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: vasotec / aspirin / minocycline / hydralazine attending: chief complaint: confusion major surgical or invasive procedure: central line by femoral access history of present illness: year-old female with esrd, chronic af on coumadin, cad, hf admitted with dyspnea and confusion. she was discharged on after being admitted for similar issues, which responeded to volume removal in hd. she would be due for hd today. on , vna found her to be hypoxemic with a o2 sat only 76-80 and she was started on 4l home o2. she had been on o2 in the hospital but d/c'd off of it. she had been confortable since getting put on oxygen. she continues to sleep much of the day and not eat more. this morning, she awoke very confused. she was refusing to go to hd and wanted to go to the instead. her daughter said she had a similar episode of confusion this past that was attributed to pain meds. in the ed, she had triage bp 70s and sats 80s, but initial vital signs were 98.8 102 97/51 26 100/nrb without intervention for her blood pressure. she was alert and oriented x 2.5. she was found to have an increased right-sided pleural effusion. she had llq pain and ct abd shoed pneumpbilia. this was atributed to her stent and thought to be an unlikely source of sepsis. she was put on bipap to tolerate the ct scan. she was given vanc/zosyn for a possible r sided pneumonia and 250 cc ns for the borderline hypotension. a left femoral line was placed given poor access. she gets hd via a fistula. prior to transfer, vs: 98.8 87 93/67 15 100% on nrb. she confirmed being dnr/dni. currently, she does not remember why she came to the hospital. her breathing feels better and she complains only of a dry mouth. she believes that she has been in the hospital for 3 weeks and wants to go home. she complains of an intermittently sore "butt". she asks for a sip of water and explains that her doctor tells her that she must chin-tuck to avoid aspiration. . review of systems: (+) poor appetite, occasional dry cough, that has been improving. occasional constipation, anuric. (-) denies chest pain, fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea, or congestion. denies nausea, vomiting, diarrhea, or abdominal pain, dysuria. denies arthralgias or myalgias. past medical history: esrd on hd t, th, sat cad s/p nstemi in diastolic chf htn brachial plexus injury anemia of chronic inflammation/ckd pulmonary htn (pasp 29-33) papillary thyroid cancer s/p total thyroidectomy in gerd h/o svt gout colon angiodysplasia with bleeding, s/p tah and bso s/p appendectomy s/p bilateral cataract surgery social history: lives with daughter. widowed. supportive daughter. current tobacco (quit >20yrs ago). no alcohol or drug use. was a 'stitcher' family history: non-contributory. physical exam: temp 95.5 (ax), hr 80 (64-92), bp 90/50, rr 18, sat 93 on 3l general: alert, oriented x2 (wrong year), says she lives with her daughter. no acute distress. cachectic. heent: sclera anicteric, no rhinorrhea, bald head, dry mouth with thick mucous. neck: supple, no appreciable jvd, no lad, hyperdynamic carotids lungs: decreased breath sounds bibasilar; otherwise cta bilaterally; cv: regular irregular; normal s1/s2; no murmurs appreciated abdomen: normoactive bowel sounds; soft, non-tender, non-distended ext: hands are cool, deformed joints with boutonnierre, ulnar deviation. no edema. faint radial pulses. neuro: cnii-xii intact; moves all extremities, although movement/strength exam limited by arthritis pertinent results: admission 07:14am blood wbc-10.3 rbc-3.83* hgb-12.8 hct-39.4 mcv-103* mch-33.4* mchc-32.5 rdw-16.6* plt ct-259 07:14am blood neuts-77.7* lymphs-18.6 monos-2.4 eos-0.7 baso-0.6 07:14am blood pt-28.9* ptt-150* inr(pt)-2.8* 07:14am blood glucose-137* urean-17 creat-3.8* na-143 k-5.2* cl-98 hco3-28 angap-22* 07:14am blood alt-15 ast-25 ld(ldh)-214 ck(cpk)-42 alkphos-17* totbili-0.1 07:14am blood ctropnt-0.19* 04:24pm blood ck-mb-notdone ctropnt-0.20* 07:14am blood calcium-9.7 phos-2.7 mg-1.8 thyroid 07:14am blood tsh-38* 06:50am blood free t4-1.0 abg on room air 07:21am type-art po2-82* pco2-47* ph-7.43 total co2-32* base xs-5 on nonrebreather 11:41am type-art temp-36.1 o2-100 po2-316* pco2-42 ph-7.47* total co2-31* base xs-7 aado2-377 req o2-65 comments-non-rebrea admission imaging cxr the cardiac silhouette is enlarged and stable since the prior study. there has been interval improvement of the moderate-sized bilateral pleural effusions and atalectasis. the pulmonary vasculature is unremarkable and there is no evidence of edema. there is no pneumothorax. ct impression: 1. moderate-sized bilateral pleural effusions with bibasilar atelectasis. 2. sigmoid diverticulosis without diverticulitis. 3. small amount of pelvic free fluid. 4. t12 compression deformity, which is new from , but seen on the prior chest radiographs from . 5. pneumobilia within the left lobe of the liver, likely related to recent sphincterotomy, but clinical correlation is advised. 