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: sulfonamides / ciprofloxacin / macrobid attending: chief complaint: cc: weak, "feel fuzzy" major surgical or invasive procedure: intubation history of present illness: hpi: 81 yo woman c hx of chronic multiple medical problems notably lower back pain tx c multiple laminectomies and chronic narcotics (methadone/fentanyl patch) awoke with weakness and slight decline in cognitive function as per son. pt. reports feeling "fuzzy." seen by pcp; in office, noted to be hypotensive to 80s sbp, sent to ed. in , pt still hypotensive to 80's. received 3 l ns bolus, 0.4 mg naloxone to which pt. had bp rise to 110s. several hours later, sbp back to 80's - in meantime, cxr done showing large l sided infiltrate. thought to have pneumonia; code sepsis called and tx c vancomycin/zosyn. also received 10 mg decadron for possible adrenal insuff. while undergoing placement of central line, had apneac episode, intubated, txf to micu. as per husband, pt c/o mild cough in am. no fevers/chills/sick contacts. past medical history: -severe oa -hand surgery, trapezius removal (at ) -chronic lbp c/b lumbar radiculopathy and osteomyletis: staph osteo in remote past spinal stenosis s/p multi-level laminectomies - dr. (t12 s1 laminectomy, l3-l4/l5-s1 fusion + graft) - dr. : for ?discitis/osteomyelitis (partial t11 laminectomy, re-do t12-l1 discectomy, l3-l5 fusion),path: no osteo, afb neg -: s/p nerveblocks -h/o vre > 10yrs ago -h.pylori -antral ulcer -hypertension -hypothyroid -diplopia, 6th nerve palsy - unknown etiology -anemia: possibly worsened w/ small bowel enteropathy w/ nsaids -baseline creatinine 1.7 -microvascular infarcts on mri brain -cluster ha -left hemicrania -neurogenic le claudication -degenerative arthropathy of b/l shoulders s/p surgery -h/o allergy shots (environemental allergies) -thoracotomy scar (unknown etiology) social history: no tob, no etoh, lives with husband. home pt, walks with a cane. family history: non-contributory physical exam: vs: t 99.0, bp 70s/palp -> 104/43, hr 70s, rr 20s, 100% on ac 500/12/5/100% gen- intubated, agitated heent- ncat pupils 2 mm, equal, reactive, anicteric, op clear, dry mm neck- supple lungs- decreased bs on r with crackles and bilat. exp wheezing cv- rrr, nl s1, s2, no mrg abd- soft, distended, nt, nabs, guiac negative ext- no edema, wwp neuro- responds to simple commands, moves all 4 extremities skin- no rashes pertinent results: admission labs: 02:35pm pt-12.9 ptt-21.6* inr(pt)-1.1 02:35pm plt count-203 02:35pm wbc-10.8 rbc-3.19* hgb-9.7* hct-27.2* mcv-85 mch-30.5# mchc-35.7* rdw-14.7 02:35pm tsh-8.5* 02:35pm probnp-* 02:35pm albumin-3.5 calcium-8.9 phosphate-2.5* magnesium-1.6 02:35pm lipase-16 02:35pm alt(sgpt)-24 ast(sgot)-19 ld(ldh)-180 alk phos-83 amylase-31 tot bili-0.3 02:35pm glucose-156* urea n-38* creat-2.0* sodium-138 potassium-4.2 chloride-103 total co2-22 anion gap-17 03:27pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 03:27pm urine color-yellow appear-clear sp -1.019 06:48pm lactate-3.0* 08:45pm cortisol-34.9* . micro: urine -ngtd blood cx x 2 - ngtd sputum cx - ngtd sputum cx - sparse yeast, rare gnr (2 colonial morphologies) urinary legionella ag : negative . cxr, : when compared with prior study, there has been interval removal of endotracheal and nasogastric tubes. a right internal jugular central venous catheter terminates in the upper superior vena cava. this is unchanged in position since prior study. when compared with prior exam, there is mild interval hilar fullness, and pulmonary vascular redistribution. again noted is a left retrocardiac opacity, and opacification of the left upper lung zone consistent with pneumonia/atelectasis. the surrounding soft tissue and osseous structures again reveal bilateral shoulder prosthesis, and scoliosis/degenerative changes of the spine. . impression: 1. right internal jugular central venous catheter in unchanged position with the tip in the upper svc. 2. stable/slight interval worsening chf. 3. stable left lower lobe consolidation/atelectasis. stable left upper lobe opacification. . echo, : the left atrium is elongated. there is mild (non-obstructive) focal hypertrophy of the basal septum. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed with hypokinesis of the mid antero-septum, distal septum, and mid to distal anterior wall including the apex. the remaining segments are hyperdynamic. no masses or thrombi are seen in the left ventricle. