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: morphine / opioids: morphine & related attending: chief complaint: sob cp major surgical or invasive procedure: na history of present illness: this is a 79 yof with hx of htn, hyperlipidemia, hypothyroidism, who presented to hosp with sob and chest pressure. according to the caridiology note from , the patient was feeling more sob recently and was having "panic attacks", where she felt more sob. on the evening of her admission, she developed severe sob and ems was called. initial ekgs were concerning for vt, so she was given lidocaine 50mg followed by amiodarone 150mg and her tachycardia broke into a lbbb. on arrival to the ed she was tachypneic, cyanotic and diaphoretic and was intubated. cxr showed pulmonary edema. presumptive diagnosis was acute mi given her acute sob as well as ?chest pressure along with vtach and lbbb not known to be old. she was given asa, plavix, bival and taken to cath lab. lca was widely patent with minor plaquing, rca was widely patent with minor plaquing. lv was noted to be enlarged with dyssynchronous contraction, diffuse hypokinesis, ef of 30%. impression by the cardiology team was that she had acute pulm edema acute systolic chf, chf due to chronic non-ischemic cariomyopathy, ?copd. of note, patient was also hyperglycemic and given insulin during her c.cath. the day following her admission , she was noted to have left facial and neck swelling, which was concerning for subcutaneous emphysema. she became febrile overnight on , she was also noted to have purulent secretions so she was started on vancomycin and zosyn. ct neck was done on which showed significant air between her trachea and esophagus. bronchoscopy was done which showed a tracheal tear with oozing. depth could not be characterized bleeding. she was transferred to for furhter management out of concern for mediastinitis and ?need for tracheal surgery. of note, per c.cath note from osh, lbbb was later found to be old since . patient also diuresed 3.5 liters between . patient was transferred to the sicu. she was extubated successfully 2 hours after transfer. bronchoscopy was performed on showed no evidence of tear. she has been treated with vancomycin, ctx and fluconazole for mediastinitis. vanco then discontinued per id recommendation. today, the patient developed wide complex tachycardia to 150s. med consult/cardiology was called, ecg reviewed and seems to be afib with rvr with aberrancy. she was given metoprolol 5mg iv x 2 with no effect. she was then given dilt 20mg iv loading dose and started on dilt 5mg/hr gtt. oxygen saturation dropped to 89% and increased with nebs. she was given lasix 20mg iv x 1 and cxr ordered. she remained normotensive and was transferred to the ccu for further care. . on arrival the patienet denies chest pain, sob, n/v, palpitations or radiating pain. she does report +chills and subjective fevers over the past few days along with diarrhea x 2 days. she denies abdominal pain. no other complaints. past medical history: hypertension hypothyroidism hyperlipidemia anxiety and depression followed at seeacoast mental health social history: denies tobacco, etoh or illicit drug use family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: general: somnolent, speaking softly with eyes closed. oriented x2 to self and date, when asked for place she said "" heent: ncat, eomi, mmm, +pursed lip breathing neck: edematous, with +subcutaneous emphysemia, jvp unappreciable edema cardiac: irregularly irregular +s1/s2, no m/r/g lungs: decreased breath sounds at bilateral bases with mild crackles, +expiratory ronchi, no wheezes abdomen: soft, ntnd, normal bs extremities: no c/c/e skin: no rashes pulses: +2 radial and pedal pertinent results: 07:54pm blood wbc-21.0* rbc-3.60* hgb-11.8* hct-34.4* mcv-96 mch-32.8* mchc-34.3 rdw-14.3 plt ct-289 03:15am blood wbc-23.4* rbc-3.88* hgb-12.5 hct-36.9 mcv-95 mch-32.3* mchc-33.9 rdw-14.3 plt ct-297 02:11am blood wbc-20.0* rbc-3.70* hgb-11.4* hct-34.7* mcv-94 mch-30.7 mchc-32.7 rdw-14.4 plt ct-317 05:00am blood wbc-18.0* rbc-3.76* hgb-11.6* hct-35.1* mcv-93 mch-30.8 mchc-33.0 rdw-14.5 plt ct-351 07:54pm blood neuts-94.4* lymphs-3.2* monos-2.1 eos-0.1 baso-0.1 07:54pm blood glucose-112* urean-33* creat-0.8 na-140 k-4.0 cl-110* hco3-22 angap-12 03:15am blood glucose-117* urean-34* creat-0.8 na-141 k-3.9 cl-110* hco3-22 angap-13 05:19pm blood glucose-113* urean-33* creat-0.7 na-143 k-3.6 cl-111* hco3-24 angap-12 02:11am blood glucose-109* urean-31* creat-0.7 na-145 k-3.8 cl-113* hco3-23 angap-13 05:26pm blood urean-34* creat-0.8 na-148* k-4.6 cl-114* hco3-22 angap-17 05:00am blood glucose-121* urean-32* creat-0.8 na-149* k-4.2 cl-114* hco3-24 angap-15 02:11am blood alt-18 ast-15 alkphos-74 totbili-1.0 07:17am blood ck-mb-5 ctropnt-0.03* 12:33pm blood ck-mb-4 ctropnt-0.03* 05:19pm blood ck-mb-4 ctropnt-0.03* 02:11am blood tsh-3.3 02:11am blood free t4-0.78* 08:28pm blood type-art temp-37.3 po2-101 pco2-43 