6. right renal and hepatic cysts. 7. trace perihepatic ascites. 8. diffuse atherosclerotic calcifications. no intra- or extra-axial hemorrhage, mass effect, or shift of midline structures is demonstrated. diffuse global atrophy is noted, which is age appropriate. periventricular white matter hypodensities are stable, compatible with chronic small vessel ischemicchanges. differentiation of -white matter is preserved. visualized paranasal sinuses and mastoid air cells are well aerated. calcification of the cavernous portions of both internal carotid arteries is again noted. brief hospital course: summary year old woman with esrd on hd, afib on coumadin, cad, chf, pulmonary htn, ?aspiation pneumonias, hypothyroidism presenting with acute agitation and possible hypoxemia. she was recently admitted for the same issue and returned within 48 hours of discharge. hypoxemia this patient's peripheral oxymetry readings are unreliable. the patient saturates well on room air if the oxymetry is taken on the forehead. the patient's pa02 on room air (on admission) was in the 80's with an otherwise normal abg. when placed on a non-rebreather, her pao2 was 347 and she became alkalotic. hypotension the patient is hypotensive at baseline with home readings that vary between 70 and 100 in the systolic value. with a pressure of 80/40, she can interact well and even explain the physiology of her 'chin-tuck' swallow technique. she was discharged on an increased dose of midodrine pleural effusions the patient has pleural effusions likely related to diastolic heart failure, hypothyroidism, afib with rvr and malnutrition. they were slightly worse on this admission but made no clinical impact afib with rvr the patient often oscillates in and out of rvr. her pressures did not tolerate an increase in metroprolol. her coumadin doses were changed on discharge esrd on hd the patient is dependent on hd for renal replacement. agitation the patient will be discharged with an rx for prn zydis poor apetitie patient was discharged on megace to be followed oxymetry to be taken on forehead blood pressures to be compared to clinical status medications on admission: acetaminophen 1000 mg po tid calcium carbonate 500 po tid cholecalciferol (vitamin d3) 800 unit po daily warfarin 1.5mg po once a day. pravastatin 40 mg po daily metoprolol tartrate 12.5 mg po bid midodrine 5 mg po tid ( b complex-vitamin c-folic acid 1 mg po daily levothyroxine 150 mcg po daily bisacodyl 10 mg po daily (daily) as needed for constipation epoetin alfa during hd lidocaine 5 %(700 mg/patch) topical once a day discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 2. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. levothyroxine 50 mcg tablet sig: three (3) tablet po daily (daily). 10. midodrine 5 mg tablet sig: 1.5 tablets po tid (3 times a day). disp:*135 tablet(s)* refills:*2* 11. outpatient lab work please draw pt/inr by vna or at pcp . 12. zyprexa zydis 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po at bedtime as needed for agitation. disp:*20 tablet, rapid dissolve(s)* refills:*0* 13. nepro 0.08-1.80 gram-kcal/ml liquid sig: one (1) container po three times a day. 14. coumadin 1 mg tablet sig: one (1) tablet po once a day: take 1mg each day on saturday and sunday. disp:*30 tablet(s)* refills:*2* 15. coumadin 1 mg tablet sig: 1.5 tablets po once a day: take 1.5mg daily on mon, tues, wed, thurs, and friday. 16. oxygen home oxygen. continuous. 2 liters per minute. 17. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: ten (10) ml po qam (once a day (in the morning)). disp:*300 ml* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary atrial fibrillation with rvr pleural effusion secondary hypotension esrd on hd discharge condition: mental status:confused - sometimes level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you were admitted for low pressure and low oxygen. you did well in the hospital and were discharged with home oxygen and a higher dose of midodrine. it is crucial that you take your oxygen levels on the forehead, as your fingers give unreliable readings. change 1) midodrine 7.5 mg tid 2) coumadin - take 1mg each day on saturday and sunday and 1.5mg daily on weekdays. 3) megace- new med for appetite followup instructions: pcp: , . as needed md, procedure: venous catheterization, not elsewhere classified hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status unspecified pleural effusion congestive heart failure, unspecified unspecified protein-calorie malnutrition atrial fibrillation other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypotension, unspecified alkalosis long-term (current) use of anticoagulants other specified disorders of biliary tract diastolic heart failure, unspecified unspecified psychosis postsurgical hypothyroidism personal history of malignant neoplasm of thyroid 

Answer: The patient is high likely exposed to