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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath, confusion major surgical or invasive procedure: endotracheal intubation picc line tracheostomy and peg placement history of present illness: 73yo f wtih severe copd on home 02 and with past intubations here with copd exacerbation. poor historian and never been here before. sent from hospital b/c no icu beds. . c/o sob x few days. unclear if f/c. increased sputum x "months". does not take inhalers at home. has never seen pulmonologist. . at osh, given nebs, solumedrol amd did not tol bipap due to discomfort. abg on 2l nc: 7.23/94/60. at ed, given nebs, azithro, ctx and repeat abg: 7.27/91/65. admit to micu for obs. . past medical history: 1. copd- on home o2. h/o intubations in the past, most recently 1 month ago at hospital. baseline pc02 55-60 hospital. denies any inhalers at home. 2. htn. on nisoldipine. 3. hypercholesterolemia. on pravachol. 4. hypothyroid. on synthroid. social history: lives at home with husband and son. alcohol use. remote tobacco use, but none currently. family history: nc physical exam: t98.8; bp 200/86; hr 93; rr 26; 93% on 4lnc gen: mild respiratory distress, speaking in full sentences heent: mucous membranes dry neck: using accesory muscles to breath lungs: crackles l base > r base cor: tachy, no nurmurs, rubs or gallops abd: soft, nt/nd/ nabs ext: no c/c/e neuro: alert and priented x 3, moving all 4 extremities pertinent results: admission labs: 09:32pm glucose-239* urea n-18 creat-0.4 sodium-141 potassium-4.0 chloride-97 total co2-39* anion gap-9 09:32pm wbc-12.8* rbc-4.17* hgb-12.2 hct-40.0 mcv-96 mch-29.3 mchc-30.6* rdw-14.3 09:32pm plt count-332 10:33pm po2-65* pco2-91* ph-7.27* total co2-44* base xs-10 . cxr: findings: there is mild cardiac enlargement. unfolding of the thoracic aorta. prominence of the central pulmonary arteries and upper zone pulmonary vasculature. there is hyperinflation of the lungs, with flattened hemidiaphragms bilaterally. linear opacity at the right base is consistent with plate-like atelectasis. there is slight prominence of the interstitial markings peripherally. no pneumothorax. the surrounding osseous structures appear unremarkable. impression: 1) mild cardiomegaly and mild congestive heart failure. 2) underlying emphysematous changes . transthoracic echo: : the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the aortic root is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . abdominal ct: ct of the abdomen with iv contrast: there are trace bilateral pleural effusions with associated atelectasis. the peg tube is in place. contrast enters the stomach and passes freely through the small bowel and into the large bowel. no evidence of extravasation of contrast. there is no intraabdominal free air. there are no intraabdominal fluid collections or evidence of intraabdominal abscess. there is a calcified gallstone without evidence of cholecystitis. the liver, spleen, pancreas, adrenal glands, kidneys, and bowel loops are unremarkable. there are no pathologically enlarged mesenteric or retroperitoneal lymph nodes. vascular calcifications are noted. ct of the pelvis with iv contrast: the bladder is decompressed with a foley in place and a small amount of air consistent with foley placement. there is a bubble of air in the vagina. the uterus is not seen. the rectum, and sigmoid colon are unremarkable. there is no pelvic free fluid. there is no pelvic or inguinal lymphadenopathy. bone windows reveal no suspicious lytic or sclerotic foci. there is a region of increased trabeculation in the t9 vertebral body consistent with a hemangioma. impression: 1) trace bilateral pleural effusions with associated atelectasis. . ct sinus: small mucus retention cyst in right maxillary sinus. no evidence of acute sinusitis. . swallow evaluation : summary: pt tolerated the placement of the pmv well with no changes in rr, o2 sats. pt has large amounts of secretions requiring frequent tracheal suctioning, however no secretion interference appreciated during the evaluation. vocal quality was wfl. pt did present with s&s of aspiration during the green dye swallow evaluation. pt had throat clearing after all boluses administered, however no aspirate material was removed via tracheal suctioning. a video swallow is recommended at this time to further evaluate swallowing physiology and make appropriate diet consistency recommendations. recommendations: swallowing: 1. remain npo at this time. 2. video swallow at rehab to further evaluate swallowing physiology and make appropriate consistency recommendations. passy muir valve: 1. always deflate cuff prior to placing the passy-muir valve! 2. monitor o2 sats / respiration while valve is in place. 3. do not allow the patient to sleep with the valve in place. 4. pmv wear schedule is up to the discretion of the nurse and/or respiratory therapist. 2) no evidence of peg tube leak or intraabdominal abscess. 