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 who was admitted on for resection of a left lower lobe adenocarcinoma. she was transferred from the micu service after a prolonged hospital course, notable for multiple pna's and atrial fibrillation. she was transferred to the micu for failure to wean. this patient was first seen by pulmonary in when she began complaining of new onset shortness of breath plus notable for chronic cough. she had some weight loss and decreased appetite. she was admitted for surgery on . there was a left lower lobe resection done with pathology that showed adenocarcinoma. she was extubated after surgery and then on she went into atrial fibrillation and her blood pressure dropped to the 90's and she had shortness of breath. she was given pronestyl, lopressor, lasix and she was diuresed with 500 cc, eventually converted back to sinus rhythm. her troponin at that time was 3.4 and her ck mb was negative. she again became short of breath on , diagnosed with left lower lobe collapse on chest x-ray. she was intubated and had left lower lobe thick secretions and collapse was thought to be secondary to mucus plugging. abg at that time on vent was 7.46 ph, co2 46, o2 107. she was rebronch'd the next day on the left airway that showed plugging. she was briefly on diamox and weaned to a pressure support of , resting in an imv overnight. respiratory rate was in the 20's and total volume 200-400 at that time, then extubated. she was reintubated secondary to a decreased saturation and an increased co2 and rebronch'd on with thick secretions and a plug on . she was started on augmentin prophylaxis on for continued secretions. a tracheostomy was placed on . on her augmentin was discontinued. then she was slowly weaned off her ventilation. she tolerated her trach mask. she had a period of atrial fibrillation on with rates in the 70's and a systolic blood pressure in the 70's. she was put on her trach mask for 24 hours and did well but did not tolerate pmv. the patient had complained of difficulty breathing, also had secretions and was unable to tolerate oral food. a peg was placed on . she was then transferred back to the floor on . cardiology fellow called emergently for systolic blood pressure in the 60's and heart rates in the 30's. the patient had been subtherapeutic on pronestyl. she was administered 200 joules with a brief normal sinus rhythm, transient increase in systolic blood pressure but then reverted back to atrial fibrillation. she received esmolol and amiodarone, eventually converting to sinus rhythm. anticoagulation was then recommended. amiodarone was continued at 400 mg tid times one week and later changed to 400 mg . on at 5 a.m. the patient was found cyanotic with her tracheostomy mask off and saturations from 80-85%. the patient was then transferred to the micu with an o2 saturation in the 90's and heart rate in the 150's with a respiratory rate of 28. she was given lasix 20 mg iv, became unable to maintain her saturations on her trach mask. abg at that time was 7.39, 62 and 75. patient then came back into sinus rhythm at 83 beats per minute. the patient had moderate thick, yellow secretions. she was bagged, tried to replace the trach mass but saturations continued from 88-90%. she was placed back on the ventilator. she was brought back to the icu and found to have bilateral pulmonary infiltrates via chest x-ray. she was then bronch'd on in the morning and found to have minimal secretions. her hospital course was notable also for intermittent confusion but baseline orientation. she was also hypotensive to pain medications. she currently has some difficulty breathing on the ventilator, was otherwise comfortable and denies pain or any other complaints. past medical history: peripheral vascular disease. she had an aaa repair in by dr. , notable for hypertension, atrial fibrillation, osteoporosis, right hip replacement, 100 pack year history of smoking, seasonal allergies and emphysema by pathology. allergies: possibly ciprofloxacin causing confusion, dated , otherwise no known drug allergies. medications: on transfer to the micu, premarin .625 mg po q d, amiodarone 400 mg po bid, levaquin 500 mg po q d, subcu heparin , lopressor 25 mg , aspirin 81 mg po q d, multivitamin, albuterol nebulizer and albuterol inhaler q 4 hours, impact with fiber 50 cc per hour, dulcolax, combivent. family history: sister died at 93, mother died at 72 and father died at 84, all in reasonably good health until later years. no family history. social history: patient lives alone in , employed as a social worker, no asbestos exposure, now retired, smoked two packs per day for about 6 years, then quit, drinks occasionally. her proxy is , ? (last digit missing). physical examination: patient's vital signs on transfer to the micu, temperature 98.6, pulse 67-99, blood pressure 88/40 to 100/44, ins and outs, positive 250 cc, ventilator simv 450 times 8, 7.5 and 50% o2, pressure support 15, total volume 290, saturation 98%. in general, cachectic, elderly white female lying in bed, tracheostomy on ventilator, in no acute distress. heent: shows perrla, eomi, grossly intact, ncat. neck supple, ej engorged, unable to assess jvp. heart, regular rate and rhythm with 3/6 systolic murmur left lower sternal border, stable with respirations and no s3 or s4. pulmonary, diminished sounds at bases, anterior bronchial breath sounds on left. abdomen distended, peg in place, positive bowel sounds, nontender and soft. extremities, distal pulses full, trace edema, symmetric. neuro, patient is very hard of hearing, difficult to arouse, but once aroused she is alert and appropriate and able to mouth words appropriately. laboratory data: on admission to the micu, white blood cells 17,000, hemoglobin 10.7, hematocrit 32.5, platelet count 282,000. dipstick urinalysis showed moderate blood, positive nitrites, 100 protein, glucose negative, ketones trace, bilirubin negative. glucose 125, bun 26, creatinine 