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: this is an 88-year-old female with severe chronic obstructive pulmonary disease with an fev1 measured at 0.6 liters, on home oxygen, who was admitted to the hospital for chronic obstructive pulmonary disease flare. the patient has had recent multiple admissions over the past nine months for similar symptoms, requiring intensive care unit stays. the patient now presents following several days of lethargy and upper respiratory infection symptoms accompanied by increasing shortness of breath and declining mental status to the point of somnolence with respiratory rate of 40. she was intubated in the field and brought to the emergency department where initial presenting gases were 7.24/119/161 with unknown ventilator parameters. she initially had a blood pressure of 99/48 with a pulse of 93 and then was noted to be hypotensive with pressure of 57/33 and a pulse of 63 and was given two liters of normal saline, one amp of narcan, 125 mg of solu-medrol, 1 gram of ceftriaxone and started on a dopamine 10 mcg/kg/minute drip with an increase in her blood pressure to 78/43 and a pulse of 83. while in the emergency department, a left subclavian triple lumen was placed, and a right radial arterial line. when the arterial line was placed, the blood pressure was noticed to be 120/64 with a pulse of 88, and the dopamine was weaned off in the next ten minutes. a transthoracic echocardiogram at the bedside showed normal left ventricular systolic function and no effusion. chest x-ray showed emphysema and no infiltrate. past medical history: her past medical history is significant for chronic obstructive pulmonary disease with fev1 of 0.66 and fvc of 1.36, ratio measured 78 percent of predicted. she is on three liters of oxygen at home via nasal cannula. she has a history of colon cancer, duke stage a, status post low anterior resection in , status post seizure in from hyponatremia, syndrome of inappropriate diuretic hormone, osteoarthritis, lower back pain, osteoporosis, old lacunar infarct in the right corona radiata. transthoracic echocardiogram in showed ejection fraction of 60 percent with normal valves. allergies: the patient is allergic to doxycycline. medications: her medications on admission were serevent two puffs b.i.d., atrovent two puffs q.6 hours p.r.n., albuterol two puffs p.r.n., regular insulin sliding scale, tums t.i.d., protonix 40 mg p.o. q.day, klonopin 0.25 mg b.i.d. social history: the patient lives with her children. she has a history of smoking one pack per day for 20 years. she stopped 30 years ago. she has no occupational exposures. she is followed by dr. . her pulmonologist is dr. . family history: family history is positive for tuberculosis and lung cancer. physical examination: on admission, her vitals were temperature 98.4, heart rate 104, blood pressure 100/68, respiratory rate 18, saturating at 100 percent on ventilator settings (unknown). the patient was intubated and sedated but arousible and moving all arms and legs on repositioning. there was no evidence of jaundice. pupils were equal, round approximately 2-3 mm and reactive to light but sluggish. there was no nasal discharge. her heart had a regular rate and rhythm. her lungs had wheezing in the left upper lobe and scattered crackles in the bases bilaterally. her abdomen was nondistended. normoactive bowel sounds were present. there was a question of fullness in the abdomen. extremities were cool to touch. there was no cyanosis, clubbing. there was 1+ pitting edema to the mid ankles. dorsalis pedis and posterior tibials were not appreciated. laboratory data: white blood cell count 8.8, hematocrit 39.4, platelets 247. sodium 132, potassium 5.2, chloride 87, bicarbonate 39, bun 15, creatinine 0.6, glucose 127. coagulations: pt 11.2, ptt 27.6, inr 0.8. her repeat gas on assist-control of 18 times 550 with 40 percent fio2 was 7.46/55/150/40. ventilator settings were subsequently changed to 16 times 500. ck was 40. chest x-ray showed emphysematous changes in upper lobes bilaterally, engorgement of pulmonary veins, arteries at bases, question of pruning, flattened hemidiaphragms, left subclavian in good position, endotracheal tube 5 cm from carina. electrocardiogram was normal sinus rhythm at 71 beats per minute, normal axis, pr, qrs, qt intervals, elevation of st segment of 1 mm in leads ii, iii, f, and v3-v4, not seen in previous tracing on , peaked ts in leads , t wave inversion in avl, notched p waves, poor r wave progression in v1-v3. hospital course: the patient was admitted to the intensive care unit with chronic obstructive pulmonary disease exacerbation, hypercarbic respiratory failure, hypotension. shortly after the patient arrived to the floor, she was very agitated, moving all extremities, following commands intermittently, then noted to have a grand mal seizure with coarse bucking body tremors, desaturation into the 60s, eyes rolling back into the head. following this, the patient had supraventricular tachycardia in the 190s which converted without intervention during seizure activity. the patient was given 2 mg of ativan, and the seizure then resolved. noncontrast head ct was completed which showed no extra-axial collection, no mass effect, no shift, no acute hemorrhage, old right caudate lacunar lesion, slightly more prominent cerebral white matter with patchy hypodensity probably relating to microvascular ischemic gliosis and infarction. mri of the head showed moderate changes of small vessel disease, brain atrophy, no evidence of hydrocephalus or mass effect, no evidence of abnormal enhancement, no evidence of acute infarct. electroencephalogram showed mildly slow background with burst of generalized data and delta slowing with sharp features. there were times of focal slowing in the left hemisphere and left temporal lobe. neurology was consulted, and the patient was loaded with dilantin. it was thought that the seizure was precipitated by a rapid correction in her bicarbonate. no further seizure activity was noted during her hospital course. the patient was started on empiric antibiotics of levaquin and ceftriaxone. she was started on steroids