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: this is an 81-year-old female with a history of emphysema (not on home o2), who presents with three days of shortness of breath thought by her primary care doctor to be a copd flare. two days prior to admission, she was started on a prednisone taper and one day prior to admission she required oxygen at home in order to maintain oxygen saturation greater than 90%. she has also been on levofloxacin and nebulizers, and was not getting better, and presented to the emergency room. in the emergency room, her oxygen saturation was 100% on cpap. she was not able to be weaned off of this despite nebulizer treatment and solu-medrol 125 mg iv x2. review of systems is negative for the following: fevers, chills, nausea, vomiting, night sweats, change in weight, gastrointestinal complaints, neurologic changes, rashes, palpitations, orthopnea. is positive for the following: chest pressure occasionally with shortness of breath with exertion, some shortness of breath that is positionally related, but is improved with nebulizer treatment. past medical history: 1. copd. last pulmonary function tests in demonstrated a fvc of 52% of predicted, a fev1 of 54% of predicted, a mmf of 23% of predicted, and a fev1:fvc ratio of 67% of predicted, that does not improve with bronchodilator treatment. the fvc, however, does significantly improve with bronchodilator treatment consistent with her known reversible air flow obstruction in addition to an underlying restrictive ventilatory defect. the patient has never been on home oxygen prior to this recent episode. she has never been on steroid taper or been intubated in the past. 2. lacunar cva. mri of the head in demonstrates "mild degree of multiple small foci of high t2 signal within the white matter of both cerebral hemispheres as well as the pons, in the latter region predominantly to the right of midline. the abnormalities, while nonspecific in etiology, are most likely secondary to chronic microvascular infarction. there is no mass, lesion, shift of the normal midline strictures or hydrocephalus. the major vascular flow patterns are preserved. there is moderate right maxillary, moderate bilateral ethmoid, mild left maxillary, minimal right sphenoid, and frontal sinus mucosal thickening. these abnormalities could represent an allergic or some other type of inflammatory process. additionally noted is a moderately enlarged subtotally empty sella turcica". 3. angina: most recent stress test was in going for four minutes with a rate pressure product of 10,000, 64% of maximum predicted heart rate without evidence of ischemic ekg changes or symptoms. the imaging portion of the study demonstrated no evidence of myocardial ischemia and a calculated ejection fraction of 84%. the patient denies angina at rest and gets angina with walking a few blocks. are alleviated by sublingual nitroglycerin. 4. hypothyroidism on synthroid. 5. depression on lexapro. 6. motor vehicle accident with head injury approximately 10 years ago. medications on admission: 1. hydrochlorothiazide 25 q.d. 2. prednisone 60 mg, 50 mg, 40 mg, 20 mg. 3. levofloxacin 500 mg q.d. 4. imdur 60 mg q.d. 5. synthroid 75 mcg q.d. 6. pulmicort nebulizer b.i.d. 7. albuterol nebulizer q.4. prn. 8. lexapro 10 mg q.d. 9. protonix 40 mg q.d. 10. aspirin 81 mg q.d. allergies: norvasc leads to lightheadedness and headache. family history: noncontributory. social history: lives with her husband, dr. an eminent pediatric neurologist at . the patient is a prior smoker, but has not smoked in over 10 years. she has no known alcohol use and she is a full code. physical exam at time of admission: blood pressure 142/76, heart rate 100 and regular, respirations at 17-21, and 97% axillary temperature. she was saturating at 100% on cpap with dry mucous membranes. an elderly female in no apparent distress. pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. oropharynx difficult to assess due to cpap machine. no evidence of jugular venous pressure, however, the strap from the cpap machine obscures the neck exam. cranial nerves ii through xii are grossly intact. neck is supple without lymphadenopathy. heart exam: tachycardic, regular, obscured by loud bilateral wheezing with increase in the expiratory phase as well as profuse scattered rhonchi throughout the lung fields. positive bowel sounds, soft, nontender, nondistended, obese, no masses. mild edema of the lower extremities without clubbing or cyanosis, no rashes. there is a right hand hematoma. strength is assessed as in the lower extremities, in the upper extremities with a normal mental status and cognition. laboratory studies: white count 19, hematocrit 41, platelets 300. chem-7: 127, 3.6, 88, 29, 17, 0.6, 143. troponin was negative. cks were negative times three. initial blood gas showed a ph of 7.4, po2 of 66, pco2 of 54. chest x-ray demonstrates a moderate sized hiatal hernia, segmental atelectasis, left lower lobe infiltrate versus segmental atelectasis. ekg shows normal sinus rhythm at 113 beats per minute, normal axis, no evidence of st-t wave changes. brief summary of hospital course: 1. copd/dyspnea/pneumonia: the patient was initially placed on an aggressive steroid taper and admitted to the medical intensive care unit due to her difficulty with oxygenation despite cpap machine. she was also given nebulizer treatments q.4h. as well as chest pt. the nebulizers were increased to q.1h. due to the fact that she continued to have labored breathing. due to persistent respiratory failure and labored breathing, the patient was intubated on in order to improve oxygenation, ventilation, and ability to suction. a bronchoscopy was performed on , which demonstrated marked narrowing of the airways with expiration consistent with tracheomalacia. on , two silicone stents were placed, one in the left main stem (12 x 25 and one in the trachea 16 x 40) by dr. under rigid bronchoscopy with general anesthesia. on , the patient was extubated to a cool mist shovel mask and her oxygen was titrated down to 2 liters nasal cannula at which time she was transferred to the medical floor. on the medical floor, the steroids were weaned to off on , and the patient was saturating at 97% on 2 liters, 92% on room air. on , the patient was seen again by the interventional pulmonology service, who agreed that she looked much improved and recommended that she go to pulmonary rehabilitation with followup within six weeks' time status post placement of stents in respiratory failure. 