3) vascular calcifications. . urine culture: >100,000 enterococcus blood cultures: 1/4 bottles with gpc in pairs and clusters brief hospital course: 1. respiratory failure: copd exacerbation. patient was admitted to the icu with hypercarbic respiratory failure consistent with copd exacerbation. on the evening of admission, she had increased work of breathing, refused non-invasive ventilation with bipap and was intubated for hypercarbic respiratory failure. sh she was initially started on azitrhomycin and ceftriaxone in the mergency department, but given the clear chest xray, the antibiotics were discontinued. she was started on steroids and inhalers. she was extubated on , but was re-intubated later that same day when her pco2 rose again to the 90s. at the time of reiintubation, she was noted to be hypertensive and developed crackles and chest xray was consistent with pulmonary edema. she was given lasix for diuresis. an echocardiogram was performed which showed a normal ejection fracition, and the patient ruled out for mi. her steroids were tapered to 20 mg po qd. given slow wean, a trachesotomy tube was placed on . she was slowely weaned and on day of dishcarge tolerated ps 10 with peep 5 and fio2 30% as well as trach mask x few hours each day. will continue to wean ventilatory at rehab. . 2. cardiovascular system. a. hypertension. she was started on multiple antihypertensives which were titrated up: diltiazem, hydralazine, captopril and clonidine. because of refractory hypertension, a renal u/s was performed which showed normal renal arteries: renal u/s: right kidney measures 11.6 cm, and the left kidney measures 11.5 cm. there is no evidence of stones, hydronephrosis, or focal lesions. the left renal artery demonstrates a normal- appearing low-resistance waveform with brisk systolic upstroke and preserved diastolic flow with the renal indices of 0.75. the right renal artery also demonstrates normal low-resistance waveform with brisk systolic upstroke, preserved diastolic flow, and resisted indices of 0.86. b. other: as above, she had a normal echocardiogram and ruled out for myocardial infarction. she was continued on pravastatin for hypercholesterolemia. . 3. mental status: her mental status was intially altered presumably due to the hypercarbia. her mental status improved with her improved ventilation. . 4. infectious disease: she began to have low grade fevers on and her wbc began to rise. fever work up ensued. chest xray showed no evidence of pneumonia. ltfs were within normal limits. ruq u/s was performed to look for acaclulous cholecystitis, which was normal. u/s: "liver appears normal in echotexture without focal lesions. portal vein demonstrates normal patent hepatopetal flow. the gallbladder contains gallstones and its wall demonstrates diffuse comet-tail artifacts raising the posibility of adenomyomatosis. there is no evidence of gallbladder wall edema, focal wall thickening, pericholecystic fluid or other signs to suggest cholecystits. patient is not tender over the gallbladder. there is no intra or extrahepatic biliary ductal dilation, and the common duct measures 1.7 mm. no stones are identified within the common duct. " she had a ct sinus which showed no sinusitis. urine culture grew enterococcus and she was started on vancomycin on which was changed to levofloxacin when sensititivies showed pan-sensitive--she should continue x 14 days for complicated uti. foley was discontinued. blood cultures grew coag negative staph presumed to be due to a skin contaminant. . 5. fen. a peg tube was placed at bedside on . she was started on tube feeds and tolerated them well. she was seen by speech and swallow and a passy muir valve was placed. she did not pass the bedside swallow evaluation and they recommended video swallow to be done at rehab. her elctrolytes were monitored and repleted as needed. . 6. code: full , 7. communication: health care proxy is : . the form was placed in thr chart. . 8. dispo: she was discharged to rehab for futher weaning of the vent, physical therapy, and swallow evaluation. medications on admission: meds: had been given an advair inhaler which she was not using synthroid guaituss pravachol nisoldipine discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 3. levothyroxine sodium 75 mcg tablet sig: one (1) tablet po daily (daily). 4. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 5. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. quetiapine fumarate 25 mg tablet sig: one (1) tablet po q12h (every 12 hours) as needed. 7. hydralazine hcl 50 mg tablet sig: 1.5 tablets po q6h (every 6 hours). 8. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q2-4 hours prn. 9. pravastatin sodium 20 mg tablet sig: one (1) tablet po daily (daily). 10. diltiazem hcl 90 mg tablet sig: one (1) tablet po qid (4 times a day). 11. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). 12. captopril 25 mg tablet sig: four (4) tablet po tid (3 times a day). 13. clonidine hcl 0.1 mg tablet sig: one (1) tablet po tid (3 times a day). 14. insulin regular human 300 unit/3 ml syringe sig: as directed subcutaneous four times a day: 201-250 mg/dl give 2 units; 251-300 mg/dl give 4 units ; 301-350 mg/dl give 6 units ; 351-400 mg/dl give 8 units > 400 mg/dl give 10 units and notify m.d. . 15. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 14 days. disp:*14 tablet(s)* refills:*0* discharge disposition: extended care facility: & rehab center - discharge diagnosis: chronic obstructive pulmonary disease exacerbation enteroccocus urinary tract infection hypertension discharge condition: stable on ventilatory support followup instructions: your pcp . at ( in weeks after discharge from rehab. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy diagnoses: pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified 

Answer: The patient is high likely exposed to