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: cisatracurium / penicillin g / morphine attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation, mechanical ventilation history of present illness: 33f w/muscular dystrophy, osa on cpap, cushings s/p pituitary resection, dmii, hypothyroid p/w sob. . presented from home. was in usoh until last night when she developed a sore throat and then uri symptoms with cough. this progressed to include nausea, vomitting and diarrhea. per her husband, she took one dose of narcotic cough syrup (likely vicodin containing). . presented to medical center where came in with lethargy, sob, af with rvr. appeared pale, cool, dusky, rr 12, sat 68% ra.given dilt f/b dilt gtt, and autoconverted back to sinus rhythm. cpap initiated. ct chest with contrast reportedly unremarkable, not sent over. trop (x) 0.196 at osh. abg 7.21 / 77 /110 on nrb. +opiates on tox screen. did have transient improvement of mental status and vomited with 2 mg narcan at osh. . pt denied any complaints (including fevers, cp, sob, palps, abd pain, n/v, ha), arousable to voice, but quickly falls back asleep. endorsed taking cough syrup last few days, unsure if contains codeine, o/w denied any drug use. ems gave supplemental o2 but not ppv. in our ed: arousable to voice then falls back to sleep, pupils 4 mm, moving all extremities. vomiting lethrgic on arrival afib co2 retention to 75- on cpap- ? response to narcan? maybe gen? - initial vitals: 97.4 90 129/77 30 96% 15l - ekg: sr@90 na ni - diltiazem gtt d/c'd - trop-t 0630 - 0.08 - bipap initiated - abg a few min after started bipap: resp acidosis, improved from prior at osh (ph 7.28 pco2 63 po2 229 hco3 31 basexs 1) - repeat abg 0810 - 7.27 pco2 64 po2 88 hco3 31 basexs 0 - cxr: poor film, ap, large heart, crowded, looks fluid overload - head ct - - additional narcan 0.4 mg --> improved mental status - ed thinking - possible unifying diagnosis would be opiate overdose leading to respiratory depression leading to hypoxia leading to nstemi and afib - 99, hr 80-90, bp 100/60, sat 99% on 50%, past medical history: myotonic dystrophy type 1 - per husband no cardiac structural abnormalities, high normal qrs and mild bradycardia. wants her to take mexiletine and modafinil. cushings s/p pituitary resection osa uses cpap, tonsillectomy that did not change cpap settings - admitted for pneumonia and discharged on o2 (multilobar pna) - admitted for lul pneumonia to saints and discharged on o2. continued shortness of breath attributed to hibiscus plant with fungal spores gout hypothyroidism last talked to pcp in about hair loss social history: she is rn with vna of . husband works in respiratory at . - tobacco: none - alcohol: none - illicits: none family history: non-contributory physical exam: admission physical: initial 97.4 90 129/77 30 96% 15l vitals at 1000: 108/72, hr 80, 99% on 50% bipap general: lethargic but arousable to voice, no acute distress heent: ncat, sclera anicteric, bipap neck: supple, jvp not elevated, no lad lungs: air movement to bases with crackles on left side to midlevel cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, 2+ edema to knees discharge physical: pertinent results: admission labs: discharge labs: micro: mrsa screen (final ): no mrsa isolated. sputum: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. 8:24 pm influenza a/b by dfa source: nasopharyngeal swab. **final report ** direct influenza a antigen test (final ): less than 60 columnar epithelial cells;. specimen inadequate for detecting respiratory viral infection by dfa testing interpret all negative results from this specimen with caution. negative results should not be used to discontinue precautions. refer to respiratory viral culture results. recommend new sample be submitted for confirmation. reported to and read back by dr 1125am. direct influenza b antigen test (final ): less than 60 columnar epithelial cells;. specimen inadequate for detecting respiratory viral infection by dfa testing interpret all negative results from this specimen with caution. negative results should not be used to discontinue precautions. refer to respiratory viral culture results. recommend new sample be submitted for confirmation. respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. 9:35 pm blood culture source: line-central. blood culture, routine (pending): 5:54 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): no growth. images: tte : conclusions the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is a borderline mild resting left ventricular outflow tract systolic gradient. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. tricuspid regurgitation is present but cannot be quantified. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. ct head w/o : impression: 1. global loss of -white matter differentiation may be secondary to hypoxic injury. for further evaluation, could consider an mri if not contraindicated. 2. no evidence of hemorrhage. cta : impression: 1. no evidence of pulmonary embolism. 2. scattered ground-glass and more consolidative opacities throughout the lungs, with a bilateral lower lobe predominance, thought to be infectious in etiology. prominence of bilateral hilar lymph nodes is likely reactive. 3. moderate bilateral lower lobe atelectasis. 