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 an 85 year-old female with a history of coronary artery disease status post four vessel coronary artery bypass graft with a history of paroxysmal atrial fibrillation who lives at a nursing home. the patient was found to have fevers to 102 degrees fahrenheit one day prior to admission with worsening lethargy for five days prior to admission and decreased oral intake. the patient was given levofloxacin and fluids at her nursing home. the fluid was discontinued when a subsequent chest x-ray showed signs of congestive heart failure. the patient was then noted by the nursing home physician to have decreased oxygen saturation and tachypnea to 30 so she was transferred to for further care. the workup in the nursing home showed urinary tract infection with greater then 100,000 e-coli, which were pan sensitive to ampicillin, ceftriaxone and quinolones. chest x-ray there showed mild congestive heart failure. the patient had been admitted most recently in for rapid atrial fibrillation and had cardiac enzymes cycled at that time with a peak creatine kinase of 373 and a peak mb of 96. cardiology had seen her at that time and recommended medical management. the patient had not been taking her oral medications for several days prior to admission secondary to changes in mental status. in the emergency department the patient had a respiratory rate of 40, heart rate of 88, blood pressure of 115/80. the patient received one dose of clindamycin and one dose of ceftriaxone as well as one dose of lopressor 2.5 mg intravenous. on admission to the floor she was lethargic and in moderate respiratory distress and 100% nonrebreather mask. her temperature at that time was 101.8, heart rate 90, blood pressure 160/69 and respiratory rate of 20. the patient was in atrial fibrillation. laboratory results at that time showed a white blood cell count of 14.4 with 80% neutrophils, creatine kinase 130, mb 8 and troponin was 1.02. chest x-ray on the floor showed small bilateral pleural effusions. urinalysis done in the emergency room showed a ph of 5.0, specific gravity 1.035, moderate blood, 100 protein, 1000 glucose, trace ketones and negative for leukocyte esterase. an electrocardiogram done on admission showed a rapid rate and an irregularly irregular rhythm of about 150 beats per minute. repeat electrocardiogram showed a rate of 97 beats per minute with some st depressions in leads 2, 3, and avf of 1 to 2 mm. a repeat electrocardiogram showed a reate in the 70s with improvement of the st depressions in leads 3 and v6 and a right bundloid interventricular block. the patient was given intravenous levaquin for her urinary tract infection and blood cultures were taken. her change in mental status was thought to be secondary to an infection. she was also given 12.5 mg of lopressor for rate control with a subsequent heart rate in the 70s to 80s. the patient does have a history of bradycardia secondary to beta blockers. on the morning of transfer to the micu the patient was found to be hypotensive with a blood pressure of 60/palp and a heart rate of 160. she was given 5 mg of lopressor with no improvement. she was given 10 mg of diltiazem with a subsequently heart rate of 130 to 140 and improved blood pressure. the patient was given 2 liters of normal saline and was transferred to the micu for further monitoring. before transfer she was given an additional 5 mg of diltiazem to bring her heart rate from 150 to 130. past medical history: 1. coronary artery disease status post four vessel coronary artery bypass graft in with an ejection fraction of 55% noted on echocardiogram in . dilated left atrium and 1 to 2+ mitral regurgitation and 1+ aortic regurgitation. 2. cerebrovascular accident times four with residual left sided weakness. 3. chronic pancreatitis. 4. vertigo. 5. paroxysmal atrial fibrillation since . 6. hypertension. 7. diabetes mellitus type 2. 8. degenerative joint disease. 9. gastroesophageal reflux disease. 10. increased cholesterol. 11. dementia. 12. parkinson's disease. social history: the patient is a resident, russian speaking with two daughters. allergies: benzodiazepines, neurontin and beta blocker resulting in bradycardia. medications on admission: 1. aspirin 325 mg po q.d. 2. prevacid 15 mg q.d. 3. glyburide 10 mg q.a.m., 5 mg q.p.m. 4. lisinopril 40 mg q.d. 5. tramadol 30 mg b.i.d. 6. colace 100 mg b.i.d. 7. senna. 8. levaquin times three days. 9. celexa 40 mg. 10. duragesic 25. 11. multivitamins. 12. tylenol prn. physical examination: the patient was found to have a temperature of 101.8, heart rate of 90 to 150, blood pressure of 160/69, respiratory rate 20 on 100% nonrebreather mask. in general, she was an elderly ill appearing woman very thin who did not respond to voice, but did open eyes spontaneously. on head, eyes, ears, nose and throat examination pupils were noted to be 0.5 mm, minimally reactive, but symmetric. the patient was noted to have dry mucous membranes. neck revealed a flat jugulovenous pulse, very stiff neck to movement and difficult to flex. lung examination revealed minimal air movement bilaterally. cardiac examination revealed a tachycardic rhythm, which was irregular with no murmurs, rubs or gallops. abdominal examination revealed a soft, nontender, nondistended belly with positive bowel sounds. extremity examination revealed no clubbing, cyanosis or edema. neurological examination revealed a high frequency