0.4, sodium 131, potassium 4.0, chloride 90, co2 30, calcium 9.2, phosphorus 2.4, magnesium 1.4. arterial blood gas with ph 7.46, co2 47 and po2 122. chest x-ray from showed some interval clearing of the left base with progressive infiltrate and left upper lobe and right upper lobe consistent with infection vs edema. assessment & plan: this is an 85-year-old status post left lower lobe lobectomy for adenocarcinoma. hospital course was complicated by respiratory distress from mucus plugging, rapid atrial fibrillation and failure to wean. the patient now has a tracheostomy and a peg tube status post an episode of respiratory distress on the floor, likely secondary to decreased fio2, rapid atrial fibrillation with elevated white blood cells and infiltrate on chest x-ray. hospital course: 1. pulmonary: pneumonia, given multiple infiltrates on the chest x-ray and elevated white blood cell count, treating aggressively for gram negative and will double cover with levaquin and ceftaz. one dose of levaquin already given in the a.m. patient's effusions are bilateral. would tap if clinical course does not improve. 2. congestive heart failure: patient likely has diastolic dysfunction when in rapid atrial fibrillation. she was then bolused with fluid for hypotension. would likely keep the patient slightly dry as tolerated by blood pressure, ventilation, continue to wean as tolerated and change pressure support as tolerated. 3. cardiology: rhythm, atrial fibrillation on amiodarone. we sent lfts and tsh and we will taper per cardiology. she is on lopressor for blood pressure and rate control. if continues on amiodarone would consider reconsulting and more invasive measures. 4. hemodynamics: the patient is slightly dry, most recent echocardiogram shows no systolic dysfunction though since then she has had a slow troponin leak likely from failure. 5. infectious disease: pneumonia as above. 6. renal/ fluids, electrolytes & nutrition: the patient's electrolytes need repletion, especially given her arrhythmia and to prevent muscle fatigue. 7. nutrition: we are giving her tube feeds via her peg tube. we will check her albumin. 8. heme/onc: the patient is anticoagulated on aspirin and coumadin will be started. 9. anemia: patient's low blood hematocrit was improving until yesterday with a hematocrit of 32. 10. oncology: unclear what follow-up will be with her oncologist. 11. neuro: the patient has a history of delirium intermittent through icu course. we will try to avoid narcotics and benzo. the patient has an a line and a peg tube and we would favor placing a picc line for long-term weaning and antibiotics. patient's pcp is . . her health care proxy is . her is dr. . prophylaxis, patient is on tube feeds and subcu heparin. the patient is a full code and we will readdress this issue as needed. hospital course: since - the patient was found to have +4 gram positive rods on bronchial washings. blood cultures showed no growth times two bottles and c. diff was negative. the patient was placed on clindamycin 600 mg iv, she is now on day #4 and is on levaquin 500 mg each day, she is on day #6. the patient will be discharged with a prescription for a total of 14 days of both antibiotics for her suspected pneumonia. the patient had a ct of her chest which showed a left pleural effusion. patient's ventilation status improved over the course of the last four days. the patient was able to off the ventilator for 8 hours yesterday and just be on the trach mask. the patient tolerated this well with an o2 saturation of 99%. the patient was also seen by pt, ot and was able to walk to the nurses station and back with a responsive o2 saturation of 99%. the patient is currently on pressure support of 10 and peep of 5, total volume in the 300's on an fio2 of 40%. the patient's arterial blood gas today was 7.41 ph, 56 co2 and 97 for oxygen. the patient reports no difficulty breathing and no difficulty being off the ventilator. the patient was put back on ventilator overnight. she had a brief episode of hypotension which responded to 250 cc of normal saline bolus. the patient continues on the amiodarone for history of atrial fibrillation. the patient is now in sinus rhythm. the patient was seen by interventional radiology to have a picc line placed for long-term iv antibiotics. patient's hematocrit is stable at 27, up from 26.1 measured on . the patient continues to have no complaints and will be discharged to , a rehab facility which can provide ventilation needs. the patient was placed on coumadin for her atrial fibrillation. she was placed on 5 mg of coumadin. her inr has been consistent at 1.0. coumadin will be increased on discharge to 7.5 with instructions to check the inr and dose appropriately. the patient will continue with tube feeds through her peg tube. the patient's subcu heparin will continue until patient is appropriately out of bed, able to get out of bed a couple of times a day. the patient will be discharged most likely to . discharge medications: include lopressor now at 12.5 mg each morning. the patient remains on clindamycin and levofloxacin. the patient has been afebrile. the patient will continue her tube feeds through her peg tube. the patient will continue on the amiodarone. discharge diagnosis: 1. adenocarcinoma. 2. pneumonia. the patient has a trach tube that will be vent assisted if needed at . follow-up: the patient will follow-up with her primary care doctor as needed. discharge status: stable. , m.d. dictated by: medquist36 procedure: fiber-optic bronchoscopy fiber-optic bronchoscopy other permanent tracheostomy percutaneous [endoscopic] gastrostomy [peg] biopsy of lymphatic structure mediastinoscopy diagnoses: pneumonia, organism unspecified mitral valve disorders unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation acute respiratory failure osteoporosis, unspecified malignant neoplasm of other parts of bronchus or lung hip joint replacement 

Answer: The patient is high likely exposed to