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: quinidine / iodine / indocin attending: chief complaint: fevers, abdominal pain major surgical or invasive procedure: none history of present illness: this is an 80 yo f with a past medical history of sss s/p pacer, hypertension, diabetes, atrial fibrillation on coumadin, cad, av replacement, presents to the ed with weakness, found to be febrile to 102, with a distended tender abdomen. she said that the abdominal pain started today (), her stools have been relatively normal, no brbpr/hematochezia. in the ed, she underwent a ct abd/pelvis which showed evidence of diverticulosis but no diverticulitis, and a small amount of free fluid in the abdomen. out of concern for a possible gi source, the patient was to receive cipro/flagyl, but got cipro and subsequently got hives. she was then given a dose of zosyn. surgery saw the patient in the ed and felt that her abdominal exam, initially was concerning, but over time had improved and given no obvious findings on ct, did not feel that there should be any surgical intervention at this time. . she was to be admitted to the floor initially for further work up, but her initial bp of 115/93 dropped to the 80's without compensatory hr elevation. she then received 2l of ns, despite concern that she was volume overloaded. a rij was attempted, but was unsuccessful. bp's returned to the 110's but then just prior to transfer to , they were back in the high 80's systolic, satting 99% 2l. . notable labs were no leukocytosis but a small left shift, mild anemia, thrombocytopenia, lactate of 1.5, creatinine of 1.6, tuberculosis 1.7 in the setting of normal lft's. she is transferred to the for stabilization of her hypotension and further work up of her fevers. . currently, at time of icu admission her bp is 115/42, and she is asymptomatic with a temp of 98.6. she c/o abdominal pain. she also claims she had chest pain in the emergency department, but it has been going away gradually over the last few hours. she denies loose stool. past medical history: - diabetes - dyslipidemia - hypertension - pacemaker placement for sss s/p generator replacement - legal blindness - pulmonary fibrosis on 2 l o2 at home; fibrosis @ lung bases bilaterally (reported as unlikely to be amiodarone related) - diastolic chf (last ef wnl in ) - as s/p avr -with "horse valve"- by dr. - paroxysmal atrial fibrillation/avj ablation - - hypothyroidism, (two thyroid surgeries as a child) - s/p appendectomy - uterine cancer, s/p complete hysterectomy - s/p hernia repair - s/p cholecystectomy - severe aortic stensois of the avr - r humerus neck fracture - r knee hemarthrosis, r knee hemarthrosis social history: patient is widowed and lives alone. she lives in an independent living facility. her son lives a few blocks away and helps her with her medications. no tobacco, no etoh, no illicits. family history: mother deceased from kidney disease and ruptured aorta, father deceased from chf. physical exam: **icu admission physical exam: physical exam: vs t = 98.6 p = 65 bp = 115/42 rr = 28 o2sat = 95% 3l nc general: elderly female nad. aaox3 heent: eomi, perrl, no scleral icterus, very dry mm, op clear, poor dentition lungs: bibasilar rales cardiac: rr, nl. obliteration of s1, normal s2, loud holosytolic, harsh decrescendo murmur with radiation to the carotids, l>r. abdomen: soft, mildly distended, normoactive bowel sounds, well healed scar midline, with ventral hernia, with significant ttp just below the umbilicus into the suprapubic region. unable to reduce hernia. no rebound or guarding. extremities: no c/c, trace pretibial edema, good pulses. neurologic: moves all extremities. alert, oriented x 3. skin: scattered ecchymoses on arms. pertinent results: 07:40a na 140 k 3.6 cr 1.5 mg 2.5 inr 3.5 **pertinent icu admission imaging as below: kub: findings: single view is somewhat limited by body habitus. there is an overall generalized paucity of bowel gas with no definite dilated loops of small bowel evident. there is no ascites or organomegaly detected. degenerative changes are noted throughout the lumbar spine, particularly at the lumbosacral junction. surgical clips are noted in the upper left hemipelvis. phleboliths are noted throughout the lower pelvis. impression: non-obstructive bowel gas pattern. . cxr: single ap chest radiograph compared to show mild interstitial edema slightly improved compared to prior exam. bibasilar atlectasis persists. the heart size remains moderately enlarged, unchanged, with incidentally noted dense mitral annulus calcification. there is no pneumothorax or pleural effusion. post surgical changes related to median sternotomy are pressent. dual leads of a left chest wall pacemaker terminate in the right atrium and right ventricle. impression: very mild interstitial edema slightly improved compared to prior exam. . ct abd/pelvis (prelim): diverticulosis without itis. no obstruction. small amount of free fluid in the abdomen, which may relate to volume overload. liver, small and nodular suggestive of underlying cirrhosis. no free air or lad. s/p cck. mild body wall anasarca. . ekg: v-paced @ 75, left axis. twi in avl. no changes from prior. 