sign, pill rolling tremor and cogwheel rigidity in all extremities including rigidity of the neck. the patient did not respond to voice or commands, but did move all extremities spontaneously. laboratories on admission to the micu: white blood cell count of 26.2, hematocrit 44.3, platelet count 267, sodium 149, potassium of 3.5, chloride 105, bicarb 31, bun of 33, creatinine 0.6, glucose of 166. creatine kinase was peaked at 130 and troponin t peak was 1.4. blood cultures times four were pending. chest x-ray at this time showed clear lungs with slight blunting of the costophrenic angles bilaterally and diffuse osteopenia. hospital course: 1. hypotension: the patient was initially hypotensive, which was thought to be secondary to hypovolemia. she did not receive fluids overnight. after 2 liters of normal saline her blood pressure and heart rate did improve, but she was still hypovolemic by examination with a urinary output of 20 cc per hour and dry mucous membranes. the patient's hypotension did not seem to be related to her rapid ventricular rate as when she was fluid replenished her blood pressure improved even while her heart rate remained in the 160s. the patient was repleted and by discharge was euvolemic. 2. atrial fibrillation: the patient continued to have paroxysmal atrial fibrillation throughout her hospital stay. as per the patient's family the patient did not want a pacer inserted. the patient has a history of not responding well to a beta blocker and therefore she was treated with diltiazem prn for several days and continued to have paroxysmal atrial fibrillation with rates in the 160s and 170s. therefore the patient was started on amiodarone to control her rate. even on amiodarone the patient still required lopressor and diltiazem prn to control her rate. 3. hypertension: the patient remained hypertensive throughout her hospital stay requiring increases in her hypertension medications. the patient was placed on lisinopril with some improvement in her blood pressure. 4. coronary artery disease: the patient was continued on aspirin and lisinopril throughout her stay. the patient was noted to have an increase in cardiac enzymes with a troponin t of 2.49. this was thought to be secondary to demand ischemia as opposed to an acute coronary syndrome. the patient was initially placed on heparin drip for acute coronary syndrome, but after consulting cardiology the heparin was discontinued as it was thought that her enzyme was peaked due to demand ischemia. as a result of increase cardiac enzymes and the patient's congestive heart failure an echocardiogram was performed on , which showed an ejection fraction of 25%, extensive regional systolic dysfunction with severe hypokinesis of the basal half of the inferior and lateral walls. the echocardiogram showed a right dilated ventricle with free wall hypokinesis, 4+ mitral regurgitation, 3+ tricuspid regurgitation and 1+ aortic regurgitation with moderate pulmonary systolic hypertension. this was a substantial decrease in function since the prior echocardiogram with a now dilated right ventricle, worse tricuspid regurgitation and new pulmonary artery hypertension. the patient was maintained on captopril and amiodarone as she had refused cardiac pacer and therefore a candidate for medical management. 5. congestive heart failure: the patient was noted to have significant congestive heart failure on chest x-ray. therefore she was given lasix with poor diuresis, therefore she was started on a nitrocor drip with some improvement in urinary output. the patient was also switched to captopril 25 mg t.i.d.and received several boluses of lasix. 6. diabetes mellitus: the patient had been on glyburide at home. she was put on regular insulin sliding scale while in the micu. on the the patient was noted to have blood sugars in the 400s and an insulin drip was started with good blood glucose control. 7. the patient was noted to be hyponatremic and was repleted with free water through nasogastric tube flushes. 8. infectious disease: the patient was admitted with a urinary tract infection and treated wit levaquin. subsequent urinary cultures remained negative. however, the patient continued to have fevers and increased white blood cell count throughout her stay. the chest x-ray showed a possible right middle lobe pneumonia, which should have been adequately covered by levaquin. the patient was noted to be c-diff positive and was started on flagyl. 9. psychiatry: the patient had been taking celexa as an outpatient. this was given to the patient as long as she was taking oral medications. 10. communications: with the patient's daughters during this visit. disposition: on the patient continued to spike a temperature of 101.4 with hypotension. the team met with the family who decided that they would make the patient comfort measures only. the patient's medications were discontinued and she expired later that day on . discharge diagnoses: 1. urinary tract infection complicated by c-difficile colitis. 2. paroxysmal atrial fibrillation with congestive heart failure. the patient expired on . , m.d. dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances injection or infusion of nesiritide diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation acute myocardial infarction of unspecified site, initial episode of care septicemia due to escherichia coli [e. coli] infection of kidney, unspecified 

Answer: The patient is high likely exposed to