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: history of present illness: the patient is a 46 year old female with a history of polysubstance abuse who was transferred from hospital on with hypoxemic respiratory failure. the patient has a complicated recent medical history including an admission to hospital in following an overdose with multiple substances, subsequently developing bilateral question aspiration pneumonias requiring an intensive care unit stay (it is not clear if the patient was intubated at this time). the patient developed persistent hypoxemia after her admission and was placed on 3 liters of nasal cannula oxygen upon in . in the interim she had restarted using alcohol, intravenous heroin, intranasal cocaine and abusing other pills including pcas. in this setting she presented to hospital on with complaints of increasing shortness of breath. she had increased her use of intravenous heroin and intranasal cocaine within the preceding week. she was begun on ceftazidime and clindamycin for possible aspiration pneumonia and also given steroids and nebulizers for compliance of reactive disease and chronic obstructive pulmonary disease. her initial chest x-rays at the outside hospital revealed diffuse bilateral infiltrates concerning for adult respiratory distress syndrome versus bilateral pneumonias due to severe aspiration. the patient had increasing oxygen requirement and was eventually placed on nonrebreather on the medical floor. by report, her echocardiogram revealed normal left ventricular function. antibiotics were changed to levaquin on and then to azithromycin on . the patient's respiratory status continued to decline and she was intubated on at hospital. the patient underwent bronchial alveolar lavage on . she had a negative lenie on . the patient continued to require increasing positive end expiratory pressure and ventilatory supports by aggressive antibiotic therapy and intensive care unit management. the patient underwent a chest computerized tomography scan on which revealed diffuse bilateral interstitial lung disease with subpleural bronchiectasis with a diffuse reticular nodular pattern. the patient underwent right open wound biopsy on after which a right tube was placed. the patient continued to require high forced inspiratory oxygen levels and positive end-expiratory pressure. the patient was transferred to for further evaluation management of her bilateral pulmonary infiltrates, question acute and chronic pulmonary disease of unclear etiology. she was transferred on . past medical history: 1. polysubstance abuse; 2. question chronic obstructive pulmonary disease; 3. question untreated obstructive sleep apnea; 4. obesity; 5. question bipolar disorder versus depression with psychotic features; 6. question reactive airway disease. allergies: codeine causes gastrointestinal upset. medications on transfer: propofol drip; versed drip; lovenox subcutaneous; morphine drip; ciprofloxacin 400 intravenously b.i.d.; lopressor; lansoprazole; solu-medrol 60 b.i.d. social history: positive tobacco use, patient lives with sister and has had a long history of polysubstance abuse including intravenous heroin, intranasal cocaine, alcohol and psychiatric medications. physical examination: upon admission temperature 99, heartrate 66, blood pressure 107/70, respiratory rate 18, oxygen saturation 96%. laboratory data: arterial blood gases, 7.41, paco2 46, pao2 72, on fio2 of 65% with positive end-expiratory pressure of 15. white count 17.3, hematocrit 37, platelets 272. chem-7 sodium 139, potassium 4, chloride 97, bicarbonate 28, bun 16, creatinine 0.3, glucose 117, normal coagulation studies. hospital course: the patient was admitted to the fennard intensive care unit on for further evaluation and management of her diffuse bilateral pulmonary infiltrate and persistent hypoxemia. the patient's initial chest x-ray revealed left lower lobe collapse and consolidation with bibasilar ill-defined pulmonary infiltrate. given that the patient had received greater than 14 days of broad-spectrum antibiotics at the outside hospital the decision was made to withhold any antibiotic treatment until sputum cultures were revealing of an infectious etiology. it is felt that the patient was in the later stages of adult respiratory distress syndrome. given that her open lung biopsy had revealed diffuse alveolar damage, consistent with adult respiratory distress syndrome and pulmonary edema, the patient was placed on midury protocol for treatment of late stage adult respiratory distress syndrome with tapering dose of solu-medrol. the patient continued, however, to have high ventilatory support requirement with positive end-expiratory pressure no less than 12.5 and fio2 no less than 50%. with decreasing positive end-expiratory pressure and fio2 the patient immediately dropped oxygen saturation to the low 80s with pao2s in the 60s. the patient continued to do well from all other perspectives without complications of other organ systems. her chest tube was removed on without