ph-7.38 caltco2-26 base xs-0 01:00am blood type-art temp-36.5 po2-80* pco2-45 ph-7.34* caltco2-25 base xs--1 05:38pm blood type-art po2-82* pco2-37 ph-7.41 caltco2-24 base xs-0 cxr the cardiomediastinal silhouette is unchanged and enlarged. there are increased perihilar and interstitial markings consistent with increasing mild volume overload. small bilateral pleural effusions have also increased. a left retrocardiac opacity is persistent. extensive subcutaneous edema predominantly within the left chest wall has mildly decreased in extent. slightly worse fluid status and increased retrocardiac density with left effusion. pneumonia cannot be excluded. tip of the ett is 2.9 cm above the carina. ngt extends below the diaphragm with the side port near the level of the eg junction. there is a retrocardiac opacity, likely atelectasis and possibly an effusion. the right lung shows no discrete consolidation. incidental note is made of some subcutaneous emphysema in the neck and left chest soft tissues. no pneumomediastinum. tte: the left atrium is elongated. the estimated right atrial pressure is 10-15mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20%), with apical segments thickening better than basal segments. this suggests a non-coronary etiology of lv dysfunction (tachycardia-mediated, toxic, metabolic, etc). the estimated cardiac index is depressed (<2.0l/min/m2). 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) 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. moderate to severe (3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: dilated and hypertrophied left ventricle with severe global systolic dysfunction and low forward stroke volume. moderate to severe mitral regurgitation. at least mild pulmonary hypertension. ct neck . multiloculated collections in the lower neck ending into the mediastinum containing air and oral contrast from the recent video swallow examination and suggestive of abscesses with evolving mediastinitis. as seen on the same day neck ct this is likely secondary to esophageal perforation. no definite tracheo- esophageal fistulous connection is identified but this should be correlated with bronchoscopy. 2. mild hydrostatic edema and superimposed aspiration/infection in the upper lobes. 3. geographic hypoattenuation in the liver, likely representing a focal fatty sparing infiltration. small nodule in the left adrenal gland likely representing an adenoma. if clinically indicated, these findings could be further characterized by mri when the patient's symptoms subside. 1. significant interval improvement in the upper left neck collection with no evidence of abscess on the prior study as well as no evidence of extravasation of the contrast from the esophagus. blunting of the left piriform sinus with thickening of the soft tissues at the area is still present, but no obvious evidence of abscess or mediastinitis is currently seen. 2. patchy ground-glass opacities unchanged since , consistent with areas of infection than aspiration given it's persistence. brief hospital course: 79 yof with hx of htn, hyperlipidemia, hypothyroidism, who presented to hosp with sob and chest pressure, found to be in acute chf, transferred here s/p traumatic intubation c/b tracheal tear and subcutaneous emphysema. now transferred to ccu for management of afib with rvr. # wide complex tachycardia: ecg consistent with afib with rvr in setting of known lbbb. afib likely exacerbated by chf/mediastinitis. rate and rythm control with amiodarone. he was started on heparin for anticoagulation with plan to transition to warfarin. please check inr and dose warfarin accordingly. goal inr . # chf: patient with ef of 30% on lv at osh. patient desaturated likely secondary to mild flash pulm edema in setting of afib. oxygenation improved with atrovent and lasix 20mg iv x 2. tte showed severe systolic dysfunction and mod-severe mr. she was diuresed with iv lasix until euvolemic. she remained euvolemic for several days before discharge. # subcutaneous emyphysema/oropharyngeal perforation: patient was transferred to initially for management of this complication. bronch done here showed no tear. tear likely healed and subq emphysema now resolved. she was started on ctx and fluc for treatment of possible mediastinitis as she was febrile at osh and cont with wbc of 20. thoracic surgery was consulted and did not feel any further intervention was warrented. however, patient spiked fever 2 days later and a ct showed esophageal perf - likely from traumatic intubation in field and peri-esophageal abscess. she was taken to the or and the abscess was drained. antibiotics were broadened to include vanc, fluc, zosyn, and cipro. her blood cx were negative. swab cx were positive for gnr (). her antibiotics were tailored to fluconazole, zosyn, and ciprofloxacin (all started on to be continued until f/u in thoracic clinic on ). antibiotics, stitches, and single remaining penrose with be d/c'd in thoracic clinic on . # fen: patient had peg placed during i&d as would not be able to eat for at least 1 week after abscess drainage given esophageal rupture. on discharge she had a video study to evaluate her ability to tolerate oral intake and she exhibited concern for aspiration. she will require another swallow study within the next week to evaluate if can transition to oral intake. she did not have any obvious evidence of a leak, but did aspirate all liquid consistencies given today significant posterior pharyngeal wall swelling. pt will likely be able to resume a full po diet once pharyngeal swelling subsides. until then patient will remain npo with ice chips only. # htn: on enalapril at home, continued enalipril iv while npo and then transitioned to po regimen. # anxiety/depression: held zoloft and mirtazapine while npo. held lorazepam iv given somnolence. restarted prior to discharge. # hyperlipidemia: held statin while npo # hyperthyroidism: restarted levothyroxine medications on admission: medications (at home): fosamax 70mg once weekly asa 81mg daily levothyroxine 75mcg daily enalapril 20mg daily mirtazapine 15mg daily zoloft 50mg daily lipitor 10mg daily ativan 2mg prn mvi medications (on transfer): albuterol 0.083% neb soln 1 neb ih q6h:prn ipratropium bromide neb 1 neb ih q6h:prn ceftriaxone 1 g iv q24h lorazepam 0.5-2 mg po/iv q4-6h:prn diltiazem 5 mg/hr iv drip infusion enalaprilat 1.25 mg iv q6h famotidine 20 mg iv q12h fluconazole 400 mg iv q24h heparin 5000 unit sc tid vancomycin 1000 mg iv q 24h metoprolol tartrate 7.5 mg iv q6h discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. ipratropium bromide 0.02 % solution sig: one (1) puff inhalation q6h (every 6 hours) as needed. 3. enalapril maleate 10 mg tablet sig: two (2) tablet po daily (daily). 4. acetylcysteine 20 % (200 mg/ml) solution sig: 1-10 mls miscellaneous q6h (every 6 hours) as needed for sticky secretions. 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 9. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 10. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 11. lorazepam 1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed: hold for sedation. 12. docusate sodium 50 mg/5 ml liquid sig: one (1) tablet po bid (2 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily). 15. carvedilol 6.25 mg tablet sig: two (2) tablet po bid (2 times a day). 16. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) bag intravenous q8h (every 8 hours) for 7 days. 17. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily) for 1 days. 18. amiodarone 200 mg tablet sig: one (1) tablet po once a day: start on and d/c 400 mg . 19. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. 20. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 21. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 22. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm for 2 days. 23. outpatient lab work please check chem-7, inr on sunday and call results to provider and dr. office at goal inr= 2.0-3.0. 24. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 25. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: - discharge diagnosis: peri-esophageal abscess esophageal perforation tracheal tear atrial fibrillation discharge condition: patient was afebrile, hemodynamically stable prior to discharge discharge instructions: you were admitted to the hospital with a rapid heart rate. you were treated with medications for this. medication changes include: start: coreg start: spironolactone start: cipro last day please remember to follow up with dr. , surgeon, on . you will continue antibiotics until that appointment. at that time the surgeon may elect to remove the remaining penrose drain as well as the stitches. please come back to the hospital or call your primary care physician if you have fevers, fainting or near-fainting, shortness of breath, chest pain, palpitations, abdominal pain, nausea, vomiting, blood in your stools or black tarry stools, leg swelling or any other concerning symptoms. followup instructions: surgery: follow-up with dr. :00am in the building chest disease center i. cardiology: provider: . phone: date/time: monday at 4:00pm. you will have another echocardiogram before this appt at 2:00pm. this will be on the clinical center, . of . primary care: please see dr. 1-2 weeks after you have been discharged from ne procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] other incision of thyroid field diagnoses: other primary cardiomyopathies congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse dysthymic disorder other and unspecified hyperlipidemia other diseases of pharynx, not elsewhere classified accidental cut, puncture, perforation or hemorrhage during other specified medical care acute combined systolic and diastolic heart failure emphysema (subcutaneous) (surgical) resulting from procedure hyperosmolality and/or hypernatremia mediastinitis open wound of pharynx, complicated 

Answer: The patient is high likely exposed to