2. cardiovascular: the patient was ruled out for a mi. she did have another episode on the medical floor of chest pain, which showed no evidence of ekg changes and negative troponin, negative cks x3. she was continued on aspirin, imdur, and diltiazem for rate control per her outpatient regimen. 3. hypertension: she was maintained on diltiazem and hydrochlorothiazide with adequate blood pressure control and normalization of electrolytes. 4. hematuria: the patient had intermittent hematuria likely secondary to foley placement. the foley catheter was discontinued on . she had serial urinalyses, which were all negative for signs of infection. 5. hyperglycemia: patient was placed on insulin-sliding scale due to hyperglycemia, which was steroid induced. this worked quite well and her glucose came back to normal levels once the steroids were tapered to off. 6. leukocytosis: patient did have a profound leukocytosis of 20 to 22 during much of her hospital course. as the steroids were tapered to off, her white blood cell count on was 15,000. it was felt that the leukocytosis was secondary to both steroids as well as question of a left lower lobe pneumonia. 7. for the left lower lobe pneumonia, the patient had initially received a course of levofloxacin 500 p.o. q.d. from to . this was restarted on for an additional seven day course given the fact that she still had the leukocytosis and still had marked rales at the left lower lobe. 8. hypothyroidism: the patient was continued on outpatient medical regimen. 9. depression: the patient was continued on lexapro per outpatient regimen. it is recommended that she follow up with a therapist as an outpatient due to the fact that she did have a blunted affect throughout much of the hospital course, and did appear clinically to be depressed. 10. prophylaxis: she was maintained on proton-pump inhibitor with subq heparin. 11. sore throat: the patient did have a sore throat for much of the hospital course post extubation. this was treated with cepacol lozenges as well as kbl liquid (a solution containing kaopectate, bismuth, and lidocaine) at bedtime. 12. communication/code status: the patient was full code throughout her hospital course, and communication was maintained with the patient and her husband. 13. muscle weakness: the patient did have profound muscle weakness and was evaluated by physical therapy, and was found to have impaired functional mobility, impaired musculoskeletal performance, impaired gas exchange, impaired endurance, impaired ventilation, and needed help with supine to sit. however, she was able to tolerate sitting in a chair for approximately one hour. on motor exam, her flexors and extensors of the lower extremities were at the knee, at the ankle, at the elbows, and hips. it was felt that this weakness was most likely due to a combination of steroid myopathy as well as muscle atrophy secondary to deconditioning after a prolonged hospital course. 14. speech/swallow: the patient had a speech and swallow evaluation showing no evidence of dysphagia, no evidence of vocal cord damage status post tracheal stent placement. discharge condition: the patient was able to oxygenate on room air at 93% at the time of discharge. she was profoundly weak, but was no longer tachycardic and had a normal blood pressure. her respirations were much improved albeit with transmitted upper airway sounds. discharge status: the patient will be discharged to for both pulmonary and physical rehabilitation. discharge medications: 1. levothyroxine 75 mcg p.o. q.d. 2. citalopram 10 mg p.o. q.d. 3. aspirin 81 mg p.o. q.d. 4. fluticasone 110 mcg two puffs inhaled b.i.d. 5. salmeterol diskus one inhalation b.i.d. 6. acetaminophen 325-650 mg p.o. q.4-6h. prn. 7. ipratropium bromide mdi two puffs inhaled q.2h. prn. 8. albuterol 1-2 puffs inhaled q.2h. prn. 9. zolpidem tartrate 5 mg p.o. q.h.s. prn. 10. isosorbide dinitrate 10 mg p.o. t.i.d. 11. diltiazem 60 mg p.o. q.i.d. 12. pantoprazole 40 mg p.o. q.24h. 13. trazodone 25 mg p.o. q.h.s. prn. 14. subq heparin 5000 units subcutaneous b.i.d. until such time that the patient is able to get out of bed twice a day. 15. cepacol lozenges q.2h. prn. 16. levofloxacin 500 mg p.o. q.d. for a seven day course to be completed on . 17. kaopectate/benadryl/lidocaine 5 ml p.o. b.i.d. prn, not to be given around mealtimes for concern of dysphagia induced by lidocaine. 18. lorazepam 0.5-2 mg iv q.6h. prn. follow-up plans: the patient is recommended to followup with dr. , within two weeks of leaving of the hospital. she is also recommended to followup with the interventional pulmonary service for followup status post stent placement. she is also recommended to followup with a neurologist if her muscle weakness does not improve within one week on physical therapy with concern for steroid-induced myopathy. final diagnoses: 1. tracheomalacia status post tracheal and left main stem bronchial stent placement. 2. hypertension. 3. hypothyroidism. 4. restrictive lung defect. 5. depression. dr., 12-207 dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy non-invasive mechanical ventilation other intubation of respiratory tract closed [endoscopic] biopsy of bronchus other operations on trachea diagnoses: pneumonia, organism unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified acute respiratory failure 

Answer: The patient is high likely exposed to