09:31pm lactate-1.5 08:44pm urine color-yellow appear-clear sp -1.016 08:44pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:44pm urine rbc-0-2 wbc-0-2 bacteria-many yeast-none epi-0 03:21pm lactate-1.5 03:00pm glucose-102 urea n-34* creat-1.6* sodium-136 potassium-4.4 chloride-97 total co2-30 anion gap-13 03:00pm estgfr-using this 03:00pm lipase-24 03:00pm alt(sgpt)-23 ast(sgot)-67* alk phos-82 tot bili-1.7* 03:00pm wbc-9.2 rbc-4.09* hgb-11.1* hct-34.3* mcv-84 mch-27.2 mchc-32.4 rdw-16.2* 03:00pm pt-19.4* ptt-36.4* inr(pt)-1.8* brief hospital course: 80 year old female with history of chf (diastolic dysfunction), atrial fibrillation on coumadin, cad, avr with stenosis, dm, ppm, pulmonary fibrosis on 2.5l o2 at baseline presented with fevers, diarrhea, and hypotension. she was rehydrated with ivf, and subsequently experienced pulmonary edema. in micu, diuresed and treated empirically for possible gi source for fevers. on floor, was further diuresed and treated for possible diverticulitis. brief hospital course, by problem, is as follows: . 1. hypotension, now resolved: on presentation, the icu team felt the patient's low blood pressure (systolic in 80s) were secondary to early sepsis etiology, given fevers, but on further labs and cultures there was no clear source and no leukocytosis. she responded transiently to 2l fluids, but then seemed to have worsened pulmonary edema on chest film. despite this, she had a drop in her bp again. was resuscitated with ivf. it was thought that given her underlying heart disease, she could not maintain the forward flow for such a sudden increase in venous return. additionally, she did not have a compensatory increase in her hr to aid in increasing her cardiac output. given hypotension and acute renal failure with low serum sodium on labs, etiology of hypotension was thought to be due to volume depletion. pulmonary embolism was also considered, however, the patient was on chronic anticoagulation for atrial fibrillation and avr so this was unlikely. pericardial effusion was also explored but no evidence of this on exam. while in the she was given gentle ivfs, urine lytes assessed, monitored urine output with goal >35cc/hr. diuretics were initially held. furosemide 80mg twice daily per home regimen was restarted in with good urine output. on medicine floor, spironolactone 25mg daily and metolazone 10mg qmonday, friday were restarted in succession. patient had good diuresis, with over 1 liter net negative each day. creatine stayed in the range of 1.4-1.5, with bun/creatinine ratio greater than 20. we considered that patient may be intravascularly depleted, although clinically she looked excellent. we asked that she have her chemistries checked again at the rehabilitation facility to ensure that she does not experience renal failure. potassium also had to be repleted on a daily basis. given her possibility for renal failure, we did not send her out with potassium. rather we asked that she have her labs checked within the week to reassess potassium status. . 2. fevers: on presentation, patient reported fevers to 102 in context of diarrhea, abdominal pain, and isolated elevations in alt and tbili. unclear etiology, did not seem to be a pattern of biliary obstruction. of note, alt was more double than ast, but this ratio appears to be chronic. urinalysis was unremarkable and portable chest film did not have any obvious consolidation. pain was in location of ventral hernia which when evaluated by ct showed no obstruction or entrapment of bowel. blood cultures were without growth. wbc remained in normal range. ct abdomen/pelvis showed diverticulosis but no diverticulitis. in ed, was given ciprofloxacin which was later stopped fever. she was then covered with zosyn in the given concern for sepsis with low blood pressure as above. in , fevers and diarrhea resolved. on medicine floor, patient remained afebrile. given that likely etiology of fevers and abdominal pain was diverticulitis, antibiotic regimen was changed to bactrim and flagyl. abdominal pain resolved, and as above patient remained afebrile and with normal wbc count. c diff panel was negative. she was discharged with flagyl and bactrim for full 7 day course. of note, repeat 2 view cxr on day prior to discharge showed consolidation that was considered to be pneumonia. clinically, the patient did not appear to have pneumonia - afebrile, without cough or pleuritic chest pain, and improving on baseline oxygen requirement. we decided not to treat for a pneumonia, but sent off for urine legionella given presentation with abdominal pain; she had been on antibiotic treatment for 4 days when it was sent; it was negative. . 3. hypoxia - patient is on 2.5l home o2. in the , she was satting in mid 90's on 3l o2. this was felt to be secondary to mild pulmonary edema given aggressive fluid resuscitation. diuresis was initially held given that it was felt that she was intravascularly depleted. on medicine floor, patient diuresed well and was satting 99-100% on 2l o2. tachypnea also resolved. she has persistent bibasilar crackles, although this may have been in part due to her reported pulmonary fibrosis. . 4. diastolic dysfunction heart failure, acute on chronic - lvef >= 55% by tte . initial portable cxr with volume overload after 2 liters of fluid (initial chest film in ed actually indicated improvement from last imaging in ). improved with diuresis per home medications (furosemide, spironlactone, and metolazone). as above, persistent basilar crackles although this may be her baseline given pulmonary fibrosis. . 