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . brief hospital course: micu course: . 1. hypotension- thought to be septic shock pna. ? element of adrenal insufficiency - pt initially required levophed to support bp -> weaned off night of -> - stim test: cortisol 34 -> 36 -> started on hydrocortisone 50 mg iv q6 on - fluid resuscitation as needed with lr and prbcs - checked echo in case there was cardiogenic component to hypotension -> ef 40-45%, hypokinesis of the mid antero-septum, distal septum, and mid to distal anterior wall including the apex, mild mr, mild pa htn - bnp 12,292 on - treatment of sepsis as below . 2. sepsis- thought to be pna - sputum and blood cultures sent -> sputum nurf, sputum grew rare gnr, yeast, urine cx and blood cx x 2 ntd - started on vanc, ceftriaxone, and azithromycin on for empiric tx of pna -> vanc d/ced on - ivf as necessary . 3. resp failure- thought to be sepsis and rll pna +/- element of narcotic od - intubated -> weaned -> extubated on - bronchodilators prn wheezing - treated pna with vanc, ceftriaxone, azithromycin - pt. had a hypoxemic event overnight -> , unresponsive, sbp 70s, o2 sat 80s, hypoventilation 8-9 -> head ct, electrolytes, glucose normal -> thought to be mucous plugging- no pulm edema on exam, no signs of r heart strain on ekg, team had low suspicion of pe as pt. recovered so quickly - checked lenis -> not yet read . 4. elevated troponins- thought to be demand ischemia, not primary cardiac event, as there were no ekg changes, no chest pain - bnp 12,292 on - troponins 0.33-0.56 from to , ck-mb 15 on -> decreasing . 5. chronic, unclear etiology, b12/folate normal. ferritin, tibc normal, could be cri - guaiced all stools - transfused 2 u prbcs overnight - checked hemolysis labs: t bili 0.1, haptoglobin 177 -> likely not hemolyzing . 6. thrombocytopenia- plt 252 -> 150 - all heparin products held - hit ab sent -> pending - plts stable around 150s . 7. pt. experienced significant pain over micu course, on a significant amount of pain medicine at home - originally on fentanyl drip and midazolam drip -> midazolam weaned off, fentanyl transitioned to patch - ativan 1 mg q4-6 prn - restarted methadone 50 mg qd on . 8. cri- baseline cr seems to be 1.4-1.8, most likely htn - cr 2.0 on -> down to 1.3 on day of transfer to floor, probably ivf . course on the floor: 1. hypotension- resolved- thought to be septic shock pna, ? element of adrenal insufficiency, pt. maintained bp without ivf or pressors for past on the floor. - stim test: cortisol 34 -> 36 -> started on hydrocortisone 50 mg iv q6 and fludrocortisone 0.5 mg qd on in micu -> we changed to prednisone 40 mg qd as stim borderline, pt. had high bp -> no hypotension on this regimen -> d/ced with prednisone taper - checked echo in case there was cardiogenic component to hypotension -> ef 40-45%, hypokinesis of the mid antero-septum, distal septum, and mid to distal anterior wall including the apex, mild mr, mild pa htn - bnp 12,292 on - treatment of pna as below . 2. sepsis/pneumonia- sepsis resolved, pt. on day 9 of tx for pna. afebrile since coming to floor with good o2 sats on ra. - sputum and blood cultures sent -> sputum nurf, sputum grew rare gnr, yeast, urine cx and blood cx x 2 ntd - started on vanc, ceftriaxone, and azithromycin on for empiric tx of pna -> vanc d/ced on - continue abx, day 8 on day of discharge, f/u cultures, cis - d/ced on po cefpodoxime to complete 2 week course . 3. resp distress- resolved, thought to be sepsis and rll pna +/- element of narcotic od, pt. now breathing comfortably with good o2 sats on ra. perhaps a component of fluid overload now. - bronchodilators prn wheezing - continue abx - f/u lenis -> not yet read at time of d/c, low suspicion for pe - repeat cxr pa and lat to eval for pulmonary edema, eval progression of pna showed clearing of infiltrate, no edema . 4. elevated troponins- thought to be demand ischemia, not primary cardiac event, as there are no ekg changes, no chest pain - bnp 12,292 on - troponins peaked at 0.83 on , 5pm -> decreasing since - evidence of old inferior mi on ekg - pharmacologic stress test scheduled for outpatient once acute event resolves per cards recs - ace added to her bp regimen for cardiac protection - already on b blocker, statin, asa . 