complications. a picc line was placed on for improved intravenous access, given poor peripheral veins due to drug use. her right internal jugular with triple lumen catheter was discontinued at this time. a repeat chest computerized tomography scan was obtained on which revealed diffuse patchy areas of groundglass opacification and consolidation. there was abnormal opacity of all areas of both lungs. consolidation has a dependent distribution and no endobronchial lesions are identified. the computerized tomography scan was felt to be consistent with diffuse alveolar damage/pulmonary edema in a patient with adult respiratory distress syndrome. the possibility of acute interstitial pneumonitis, ( syndrome) was suggested. radiologically, infectious etiology can not be excluded. multiple discussions were held in an attempt to further elucidate the etiology of the patient's persistent hypoxemia. it appears that this hospitalization was precipitated by an acute injury in the setting of chronic interstitial lung disease. whether the patient has interstitial pulmonary fibrosis is not clear. it is clear that the patient has a long history of chemical dependence and overdoses with ? development of chemical pneumonitis and repeat chemical versus infectious lung injury. the patient had tracheostomy placed on as it became clear that she would require continuous ventilatory support in the rehabilitation setting. placement of tracheostomy was without complications. the patient continued to do well after tracheostomy placement and eventually had a percutaneous enterogastric jejunostomy tube placed on for nutritional support. the procedure was without complications and tube feeds were started through her gastrostomy tube without complications. the patient was seen by physical therapy and did well. at the time of , the patient has ventilatory settings of pressure support 15 with positive end-expiratory pressure of 12.5, fio2 40 to 50%. in this setting her minute ventilation was 10-12 liters per minute with a title volume of 4 to 600. of note, the patient desaturates rapidly with excessive coughing and agitation. she has required persistently increasing amount of klonopin and risperdal for agitation. it is clear that her substance abuse issues need to be addressed as an outpatient as well as her anxiety issues. of note, the patient had increasing secretions on with mildly increased temperatures and mild leukocytosis to 15,000. given clinical scenario of increasing secretion and history of greater than 20 days on the ventilator, the patient was treated aggressively for ventilator associated pneumonia and responded well with double coverage of gram negative rods with ceftazidime and levofloxacin. she is to complete a 14 day course which showed finish on . the patient's secretions decreased significantly and the patient has remained afebrile without leukocytosis since initiation of these antibiotics. the patient will need follow up with pulmonary doctor , as her diagnosis and prognosis remains unclear. she is improving with ventilatory support, however, her ultimate oxygen requirements remain unclear at this time. it was recommended that she follow up with dr. at . she will be discharged to for ventilatory support and pulmonary rehabilitation as well as physical therapy. she is felt to be an excellent rehabilitation candidate given her lack of other medical issues. diagnosis: 1. hypoxemic respiratory failure due to question acute and chronic lung disease of unclear etiology. 2. polysubstance abuse with history of multiple overdoses. 3. question bipolar disorder versus depression with psychotic features. 4. question obstructive sleep apnea untreated. 5. obesity. 6. question reactive airway disease versus chronic obstructive pulmonary disease. medications on : 1. ceftazidime 1 gm intravenously q. 8 times 12 days 2. levofloxacin 500 mg p.o. q. 24 hours times 12 days 3. clonazepam 3 mg p.o. t.i.d. 4. risperidone oral solution 1 mg p.o. q. am 5. risperdal oral solution 2 mg per gastrostomy tube q.h.s. 6. regular insulin sliding scale 7. heparin subcutaneously 5000 units q. 8 8. fentanyl patch 75 mcg/hr, transdermal q. 72 hours 9. dulcolax 10 mg p.r. q.h.s. 10. multivitamin 5 ml p.o. q.d. 11. lactulose 30 ml p.o. q. 8 hours prn constipation 12. albuterol 2 puffs inhaled q. 6 hours 13. atrovent 2 puffs inhaled q. 4 hours 14. lansoprazole oral solution 30 mg per percutaneous endoscopic gastrostomy tube q.d. 15. tylenol prn 16. miconazole powder 2% apply to affected areas t.i.d. prn condition: good , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances thoracentesis other bronchoscopy temporary tracheostomy percutaneous [endoscopic] gastrojejunostomy diagnoses: other pulmonary insufficiency, not elsewhere classified other, mixed, or unspecified drug abuse, unspecified chronic airway obstruction, not elsewhere classified pneumonitis due to inhalation of food or vomitus unspecified sleep apnea other diseases of lung, not elsewhere classified obesity, unspecified 

Answer: The patient is high likely exposed to