5. coronary artery disease - continued statin, aspirin. not on beta blocker, paced in the 60s. was on amiodarone for sss, but stopped secondary to ipf and progressive hypoxia. . 6. aortic valve replacement with severe stenosis: s/p avr in . likely contributed to acute on chronic heart failure as above. . 7. pulmonary fibrosis: on admission, slightly more hypoxic than at her baseline. required 3l in icu, and on floor came down nicely to 2l. continue advair and as needed albuterol nebs per home regimen. . 8. diabetes mellitus, type ii: in hospital, oral hypoglycemics held. continued on sliding scale insulin with good blood glucose control. . 9. atrial fibrillation: continued coumadin. after start of antibiotics, inr increased to 3.5. coumadin held on the day of discharge, and on discharge gave instructions to the rehabilitation facility to monitor inr and dose accordingly while on antibiotics, with likely return to home dose after completing antibiotics. . 10. anemia: iron-deficiency. hematocrit stable at baseline. continue iron supplentation per home regimen. . 11. hypothyroidism: continued synthroid per home regimen. . 12. hyperlipidemia: continued statin per home regimen. . 13. thrombocytopenia - trasient. given elevated lfts and cirrhosis noted on ct abdomen, may be to reduced tpo production. also given mild splenomegaly, may be sequestration. on discharge, platelets trending up and in normal range. *code status: full code, confirmed with patient medications on admission: 1. montelukast 10 mg tablet sig: one (1) tablet po daily 2. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. atorvastatin 10 mg tablet sig: one (1) tablet po hs 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily 6. senna 8.6 mg tablet sig: one (1) tablet po bid 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid 8. levothyroxine 125 mcg tablet sig: one (1) tablet po daily 9. spironolactone 25 mg tablet sig: one (1) tablet po daily 11. hexavitamin tablet sig: one (1) tablet po once a day. 12. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 13. potassium chloride 10 meq capsule, sustained release sig: one (1) capsule, sustained release po once a day. 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 15. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 16. warfarin 2.5 mg tablet sig: one (1) tablet po 5x/week (mo,tu,we,th,fr). 17. metolazone 10mg qmonday, friday discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 8. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 11. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 12. metolazone 5 mg tablet sig: two (2) tablet po every monday and friday (). 13. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 2 days. disp:*6 tablet(s)* refills:*0* 14. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po daily (daily) for 2 days. disp:*2 tablet(s)* refills:*0* 15. warfarin 2.5 mg tablet sig: one (1) tablet po every mo, tu, we, th, fr: while you are on the antibiotics the next 2 days, you should have your inr check daily at the rehabilitation facility. they will determine how much warfarin you should take those 2 days. after you complete your antibiotics thursday night, you can resume your coumadin regimen as normal on friday, . discharge disposition: extended care facility: - discharge diagnosis: fever, possibly secondary to diverticulitis hypotension, now resolved llq pain, now resolved diastolic dysfunction heart failure, acute on chronic discharge condition: hemodynamically stable, ambulatory discharge instructions: you were admitted on for fevers and abdominal pain. in the first couple days of your hospital course, your blood pressure dropped and you were given fluids through your iv to maintain your blood pressure and you ended up having fluid in your lungs. you were also started on antibiotics to cover a possible infection in your abdomen. you were slowly started back on your home diuretic regimen (furosemide, spironolactone, and metolazone) and your breathing improved considerably. at discharge, you should complete your antibiotic course and continue to take your medications just as you were at home. it is also very important that you follow up with your doctors as below. given your diagnosis of heart failure, you should weigh yourself every morning and call your physicians if weight increases > 3 lbs. you should also adhere to a 2 gm sodium diet and restrict your daily fluid intake to less than 2 liters. if you experience any shortness of breath, chest pain, dizziness, or abdominal pain, please contact your primary care provider or come to the emergency department immediately. followup instructions: provider: . . date/time: - 1:45pm or make an appointment for within 1 week after discharge from rehabilitation facility. provider: function lab phone: date/time: 11:10 provider: ,interpret w/lab no check-in intepretation billing date/time: 11:30 provider: . phone: date/time: 11:30 procedure: venous catheterization, not elsewhere classified diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation acute on chronic diastolic heart failure personal history of malignant neoplasm of other parts of uterus pulmonary collapse heart valve replaced by other means hypotension, unspecified postinflammatory pulmonary fibrosis iron deficiency anemia, unspecified cardiac pacemaker in situ hypoxemia diverticulosis of colon (without mention of hemorrhage) legal blindness, as defined in u.s.a. volume depletion, unspecified 

Answer: The patient is high likely exposed to