5. anemia- chronic (baseline hct 26-32), unclear etiology, b12/folate normal. ferritin, tibc normal, could be cri - guaic all stools - checked hemolysis labs: t bili 0.1, haptoglobin 177 -> likely not hemolyzing - monitor hct, transfuse if hct < 21 -> hct stable on floor, no transfusion necessary . 6. thrombocytopenia- plt 252 -> 150 - all heparin products held - hit ab sent -> pending at time of discharge - plts stable around 150s-> 180s . 7. pt. reported pain was well controlled over her course on the floor - fentanyl patch 50 mcg q72 - ativan 1 mg q4-6 prn - restarted methadone 10 mg 5x/day - changed iv dialudid to dilaudid 2-4 mg po q 2-3 hrs prn pain - discharged on home regimen . 8. cri- baseline cr seems to be 1.4-1.8, most likely htn - cr 2.0 on -> 1.2 on , probably ivf . 9. prophylaxis- venodynes (decreased plts on heparin so no hep sc), pantoprazole 40 mg po qd . 10. - husband , . 11. dispo - to rehab with outpatient pharmocologic stress test scheduled for outpatient . medications on admission: fentanyl patch 75 mcg -> 50 mcg synthroid 300 mcg qd methadone 10 mg 5 times a day protonix 40 mg qd naprosyn neurontin 300 mg tid prednisone 50 mg qd labetalol ambien fosamax lexapro 10 mg qd discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 2. levothyroxine sodium 300 mcg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin calcium 80 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. acetaminophen-caff-butalbital mg tablet sig: tablets po q4-6h (every 4 to 6 hours) as needed. 6. methadone 10 mg tablet sig: one (1) tablet po 5 times/day (). 7. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 8. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 9. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. cefpodoxime proxetil 200 mg tablet sig: one (1) tablet po once a day for 5 days. disp:*5 tablet(s)* refills:*0* 11. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. prednisone 40 mg qd x 1 week (- ), 30 mg qd x 1 week (- ), then 20 mg qd discharge disposition: extended care facility: of discharge diagnosis: primary: pneumonia secondary: hypertension, anemia, chronic renal insufficiency, osteoarthritis, coronary artery disease discharge condition: pt. was breathing comfortably on room air with good oxygen saturations. she was afebrile for 5 days prior to discharge. discharge instructions: please take all medications as prescribed. we have given you a prescription for an antibiotic for your pneumonia, called cefpodoxime. you should take it once a day for the next 5 days. we have written you a prescription for prednisone. you should decrease your dose by 10 mg every week, as directed, and follow up with dr. about the most appropriate dose of prednisone for you. we made some changes in your blood pressure medications. we have given you prescriptions for metoprolol 100 mg twice a day and lisinopril 10 mg daily. you should take these as directed and have dr. check your blood pressure at your next visit, so he can make any changes that are needed. please call your pcp or come to the er if you have any chest pain, shortness of breath, nausea, fever, chills, cough, or any other symptoms that concern you. followup instructions: 1. please call your pcp, , at , and schedule an appointment to see him in the next week. please tell his secretary that you need a follow-up appointment from being in the hospital. please have him check your blood pressure as we have made some changes in your blood pressure medications. please talk to him about the prednisone you are taking and have him take a look at the results of your stress test. . 2. you have a stress test scheduled on at 9:10 am. please do not eat anything for 2 hours before the test, or drink any caffeinated beverages for 12 hours before the test. please do not smoke for 2 hours before the test. you should go to the nuclear medicine department on the of , on the of the building. the is located on . please call if you have any questions or need to reschedule. . previously scheduled appointments: . 1. provider: ,(a) pain management center where: fd building (/ complex) pain management center phone: date/time: 8:30 . 2. provider: psychology where: fd building (/ complex) pain management center phone: date/time: 1:00 . 3. provider: , .d. where: neurology phone: date/time: 2:30 . md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transfusion of packed cells diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism acute respiratory failure osteoarthrosis, unspecified whether generalized or localized, site unspecified 

Answer: The patient is high likely exposed to