4. diffuse hepatic fat deposition. cxr : impression: 1. the right subclavian picc line now has its tip in the mid svc in satisfactory position. the right internal jugular central line continues to have its tip in the right atrium. a nasogastric tube is seen coursing below the diaphragm with the tip not identified. endotracheal tube continues to have its tip approximately 4 cm above the carina. 2. relatively low lung volumes with crowding of the vasculature and likely residual perihilar edema. left basilar airspace process appears slightly worsened and may reflect worsening lower lobe atelectasis. pneumonia should also be considered. no large right effusion. no large pneumothorax on the supine film. brief hospital course: mrs. is a 33 f with myotonic dystrophy type 1, remote history of multilobar pneumonia, and new rapid respiratory failure in the setting of uri symptoms and recent history of presents with lethargy and sob. she was admitted to the micu and intubated for respiratory failure. # hypercapneic respiratory failure: the patient was intubated in the ed, and transferred to the icu. etiology was thought to be due to her underlying neuromuscular disorder in combination with pneumonia and/or possible viral bronchitis and use of opioid-based cough suppressants. her cxr showed opacities concerning for pneumonia, and she was treated with ceftriaxone and levofloxacin for a total of a 7 day course. her respiratory viral screen was negative. cta done on and was negative for pe's, but did show ground glass opacities concerning for infection versus atelectasis. her ventilation was weaned, and she was extubated on hd #4. the extubation was complicated by laryngeal edema treated with a steroid and was nearly resolved by discharge. she was transferred to the medical floors on hd#5 and continued to improve and was discharge on hd# 7 after her last dose of antibiotics. she was instructed to follow up with her neuro muscular specialist and to avoid opioid-based cough suppressants. # somnolence: thought in part due to narcotics and hypercapnea in setting of respiratory failure. thought that narcotics may have contributed to respiratory depression, leading to hypercarbia and worsening somnolence. the patient's mental status improved on hd#2 and she was following commands. pt's mental status back to baseline by extubation. # r thigh pain: patient endorses burning r thigh pain, which has been unchanged for 2 weeks prior to presentation. patient was told to follow up with her pcp for further evaluation and management. # hypothyroid: continued on levothyroxine. # elevated liver enzymes: nonspecific pattern potentially related to md, likely nafld/nash, given ct findings. would recommend follow-up for further evaluation as an outpatient. # elevated troponin: elevated on admission to 0.08, potentially related to initial afib, and down trended with flat ck-mb. # afib: single episode on arrival to ed, likely triggered by hypoxia, resolved in the icu. not started on anti-coagulation and the patient remained in sinus rhythm from hd#1 until discharge. # diarrhea- the patient developed watery non-bloody on hd#5, which was c.diff negative thought to be secondary to antibiotic use. she was able to maintain adequate hydration to replace the diarrheal losses. medications on admission: levoxyl 127 historical meds allopurinol 100 lasix 20 prn albuterol advair 250 cal-d, vitamin, new cough syrup discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*0* 2. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 3. levothyroxine 137 mcg capsule sig: one (1) capsule po once a day. 4. home oxygen supplement oxygen (1-3l) via nasal canula to titrate oxygen saturation to greater than 95% during the day time. please exclusively use bi-pap with supplement oxygen at night. discharge disposition: home discharge diagnosis: hypercarbic respiratory failure pneumonia muscular dystrophy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , it was a pleasure taking care of you at . you were admitted for respiratory distress and required intubation. we believe you had respiratory distress due to both an underlying neuromuscular disorder and from pneumonia. you have been treated with antibiotics and have complete treatment for the pneumonia. you continue to require supplemental oxygen, which you should continue after you are discharge until no longer needed. please continue to use the bi-pap as prescribed. please also follow up with your primary care doctor and your . while in the hospital, you developed diarrhea, we tested the stool for c. difficile which was negative. the diarrhea is likely related to recent antibiotic use and is unlikely to be infectious. medication changes: please take albuterol puff every 4-6 hours as needed for shortness of breath or wheezing please continue to take levothyroxine as prescribed please take imodium up to 4 times daily as needed for diarrhea followup instructions: please follow up with your primary care doctor within 2 weeks of discharge procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism gout, unspecified atrial fibrillation other opiates and related narcotics causing adverse effects in therapeutic use other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure diarrhea examination of participant in clinical trial other abnormal blood chemistry other alteration of consciousness other nonspecific abnormal serum enzyme levels cushing's syndrome edema of larynx pain in limb unspecified antibiotic causing adverse effects in therapeutic use myotonic muscular dystrophy 

Answer: The patient is high likely exposed to