with a rapid taper. she was extubated on with her gas after extubation on three liters nasal cannula with an oxygen saturation of 92 of 7.44/58/85. the patient had recurrent episode of hypotension with systolic low as the 80s and maps in the 50s and was restarted on low-dose dopamine which was then discontinued. the patient was transferred to the floor on . she continued to have a rapid respiratory rate as high as the 40s but denied any complaints of shortness of breath. her oxygen saturation was maintained between 88 and 92 percent, and her oxygen requirement was weaned from three liters down to one liter. pulmonary was consulted given the patient's repeated intubations this year. the recommendation was made for follow-up pulmonary function test which revealed poor effort but fev1 of 0.65 which is 52 percent of predicted, and fvc of 0.74 which is 33 percent. arterial blood gases were 7.39/65/57. follow-up ct showed extensive emphysema with bullae. no infiltrate. mucous in the trachea. left pleural effusion, small. marked hyperexpansion. there was a question of possible thrombus in the pulmonary vasculature. the patient was started empirically on heparin infusion while cta was obtained which was negative for pulmonary embolus. the patient's ct was concerning for numerous pulmonary nodules which were coarsely calcified and consistent with granulomatous infection. she had two irregular nodular densities in the right upper lobe which lacked calcification and were associated with right hilar adenopathy. a speech and swallow evaluation showed that the patient has silent aspiration of liquids via straw. she is able to tolerate regular liquids via cup. cough reflex is quite poor. follow-up echocardiogram showed ejection fraction of greater than 75 percent, no mitral regurgitation or aortic regurgitation, hyperdynamic heart. it was recommended that the patient try bi-pap at night in order to rest her respiratory muscles and hopefully improve oxygenation over night. the patient was not able to tolerate the bi-pap mask. she was transitioned to metered dose inhalers, but there was a question of whether the patient was able to use them appropriately. she was then returned to nebulizers. she was started on flovent as well. she had continued low sodium, predominantly in the 130s which is at her baseline. the patient was fluid restricted for likely syndrome of inappropriate diuretic hormone given her uric acid was 1.0. despite this, her sodium did not increase. at one point, her sodium decreased to 126. the patient was given one liter of normal saline as a trial for possible dehydration which improved her sodium to 128. it was felt like this was her baseline, and the patient should continue with a fluid restriction. repeat urine electrolytes were pending at the time of this dictation. it was felt that given her chronic lung disease as well as the pulmonary nodules, the patient has syndrome of inappropriate diuretic hormone; however, the patient is asymptomatic with sodium at this level. it was the opinion of the pulmonary and primary medical team that given the patient's advanced chronic obstructive pulmonary disease and accelerating clinical course, that no further workup is recommended for the pulmonary nodules at this time. repeat chest ct in three to six months is recommended. the rationale is that the patient's mortality for chronic obstructive pulmonary disease with an fev1 less than 30 percent predicted is likely to be higher than that from a pulmonary nodule which is not radiographically seen. also, the patient is a poor candidate for intervention whether by bronchoscopy, biopsy, radiation, or chemotherapy. the possibility of mini tracheotomy for more frequent suctioning and pulmonary toilet is a possibility to be discussed with the family in the future in order to possible prophylaxis further intubation and decrease the number of chronic obstructive pulmonary disease exacerbations. however, this would be aggressive management, and at the time of this dictation, a lengthy family discussion regarding mrs. had not taken place yet. physical therapy evaluated the patient and felt that she would benefit from acute level rehabilitation. condition at discharge: the patient's condition upon discharge is fair. discharge diagnosis: chronic obstructive pulmonary disease exacerbation, status post seizure, hyponatremia. discharge medications: 1. heparin 5000 units subcutaneously b.i.d. 2. prednisone taper, currently at 30 mg p.o. q.day, started on with decrease to 20 mg on , with decrease to 10 mg on for four additional doses and then discontinue. 3. atrovent nebulizers one nebulizer q.6 hours. 4. albuterol nebulizers one nebulizer q.6 hours. 5. fluticasone propionate 110 mcg two puffs b.i.d. with spacer. 6. aggrenox one capsule p.o. b.i.d. 7. metoprolol 40 mg p.o. q.day. 8. colace 100 mg p.o. b.i.d. 9. .................... sodium 5 mg p.o. q.day. 10. vitamin d 400 units p.o. q.day. 11. calcium carbonate 500 mg p.o. t.i.d. 12. levofloxacin 500 mg p.o. q.day for a total of a two-week course, to discontinue on . 13. dilantin 100 mg p.o. t.i.d. the patient is to be on aspiration precautions, not to drink any liquids via straw. she is to be on a strict fluid restriction of one liter in. crush medications that can be crushed with food. maintain nasal cannula for oxygen saturation approximately of 90 percent with range between 88 and 92 percent. follow-up: she as a follow-up appointment already scheduled with dr. of neurology on . she is to have an outpatient electroencephalogram prior to this visit. she should have a dilantin level checked two weeks after discharge from the hospital. she should also follow-up with dr. of pulmonary two weeks after discharge from rehabilitation. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other oxygen enrichment diagnoses: obstructive chronic bronchitis with (acute) exacerbation other convulsions personal history of tobacco use acute respiratory failure other specified cardiac dysrhythmias personal history of malignant neoplasm of large intestine other disorders of neurohypophysis other specified hypotension 

Answer: The patient is high likely exposed to