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 6. gabapentin 100 mg capsule sig: one (1) capsule po qhd (each hemodialysis). 7. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 8. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). 9. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 10. insulin nph-regular human rec 100 unit/ml (70-30) suspension sig: see below subcutaneous twice a day: take 38 units qam and 5 units qpm. discharge disposition: home with service facility: vna discharge diagnosis: primary: chronic heart failure secondary: end stage renal disease on hemodialysis diabetes mellitus coronary artery disease hypertension discharge condition: stable discharge instructions: you were admitted to the hospital with shortness of breath due to fluid overload related to your kidney disease. while in the hospital, you were dialyzed twice and continued on your home medications. your chest x-rays showed improvement from the day of admission. . please weigh yourself every morning, and call your doctor if your weight is up > 3 lbs. adhere to 2 gm sodium diet. . please continue to receive dialysis as per your usual routine. . please call your doctor or come to the emergency room if you have worsening shortness of breath, persistent cough, chest pain, fevers, chills, or change in the color of your sputum. . no changes were made to your home medications while you were in the hospital. followup instructions: please follow-up with your primary care physician weeks. procedure: hemodialysis diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes diastolic heart failure, unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy 

Answer: The patient is high likely exposed to